the rockingham county senior community assessment...

The Rockingham County Senior Community Assessment

An Action-Oriented Community Diagnosis: Findings and Next Steps of Action

May 22, 2007

Whitney Davis, Christine Nielsen, Andi Kravitz, Carol Squillace, and Karen Ziarnowski

Brittan Williams, MPH, CHES

Rockingham County Department of Public Health

Debbie Mason, BS, CHES Rockingham County Healthy Carolinians

Instructors: Eugenia Eng, DrPH; Kate Shirah, MPH;

Jim Amell, PhD; & Dionne Smith, PhD

Completed during 2006-2007 in partial fulfillment of requirements for HBHE 741

Department of Health Behavior and Health Education School of Public Health

University of North Carolina at Chapel Hill

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Table of Contents

Table of Contents............................................................................................................................. i List of Tables ................................................................................................................................. iii Acknowledgements........................................................................................................................ iv Executive Summary........................................................................................................................ v I. Introduction ................................................................................................................................. 1 II. Background ................................................................................................................................ 3

Demographics ........................................................................................................................ 4 Geography and Physical Layout ............................................................................................ 5 History.................................................................................................................................... 6 Economy ................................................................................................................................ 6 Group Transportation............................................................................................................. 7 Healthcare and Health............................................................................................................ 8 Services and Activities for Seniors ........................................................................................ 9

III. Methods .................................................................................................................................. 10 Gaining Entrée ..................................................................................................................... 10 Secondary Data Collection .................................................................................................. 11 Primary Data Collection ...................................................................................................... 12 Developing Interview and Focus Group Materials.............................................................. 12 Conducting Interviews ......................................................................................................... 13 Conducting Focus Groups.................................................................................................... 14 Codebook ............................................................................................................................. 15 Primary Data Transcription and Coding .............................................................................. 15 Analysis of Field Notes and Secondary Data ...................................................................... 16 Forum Planning.................................................................................................................... 17

IV. Findings .................................................................................................................................. 19 Community Strengths .......................................................................................................... 19 Countywide Challenges ....................................................................................................... 20 Senior Community Challenges ............................................................................................ 21 Awareness of Services .................................................................................................. 21 Alzheimer’s and Dementia ........................................................................................... 23 Transportation ............................................................................................................... 25 Insurance Gap ............................................................................................................... 28 Streamlining Services ................................................................................................... 30

V. The Rockingham County Senior Community Forum.............................................................. 31 Awareness of Services ......................................................................................................... 33 Alzheimer’s and Dementia .................................................................................................. 34 Transportation ...................................................................................................................... 35 Insurance Gap ...................................................................................................................... 36 Streamlining Services .......................................................................................................... 37

VII. Limitations ............................................................................................................................ 37 VIII. Conclusions and Recommendations .................................................................................... 39 References..................................................................................................................................... 42 Appendix A: Interview Materials ................................................................................................. 44 Appendix B: Primary Data Summary........................................................................................... 62 Appendix C: Secondary Data Sources.......................................................................................... 65

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Appendix D: Community Forum Materials.................................................................................. 78 Appendix E: Community Forum Planning Materials ................................................................. 117 Appendix F: Data Coding and Analysis ..................................................................................... 129 Appendix G: Community Resources .......................................................................................... 139

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List of Tables Table 1: Distribution of Rockingham Population Age 50 and Older, 2005……………………...4 Table 2: Municipalities and Populations of Rockingham County………………………………..5 Table 3: Selected Economic Indicators: Rockingham County and North Carolina……………...7

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Acknowledgements

The team extends the utmost thanks, gratitude, and appreciation to…

• The service providers and community members of Rockingham County. Your

generosity, commitment, and kindness have contributed to the process in numerous ways,

and for your passion and enthusiasm, we cannot thank you enough.

• Our Forum Planning Committee, who worked with such dedication to the process

and offered invaluable resources, time, and energy. We looked forward to each time we

were able to meet with you.

• Our preceptors, Brittan Williams, MPH, CHES, and Debbie Mason, BS, CHES who

have made this experience enjoyable and professional, and who offered realistic guidance

from start to finish.

• The teaching team, Eugenia Eng, DrPH, Kate Shirah, MPH, Jim Amell, PhD, and

Dionne Smith, PhD, and our teaching assistants, Erin Stephens and Michele Lanham, for

their advice and assistance throughout the past year.

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Executive Summary The Rockingham County Senior Community Assessment project was conducted from

October of 2006 through April of 2007 by a five-member student team from the University of

North Carolina at Chapel Hill, School of Public Health, Department of Health Behavior and

Health Education. The student team worked under the guidance of two preceptors, Brittan

Williams, MPH, CHES, of the Rockingham County Department of Public Health, and Debbie

Mason, BS, CHES, of Rockingham County Healthy Carolinians. The Rockingham County

Senior Community Assessment (RCSCA) was conducted using a health education tool known as

Action-Oriented Community Diagnosis (AOCD)1. The AOCD process addresses a wide variety

of factors in the community that contribute to health, such as social and economic factors as well

as community dynamics, with the goal of generating community-owned action steps for positive

change 2.

This report presents a synthesis of the multiple steps taken in completion of the RCSCA,

beginning with collection and analysis of secondary data that provided an overview of what life

was like for seniors in the community. Getting to know the community, or “gaining entrée” to

the community itself, was an ongoing process that began with a county tour and continued with

team attendance at important community meetings and events. The team also collected primary

data through interviews and focus groups with 17 local service providers and 21 community

members, who possessed a broad knowledge of community functioning. From this data, the

team identified four community strengths and ten community challenges. The strengths were

family and senior relationships, religion, caring community, and an abundance of resources

available for seniors. The challenges, listed below as theme, or summary, statements, included

awareness of services, Alzheimer’s and dementia, transportation, the insurance gap, and

streamlining services.

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Following the analysis of all collected data, the findings were presented to the community

through the Rockingham County Senior Community Forum, held on April 20, 2007. Topics

explored in-depth were based on identified challenges. The forum marked the end of the student

team’s work in Rockingham County and was primarily intended to transfer ownership of

findings to the community. Specific action steps for change were generated through a discussion

of important themes selected by the Forum Planning Committee:

Theme 1: Seniors are often unaware of the services and events that are available to them throughout the county. Action Steps:

• Initiate a letter writing campaign, working with the Council on Aging and potentially the News and Record, to help make the needs and desires of seniors known

• Contact Home Health Care and Caregivers of Rockingham County as a way of spreading awareness to homebound seniors

• Contact ministerial groups of Eden and Reidsville to investigate working with church groups to increase service awareness

Theme 2: Although the county offers some mental health services, adequate care does not exist for the growing concerns surrounding Alzheimer’s and dementia among seniors and support for their families. Action Steps:

• Heavily advertise an upcoming information session at the Carolina House of Reidsville for those affected by and those interested in learning more about Alzheimer’s

• Acquire a list of county services and distribute at nutrition sites and senior events, specifically the Senior Games, to educate Rockingham County community members about the services that are currently offered in the county for seniors

Theme 3: Given Rockingham County’s geographic layout and the shortage of consistent, low cost transportation, seniors have difficulty using transportation to access services and activities.

Action Steps: • Include information on available transportation options/rates for seniors from

Council on Aging transportation services in the next Center for Active Retirement newsletter

• Attend and present information about available transportation options at upcoming meetings with both the Service Providers Network and the Rockingham County Planning Meeting for Services to the Elderly

• Call WLOE about a potential radio spot to discuss transportation

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• Investigate potential advertising options for transportation services in local utility bills

• Contact local newspapers and churches to post transportation information in their bulletins

• Help create flyers to be distributed to advertise Council on Aging transportation services

• Contact the Council on Aging to get information on their transportation services and to discuss collaboration options

Theme 4: Due to age and income restrictions for current health insurance options, seniors may fall into a gap where they do not have sufficient health insurance to cover medical costs. Action Steps:

• Take this theme to the Rockingham Senior Service Providers meeting • Create a resource guide focusing on insurance issues and advice for seniors • Distribute resource guide at churches, physician’s offices, Meals on Wheels,

pharmacies, and through home health services • Create a resource team to present information about resources at local

organizations such as churches, Meals on Wheels, pharmacies, and home health services

• Vote for candidates who want to address the insurance gap Theme 5: While many service providers work together efficiently and productively, communication and service delivery is not always streamlined. Action Steps:

• Contact Region G Agency on Aging to host an online resource • Look into creating a free Rockingham community page, network, and bulletin

board online • Create a list of resources that promote, advertise, and publicize events for seniors • Create a senior newspaper • Secure funding for the senior newspaper

Based on the process as a whole, the team makes the following recommendations for

future work in the Rockingham County senior community:

• The term “senior” may include individuals younger than 65, and care should be taken to recognize that some members of the county who are not 65 or older identify themselves as members of the senior community.

• County demographics are changing, and attention should be paid to the senior members of

different ethnic groups, especially the Latino population. • Future work with seniors should include a focus on isolated and homebound seniors.

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• Given the number of existing quality services for seniors in the county, efforts should include building upon what is already available.

• Service providers and community members should place increasing awareness of services

and events at the forefront of all efforts. • Use of multiple communication methods, including direct mail, the Internet, and radio, will

be an important component of raising senior awareness in the future and should be considered in service and health promotion efforts.

• Grassroots networking among seniors, with the purpose of sharing resources, should be

recognized and increased, utilizing the informal ties that already exist. • Religion is an important component of life, and church networks should be investigated as a

channel for improving life for seniors. • Broader participation in the county’s existing senior service provider groups/networks should

be encouraged, making coordination key. • Collaboration on developed action steps will be crucial in moving towards their successful

implementation, especially given the overlap in many of the steps that were developed. This document is intended to be a working document, one that will provide the senior

community and senior service providers with a foundation from which to move forward into the

future. Background summary, methods used in the RCSCA, detailed findings from the primary

data, and a discussion of the forum and resulting action steps are offered in the following pages.

The team presents the report with the hope that positive change can be made for the kind,

generous, and thoughtful senior residents of Rockingham County and those who work tirelessly

to enrich and improve their lives.

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I. Introduction The Rockingham County Senior Community Assessment project was conducted from

October of 2006 through April of 2007 by a five-member graduate student team from the

University of North Carolina at Chapel Hill, School of Public Health, Department of Health

Behavior and Health Education. The team worked actively in the community to put into practice

a public health education tool known as an Action-Oriented Community Diagnosis (AOCD) 1.

While the AOCD process addresses specific community health concerns, its broader purpose is

to examine life in a particular community, including the nature of community relationships,

dynamics, strengths, challenges, and significant influences, all with the intent of mobilizing the

community for action around issues of importance for improving quality of life 2. The

Rockingham County Senior Community Assessment (RCSCA) looked at health issues, as well

as significant economic, social, and environmental factors that impact the lives of seniors in the

county, and the steps of the process highlighted the integration of health education research and

practice1. The team was guided by two preceptors, Brittan Williams, MPH, CHES, of the

Rockingham County Department of Public Health, and Debbie Mason, BS, CHES, of

Rockingham County Healthy Carolinians, who offered support, knowledge, and a community

contact base.

The RCSCA began with gathering secondary data sources, or existing information about

the community that offered an increased knowledge and understanding of community life.

Sources included but were not limited to newspapers, print materials, websites, the county

phonebook, and current statistics. While collecting secondary data, the team also worked to get

to know the community, i.e. to gain entrée into the community, by introducing the project

through attendance at meetings and community events while recording personal impressions and

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observations. Both secondary data collection and gaining entrée continued throughout the course

of the RCSCA. A key component of the process was gathering primary data through interviews

and focus groups with community “movers and shakers,” namely 22 senior community members

and 16 local service providers who offer services and support to the senior community. Finally,

the formal RCSCA process concluded with the Rockingham County Senior Community Forum.

The findings reported in this document will help to inform the 2008 Rockingham County

Community Health Assessment, and will offer a more detailed look at this one particular

community within the county.

The AOCD process begins with defining the community, but such a definition must be

reexamined as primary and secondary data are collected. The team initially defined a member of

the senior community as an individual living in Rockingham County who is 65 years old or

older, but through the course of interviews it became clear that this definition excluded younger

people who considered themselves seniors. Through discussions with both community members

and those who provide services to seniors, it became apparent that the community was difficult

to define, with some services offered to those as young as 55 and others offered only to older

individuals. For the purposes of the RCSCA, the senior community included any individual who

identified as a senior and was age 55 or older. Because the AOCD process is most successful

when those who consider themselves part of the community, based on geographic location,

common values, shared strengths and challenges, and mutual identity, can come together with

service providers and the student team for positive change, the team felt comfortable with this

definition of community 2, 3.

One of the goals of gathering primary data is to provide a comparison between the

perspective of insiders, traditionally defined by the AOCD process as community members, and

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outsiders, traditionally defined as service providers and team members 4. While this comparison

is possible to some degree, it is important to note that some of the service providers interviewed

were also senior residents of Rockingham County, and thus had an insider’s perspective on the

community. Some service providers, although not members of the senior community, worked so

closely with the senior community that they shared many of the same perspectives as well. Thus,

service provider and community member perspectives often paralleled each other. While

individuals were asked to respond to interview questions from either the perspective of a

community member or a service provider, the only definitive outsider perspective in many

instances was the team perspective.

What follows in this document is a summary of the team’s secondary data collection as it

pertains to relevant primary data collected. Next, a description of methods used to collect and

analyze information is provided. The report also presents the perspectives of service providers,

community members, and team members, and includes a comparison of those perspectives.

Presentation of primary data is followed by a report on the community forum, including a

summary of discussion points and action steps and is followed by a presentation of the team’s

conclusions and recommendations for future action as a result of the RCSCA.

II. Background Background information is presented to provide a general overview of Rockingham

County and its senior community as well as a backdrop for the primary data presented in

subsequent sections. Although this summary is not exhaustive, it highlights some of the

important demographic, geographical, historic, economic, environmental, social, and cultural

factors that influence the senior community.

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Demographics In 2005, the total population of Rockingham County was estimated to be 91,419 people

and was 49.3 percent male and 50.7 percent female. Racial and ethnic breakdown for the same

year indicates that the county was 77 percent white, 18 percent Black or African American, and

4.5 percent Hispanic or Latino. The median age in the county was 39.2 years old, which is older

than the North Carolina median age of 36.2 years 5, 6. Over three-quarters of the county’s

population were born in Rockingham County 7. As of 2005, approximately 10 percent of the

population held a bachelor’s degree or some higher level of education 5, which is significantly

lower than the overall North Carolina rate of 25.1 percent 6.

The demographics of the senior population point to the need for careful consideration of

available services and general senior quality of life. In 2005, over 14 percent of the county’s

population consisted of individuals over 65, and this number is projected to increase to over 19

percent by 2020 5, 8. Among Rockingham County seniors, there were more women than men,

particularly as the population neared 80 years of age. Because the interview data showed that 65

is not necessarily the age at which a person may be considered a senior, the 2005 age structure

for those age 55 or older in Rockingham County is presented in Table 1.

Table 1. Distribution of Rockingham Population Age 50 and Older, 2005.9

Total Male Female Total Population 91,419 45,029 46,390

AGE 55 to 59 years 6.6% 6.0% 7.2% 60 to 64 years 5.0% 5.3% 4.7% 65 to 69 years 4.3% 3.9% 4.8% 70 to 74 years 3.5% 3.3% 3.8% 75 to 79 years 2.7% 2.4% 3.0% 80 to 84 years 2.1% 1.4% 2.9% 85 years and over 1.7% 1.0% 2.4% Total 25.9% 23.3% 28.8%

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Geography and Physical Layout Geography plays a large role in the lives of the residents of Rockingham County and the

senior population in particular. Rockingham County is located in the foothills of the Blue Ridge

Mountains in the northwestern portion of North Carolina. The county borders Virginia and is

located in a region known as the Piedmont Triad. The county is called North Carolina’s North

Star due to its beautiful topography and northernmost geographic location within the state. It is

approximately 30 miles north of Greensboro and 100 miles northwest of Raleigh, North

Carolina’s capital (see Appendix C). Rockingham is a rural county with a landmass of 572

square miles and approximately 162 people per square mile, compared to 182 people per square

mile for the state as a whole 6. The Dan and the Mayo rivers are located in the northern part of

the county and come together near the towns of Madison and Mayodan. There are also two

lakes: Lake Reidsville and Belews Lake. The six incorporated municipalities in Rockingham

County are Eden, Reidsville, Wentworth, Stoneville, Madison, and Mayodan, and the

populations of the towns are shown in Table 2. Wentworth, the county seat, is situated in the

center of the county with the other towns disbursed around it. Stoneville, Madison, and

Mayodan are often collectively referred to as “Western Rockingham.”

Table 2. Municipalities and Populations of Rockingham County.10

Municipality Population Eden 15,908 Reidsville 14,485 Wentworth 2,779 Mayodan 2,417 Madison 2,262 Stoneville 1,002

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History Rockingham County, named for Charles Watson Wentworth, the Second Marquis of

Rockingham, was created in 1785 following its split from the northern portion of Guilford

County7. The county’s history is closely tied to its economy, which has its foundations in

tobacco, farming, and textile mills11. Religious influences, including those of Baptists,

Methodists, and Presbyterians, were strong early in the county’s history as well, and religion

continues to form the cornerstone of daily life for many of the county’s residents, with more than

300 churches in the area10, 11.

Reidsville, the second largest town in the county, was incorporated in 1873 and

developed with a history and economy closely tied to tobacco12. Madison incorporated around

the same time, and was followed shortly thereafter by Mayodan10. In more recent history,

residents from what was then known as Leaksville, Spray, and Draper voted in 1967 to

consolidate the three towns to form Eden, a town that’s development was influenced by its

rolling geography and rivers10, 13. Wentworth recently incorporated in 1998 and is the location of

the Rockingham County Governmental Center, Courthouse, and Community College10, 13.

Economy The economic base of Rockingham County, tied in large part to its historical

development, was built primarily on textiles, tobacco, and other small industry10. With these

industries declining in the last decade, many key businesses began to leave the county, although

manufacturing remains an important part of the current economy10. The general outflow of

business, however, created an economic downturn, often placing residents in challenging

personal financial situations10. In an effort to look toward economic improvement, the

Rockingham County Partnership for Economic and Tourism Development has developed

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Prosperity 2010, a five-year plan that seeks to unify the county in order to revitalize its

economy14.

Currently, the leading employers in the county are yarn and fleece manufacturers, which

employ over 20,000 people10. Miller Brewing Company, which has a brewery in Eden, is the

county’s third largest employer, with more than 750 employees15. In 2005, Wal-Mart opened in

Eden and boosted the economy, generating 419 jobs and $22,500 in charitable donations to local

organizations16.

The general economic situation of the county is especially important for seniors. Less

than 13 percent of individuals 65 to 74 years old in Rockingham County worked in 2005, a

number which drops to less than 6 percent for individuals 75 years of age or older17. The mean

retirement income is just over $15,000, which is significantly lower than the mean household

income of $43,50118. Important indicators of the Rockingham County economy are presented in

Table 3.

Table 3. Selected Economic Indicators: Rockingham County and North Carolina.18

Rockingham Co. North Carolina

Mean household income $43,501 $54,503

Percent unemployed 8.4% 7.1%

Individuals aged 18-64 living in poverty 12.9% 13.2%

Individuals 65 or older living in poverty 15.4% 11.7%

Group Transportation There is no formal system of public transportation in Rockingham County. The Council

on Aging, a senior service agency, and Pelham Transportation, an independently owned

company, both provide van transportation for seniors to travel to doctor’s appointments, grocery

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shopping, or other locations. The 2006 Rockingham County phonebook also lists six cab

companies located throughout the county.

Healthcare and Health In Rockingham County, there are approximately 59 primary care physicians, or 6.4

primary care physicians per 10,000 county residents19. Roughly 9.9 percent of the county’s

residents of all ages are uninsured, and over 18 percent of individuals between the ages of 50-65

are uninsured, leading to a gap in coverage for many of the county’s senior residents10, 20. From

2003-2004, over 13,500 county residents who were 65 or over had some form of Medicare, and

over 3,000 adults of all ages received Medicaid21, 22. There are two major hospitals in the

county; Annie Penn Hospital in Reidsville and Morehead Memorial Hospital in Eden, with a

combined total of just over 200 acute care hospital beds19. Other sources of healthcare, in

addition to private offices, include the Free Clinic of Reidsville and Vicinity, which services low

income, employed residents of the county, and the Rockingham County Department of Public

Health. Home healthcare services are also available through a number of private organizations

as well as Caregivers of Rockingham County, Hospice, and the Council on Aging23.

Mental healthcare is offered primarily through county government. Recently, the county

has joined a three-county system of service management, making the Rockingham County

Mental Health Center solely a service provider instead of both provider and manager and placing

the management process out of direct, local control24. In addition to county-provided services,

there are several private providers, including the Moses Cone Behavioral Health System23. Help,

Inc, a local non-profit agency, also operates a domestic elder abuse program and offers

counseling services25. Finally, the Carolina House of Reidsville, an adult care home, and

Britthaven of Madison, a nursing home, both contain an Alzheimer’s and dementia care unit26.

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The 2004 Rockingham County Community Health Assessment identified the leading

causes of death as cancer (especially breast and lung), heart disease, cerebrovascular disease, and

chronic lower respiratory disease10. The mortality rate for each of these diseases is higher in

Rockingham County than it is for North Carolina as a whole10. The senior community is also

faced with a number of important mental health issues, including Alzheimer’s, dementia,

depression, suicide, and elder abuse, which can be both mental and physical10.

Services and Activities for Seniors Rockingham County has an abundance of resources for its senior community members,

not all of which could be listed in this summary. A partial list of services is provided in

Appendix G. One of the county’s largest senior oriented agencies is the Council on Aging,

which provides adult day care, congregate nutrition sites, Meals on Wheels, the Community

Alternatives Program, personal care services, respite services, prescription assistance, and

transportation services27. The United Way of Rockingham County is also a source of support for

seniors through a variety of channels, and Caregivers of Rockingham County assists the county’s

seniors and their caregivers through volunteers who make home visits and provide assistance

with transportation and errands. Finally, there are two monthly meetings of senior service

providers, which include the Service Providers Network, a coordination group that comes

together to discuss service provision for seniors, and the Rockingham Planning Committee for

Services to the Elderly.

Rockingham County also offers many activities for seniors. There are three senior

centers, located in Eden, Reidsville, and Mayodan, which provide seniors with opportunities to

stay physically, mentally, and socially active. The Senior Games are also a popular activity for

the county’s senior residents and offer the opportunity to participate in events ranging from

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swimming to painting. Finally, the Center for Active Retirement offers seniors the chance to

participate in trips, take computer classes, and participate in a wide variety of other events 23.

III. Methods The student team began work in Rockingham County in late September 2006, continuing

through April 2007, in order to assess the strengths and challenges facing the county’s senior

community. The following is a detailed description of the methods used by the team to become

familiar with the senior community, to gather and analyze secondary and primary data, and to

plan the community forum.

Gaining Entrée Fostering relationships with members of the Rockingham County community was an

important aspect of the RCSCA. The AOCD term “gaining entrée” is used to explain this

continual process of creating personal and professional relationships within the community 2 .

Prior to beginning work in Rockingham County, the AOCD team met its assigned preceptors,

who helped the team make initial contacts in the county. On September 29, 2006, the AOCD

team was invited to a planning meeting hosted by the Rockingham County Department of Public

Health at Morehead Memorial Hospital to discuss the 2008 Community Health Assessment.

Given that the results of the team’s research regarding Rockingham County seniors will feed

directly into the 2008 Community Health Assessment, this planning meeting was an opportune

venue for an official introduction to local service providers. On October 16, 2006, the team

participated in a windshield tour of Rockingham County led by both preceptors. A windshield

tour is a first look at the community and is designed to gain an initial sense of the community,

geographic layout, and important landmarks and spaces4. Recognizing that gaining entrée is a

continual process, the team also attended community events and additional service provider

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coalition meetings throughout the process (see Appendix B). In an effort to publicize the

RCSCA more widely and to build relationships in the community, team members also made a

conscious effort to patronize local restaurants and stores in Rockingham and to discuss the

project with storeowners and employees when appropriate. Team members also distributed

business cards with a team email account and an 800 number at which they could be reached,

facilitating connections in the county as the team continued to meet new people.

At each event or meeting, team members introduced themselves as being part of a “five-

member team of graduate students from the UNC School of Public Health working with the

Rockingham County Department of Public Health to gain an understanding of Rockingham’s

senior community, including its strengths and challenges.” In discussing the RCSCA, the team

also took care to mention that its work would culminate in a community forum and would

contribute to the 2008 Rockingham County Community Health Assessment. Following events,

each team member in attendance wrote detailed field notes that were used in data analysis.

These field notes included a summary of the event, observations, and personal reflections.

Attendance at events and meetings not only helped to shape the team’s understanding of the

community but also nurtured relationships with service providers and senior community

members and served as a means of recruiting potential interviewees.

Secondary Data Collection Each team member contributed to the collection of secondary data. At the beginning of

the process, the team gathered general data on demographics, the physical environment, health

status, community history, culture, and services. From this initial search, the team generated an

extensive list, including websites, print materials, newspaper articles, census data, the previously

published health assessment, and maps. As work continued data, brochures, and print materials

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from meetings and organizations were collected throughout the RCSCA and were maintained by

each member of the team. Following the creation of summary statements generated from

primary data, discussed below, secondary data specific to these statements was sought during the

latter part of the process.

Primary Data Collection The AOCD team collected primary data through field notes, as well as interviews and

focus groups with senior community members and service providers who work with the senior

community. The team conducted 10 community member interviews, 17 service provider

interviews, and 2 community member focus groups. Seven community members participated in

a focus group on February 23, 2007, and five community members participated in a focus group

on March 7, 2007. In total, 21 community members and 17 service providers participated in

primary data collection for a total of 38 individuals (see Appendix B).

Developing Interview and Focus Group Materials Before conducting interviews, the team wrote and pre-tested interview guides and

consent procedures. The interview guides for service providers and community members were

adapted from guides used by the 2002 AOCD student team working with socially isolated older

adults in Durham County28. Individual interview guides were modified for use during the

RCSCA by recognizing the narrower scope of the Durham AOCD and by incorporating

knowledge gained through team participant observation, secondary data collection, and

discussion with the team’s preceptors. In creating the focus group guide, the team selected seven

questions from the community member interview guide that would most likely generate rich

conversation. In addition to the guides, the team developed three distinct consent procedures and

forms, individually tailored to service providers, community members, and focus group

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participants, that included a description of the project, what the interviewee would be asked to

do, risks and benefits of participation, and confidentiality rights.

Feedback on the developed guides was solicited several times. After the first draft was

completed, the team shared the guides and consent procedures with the preceptors and the

teaching team to elicit feedback. Pre-test interviews were then conducted with a community

member and a service provider to ensure that the questions were understandable and appropriate.

However, no focus group pre-test was conducted. Approximately one month into the interview

process, additional edits were made to each guide to reflect when the team had gathered enough

information to reach a thorough understanding of a topic, as well as to add new questions to

further investigate emerging topics.

Conducting Interviews The team paid special attention to ensure that multiple perspectives were represented

through interviews, while acknowledging the limitation of gathering these perspectives in a short

timeframe. The team attempted to gather a diversity of perspectives in terms of race, ethnicity,

gender, socioeconomic status, and geographic location within the county, but was not entirely

successful in all regards (see Appendix B). Service providers interviewed were affiliated with

diverse organizations and worked in a variety of settings.

Potential interviewees were recruited via word of mouth and recommendations from

service providers and community members. The preceptors identified an initial list of service

providers, many of whom referred subsequent contacts. While service providers were contacted

directly by a team member upon referral, each identified community member was first contacted

by the person who referred him or her to obtain consent for the team to contact them. Only one

community member declined the invitation to participate. A small number of interviews were

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solicited, where appropriate, at community events and service provider meetings. To reflect the

senior community appropriately, those individuals who self-identified as seniors and were over

the age of 55 were considered eligible for interviews. Service providers needed to work with a

Rockingham County agency or organization serving seniors in some capacity to be eligible for

participation in an interview.

After contacting a community member, the team asked him or her to identify a

comfortable and convenient interview location. Interviews for service providers were most often

conducted at the provider’s agency. Before each interview, which varied in length from 45 to 80

minutes, a confidential identification number was assigned to the interviewee in order to protect

his or her privacy. Two team members were present at each interview, one as the interviewer

and the other as a note-taker. At the beginning of each interview, the interviewer reviewed the

consent procedures and asked for oral consent from the interviewee to proceed as well as to tape

record the interview. Recording began following the initial consent, and then one additional oral

agreement statement to continue was recorded on tape. Participants were given a copy of the

consent procedure to keep, along with contact information for the RCSCA team and UNC

teaching staff. The interviewer also asked for permission for the note-taker to record notes

during the interview.

Conducting Focus Groups Focus groups were organized with the help of two service providers, who assisted in

recruiting participants from their currently existing community organizations. Both groups

represented distinct community perspectives. Each member of the focus group was identified

with a number based on seating arrangement. Two team members were present at each focus

group, one as facilitator and the other as note-taker. Focus group participants were each given

15

consent procedures and asked for verbal consent prior to the beginning of the discussion. Both

consent and the discussion were recorded, and the discussion proceeded as an informal

conversation, with the facilitator leading the discussion using the focus group guide.

Codebook Approximately one-third of the way through the interviewing process, the team created a

codebook based both on the interview guide as well as preliminary data gathered through

interviews (see Appendix F). A codebook is a method of sorting qualitative, or descriptive, data

so that it can be effectively analyzed. The codebook names several large topics (domains), such

as “Personal Transportation” or “Challenges” that are then broken down into small topics. In

some cases, these smaller topics are further divided, for example dividing transportation into

issues of quality, access, and cost. The most specific topic for each domain is referred to as a

code. This process was informed by our interview guide and responses from the early interview

participants. Microsoft Excel files were used to store the data generated for each code.

Primary Data Transcription and Coding Following each interview and focus group, tape recordings were reviewed by the

interviewer, who listened to the tape in order to supplement written notes from the interview with

direct quotes and/or other specific details from the recording not captured by the note-taker.

These transcripts were used as the basis for the data coding. One team member read through

each transcript and sorted sections of text according to all relevant codes. These passages were

then copied into the appropriate Excel files, marked with the interview ID number from which

the data was generated, and separated by affiliation (service provider or community member).

After all of the interviews and focus groups were coded, the team counted frequencies,

which is a way to track the number of individuals who mentioned each code (see Appendix F).

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Due to the somewhat arbitrary nature of what constituted “mentioning” a code, the team counted

frequency based on the number of individuals who discussed a certain topic rather than the

number of times a certain topic was mentioned within the context of one interview. The team

then selected the codes with the highest frequencies in order to create a theme, or summary

statement, identifying patterns, linkages, and ideas within and among codes. At times, the team

relied on its own discretion to determine when a frequency was sufficiently high to include the

code in theme development. Some codes were selected specifically because of very high

frequencies, while others were selected because they had the highest frequency within an

important domain (e.g. Alzheimer’s and dementia for mental health). Theme development was

also informed by indications of particular needs evident in the secondary data. As a result of this

data analysis process, the team wrote 11 initial theme statements, which were presented to the

Forum Planning Committee (FPC), explained in detail in the section on forum planning. Final

themes were selected by this committee, who voted on the top five themes they considered most

important and changeable and through extensive discussion offered suggestions on how to refine,

narrow, and word the final five forum themes. At this point, the data analysis merged with

forum planning.

Analysis of Field Notes and Secondary Data The field notes and secondary data went through a much more limited data analysis

process than primary data. After the selection of the five themes to be presented at the

community forum, secondary data was reviewed again to inform the developed themes

appropriately. Due to time constraints, the team coded field notes only for information relevant

to the chosen themes.

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Forum Planning The Rockingham County Senior Community Forum was the culmination of the RCSCA.

Integral to successfully planning and carrying out the forum was the formation of the FPC.

Seventeen people were invited to participate in the planning process, and twelve people attended

at least one meeting. Participants included senior community members and service providers

from several county organizations focused on the care of senior citizens in Rockingham County.

Committee members were recruited based on expressed enthusiasm for the goals and objectives

of the RCSCA, as judged by the team during interviews.

Four weekly FPC meetings were held in March and April for one hour each at the

Rockingham County Department of Public Health. During these meetings, the student team

discussed the purpose of the forum and the role of the FPC, as well as the process for transferring

ownership of the project to the community at the forum (see Appendix E). The main goal of

bringing together this dynamic and enthusiastic group was to instill a sense of community

ownership of the forum planning process, the forum, and follow-through of action steps. FPC

members were consulted on every aspect of the planning process, including fundraising,

invitation and brochure design, and theme selection as discussed above. FPC members also

actively contributed to forum small group discussions, informed by a special knowledge of the

theme selection.

A total of 130 personal invitations were sent by mail to key invitees identified by the FPC.

These invitees included everyone who had been interviewed or participated in a focus group, key

leaders of all local senior service provider agencies, and town, county, and state government

representatives. Additionally, key individuals were contacted by phone to collect additional

information relevant to small group discussions, to inform them of themes relevant to their work,

and to stress the collaborative nature of the project. The forum was advertised by widely

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distributing flyers via service provider meetings, FPC personal networks, and through posting

flyers in local business storefronts. The student team also participated in two local AM radio

programs popular with Rockingham County seniors to advertise the event. Finally, in the two

weeks prior to the forum, the student team made personal phone calls to remind people about the

forum and encourage them to attend. An RSVP was requested but not required.

Since transportation emerged as a major issue facing Rockingham County’s seniors, the

student team made an effort to arrange for van transportation that could transport interested

seniors from nutrition sites and other senior centers to the community forum. Ironically,

however, once vans were secured, the team had trouble finding enough interest in the proposed

van services, as seniors at those sites had already arranged for transportation via their own or a

friend’s car, and the effort was therefore eventually dropped.

At the suggestion of the FPC, the team’s fundraising plan included soliciting donations

from organizations in the main towns across the county, as well as fee-based participation in the

health fair. Donations included food, monetary gifts, and door prizes, and were collected both by

visiting businesses door-to-door and by making calls to additional businesses. In addition, the

venue for the forum as well as tables, chairs, and audio equipment, were graciously donated.

(see Appendix E for the donation letter). Using an initial list generated by the FPC, the team also

contacted a variety of organizations for participation in a mini-health fair (see Appendix D for a

complete list of booth participants). For-profit organizations were required to make a $25

donation to reserve a booth (see Appendix E for booth reservation form), and non-profit

participants were not charged but were encouraged to contribute a door prize. In total, 22

organizations participated in the health fair, and the team raised $175 through booth reservations.

Booths also served as an informative tool for educating seniors about some of the available

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services throughout the county, as well as a networking tool for service providers.

IV. Findings Part of the AOCD process is the generation of data and, from that data, the development

of relevant themes, including both strengths and challenges. The RCSCA identified four major

strengths of the senior community, two challenges facing the county as a whole, and ten

challenges specific to the senior community. The community challenges presented here are

those selected by the FPC for a discussion at the forum. These five challenges are discussed in-

depth from the perspective of community members, service providers, and the student team.

Background information for each theme can be found in the previous secondary data sections.

For a summary of additional challenge themes not selected, please see Appendix F. In the

presentation of primary findings, some of the viewpoints of the community members and service

providers are similar or shared. These two perspectives are presented separately, however,

because the team believed that, despite sometimes shared viewpoints, service providers and

community members had different perspectives in terms of their roles within the community.

Community Strengths Over the course of the RCSCA, the team uncovered four strengths of the Rockingham

County senior community through interviews and focus groups. First, family and senior

relationships emerged as strong positive aspects of life in the county. Many people reported that

they look to each other for support and socialization and strongly value the interactions they have

with family members who remain in the area. Second, religion plays an important part in

community life. Many seniors participate in church activities, and one community member

stated, “it’s a social function as well as religious function.” Third, both community members and

service providers described Rockingham County as a caring community. Senior community

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members look out for each other, check in on a regular basis, and provide help when needed.

Likewise, many service providers take the care they provide for seniors beyond what is directly

required for their jobs. According to one service provider, “I love my people, that’s what I call

‘em, I don’t call ‘em clients, I don’t call ‘em participants, they’re my people.” Finally, the

county offers an abundance of resources and activities for seniors, including physical activity

groups, social groups, and artistic groups. Seniors also keep themselves occupied through

volunteering in a variety of settings across Rockingham County.

Countywide Challenges The relatively recent economic downturn in all of Rockingham County has posed

challenges to many of the county’s residents. These county level challenges affect all residents

and are not limited to the senior community, but seniors often commented on the countywide

issues as it pertained to their lives. Seniors often reported their disappointment that younger

generations are unable to remain in the county for financial reasons. Seniors value their families

highly and express disappointment that their children and grandchildren must move away to find

work. Plant closings and other economic difficulties also affect seniors more directly, as older

adults who were laid off from industrial jobs are often unable to find new work to support

themselves until reaching the federal retirement age of 65 or had insufficient retirement benefits,

depending on place of employment. In addition, service providers commented on the county’s

economic situation, referencing both financial challenges in their own agencies and the

challenges facing all of the county’s residents.

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Senior Community Challenges

Awareness of Services Theme: Seniors are often unaware of the services and events that are available to them throughout the county. Community Member Perspective

“My biggest concern for the seniors in Rockingham County is that I really believe that most of the senior citizens do not have any idea what’s available for them in the community. We may

not have a lot of things, but I don’t think they even know what we have, for the most part.”

Despite the number of services and activities available for seniors in Rockingham

County, many seniors expressed concern regarding the lack of events in the community or stated

that they were not aware of what was available. Others stated that events and services were

available in the community but that they were unable to obtain sufficient information to be able

to participate in activities or utilize relevant services. Seniors who participate in more activities

within the community reported that they use word of mouth to share information with other

seniors. Another existing method of communication about activities and services is through

churches; seniors reported a high level of church attendance and interest in the information

presented at church.

Service Provider Perspective “You beat your head against the wall sometimes because, you know the information is out there but you got to hit a person when they need it. It is getting info to people when they’re looking

for it. And how do you do that?”

Service providers stated that it was difficult to inform seniors of their services, events,

and activities due to the rural nature of the county as well as communication difficulties,

especially with seniors. Service providers acknowledged that print may be the best way to reach

seniors but is also the most expensive method. Some service providers expressed concern that

their agencies may have acquired a negative image in the community or that seniors resisted

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using their services out of a dislike of dependence or “taking charity.” They expressed

frustration with their inability to correct these misperceptions or to convince seniors who would

benefit from their services to come to the organization. Another common concern was a

miscommunication of offered activities and services; service providers stated that some seniors

think that some services are for a certain type of senior when, in reality, the services are offered

to a much broader portion of the community. In terms of activities, service providers also

reported that community members believe that their agency only offers certain types of activities

when the agency actually offers a wide variety of programs. Only one service provider stated

that seniors actively seek services and volunteer opportunities with the agency rather than the

service provider having to market the agency aggressively.

Team Perspective

At first, the team noted a general sense of surprise that seniors did not know of all the

services and organizations they encountered during their time in Rockingham County. Upon

further reflection, however, the team noted the degree of effort they had put in to locating

services in the county, and surmised that a similar amount of dedication would be required on the

part of community members. Additionally, the rural nature of Rockingham County makes word

of mouth from one side of the county to the other difficult and limits the scope of this method of

information sharing.

Comparison of Perspectives

Service providers and community members approached this topic from differing but

complementary viewpoints. Whereas service providers concentrated on the difficulty in reaching

seniors, community members commented on the difficulty connecting with agencies and

organizations in the county. There is interest in this problem from both sides of the issue, but

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there appear to be difficulties connecting in the middle. Team members did not have specific

experiences with one side of the issue or the other, but noted general concerns inherent to the

county that must be considered when advertising events or services. What is most notable,

perhaps, is that both service providers and community members were aware of and willing to

address these challenges.

Alzheimer’s and Dementia Theme: Although the county offers some mental health services, adequate care does not exist for the growing concerns surrounding Alzheimer’s and dementia among seniors and support for their families. Community Member Perspective

“When we were children you hardly ever heard… well now and then you’d hear… they’d say that they lost their mind…. But now you just hear that in every family just about somebody has

got dementia or Alzheimer’s.”

Many community members expressed fear that they would begin to suffer from

Alzheimer’s or dementia. As one community member stated, “The thing that bothers me is just

the thoughts. I have Alzheimer’s in my family.” They also noticed the prevalence of these

conditions in the community. Many community members noted watching friends and family

undergo these disease processes, which potentially influences their own fear about the possibility

of developing Alzheimer’s or dementia. Seniors also viewed Alzheimer’s and dementia as

natural processes that occurred with aging, and did not express any desires to change the

situation in terms of disease prevention. They did, however, express a desire to improve services

for individuals living with these conditions in the community. Concerns about Alzheimer’s and

dementia were situated in a larger context of concern for general mental healthcare and services

for seniors.

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Service Provider Perspective

“In conjunction with that, and even another, is that the ever growing need for Alzheimer’s care, which by licensing is a special care unit, there’s nothing. There’s only one special care unit in

our county and it is full with a wait list.”

Through interviews with service providers, it became apparent that there is a need for

more comprehensive Alzheimer’s and dementia care services for seniors and support for their

families in Rockingham County. Service providers expressed concern regarding the capacity of

facilities to keep individuals who are suffering from these diseases engaged in life in a

meaningful way. Additionally, they reported that the few services available in the county had

waiting lists for entrance into programs. One service provider highlighted the need for services

to care for individuals who were experiencing the onset of Alzheimer’s or dementia symptoms

but who had not yet experienced the total loss of mental faculties associated with disease

processes. Service providers expressed concern that family members are unable to locate

resources to care for parents or grandparents with Alzheimer’s or dementia.

Team Perspective

The team did not directly observe the need for Alzheimer’s and dementia care services in

the county but rather interpreted interactions with community members and service providers.

Many community members seemed frightened or distressed about what would happen in the

future if they began to experience symptoms of Alzheimer’s or dementia, and expressed concern

that there would not be enough services to help them and their loved ones cope with the illness.

Additionally, the team noted that there are not a lot of mental health facilities in Rockingham

County; the Carolina House of Reidsville and Britthaven provide the county’s only Alzheimer’s

care units and the county government has only one mental health center.

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Community members, service providers, and team members all expressed concern

regarding the availability of Alzheimer’s and dementia care services in Rockingham County.

Service providers and team members viewed the situation more from a clinical point of view,

noting the diseases’ impact on individuals and their families. Community members, however,

expressed fear regarding the possibility of living with these diseases. This distinction makes this

issue one of the few in which the service provider viewpoint represents a true “outsider’s” point

of view.

Transportation Theme: Given Rockingham County’s spread out geographic layout and the shortage of consistent, low-cost transportation, seniors have difficulty using transportation to access services and activities. Community Member Perspective

“I really think transportation is the one big problem here.”

Community members routinely cited the lack of available community transportation and

the difficulty accessing such sources of transportation. Of the seniors interviewed, the vast

majority are still able to drive. Seniors view the continued ability to drive as a marker of

continued independence and often stated that they wished to retain their independence for as long

as possible. If a senior is unable to drive him or herself, however, they next turn to friends or

family for transportation. Younger seniors drive older seniors, and friends call others they know

are unable to drive if they are going on errands and have room in the car to take someone else

along. Use of these informal networks is seen as preferable to using group transportation

services for a variety of reasons. First, the group transportation services are viewed as

inconvenient due to the fact that a senior has to travel with many other individuals, which may

26

increase time spent waiting to be picked up Second, these transportation services are sometimes

viewed as uncomfortable due to the condition of vans or the level of service received from staff.

Third, seniors commented that cost can be prohibitive when using the for-profit van service or

other methods of transportation (such as a cab) to move across the county.


“Transportation is one of the biggest issues we have here – lack of. Because the way our

population is placed in the county.”

Service providers in Rockingham County consistently agreed that transportation is an

important issue facing the county’s seniors. Many also acknowledged that improved

transportation would be an asset to seniors in the county. Family and friends were consistently

identified as people whom seniors relied on for transportation assistance, and when seniors are

no longer able to drive themselves, they consider it a loss of independence. Service providers

acknowledged that the spread-out nature of the county complicates providing transportation

services.

Service providers also described transportation as it relates to other issues and themes.

Given the rural nature of the county, seniors may be isolated by a lack of transportation, which

may contribute to depression or withdrawal. Transportation poses a challenge to accessing other

important necessities, such as groceries. Many service providers also noted that a lack of

transportation is a barrier to accessing medical care. Finally, transportation is important for

seniors to access social opportunities. For example, one service provider stated that most seniors

have to drive themselves to social functions, and “if they don’t have a car or family isn’t willing

to drive them - it’s tough.”

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Team Perspective

Transportation was one of the first potential themes to become apparent to the team. It

was mentioned frequently and clearly, and, during the initial tour of the county, several team

members noted the spread-out geographic nature and wondered how seniors would be able to

navigate the county. Many of the community members with whom the team interacted drove

their own vehicles to interviews and events, giving the impression that many seniors are still able

to drive. However, because of acknowledged difficulties in accessing the isolated population,

the team may not have the complete perspective that can be gained when examining service

provider and community member data.


The team, service providers, and community members all identified transportation as a

challenge facing the senior community of Rockingham County. Although the team had no

specific knowledge of transportation in Rockingham County, they initially identified the rural

nature of the county as a barrier to effective transportation services. Service providers echoed

the team’s comments, but also view transportation from the point of view of accessing services.

They are often frustrated that the seniors they attempt to reach are unable to travel to their sites

or have difficulty doing so. Seniors shared this concern with accessing services and basic needs,

but further expanded on the idea of individualism. Ride sharing with friends or family is

strongly preferred over group transportation services due to its more personal nature.

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Insurance Gap Theme: Due to age and income restrictions for current health insurance options, seniors may fall into a gap where they do not have sufficient health insurance to cover medical costs. Community Member Perspective

“…it’s been being able to get to the doctors for help. A lot of people I’ve been acquainted with, they stay at home, especially if they don’t have proper insurance and all.”

Community members discussed the insurance gap in terms of accessing doctors or, more

specifically, healthcare resources other than the emergency room. They noted that friends

without sufficient insurance stay at home rather than paying additional money for a doctor’s

visit, or that they wait until a condition progresses to a stage that requires an emergency room

visit. Additionally, they discussed seniors’ reluctance to risk incurring medical costs by going to

the doctor, even if they do have health insurance.


“There are people, 55, who need to work another ten or fifteen years who are having trouble finding work or are 62 and don’t have insurance.”

Service providers offered information regarding the mechanics of the insurance gap and

provided information about its root causes. First, many noted that the economic downturn facing

the county directly impacts seniors and manifests itself in the insurance gap. Some community

members were laid off late in their careers and often are unable to locate new employment or are

unwilling to start a new career. This situation leaves them without income or benefits from

employment. Additionally, if they are under 65 years of age they are unable to qualify for

Medicare and face the possibility of a decade or more before they qualify for federal benefits.

On the other hand, individuals that qualify for Medicare are not always able to pay the additional

healthcare costs not covered by this program. Service providers reported situations in which

seniors have too much income, sometimes by as little as one dollar, to qualify for benefits. They

29

also noticed that recent legislation and Medicare Part D improved the insurance gap, as most

seniors are now able to qualify for prescription assistance.

Team Perspective

The team did not directly observe the insurance gap in Rockingham County because it is

a rather hidden issue. Through participant observation, however, during the interviews and

interactions with service providers and community members outside of formal interviews, the

team noted that the insurance gap is a source of distress for both groups. Additionally, the team

reflected that, due to its inextricable ties to federal policies, the insurance gap itself would be

difficult to resolve on a local level and requires a much stronger and more sustained lobbying

presence at the federal level.


Compared to community members, service providers tended to view the insurance gap as

more of a practical challenge, explainable in dollars and ages. However, both groups noted the

gap’s effect on the community. Community members viewed the issue from a more personal

point of view, while service providers explained the various forms the insurance gap could take.

The team had no direct experience with the insurance gap issue, but rather noted the gravity of

others’ responses and experienced the personal challenges of understanding Medicare and

Medicaid.

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Streamlining Services Theme: While many service providers work together efficiently and productively, communication and service delivery is not always streamlined. Community Member Perspective

Individuals who identified only as community members did not discuss this theme, most

likely due to the fact that this issue may be relatively hidden from community members who are

uninvolved in service provider operations. However, when the topic was explained to

community members in later meetings, they were receptive to the topic and understood the

service providers’ point of view. Additionally, individuals who identified as both community

members and service providers discussed the topic only in terms of their roles as service

providers.


“It’s pretty much everybody in his own little spot. We call other agencies if we run into other problems they can help with, especially the home health agencies and private physical therapists.

But yet pretty much everyone stays in his own little territory.”

Service providers often mentioned working with and partnering with other agencies.

They refer clients to other agencies as well as receiving referrals from other agencies. Service

providers keep in touch through two main meetings that are held on a monthly basis in

Rockingham County. However, other service providers reported feeling disconnected from the

larger service provider network or feeling that obtaining necessary information about other

service providers is difficult or time-consuming. Service providers do not often search out other

agencies, and some feel that contact is on an as-needed basis rather than with the intent to form

lasting relationships or more formalized partnerships. It is important to note, however, that the

existing connections between agencies were often cited as a source of pride and accomplishment.

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Team Perspective

During the RCSCA, the team attended both of the service provider meetings held in the

county. One meeting focuses on information sharing between the service providers in

attendance, while the other provides in-depth information on a specific topic through a lecture

delivered by a local service provider. Despite noting some inefficiency in communication

processes and some miscommunication between service providers, the team was generally

impressed with the effort made by service providers to communicate with each other.

Additionally, when service providers listed the other agencies with which they worked, the team

noted that service providers would often form small clusters within the larger context of

Rockingham County agencies, with each cluster having relatively little contact with other

clusters. However, the team noticed that some service providers were unaware of other agencies

that worked with seniors in the county.


In this case, the community members are the most removed from this issue of

streamlining services as they are not involved in the day-to-day operations of agencies. Service

providers noted pride in their accomplishments in terms of communication, and the team took

special note of the level of communication already present between service providers. Both

groups, however, noted the need for improvement in several areas of communication, and that

broader communication networks would benefit both the service providers and the senior

community.

V. The Rockingham County Senior Community Forum The goal of the Rockingham County Senior Community Forum was to bring community

members and service providers together in order to present the findings of the RCSCA, to

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develop specific steps to address challenges, and to transfer ownership of the project to the

community in an empowering way. It was held on Friday, April 20, 2007 at the Cooperative

Extension at the Agricultural Center in Reidsville, NC. The forum was held from 12:00-2:30pm,

and included lunch, a health fair, entertainment from a local senior line-dancing team, and a

raffle. There were also two speakers, an opening speech from a well-recognized service provider

and a closing speech from a Rockingham County Commissioner. A total of 93 people signed in

at the registration table, but the student team estimated that approximately 120 people attended

the forum, including community members, key service providers, and officials from varying

levels of local government.

The team opened the forum by reporting findings of the process, including community

strengths and challenges, and then detailed their formal exit from the community. To allow for

in depth conversation about the five themes prioritized by the FPC, the forum moved into small

group discussion sessions. Each group was lead by a student team member who guided

discussion using a small group facilitation technique known as Force Field Analysis. Based on

the current situation for each theme, participants identified a goal. The group then listed

important and changeable factors currently existing in the county that either help to reach the

goal or hinder reaching the goal. A complete list of factors generated by individual discussion

groups can be found in Appendix D. Based on the factors discussed, each group generated

specific action steps for which group members volunteered to complete.

After the breakout groups, all participants reconvened in the main room to share action

steps with the larger group. Because many action steps pointed in similar directions, several

forum participants made immediate plans to discuss the forum and ways to collaborate at an

upcoming service providers meeting. After the discussion of all the groups’ action steps, the

33

student team gave their closing remarks and expressed gratitude to the community for being so

welcoming and engaged throughout the process. Each small group is discussed in further detail

below.

Awareness of Services Approximately 30 people, including a mix of service providers and seniors, attended the

service awareness small group discussion. The group talked about many issues relevant to this

theme, which was stated for the group as “seniors are often unaware of the services and events

that are available to them throughout the county.” Major topics discussed included important

modes of making seniors aware of services, such as through newspapers, television, radio,

technology including email and the Internet, the United Way 211 phone number, and the

phonebook. Venues and organizations important to increasing awareness included nutrition

sites, libraries, YMCAs, and senior centers and associated newsletters and technical trainings.

Churches were also mentioned as a very important way of communicating with seniors,

especially given the large number of religious organizations in the county. Finally, group

members discussed word of mouth communication among seniors, encouraging attendance at

events and sharing knowledge of community events and services.

From this lively discussion, the group generated several important action steps intended

to increase senior awareness of services. These steps involved both advocacy on the part of the

senior community and information collection:

• Initiate a letter writing campaign, working with the Council on Aging and potentially the

News and Record, to help make the needs and desires of seniors known

• Contact Home Health Care and Caregivers of Rockingham County as a way of spreading

awareness to homebound seniors

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• Contact ministerial groups of Eden and Reidsville to investigate working with church

groups to increase service awareness

Alzheimer’s and Dementia

Twenty-one community members and service providers joined this small group

discussion to talk about services offered in Rockingham County for those living with

Alzheimer’s and dementia and support for their families. Participants had a varied breadth of

knowledge about the topic, ranging from community members who were uncertain about the

distinction between Alzheimer’s and dementia to service providers working with organizations

currently offering services to seniors, including those specifically working with Alzheimer’s

patients. One of the biggest points of discussion centered on the role of caregivers for those who

are living with dementia and Alzheimer’s. Having some way to care for those with Alzheimer’s

or dementia or knowing where to turn for help were mentioned as important topics to many in

the county, including looking to other organizations that can offer care outside of specific

facilities with Alzheimer’s or dementia units.

The group developed the following action steps, and several participants volunteered to

follow up on each item:

• Heavily advertise an upcoming information session at the Carolina House of

Reidsville for those affected by and those interested in learning more about

Alzheimer’s

• Acquire a list of county services and distribute at nutrition sites and senior events,

specifically the Senior Games, to educate Rockingham County community

members about the services that are currently offered in the county for seniors

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Transportation

Approximately 14 people attended the transportation small group discussion. The

majority of attendees were service providers, although almost all of those were also senior

residents of Rockingham County. Representatives from each of the two main transportation

providers (the Council on Aging and Pelham Transportation) were also in attendance. The group

agreed that awareness of available transportation services was an important issue, and

subsequently discussed increasing marketing of these available services. Finally, the group listed

the following action steps, for which at least one participant from the group volunteered to

follow-up on each item:

• Include information on available transportation options/rates for seniors from Council

on Aging transportation services in the next Center for Active Retirement newsletter

• Attend and present information about available transportation options at upcoming

meetings with both the Service Providers Network and the Rockingham County

Planning Meeting for Services to the Elderly

• Call WLOE about a potential radio spot to discuss transportation

• Investigate potential advertising options for transportation services in local utility

bills

• Contact local newspapers and churches to post transportation information in their

bulletins

• Help create flyers to be distributed to advertise Council on Aging transportation

services

• Contact the Council on Aging to get information on their transportation services and

to discuss collaboration options

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Insurance Gap

The small group discussion on the insurance gap for seniors focused on age and income

restrictions for current health insurance options. There were 14 participants, including members

of local government, community members, local service providers, and representatives from a

local senior health insurance provider. Participants decided upon “need to increase education

about, advocacy for, and communication of health insurance information for people of all ages,”

as the primary focus for the discussion. The group felt strongly that education, advocacy, and

communication for seniors, service providers, and all healthcare providers (especially

physicians) were crucial in addressing this issue. Additionally, there was a discussion about the

importance of educating young people for the purpose of preventing them from falling into the

insurance gap in the future. The group acknowledged that there is currently some education and

advocacy in place, especially around Medicaid Part D and prescription medication, but that there

is room for more, especially in terms of outreach education. The small group formulated specific

action steps from the discussion:

• Take this theme to the Rockingham Senior Service Providers meeting

• Create a resource guide focusing on insurance issues and advice for seniors

• Distribute resource guide at churches, physician’s offices, Meals on Wheels,

pharmacies, and through home health services

• Create a resource team to present information about resources at local organizations

such as churches, Meals on Wheels, pharmacies, and home health services

• Vote for candidates who want to address the insurance gap

37

Streamlining Services

Approximately 10 individuals participated in the small group discussion about

streamlining services. Participants included three service providers and two seniors who are very

active in their community. The group discussed methods for making service delivery more

efficient among service providers and how to increase communication about programs among

service providers. Conversations revolved around the challenges in streamlining services,

including lack of awareness from service providers about what other services are offered in the

county, not seeking out other services, and insufficient use of the Internet. The group cited the

Service Providers Network meetings, the county’s 211 service provided by the United Way, and

event calendars in the local papers as factors that currently contribute to delivering streamlined

services. The group ultimately focused on creating a centralized information resource for service

providers and community members and developed appropriate action steps:

• Contact Region G Agency on Aging to host an online resource

• Look into creating a free Rockingham community page, network, and bulletin

board online

• Create a list of resources that promote, advertise, and publicize events for seniors

• Create a senior newspaper

• Secure funding for the senior newspaper

VII. Limitations As a method of community health education, the AOCD process in general and the

team’s own methodological processes were not without limitations. First, the project was

constrained by a fairly defined timeframe within which the team was attempting to gain entrée,

gather primary and secondary data, and report back to the community via the forum. With a

38

more extensive period in which to work, more interviews could have been conducted and themes

would have the support of additional perspectives. In addition, other segments of the senior

community, such as Latinos or homebound seniors, could have been reached to contribute to this

understanding. However, the team recognizes that the AOCD process includes a longer

timeframe than is available to many public health practitioners. The method of sampling the

population for interviews is a second limitation of the AOCD process as utilized by the RCSCA.

Because individuals tended to recommend friends that were often, though not always, members

of the same social circles, socioeconomic class, or that participated in the same activities,

gathering more diverse perspectives became increasingly challenging as the project progressed.

The team sought to address this limitation by soliciting community member referrals from both

service providers and other community members, but this method was not always successful.

Another limitation of the methods used in the RCSCA was the combination of deductive

and inductive coding of data. Deductive codes were created from interview questions prior to

examining the data, whereas inductive codes were created after looking at preliminary

interviews. Combining these two methods of coding was not often seamless and may have

influenced the way in which data was interpreted when generating themes. By looking across

codes, however, themes were generated that were not restricted to one particular inductive or

deductive code.

Finally, because of the focus on the senior community, the scope of findings for which

action steps can be generated is limited. For example, primary data often revealed challenges the

county faces due to a large proportion of younger people leaving the county, but because this

issue was not mentioned as a specific challenge facing the senior community, it was not

developed into a theme statement. What is important, however, is that these issues were

39

expressed in a context in which community “movers and shakers” were made aware of future

directions necessitating follow up.

The team noted limitations not only with the methods used in the AOCD process but also

with the data itself. In compiling secondary data, the team had difficulty locating current data

sources regarding the proportion of the county utilizing Medicare and Medicaid services.

Having this information more readily available would have provided a more complete

understanding of the gaps in services and needs. However, the team recognizes that this

limitation reflects a real-world situation in which desired data is not always available.

In the presentation of the primary data, the team fully acknowledges several limitations of

the primary data collected. As previously mentioned, no isolated or homebound seniors were

reached for interview, and thus their perspectives are not incorporated into the findings

presented. Given the timeframe within which work was conducted, it was difficult for the

student team to access this segment of the senior community. In the future, the team

recommends a community assessment based solely on this population as well as those who care

for them. Additionally, the team did not reach any Latino senior community members, and while

several key informants mentioned the lack of community knowledge regarding the small Latino

portion of the county’s population, few knew the number of seniors it included. Special attention

should be paid to this population in the future as the number of Latino seniors increases.

VIII. Conclusions and Recommendations The AOCD process serves to address the many complex community factors contributing

to health with the goal of addressing these factors through specific action steps. This report

summarizes a specific AOCD process, the Rockingham County Senior Community Assessment,

which uncovered strengths of and challenges facing the senior community. The RCSCA was a

40

rewarding and unique experience, both for the team and hopefully for the members of the

community and its service providers. The team was consistently struck by the caring individuals

who truly enjoy living in the county as well as by those who are extremely dedicated to serving

the county’s residents. In the short time period in which the RCSCA was conducted, the team

and the community formed valuable relationships that speak to the exemplary nature of

Rockingham County and the people that live and work there.

At the conclusion of the process, the team truly felt as though a valuable dialogue was

initiated, connections among service providers were fostered for the betterment of the

community, and that seniors were able to come together in a meaningful way. The team is

confident that the community possesses the enthusiasm and the capacity to make Rockingham

County an even better place for seniors to live. There is a great deal of overlap between what

service providers and community members identified as important issues, providing common

ground for working collectively. Additionally, the county is fortunate to possess a number of

resources that are useful to the senior community. The ultimate task that lies ahead will be to use

these resources in a collaborative, productive way that will result in useful and successful action.

The team cautions that the action steps generated at the forum are a starting point to addressing

the challenges facing the senior community and that they are not the only potential course of

action. However, individuals and organizations must take ownership of the initial steps and

ensure their completion for successful change to take place in the senior community. Based on

the process, the RCSCA findings, and the community forum, the team makes the following

recommendations for the future:

• The term “senior” may include individuals younger than 65, and care should be taken to recognize that some members of the county who are not 65 or older identify themselves as members of the senior community.

41

• County demographics are changing, and attention should be paid to the senior members of different ethnic groups, especially the Latino population.

• Future work with seniors should include a focus on isolated and homebound seniors. • Given the number of existing quality services for seniors in the county, efforts should include

building upon what is already available. • Service providers and community members should place increasing awareness of services

and events at the forefront of all efforts. • Use of multiple communication methods, including direct mail, the Internet, and radio, will

be an important component of raising senior awareness in the future and should be considered in service and health promotion efforts.

• Grassroots networking among seniors, with the purpose of sharing resources, should be

recognized and increased, utilizing the informal ties that already exist. • Religion is an important component of life, and church networks should be investigated as a

channel for improving life for seniors. • Broader participation in the county’s existing senior service provider groups/networks should

be encouraged, making coordination key. • Collaboration on developed action steps will be crucial in moving towards their successful

implementation, especially given the overlap in many of the steps that were developed.

While this report summarizes the conclusion of a process, it also marks the beginning of

an exciting time. The team sincerely recommends that the action steps developed be carried out

to their full potential and hopes that these steps will lead to even more inspired change in the

future. Through the Rockingham Community Senior Community Assessment, the strengths of

the senior community were celebrated, its challenges were discussed in a meaningful way, and

the resulting outlook for change is positive.

42

References

1. Eng, E., & Blanchard, L. (1991). Action-oriented community diagnosis: A health education tool. International Quarterly of Community Health Education, 11, 93-110.

2. Shirah, K. (2006). What is an action-oriented community diagnosis?: Lecture notes for HBHE 740: Foundations of health education practice. University of North Carolina at Chapel Hill.

3. Steckler, A., Dawson, L., Israel, B., & Eng, E. (1993). Community health development: An overview of the works of Guy W. Steuart. Health Education Quarterly, Supplement 1, S3-S20.

4. Eng, E., Moore KS, Rhodes SD, Griffith, D., Allison, L., Shirah, K., et al. (2005). Insiders and outsiders assess who is "the community": Participant observation, key informant interview, focus group interview, and community forum. In B. Israel, E. Eng, A. Schulz & E. Parker (Eds.). Methods in community-based participatory research for health. San Francisco, CA: Jossey-Bass.

5. US Census Bureau. (a). Population fact finder: Rockingham County. Retrieved March 6, 2007, from http://factfinder.census.gov.libproxy.lib.unc.edu.

6. US Census Bureau. Population fact finder: North Carolina. Retrieved March 6, 2007, from http://factfinder.census.gov.

7. Rockingham County Government. (2000). County government facts. Retrieved March 6, 2007, from http://www.co.rockingham.nc.us/cofacts.htm.

8. Piedmont Triad Council of Governments Regional Data Center. Older adults in Rockingham County.

9. US Census Bureau. (b). Rockingham County, North Carolina- age and sex. Retrieved April 23, 2007, from http://factfinder.census.gov/servlet/STTable?_bm=y&-geo_id=05000US37157&-qr_name=ACS_2005_EST_G00_S0101&-ds_name=ACS_2005_EST_G00_&-redoLog=false.

10. Rockingham County Department of Public Health and Rockingham County Healthy Carolinians. (2004). Community health assessment 2004. Rockingham County, North Carolina.

11. Rockingham County Historical Society. The history of Rockingham County, NC. Retrieved April 23, 2007, from http://www.rockinghamcountyhistory.com/id22.htm.

12. City of Reidsville, North Carolina. Reidsville, NC- community history. Retrieved March 6, 2007, from http://reidsvillenc.accountsupport.com/history.htm.

13. Leaksville.com. Welcome to Leaksville, North Carolina. Retrieved March 6, 2007, from http://www.leaksville.com.

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14. Rockingham County Partnership for Economic and Tourism Development. Prosperity 2010. Retrieved March 6, 2007, from http://www.ncnorthstar.com/2010/prosperity.asp.

15. Miller Breweries. Eden, North Carolina. Retrieved March 6, 2007, from http://www.millerbrewing.com/brandsBreweries/eden.asp.

16. Wal-Mart Facts. (2005). Eden Wal-Mart Supercenter celebrates grand opening. Retrieved March 6, 2007, from http://www.walmartfacts.com/articles/2075.aspx.

17. US Census Bureau. (c). Rockingham County, North Carolina- employment status. Retrieved April 23, 2007, from http://factfinder.census.gov/servlet/STTable?_bm=y&-geo_id=05000US37157&-qr_name=ACS_2005_EST_G00_S2301&-ds_name=ACS_2005_EST_G00_&-redoLog=false.

18. US Census Bureau. (d). Rockingham County, North Carolina- selected economic characteristics: 2005. Retrieved March 26, 2007, from http://factfinder.census.gov.libproxy.lib.unc.edu/servlet/ADPTable?_bm=y&-geo_id=05000US37157&-qr_name=ACS_2005_EST_G00_DP3&-ds_name=ACS_2005_EST_G00_&-_lang=en&-_sse=on.

19. Cecil G. Sheps Center for Health Services Research. (2005). North Carolina health professions data system: Rockingham

20. Small Area Health Insurance Estimates. (2005). Health insurance coverage for North Carolina Counties, 2000: Experimental estimates. Retrieved April 23, 2007, from http://www.census.gov/cgi-bin/hhes/sahie/sahie.cgi.

21. Centers for Medicare and Medicaid Services. (2005). Medicare county enrollment. Retrieved April 27, 2007, from http://www.cms.hhs.gov.libproxy.lib.unc.edu/MedicareEnrpts/.

22. Rockingham County Department of Social Services. (2004). Annual report 2003-2004.

23. Tarheel Publishing. (2006). Tarheel pages: Rockingham County 2006 phonebook (8th ed.).

24. Stratton, S. (2006). Mental health clinics see changes. Reidsville Review.

25. Help, Incorporated: Center Against Violence Domestic Elder Abuse Program. Statement of purpose.

26. Piedmont Triad Council of Governments. Piedmont Triad Area Agency on Aging: Area providers. Retrieved April 27, 2006, from http://ptcog.org/aging/providers.html.

27. Rockingham County Council on Aging. Informational booklet

28. Debnam, K., Harris, J., Morris, I., Parikh, S., & Shirey, L. (2002). Durham County socially isolated older adults: Durham, NC.

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Appendix A: Interview Materials Appendix A1 Community Member Interview Guide

p.45

Appendix A2 AOCD Interview Fact Sheet and Oral Consent Guide: Community Member

p.48

Appendix A3 Service Provider Interview Guide

p.51

Appendix A4 AOCD Interview Fact Sheet and Oral Consent Guide: Service Provider

p.54

Appendix A5 Focus Group Guide

p.57

Appendix A6 AOCD Focus Group Fact Sheet and Oral Consent Guide

p.58

Appendix A7 Participant Referral Form

p.61

45

Community Member Interview Guide

Introduction: Hello, my name is _______________, and I will be leading our interview today. This is ___________, who will be taking notes and assisting me. We will be here for about an hour to discuss your perspectives on seniors in Rockingham County, and on Rockingham County in general. Before we begin, I’d like to go over our consent procedures with you. (go to consent form) We are interviewing community members in Rockingham County who will all have different points of view about community, and the purpose of our interviews is to gather these different viewpoints. Let’s go over a few things before we get started:

• There are no wrong answers, just different opinions. If you don’t feel comfortable answering a question or don’t have an opinion, just let me know.

• We value your opinions, both positive and negative, and we hope you choose to express them during the discussion.

• We are interested in information you give us about yourself, but would also like to hear your perspective on the community as a whole.

• (Again) Nothing you say will be associated or linked directly back to you. • For clarification, throughout the interview, when we say Rockingham or Rockingham

County, we are referring to the entire county of Rockingham. • Do you have any questions before we begin?

Questions:

1. How long have you lived in Rockingham County?

a. Where in the county do you live? b. Can you please describe what type of home you live in. (apartment, single-family

home, community living situation, etc.) i. Do you live alone or with family?

2. How would you describe life in Rockingham County in general? (How about the community as a whole?) (For example, describe the pace of life; the people)

3. How would you describe the senior community? (What’s your best guess?) a. Composition (ethnicity, gender, widowed or not) (What’s your best guess?) b. At what age do you think a person is considered a “senior?” c. How does religion influence the lives of the senior community? d. How does the economy of Rockingham County affect the senior community? e. Motivation to remain or retire in the community

4. How would you describe the level of either family or friend support within the senior community?

a. Do you think seniors are there for each other? b. Who do you think is affected by a lack of support? (What’s your best guess?)

46

i. How does isolation affect those seniors? c. Why do you think that is?

5. What activities do senior community members participate in? a. What recreational activities are available? b. What volunteer activities are available? c. What attracts you to participate in these activities? d. What are barriers to participation in these activities? e. Can you describe anything that you wish that you could do that you do not do? f. (In case they do not respond – ask about religious activities)

6. What services do members of the senior community use? (What’s your best guess? What have you heard?)

a. Transportation i. What are the sources of transportation utilized by Rockingham County

seniors? ii. What type of transportation do you use?

b. Food i. How do seniors get their food?

ii. Please describe any programs that provide subsidized food, either monetarily or through physical delivery and increased access.

c. Medical care i. What are the most prevalent health concerns of the senior community?

(What have you heard? Think of your friends.) ii. What are the mental health concerns of the community?

1. How does being widowed affect mental health? iii. What are the specific healthcare organizations or facilities utilized by

seniors? iv. Describe how seniors access healthcare.

d. Housing i. What types of housing do the elderly live in? (Do you think that there are

other seniors who live in other types of housing?) ii. Would you say that many seniors have care-givers? (What kind of care-

giver?) iii. How do most seniors pay for their housing?

e. How accessible are these services? f. How affordable are these services?

7. What do you like about life as a member of the senior community in Rockingham County?

8. What challenges are facing the senior community in Rockingham County? a. What divisions, if any, are there is the senior community? b. What can you tell us about any mistreatment of seniors in Rockingham County?

1. Families 2. Scams

c. What improvements would you suggest? 9. Is there anyone else in the community you think would be willing to talk to us? (It can be

someone that you’re friends with or know from one of the activities that you mentioned) a. Would you be willing to contact them on our behalf?

47

b. Why do you think they would be beneficial to talk with? c. Is there anyone whom you would describe as being particularly isolated from the

community that you think we should speak to? 10. Is there anything else that you would like us to know? 11. Would you mind telling us your age? 12. Is it alright if we contact you in the future if we have any further questions or wish to

follow up? a. What is the best way for us to reach you?

Thank you!

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AOCD Interview Fact Sheet and Oral Consent Guide: Community Member WHAT IS THIS PROJECT ABOUT? We are both part of a five person graduate student team from the UNC School of Public Health that is conducting the project as part of our class requirement. The purpose of the project is to better understand the lives of the senior community in Rockingham County. You are being asked to participate because we want to gain your perspective on Rockingham County’s strengths and challenges. This is one of many interviews we will be conducting from January-March, 2007. The findings from these interviews will be shared at a Community Forum to be held here in Rockingham County in April. The results will also be used by the Health Department in their Community Health Assessment. If you have any questions, please contact our graduate student team, toll free at 1-866-610-8273, or by e-mail ([email protected]). You may also contact our instructor, Kate Shirah, by calling, collect if you wish, (919) 966-0057 with questions. WHAT WILL I BE ASKED TO DO? You will be asked a series of questions. There are no wrong answers, just different opinions. We are looking for different points of view, so just say what’s on your mind. If you don’t feel comfortable answering a question or don’t have an opinion, just let us know. We are interested in your perspective as a community member in Rockingham County, so please keep that perspective in mind during the discussion. We estimate that it will take about 45 minutes to 1 hour of your time to complete the interview. Your participation in the interview will be one-time only. During this discussion we are going to record what is said on a piece of paper. If you have no objections, we will also tape record the discussion to make sure we do not miss anything. Only our five group members will listen to the tape. Afterwards, the tape will be erased. You can ask for the recorder to be turned off at any time during the discussion. We ask that you talk in a voice at least as loud as mine.

49

WHAT ARE THE RISKS OF MY PARTICIPATION? You are not likely to experience any risks by participating in this study, as we will be asking you general questions about life in Rockingham County. However, some questions, such as those about problems or needs in your community, may cause you to feel uncomfortable. Therefore, you can skip over any questions which you do not wish to answer. ARE THERE ANY COSTS? There will be no costs for participating, except for time spent in the interview. WHAT ARE THE BENEFITS OF PARTICIPATING? You will not be paid for your participation in this interview. However, your opinions will contribute to a better understanding of life for seniors in Rockingham County. Although you may not experience any direct benefits, your participation may be beneficial to community improvement efforts. Your decision whether or not to participate in this project will not affect any services rendered in the community or your relationship with UNC and any of its affiliations. YOUR RIGHTS AND CONFIDENTIALITY If you agree to participate in this project, please understand that you do not have to do it. You have the right to withdraw your consent or stop your participation at any time without penalty. You have the right to refuse to answer particular questions. You may ask that the recording be stopped at any time. To protect your privacy, your replies will remain confidential. Your name will not be linked in any way with what you have said in this interview. The only people who have access to the data are the community assessment team and faculty advisor. Identifying information such as your age, ethnicity, sex, and number of years residing in or working in Rockingham County may be obtained throughout the interview. This information will only be used for summarizing data and will not be linked to any statements you have made. The audiotapes will be stored in a secure file cabinet at the UNC School of Public Health. The tapes will be erased after data has been summarized (no later than June 1, 2007). Every effort will be taken to protect the identity of the participants in the study. However, there is no guarantee that the information cannot be obtained by legal

50

process or court order. You will not be identified in any report or publication of this study or its results. If you wish to withdraw from the study or have any questions, contact: Rockingham County Student Team UNC School of Public Health Department of Health Behavior and Health Education Campus Box 7440 Chapel Hill, NC 27599-7440 [email protected] Toll free: 1-866-610-8273

AGREEMENT STATEMENTS Do we have your permission to tape record the interview? Do we have your permission to continue with the interview?

51

Service Provider Interview Guide

Introduction: Hello, my name is _______________, and I will be leading our interview today. This is ___________, who will be taking notes and assisting me. We will be here for about an hour to discuss your perspectives on seniors in Rockingham County, and on Rockingham County in general. Before we begin, I’d like to go over our consent procedures with you. (go to consent form) We are interviewing service providers in Rockingham County who will all have different points of view about community, and the purpose of our interviews is to gather these different viewpoints. Let’s go over a few things before we get started:

• There are no wrong answers, just different opinions. If you don’t feel comfortable answering a question or don’t have an opinion, just let me know.

• We value your opinions, both positive and negative, and we hope you choose to express them during the discussion.

• (Again) Nothing you say will be associated or linked directly back to you. • For clarification, throughout the interview, when we say Rockingham or Rockingham

County, we are referring to the entire county of Rockingham. • Do you have any questions before we begin?

Questions:

1. Please describe your role as a service provider within your agency or organization. a. What is your job title? b. How would you describe your duties and responsibilities? c. How long have you been involved with the agency or organization? d. Do you live in Rockingham County? (If not, what county?)

2. Please describe your agency’s mission or purpose in Rockingham County. 3. How would you describe life in Rockingham County in general? Transition: Now that we’ve talked a little bit about the County in general, let’s focus on its senior members. 4. When you think about the senior community, how would you describe its members?

a. Please describe the composition (race/ethnicity, urban/rural, gender, SES). b. At what age do you think a person is considered a “senior?” c. How does religion influence the activity of Rockingham County seniors? d. How does the economy of Rockingham County affect seniors? e. What types of recreational activities are available for seniors in Rockingham

County? f. What do you think motivates seniors to retire/remain in this community? g. How does isolation affect the senior community? h. Who in the senior community stands out as a positive leader or role model?

Transition: Now, getting back to the work at your agency…

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5. How does the work that you do apply specifically to the senior community? a. In what ways do you feel that your agency is successfully connecting with the

senior population? i. What facilitates these connections?

b. In what ways do you feel as though you are not successfully connecting with the senior population?

i. What are the specific barriers to these connections? 6. What other agencies or organizations are you aware of that provide services for seniors?

a. Please describe the quality of those services. b. How would you describe the utilization of those services? (under- or over-

utilized?) c. (Regarding the services that have not yet been discussed)

Please describe these services: i. Transportation

1. What are the sources of transportation utilized by Rockingham County seniors?

2. How accessible are they? 3. How affordable are they?

ii. Food 1. How do seniors get their food? 2. Please describe any programs that provide subsidized food for

seniors or any food delivery programs. iii. Monetary assistance

1. Please describe programs designed to assist seniors monetarily (welfare, Medicare, Social Security).

iv. Medical care 1. What are the most prevalent health concerns of the senior

community? 2. What are the specific healthcare organizations or facilities utilized

by seniors? 3. Describe how seniors access healthcare.

v. Housing 1. What types of housing do seniors live in? 2. How do most seniors pay for their housing?

d. What is the nature of your relationships with these other service providers? e. Are there any community organizations (other than service providers) with which

the senior population is actively involved? Transition: Getting back to the senior community in Rockingham…

7. What are the particular strong points or assets of the senior community in Rockingham? 8. What are the challenges facing the senior community in the county?

a. What would make it easier for seniors to live in Rockingham County? b. Are there any particular divisions within the senior community? (racial/ethnic,

socioeconomic status) 9. How do you feel that life for the senior population in Rockingham County has changed

over the past five to ten years? 10. Is there anyone else in the community with whom you think we should talk?

53

a. Would you be willing to contact them on our behalf? b. Why do you think they would be beneficial for us to contact?

11. Is there anything else that you’d like us to know? 12. Is it alright if we contact you in the future if we have any further questions or wish to

follow up? a. What is the best way for us to reach you?

Thank you!

54

AOCD Interview Fact Sheet and Oral Consent Guide: Service Provider WHAT IS THIS PROJECT ABOUT? We are both part of a five person graduate student team from the UNC School of Public Health that is conducting the project as part of our class requirement. The purpose of the project is to better understand the lives of the senior community in Rockingham County. You are being asked to participate because we want to gain your perspective on Rockingham County’s strengths and challenges. This is one of many interviews we will be conducting from January-March, 2007. The findings from these interviews will be shared at a Community Forum to be held here in Rockingham County in April. The results will also be used by the Health Department in their Community Health Assessment. If you have any questions, please contact our graduate student team, toll free at 1-866-610-8273, or by e-mail ([email protected]). You may also contact our instructor, Kate Shirah, by calling, collect if you wish, (919) 966-0057 with questions. WHAT WILL I BE ASKED TO DO? You will be asked a series of questions. There are no wrong answers, just different opinions. We are looking for different points of view, so just say what’s on your mind. If you don’t feel comfortable answering a question or don’t have an opinion, just let us know. We are interested in your perspective as a service provider in Rockingham County, so please keep that perspective in mind during the discussion. We estimate that it will take about 45 minutes to 1 hour of your time to complete the interview. Your participation in the interview will be one-time only. During this discussion we are going to record what is said on a piece of paper. If you have no objections, we will also tape record the discussion to make sure we do not miss anything. Only our five group members will listen to the tape. Afterwards, the tape will be erased. You can ask for the recorder to be turned off at any time during the discussion. We ask that you talk in a voice at least as loud as mine.

55

WHAT ARE THE RISKS OF MY PARTICIPATION? You are not likely to experience any risks by participating in this study, as we will be asking you general questions about life in Rockingham County. However, some questions, such as those about problems or needs in your community, may cause you to feel uncomfortable. Therefore, you can skip over any questions which you do not wish to answer. ARE THERE ANY COSTS? There will be no costs for participating, except for time spent in the interview. WHAT ARE THE BENEFITS OF PARTICIPATING? You will not be paid for your participation in this interview. However, your opinions will contribute to a better understanding of life for seniors in Rockingham County. Although you may not experience any direct benefits, your participation may be beneficial to community improvement efforts. Your decision whether or not to participate in this project will not affect any services rendered in the community or your relationship with UNC and any of its affiliations. YOUR RIGHTS AND CONFIDENTIALITY If you agree to participate in this project, please understand that you do not have to do it. You have the right to withdraw your consent or stop your participation at any time without penalty. You have the right to refuse to answer particular questions. You may ask that the recording be stopped at any time. To protect your privacy, your replies will remain confidential. Your name will not be linked in any way with what you have said in this interview. The only people who have access to the data are the community assessment team and faculty advisor. Identifying information such as your age, ethnicity, sex, and number of years residing in or working in Rockingham County may be obtained throughout the interview. This information will only be used for summarizing data and will not be linked to any statements you have made. The audiotapes will be stored in a secure file cabinet at the UNC School of Public Health. The tapes will be erased after data has been summarized (no later than June 1, 2007). Every effort will be taken to protect the identity of the participants in the study.

56

However, there is no guarantee that the information cannot be obtained by legal process or court order. You will not be identified in any report or publication of this study or its results. If you wish to withdraw from the study or have any questions, contact: Rockingham County Student Team UNC School of Public Health Department of Health Behavior and Health Education Campus Box 7440 Chapel Hill, NC 27599-7440 [email protected] Toll free: 1-866-610-8273

AGREEMENT STATEMENTS Do we have your permission to tape record the interview? Do we have your permission to continue with the interview?

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Focus Group Guide

Introduction: Hello, my name is _______________, and I will be leading our interview today. This is ___________, who will be taking notes and assisting me. We first would like to offer a big thank you for agreeing to participate in the discussion today. Your perspectives are important to us, and we appreciate you taking the time to join us. We will be here for about an hour to discuss your perspectives on seniors in Rockingham County, and on Rockingham County in general. As a team of five graduate students, we are conducting a project in Rockingham County to better understand the members, community health, and general quality of life of the senior community. The information that we gather will be presented in April at a community meeting in the hopes that it will be used to improve the health and lives of the seniors in the community. Before we begin, I’d like to go over our consent procedures with you. (go to consent form) Do I have your consent to continue with the focus group? (turn on tape and wait for “yes” to be recorded) We’d like to remind you a few things before we get started:

• We are interested in information you give us about yourself, but would also like to hear your perspective on the community as a whole.

• For clarification, throughout the interview, when we say Rockingham or Rockingham County, we are referring to the entire county of Rockingham.

• Do you have any questions before we begin? Turn off tape.

1. Let’s first go around and introduce ourselves and say how long you have lived in Rockingham County.

2. How would you describe Rockingham County in general?

3. How would you describe the senior community?

4. What do you think are the major health issues facing the senior community in the county?

5. What do you like about life as a member of the senior community?

6. What challenges are facing the senior community?

7. Is there anything else that anyone feels we should know?

As we wrap up, I’d just like to you remind you one more time that everyone’s answers are confidential, so we would appreciate it if you would not discuss what has been shared with others outside of the focus group. Our contact information is on the consent sheets we provided you with if you with if you think of something else you feel we should know. And finally, sincere thanks for your participation- we really appreciate everything you have shared with us today.

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AOCD Focus Group Fact Sheet and Oral Consent Guide WHAT IS THIS PROJECT ABOUT? We are both part of a five-person graduate student team from the UNC School of Public Health that is conducting the project as part of our class requirement. The purpose of the project is to better understand the lives of the senior community in Rockingham County. You are being asked to participate because we want to gain your perspective on Rockingham County’s strengths and challenges. This is one of many interviews or focus group discussions we will be conducting from January-March, 2007. The findings from these interviews and focus group discussions will be shared at a Community Forum to be held here in Rockingham County in April. The results will also be used by the Health Department in their Community Health Assessment. If you have any questions, please contact our graduate student team, toll free at 1-866-610-8273, or by e-mail ([email protected]). You may also contact our instructor, Kate Shirah, by calling, collect if you wish, (919) 966-0057 with questions. WHAT WILL I BE ASKED TO DO? You will be asked a series of questions. There are no wrong answers, just different opinions. We are looking for different points of view, so just say what’s on your mind. If you don’t feel comfortable answering a question or don’t have an opinion, just let us know. We are interested in your perspective as a community member in Rockingham County, so please keep that perspective in mind during the discussion. We estimate that this focus group discussion will take about 1 hour of your time. Your participation in the focus group discussion will be one-time only. During this discussion we are going to record what is said on a piece of paper. If you have no objections, we will also tape record the discussion to make sure we do not miss anything. Only our five group members will listen to the tape. Afterwards, the tape will be erased. We ask that you talk in a voice at least as loud as mine.

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WHAT ARE THE RISKS OF MY PARTICIPATION? You are not likely to experience any risks by participating in this project, as we will be asking you general questions about life in Rockingham County. However, some questions, such as those about problems or needs in your community, may cause you to feel uncomfortable. Therefore, you can skip over any questions which you do not wish to answer. ARE THERE ANY COSTS? There will be no costs for participating, except for time spent in the interview. WHAT ARE THE BENEFITS OF PARTICIPATING? You will not be paid for your participation in this focus group. However, your opinions will contribute to a better understanding of life for seniors in Rockingham County. Although you may not experience any direct benefits, your participation may be beneficial to community improvement efforts. Your decision whether or not to participate in this project will not affect any services rendered in the community or your relationship with UNC and any of its affiliations. YOUR RIGHTS AND CONFIDENTIALITY If you agree to participate in this project, please understand that you do not have to do it. You have the right to withdraw your consent or stop your participation at any time without penalty. You have the right to refuse to answer particular questions. You may ask that the recording be stopped at any time. To protect your privacy, your replies will remain confidential. Your name will not be linked in any way with what you have said in this focus group. The only people who have access to the data are the community assessment team and faculty advisor. We also ask that you do not share what has been said during the focus group with others. Identifying information such as your age, ethnicity, sex, and number of years residing in or working in Rockingham County may be obtained throughout the interview. This information will only be used for summarizing data and will not be linked to any statements you have made. The audiotapes will be stored in a secure file cabinet at the UNC School of Public Health. The tapes will be erased after data has been summarized (no later than June 1, 2007). Every effort will be taken to protect the identity of the participants in the project.

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However, there is no guarantee that the information cannot be obtained by legal process or court order. You will not be identified in any report or publication of this study or its results. If you wish to withdraw from the project or have any questions, contact: Rockingham County Student Team UNC School of Public Health Department of Health Behavior and Health Education Campus Box 7440 Chapel Hill, NC 27599-7440 [email protected] Toll free: 1-866-610-8273

AGREEMENT STATEMENTS Do we have your permission to tape record the focus group? Do we have your permission to continue with the focus group?

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Participant Referral Form Thank you for being a part of our Action-Oriented Community Diagnosis project with the senior community of Rockingham County! The information you have given us will help us write a report about the strengths and weaknesses of the senior community of Rockingham County. We hope that the report will help Rockingham County use its great strengths to improve weaknesses and make the community a better place for seniors to live. It might be helpful for us to talk with more people in the community just as we have talked with you. If you would like to suggest the names of people that we should talk to, here is how you can help us contact them: 1. Please contact the person or persons with whom you think we should talk. Tell them why we want to talk with them. Please tell them: A team of five graduate students from the UNC School of Public Health are conducting a project to better understand the Rockingham County senior community and its members, community health, and general quality of life. They would be interested in contacting you to participate in an interview for their project and would be interested to learn from your knowledge of the senior community. They will report the information that people give them at a community meeting and hope that it will be used to improve the health and lives of the seniors in the community. After you talk with them, they will not use your name or connect you with the information included in the report. Additionally, if you agree to be contacted by the team, you will be given more information about the project and will have the opportunity to decide whether or not you wish to participate. I will not know whether or not you decide to participate. May I have your permission to give your name and contact information to them, and if so, what is the best way for them to get in touch with you? 2. We will call you or visit you to see if this person or persons would like to talk with us. 3. If so, we will get those people’s names, phone numbers, or addresses from you. Then we will talk to those people ourselves, give them some information about the project, and arrange a time to meet. If you would like to ever call us, please feel free to call our toll free phone number at school and leave us a message. The number is 1-866-610-8273. Thank You!

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Appendix B: Primary Data Summary Appendix B1 Interview Summary Grid

p.63

Appendix B2 Summary of Events Attended in the Community

p.64

63

Interview Summary Grid Interview Date Gender Race SP CM 1/29/07 F African-American X 1/29/07 M White X 2/2/07 F White X 2/2/07 F White X 2/2/07 F African-American X 2/2/07 M African-American X 2/2/07 F White X 2/2/07 F White X 2/9/07 F White X 2/9/07 F White X 2/15/07 F White X 2/15/07 F White X 2/16/07 F White X 2/16/07 F White X 2/16/07 M White X 2/21/07 F White X 2/21/07 F White X 2/21/07 M White X 2/22/07 M White X 2/22/07 M White X 3/2/07 F White X 3/2/07 F African-American X 3/2/07 M African-American X 3/2/07 F White X 3/2/07 F White X 3/22/07 M African-American X Focus Group 1 2/23/07 1 F White X 2 F White X 3 F White X 4 F White X 5 F White X 6 F White X 7 F White X Focus Group 2 3/7/07 1 F White X 2 F White X 3 F White X 4 F African-American X 5 M White X Totals 9 Males 7 African-American 16 SP 22 CM 29 Females 31 White

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Summary of Events Attended in the Community

Date Event Number of team members who attended

9/29/06 Healthy Carolinians 2008 Community Health Assessment Planning Meeting

5

10/16/06 Windshield Tour of Rockingham County

5

10/21/06 Hispanic Health Fair 3 10/21/06 Eden Apple Festival 3 11/11/06 Christmas Craft Fair 2 11/11/06 Moose Pottery Show 2 1/25/07 Senior Day 1 2/7/07 Service Providers Meeting 1 2/14/07 Rockingham County Planning

Committee Meeting for Services to the Elderly

3

4/4/07 Service Providers Meeting 2

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Appendix C: Secondary Data Sources Appendix C1 Maps of Rockingham County

p.66

Appendix C2 Federal, State, and Local Resources

p.67

Appendix C3 Demographics

p.71

Appendix C4 Physical Environment

p.72

Appendix C5 Health Status

p.73

Appendix C6 Community History

p.74

Appendix C7 Services

p.76

Appendix C8 Social Determinants

p.77

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Maps of Rockingham County

Map of North Carolina with Rockingham County circled, from http://www.learnnc.org/media/lessons/cpoovey4212004744/North_Carolina_Counties_blank.jpg

Map of Rockingham County from http://www.ncnorthstar.com/pdfs/county_map.pdf

http://www.learnnc.org/media/lessons/cpoovey4212004744/North_Carolina_Counties_blank.jpg

http://www.ncnorthstar.com/pdfs/county_map.pdf

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Federal, State, and Local Resources

County government website: http://www.co.rockingham.nc.us/ General county information, including local government, development services, property related services, county commissioners, environmental services, public safety, recreational/historic, education, and human services

-Human services directory, including elder services http://www.co.rockingham.nc.us/hsdirect/index.htm

• Rockingham County Board of Commissioners’ Meeting Minutes. http://www.co.rockingham.nc.us/minutes/121205.htm • Rockingham County 2006 phone book:

o Adult homes Cornerstone Assisted Living Daphne’s Adult Care Homes (Also does geriatric consulting and services)

o Adult day care Rockingham Friendship Center

o Arts Organizations and Information Rockingham county Arts council

o Assisted living Bayberry Retirement Inn Carolina House of Reidsville Diversicare Assisted Living of Reidsville Eden Estates Eden Ridge Independent Living North Pointe of Mayodan Pine Forrest Rest Home Self Enhancement Care Services

o Barbers/Beauty Salons o Cemeteries o Churches

General Apostolic Assemblies of God Baptist ….all the way to Wesleyan

o Fire Departments o Fraternal organizations

Masons Moose

o Funeral homes o Golf courses, public and private o Grocers o Hearing analysis, aids, and rehabilitation o Historical places

http://www.co.rockingham.nc.us/

http://www.co.rockingham.nc.us/hsdirect/index.htm

http://www.co.rockingham.nc.us/minutes/121205.htm

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Chinqua-Penn Plantation The Virginia Dare Community Center

o Home health service Advanced Home Care Bayada Nurses Caregivers of Rockingham County Council on Aging Davita Dialysis Hearthside Homecare

o Hospice of Rockingham County o Hospitals o Hunting and Fishing preserves o Health insurance o Labor organizations

Bakery Confectionery and Tobacco Worker’s International Union Teamsters Local 391 Unite

o Long term care insurance o Mental Health Services o Nursing Homes

Avante at Reidsville Brain Center Health and Rehabilitation/Eden Britthaven of Madison Carolina House of Reidsville Cornerstone Assisted Living Countryside Manor Daphne’s Adult Care Homes Morehead Nursing Center Penn Nursing Center

o Occupational Therapists o Organizations

American Legion Post 254 Best Friends of Rockingham County Boys & Girls Club of Eden, Inc Chamber of Commerce Dan River Lodge 129 Eden Chamber of Commerce Eden Moose Lodge 626 Masonic Temple 419 Salvation Army Thrift Store Western Rockingham Chamber of Commerce YMCA

o Parks Dehart Ball Park Farris Memorial Park Stoneville Park

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Town of Mayodan o Pharmacies o Physical Therapists o Physicians o Professional Organizations

Rockingham Habitat for Humanity o Recreation centers

Eden: Boone Road Community Bldg Eden: Draper Recreation Center Madison-Mayodan Recreation Department

o Rehabilitation Services o Religious Organizations o Rest homes o Rubbish removal o Schools o Senior citizen planning service: Senior Center Nutrition Site o Social service organizations

American Red Cross Cooperative Christian Ministries Family Life Center Goodwill Industries Pathways A Connection Reidsville Soup Kitchen Rockingham County Help for the Homeless and Thrift Rouse’s ICF/MR Group Home Salvation Army Worship Center

o Textile manufacturers and mills o Tobacco products and warehouses o Wheelchairs

• Rockingham County Visitor’s Bureau

o http://www.ncnorthstar.com/home.html o Tourism and Economic Development sections, including case studies o Maps of the county o Also discusses accommodations, lakes, and community heritage o Hard copy brochures we have collected include the visitor’s guide, rivers, and

specialty shopping guide • LINC- North Carolina Census Data Information, including household composition, racial data

o http://data.osbm.state.nc.us/pls/census/dyn_census_rframe.show?p_arg_names=reportid&p_arg_values=profiles&p_arg_names=varid&p_arg_values=2&p_arg_names=geoid&p_arg_values=157

• Eden Daily News: http://www.edendailynews.com/ • Madison: The Messenger: http://www.madison-messenger.com/

http://www.ncnorthstar.com/home.html

http://data.osbm.state.nc.us/pls/census/dyn_census_rframe.show?p_arg_names=reportid&p_arg_values=profiles&p_arg_names=varid&p_arg_values=2&p_arg_names=geoid&p_arg_values=157



http://www.edendailynews.com/

http://www.madison-messenger.com/

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• Reidsville: The Reidsville Review: http://www.reidsvillereview.com/ • The Neely Chronicles. Local community rag newspaper. • Rockingham County Connections. Newsletter for and about county employees

http://www.reidsvillereview.com/

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Demographics General Statistics and Demographic Information • County Demographics: http://www.answers.com/topic/rockingham-county-north-carolina • State Demographics Site: Choose county/state estimates on the left, then growth map under the certified 2005, then click on Rockingham in the map, a nice grid called 2005 Certified County Population Estimates comes up with some nice information on it (county growth information, deaths, etc.) http://demog.state.nc.us/ • Older adults in Rockingham: http://ptcog.org/rockinghamdemographics.htm Sociodemographics • NC State Data Center. Occupation of employed civilians 16 years old and over by sex, race, and Hispanic/Latino origin, census 2000. Retrieved December 1, 2006, from http://data.osbm.state.nc.us.libproxy.lib.unc.edu/occupation/157.xls • NC State Data Center. Workers who commute into a North Carolina county, 2000. Retrieved December 1, 2006, from http://data.osbm.state.nc.us.libproxy.lib.unc.edu/commute/commute_00_157.pdf • U.S. Census Bureau. Reference maps. Retrieved December 1, 2006, from http://factfinder.census.gov.libproxy.lib.unc.edu/servlet/ReferenceMapFramesetServlet?_bm=y&-context=rm&-PANEL_ID=rm_result&-ds_name=null&-rm_config=|b=50|l=en|t=420|zf=0.0|ms=ref_sd_00dec|dw=0.23535873215161068|dh=0.13167123587626114|dt=gov.census.aff.domain.map.EnglishMapExt • U.S. Census Bureau. Rockingham County, North Carolina: Fact sheet. Retrieved December 1, 2006, from http://factfinder.census.gov.libproxy.lib.unc.edu/servlet/ACSSAFFFacts?_event=Search&geo_id=04000US37&_geoContext=01000US%7C04000US37&_street=&_county=Rockingham+County&_cityTown=Rockingham+County&_state=04000US37&_zip=&_lang=en&_sse=on&ActiveGeoDiv=geoSel • U.S. Census Bureau. State & county QuickFacts. Retrieved December 1, 2006, from http://quickfacts.census.gov.libproxy.lib.unc.edu/qfd/states/37/37157.html • U.S. Census Bureau. Age and age distribution data. Retrieved December 1, 2006 from http://factfinder.census.gov/servlet/SAFFPeople?_event=&geo_id=05000US37157&_geoContext=01000US%7C04000US37%7C05000US37157&_street=&_county=Rockingham+County&_cityTown=Rockingham+County&_state=04000US37&_zip=&_lang=en&_sse=on&ActiveGeoDiv=geoSelect&_useEV=&pctxt=fph&pgsl=050&_submenuId=people_3&ds_name=null&_ci_nbr=null&qr_name=null&reg=null%3Anull&_keyword=&_industry=

http://www.answers.com/topic/rockingham-county-north-carolina

http://demog.state.nc.us/

http://data.osbm.state.nc.us.libproxy.lib.unc.edu/occupation/157.xls

http://data.osbm.state.nc.us.libproxy.lib.unc.edu/commute/commute_00_157.pdf

http://factfinder.census.gov.libproxy.lib.unc.edu/servlet/ReferenceMapFramesetServlet?_bm=y&-context=rm&-PANEL_ID=rm_result&-ds_name=null&-rm_config=%7Cb=50%7Cl=en%7Ct=420%7Czf=0.0%7Cms=ref_sd_00dec%7Cdw=0.23535873215161068%7Cdh=0.13167123587626114%7Cdt=gov.census.aff.domain.map.EnglishMapExt




http://factfinder.census.gov.libproxy.lib.unc.edu/servlet/ACSSAFFFacts?_event=Search&geo_id=04000US37&_geoContext=01000US%7C04000US37&_street=&_county=Rockingham+County&_cityTown=Rockingham+County&_state=04000US37&_zip=&_lang=en&_sse=on&ActiveGeoDiv=geoSel




http://quickfacts.census.gov.libproxy.lib.unc.edu/qfd/states/37/37157.html

https://webmail3.isis.unc.edu/mail/services/go.php?url=http%3A%2F%2Ffactfinder.census.gov%2Fservlet%2FSAFFPeople%3F_event%3D%26geo_id%3D05000US37157%26_geoContext%3D01000US%7C04000US37%7C05000US37157%26_street%3D%26_county%3DRockingham%2BCounty%26_cityTown%3DRockingham%2BCounty%26_state%3D04000US37%26_zip%3D%26_lang%3Den%26_sse%3Don%26ActiveGeoDiv%3DgeoSelect%26_useEV%3D%26pctxt%3Dfph%26pgsl%3D050%26_submenuId%3Dpeople_3%26ds_name%3Dnull%26_ci_nbr%3Dnull%26qr_name%3Dnull%26reg%3Dnull%3Anull%26_keyword





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Physical Environment

• 1997 Survey of GIS Data Availability for NC Counties http://www.cgia.state.nc.us/cosurvey97/index.html • North Carolina Geographic Information Coordinating Council http://www.cgia.state.nc.us/gicc/index.html • North Carolina Center for Geographic Information and Analysis http://www.cgia.state.nc.us/cgia/ • Information about the National Water Information System (it's a real-time graph!) http://waterdata.usgs.gov/nwis/uv?02071000

http://www.cgia.state.nc.us/cosurvey97/index.html

http://www.cgia.state.nc.us/gicc/index.html

http://www.cgia.state.nc.us/cgia/

http://waterdata.usgs.gov/nwis/uv?02071000

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Health Status

• Healthy Carolinians. (2005). Rockingham County Healthy Carolinians. Retrieved December 1, 2006, from http://www.healthycarolinians.org/counties/rockingham_county.htm • NC Cooperative Extension. (2006). Health & nutrition. Retrieved December 1, 2006, from http://rockingham.ces.ncsu.edu.libproxy.lib.unc.edu/index.php?page=healthnutrition • NC Health Info. Health services - web sites searching rockingham county. Retrieved December 1, 2006, from http://www.nchealthinfo.org.libproxy.lib.unc.edu/resources.cfm?info=0,0,79,0,0 • NC State Center for Health Statistics. (2005). Detailed mortality statistics. Retrieved December 1, 2006, from http://www.schs.state.nc.us.libproxy.lib.unc.edu/SCHS/deaths/dms/2005/rockingham.pdf • NC State Center for Health Statistics. NC statewide and county trends in key health indicators: Rockingham county. Retrieved December 1, 2006, from http://www.schs.state.nc.us.libproxy.lib.unc.edu/SCHS/data/trends/pdf/Rockingham.pdf • Rockingham County Department of Public Health. Board of health. Retrieved December 1, 2006, from http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/Publichealth/index.htm • Rockingham County Department of Public Health. Pharmacy. Retrieved December 1, 2006, from http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/Publichealth/phclin.htm#Prescription%20Assistance%20Program%20(PAP) • Rockingham County Department of Public Health, & Rockingham County Healthy Carolinians. Community health assessment 2004. Retrieved December 1, 2006, from http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/Publichealth/cha.htm • Rockingham County Department of Social Services. (2004). Annual report 2003-2004. Retrieved December 1, 2006, from http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/SocialServ/report.htm • Rockingham County Healthy Carolinians. (2005). Rockingham county: 2005 state of the county health report. North Carolina: Rockingham County Healthy Carolinians. From http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/Publichealth/2005%20SOTCH%20(1).pdf • 2008 Community Health Assessment Planning/Training Meeting. Information packet including powerpoint presentation, focus group moderator guide, community assessment survey, community health action plan

http://www.healthycarolinians.org/counties/rockingham_county.htm

http://rockingham.ces.ncsu.edu.libproxy.lib.unc.edu/index.php?page=healthnutrition

http://www.nchealthinfo.org.libproxy.lib.unc.edu/resources.cfm?info=0,0,79,0,0

http://www.schs.state.nc.us.libproxy.lib.unc.edu/SCHS/deaths/dms/2005/rockingham.pdf

http://www.schs.state.nc.us.libproxy.lib.unc.edu/SCHS/data/trends/pdf/Rockingham.pdf

http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/Publichealth/index.htm

http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/Publichealth/phclin.htm#Prescription%20Assistance%20Program%20(

http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/Publichealth/phclin.htm#Prescription%20Assistance%20Program%20(

http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/Publichealth/cha.htm

http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/SocialServ/report.htm

http://www.co.rockingham.nc.us.libproxy.lib.unc.edu/Publichealth/2005%20SOTCH%20(1).pdf

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Community History

• City of Eden. (2006). Calendar of events. Retrieved 11/30/2006, from http://www.egovlink.com/eden/events/calendar.asp Community events in the city of Eden – includes recreation activities and official government meetings • City of Eden. (a). Eden city history. Retrieved 11/30/2006, from http://www.ci.eden.nc.us/coe-history.html The history of Eden – includes founding and economic history • City of Eden. (b). Eden city's freedom park. Retrieved 11/30/2006, from http://www.ci.eden.nc.us/coe-freedom-park.html Recreation space in Eden • City of Reidsville. (2006). Calendar of events. Retrieved 11/30/2006, from http://reidsvillenc.accountsupport.com/CalendarofEvents.htm Community events in the city of Reidsville – includes recreation activities and official government meetings • City of Reidsville. (a). Community history. Retrieved 11/30/2006, from http://reidsvillenc.accountsupport.com/history.htm The history of Reidsville – includes founding, incorporation, and notable figures • City of Reidsville. (b). Parks and recreation. Retrieved 11/30/2006, from http://reidsvillenc.accountsupport.com/parksrec.htm Recreation activities available in Reidsville – includes information on the senior center, outdoor activities, sports leagues, community pool, and fitness center • City of Reidsville. (c). The Penn house: History. Retrieved 11/30/2006, from http://reidsvillenc.accountsupport.com/Pennhouse_history.htm A brief history of the Penn House, a local landmark built in the early 1900s with tobacco money • City of Reidsville. (d). Reidsville senior center. Retrieved 11/30/2006, from http://reidsvillenc.accountsupport.com/seniorcenter.htm Webpage for the Reidsville Senior Center – includes information on services, classes, and leisure activities • City of Reidsville. (e). Visit downtown Reidsville! Retrieved 11/30/2006, from http://reidsvillenc.accountsupport.com/downtown.htm Stores, events, and promotions in downtown Reidsville • National Weather Service. March 20, 1998 severe weather and tornado outbreak. Retrieved 11/30/2006, from http://www4.ncsu.edu/~nwsfo/storage/cases/19980320/ Information on the tornado that hit Stoneville in 1998, causing severe damage to the town - includes damage information and photos • Reidsville Chamber of Commerce. (a). The city of Reidsville. Retrieved 11/30/2006, from http://www.reidsvillechamber.org/city.php General Reidsville information from the business community’s point of view

http://www.egovlink.com/eden/events/calendar.asp

http://www.ci.eden.nc.us/coe-history.html

http://www.ci.eden.nc.us/coe-history.html

http://www.ci.eden.nc.us/coe-freedom-park.html

http://reidsvillenc.accountsupport.com/CalendarofEvents.htm

http://reidsvillenc.accountsupport.com/history.htm

http://reidsvillenc.accountsupport.com/parksrec.htm

http://reidsvillenc.accountsupport.com/Pennhouse_history.htm

http://reidsvillenc.accountsupport.com/seniorcenter.htm

http://reidsvillenc.accountsupport.com/downtown.htm

http://www4.ncsu.edu/~nwsfo/storage/cases/19980320/

http://www.reidsvillechamber.org/city.php

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• Reidsville Chamber of Commerce. (b). The history of Reidsville. Retrieved 11/30/2006 from http://www.reidsvillechamber.org/history.php Reidsville history – including founding and major events • Reidsville Chamber of Commerce. (c). A variety of recreation. Retrieved 11/30/2006, from http://www.reidsvillechamber.org/recreation.php Recreation activities offered in Reidsville – including golfing, outdoor activities, antique shops, and the YMCA • Rockingham County Historical Society. Rockingham county historical society home page. Retrieved 11/30/2006, from http://www.rockinghamcountyhistory.com/id18.htm Comprehensive historical information on Rockingham County as a whole • Town of Stoneville. (1999a). History. Retrieved 11/30/2006, from http://www.town.stoneville.nc.us/history.asp Stoneville history – includes information on history through the late 19th century • Town of Stoneville. (1999b). The tornado. Retrieved 11/30/2006, from http://www.town.stoneville.nc.us/Tornado.asp Information on the tornado that hit Stoneville in 1998, causing severe damage to the town includes damage information and photos • Town of Stoneville. (a). Historical images. Retrieved 11/30/2006, from http://www.town.stoneville.nc.us/LocalSearch.asp?SearchString=history Selection of historical images from Stoneville • Town of Stoneville. (b). Virtual tour. Retrieved 11/30/2006, from http://www.town.stoneville.nc.us/tour.asp Visual image tour of Stoneville, but doesn’t contain much textual information • Welcome to Leaksville, North Carolina. Retrieved 11/30/2006, from http://www.leaksville.com/ Town that merged with three other government areas to form what is now Eden

http://www.reidsvillechamber.org/history.php

http://www.reidsvillechamber.org/recreation.php

http://www.rockinghamcountyhistory.com/id18.htm

http://www.town.stoneville.nc.us/history.asp

http://www.town.stoneville.nc.us/Tornado.asp

http://www.town.stoneville.nc.us/LocalSearch.asp?SearchString=history

http://www.town.stoneville.nc.us/tour.asp

http://www.leaksville.com/

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Services

• North Carolina Community Health Care Association, Community health clinic in Reidsville (Rockingham Medical Services Associates) • Baptist Health Care Fellowship of North Carolina (brochure) • Human Services Directory, 2005. Compiled by the Public Information Office of Rockingham County. http://www.co.rockingham.nc.us/hsdir05.pdf Comprehensive book of information on all services provided in Rockingham County. • Piedmont Triad Council of Governments • Piedmont Triad Area Agency on Aging: Area Providers http://www.ptcog.org/aging/providers.html • Piedmont Triad Area Agency on Aging: Resources http://www.ptcog.org/aging/resources.html • Rockingham County senior service agencies and contact information http://www.ptcog.org/files/rockprov.htm • Rockingham County Council on Aging (booklet).

Twelve page booklet describing Council on Aging services such as adult day care, transportation, and meals on wheels, as well as complete information on how to access the services.

• Rockingham County Council on Aging: Prescription Assistance Program (brochure). Brochure explaining the prescription assistance program benefits, eligibility, and how to sign up. • Rockingham County Department of Public Health http://www.co.rockingham.nc.us/Publichealth/index.htm • Rockingham County Emergency Services (brochure). Brochure detailing emergency management, 911 services, and EMS services in Rockingham County. Also contains contact names and phone numbers. • Rockingham County Governmental Center; Department of Social Services. http://www.co.rockingham.nc.us/SocialServ/index.htm • Rockingham County Veterans Services http://www.co.rockingham.nc.us:80/VA/ • Services of the Rockingham County Public Health Department (brochure).

http://www.ptcog.org/aging/providers.html

http://www.ptcog.org/aging/resources.html

http://www.ptcog.org/files/rockprov.htm

http://www.co.rockingham.nc.us/Publichealth/index.htm

http://www.co.rockingham.nc.us/SocialServ/index.htm

http://www.co.rockingham.nc.us/VA/

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Social Determinants

Economics • Eden Wal-Mart Supercenter Celebrates Grand Opening. Store’s impact seen in 242 new jobs, benefits, and $22,500 in charitable donations. http://www.walmartfacts.com/articles/2075.aspx • Living Wage; Rockingham County. http://www.livingwage.geog.psu.edu/results.php?location=1780 Contains information about typical expenses and typical earnings in Rockingham County . • North Carolina Department of Commerce. Economic Development Information System. Rockingham County Profile, 4th Quarter, 2005. http://cmedis.commerce.state.nc.us/countyprofiles/files/pdf/Rockingham_200 .pdf • Prosperity 2010 http://www.ncnorthstar.com/2010/prosperity.asp • Rockingham County Economic Development http://www.ncnorthstar.com/economics/economic.html

Transportation • PART (Piedmont Authority for Regional Transportation) http://www.partnc.org/ • RCCOA (Rockingham County Council on Aging) http://www.co.rockingham.nc.us/hsdirect/alphalist.htm#COUNCIL%20ON%20AGING

http://www.walmartfacts.com/articles/2075.aspx

http://www.livingwage.geog.psu.edu/results.php?location=1780

http://cmedis.commerce.state.nc.us/countyprofiles/files/pdf/Rockingham_200%09.pdf

http://www.ncnorthstar.com/2010/prosperity.asp

http://www.ncnorthstar.com/economics/economic.html

http://www.partnc.org/

http://www.co.rockingham.nc.us/hsdirect/alphalist.htm#COUNCIL%20ON%20AGING

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Appendix D: Community Forum Materials Appendix D1 Community Forum Flyer: Sun

p.79

Appendix D2 Community Forum Flyer: Tree

p.80

Appendix D3 Community Forum Invitation

p.81

Appendix D4 Senior Community Forum Agenda

p.82

Appendix D4 Community Forum Program

p.83

Appendix D5 Forum Welcome Banner

p.92

Appendix D6 Forum Poster

p.93

Appendix D7 Forum Poster: Strengths

p.94

Appendix D8 Forum PowerPoint Presentation

p.95

Appendix D9 Discussion Guide for Small Group Facilitators

p.105

Appendix D10 Force Field Analysis: Awareness of Services

p.107

Appendix D11 Force Field Analysis: Alzheimer’s and Dementia

p.108

Appendix D12 Force Field Analysis: Transportation

p.109

Appendix D13 Force Field Analysis: Insurance Gap

p.111

Appendix D14 Force Field Analysis: Streamlining Services

p.113

Appendix D15 Vendors and Agencies with Booths at the Forum Health Fair

p.115

Appendix D16 Community Forum Evaluation

p.116

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Come to a lunch-time discussion at

the…

Friday April 20, 12:00pm - 2:30pm

Cooperative Extension at the Agricultural Center (Hwy 65, close to Rockingham Community College and the Rockingham County Health Dept.)

• Free food • Entertainment • Speakers • Door prizes • Booths from local service providers

Please RSVP to 1-866-610-8273 or [email protected]

Co-sponsored by: The Rockingham County Health Department The UNC Chapel Hill School of Public Health *Wheelchair accessible*

Want to celebrate the senior community in Rockingham County? Want to learn about the findings of the senior community health assessment?

mailto:[email protected]

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Friday April 20, 12:00pm - 2:30pm Cooperative Extension at the Agricultural Center

(Hwy 65, close to the RCCC and the Rockingham County Health Dept.)

• Free food • Entertainment • Speakers • Door prizes • Booths from local service providers

Please RSVP to 1-866-610-8273 or [email protected]

Co-sponsored by: The Rockingham County Health Department The UNC Chapel Hill School of Public Health *Wheelchair accessible*

Come to a lunch-time discussion at the…

Want to celebrate the senior community in Rockingham County? Want to find out how to make the Rockingham County senior

community even stronger?

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Community Forum Invitation

You are cordially invited to attend…

The Rockingham County Senior Community Forum

April 20, 2007, 12-2:30pm Cooperative Extension at the Agricultural Center

525 Hwy 65, Reidsville

Come find out the results of the senior community health assessment and help be a part of creating solutions

for issues facing seniors!

The forum is an opportunity for service providers and community members to discuss strengths and challenges facing the senior community in Rockingham County.

Please RSVP by April 13 to 1-866-610-8273, ext. 4, or [email protected] Food & drinks will be provided

Hosted by the UNC School of Public Health and the Rockingham County Health Department

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Senior Community Forum Agenda April 20, 2007

11:30 – 12:00 Check-In

12:00 – 12:10 Welcome from Student Team

12:10 – 12:15 Opening Speech

12:15 – 12:30 Presentation of Strengths and Themes

12:30 – 1:00 Lunch and Entertainment

1:00 – 1:05 Explanation of Small Groups

1:05 – 1:50 Small Group Sessions

1:50 – 2:15 Small Group Presentations of Action Steps

2:15 – 2:20 Closing Speech

2:20 – 2:30 Student Team Closing and Raffle

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Community Forum Program

92

Forum Welcome Banner

93

Forum Poster

94

Forum Poster: Strengths

95

Forum PowerPoint Presentation

Welcome!


Who We AreWe are a team of 5 graduate students from the UNC Chapel Hill School of Public Health

Collaborating with:• The Rockingham County Department of

Public Health• Rockingham County Healthy Carolinians

Purpose of the ProjectTo conduct a health assessment of seniors living in Rockingham County

To understand the strengths and challenges of the senior community in Rockingham County

The results will be part of the 2008 Rockingham County Community Health Assessment

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Our Process September 2006 - May 2007

Getting to know the community• Secondary data collection• Windshield tour of the county• Attending events and meetings

Gathering primary information• 38 interviews, including 2 focus groups

– 22 (58%) community members– 16 (42%) service providers– 18% African American, 82% Caucasian– 24% male, 76% female

Our Process continued

Generating themes• How many times was something

mentioned?

Bringing together the Forum Planning Committee• Selection of final themes• Planning today’s event



Purpose:• Discuss findings of our work• Generate ideas for action • Create and reinforce relationships

between service providers and community members

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What will happen after the forum?Reporting our findings back to the community

• Final report• Brochure• Part of the countywide health assessment

Leaving the community• Handing off our work• Today is your opportunity to participate!

Today’s Schedule11:30 – 12:00 Check-In12:00 – 12:10 Welcome from Student Team12:10 – 12:15 Opening Speech12:15 – 12:30 Strengths and Themes12:30 – 1:00 Lunch and Entertainment1:00 – 1:05 Explanation of Small Groups1:05 – 1:50 Small Group Sessions1:50 – 2:15 Presentations of Action Steps2:15 – 2:20 Closing Speech2:20 – 2:30 Student Team Closing and Raffle

Opening Speaker

Amanda MooreExecutive Director

Arbor Ridge at Eden

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The ThemesBoth strengths and challenges emerged from the information we collectedChallenges were turned into 10 statementsThe Forum Planning Committee voted on the top 5 challenge themesThemes were chosen based on:

– How important is this?– How changeable is this?

Statements were revised or reworded as needed

Strengths of the communityFamily and senior relationships emerged as strong positive elements. Many people reported that they look to each other for support and social interaction and strongly value the relationships they have with family members who remain in the area.

Religion plays an important part in the lives of Rockingham’s seniors, and many seniors participate in church activities.

Strengths of the communityWe’ve often heard Rockingham County referred to as a caring community, including service providers who are very concerned about the well-being of their clients, and community members who look out for each other by checking in and offering a lending hand when needed. Additionally, we have heard seniors described as generous and hardworking.

A lot of activities are offered in Rockingham for seniors. There are opportunities for physical activity groups, artistic groups, and many others. Many seniors reported that they enjoy volunteering and giving back to the community.

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Theme 1Alzheimer’s and Dementia

Although the county offers somemental health services, adequate caredoes not exist for the growing concernssurrounding Alzheimer’s and dementiaamong seniors and support for theirfamilies.

Theme 2 TransportationGiven Rockingham County’s spreadout geographic layout and the shortageof consistent, low cost transportation,seniors have difficulty usingtransportation to access services andactivities.

Theme 3Service Awareness

Seniors are often unaware of theservices and events that are availableto them throughout the county.

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Theme 4Insurance Gap

Due to age and income restrictions forcurrent health insurance options,seniors may fall into a gap where theydo not have sufficient health insuranceto cover medical costs.

Theme 5Streamlining Services

While many service providers worktogether efficiently and productively,communication and service delivery isnot always streamlined.

Additional ThemesCardiovascular disease is a commonly mentioned physical health problem facing seniors in Rockingham County.

Following years of work in local businesses, seniors face significant financial challengesin their retirement and may be forced to make difficult financial decisions.

The spread out geographic layout of the county presents a challenge to seniors as they try to access services and activities.

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Additional ThemesAs a result of a limited number of providersin the county, seniors may have difficulty finding doctors who accept Medicare, Medicaid, or those without supplemental insurance.

While Rockingham County has many activities for seniors, for a variety of physical, social, or economic reasons, seniors may not have the motivation to become involved in the larger community.

Please take some time to look at the serviceprovider displays in the hallway.

Please be sure to be back in your seat by 12:45pm for some very special entertainment.

Please welcome…TheMammasand the Papa

Eden YMCA Line-Dancing Team

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Small Group DiscussionsLeaders and Locations

Alzheimer’s and dementia: (Andi)Transportation: (Whitney)Service awareness: (Karen)Insurance gap: (Christine)Streamlining services: (Carol)

Action Steps andMoving Forward

How will you contribute?

Closing Speaker

Amelia DallasRockingham County CommissionerRockingham County RealtorLifelong Resident of Rockingham County

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Raffles!Do you have the winning ticket?

Thank you!Our preceptors, Brittan Williams and Debbie MasonGlen Martin and the Rockingham County Department of Public HealthAmanda Moore and Amelia DallasOur Forum Planning CommitteeBrenda Sutton, Ann Dalton, and the Cooperative ExtensionEveryone who participated in our interviews and focus groupsAll of our sponsors and boothsOur UNC teaching teamAll of our volunteers

Thank you!

To everyone here for participating in today’s forum

To all of the citizens of Rockingham County for being so

welcoming to us

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Contact Information Contact information can be found in your booklet

A full report of our project will be available online as of July 1, 2007

We will create and distribute brochures widely this summer

Thank you for coming!

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Discussion Guide for Small Group Facilitators

• Welcome and introduce self and the note taker

• Summary of what we are going to do in the small group: o Just to make sure that we are all on the same page, you have all chosen the ________

discussion today – our discussion will last about 45 minutes. o Our goal is to identify some key action steps that will lead to addressing some of the

challenges related to _____________ and then to identify community members or service providers who are willing to serve as a point person for addressing these action steps.

o I encourage you to ask questions throughout our discussion.

• Brief statement about group norms: o Before we get going, I just want you to keep in mind that during the discussion, there

are no wrong answers, only different opinions, and I would like for all of you to feel comfortable expressing your opinion, whatever it may be. So with that in mind, please be respectful of all of the opinions expressed here today and let’s keep the tone courteous and polite.

o Is everyone okay with that?

• Restatement of the theme o So let’s get started, the purpose of our discussion today is to discuss ______

challenges for seniors here in the county – the theme is spelled out on the __ page of your brochure. There are also notes pages at the end of your brochure if you’d like to take notes there.

o To restate the theme, it is: (restate relevant theme)

• Prompts to facilitator for how to prompt force field discussion: o The theme represents the current situation here in terms of _______. To get started,

we are going to come up with a goal that will help us to address the theme – if you could turn this statement into a goal, what would it be?

o Work on goal – anyone else? Anyone disagree? o Now, based on the goal that we’ve chosen, we are going to brainstorm a list of factors

that would either help or hurt efforts to change the current situation. Work on helping/hurting factors Get to the goal by increasing helping or reducing hurting

o Next, we are going to decide which of those factors is the most important to reaching that goal and the most realistic or do-able.

Identify most important/changeable factor o Now we are going to repeat this process one more time so that we end up with a goal

that is achievable and then we will start to make a list of action steps, at which point I will need some volunteers from our group here to follow-up on those action steps –repeat and work on action steps

o Time for the action steps, and by action steps I mean specific items that people in this group can do and follow up on

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o NEED TO BE WRAPPING UP THE ACTION STEPS ABOUT 1:50 – NO LATER THAN 1:55 – EVERYONE BACK IN BIG ROOM BY 2P

o Ask for volunteer to report back on the action steps at the big group and tell them that we will be standing with them.

• Quotes from the data to support our theme: • Quotes relevant to given theme discussion group

• Other facts: • Other facts relevant to given theme discussion group

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Force Field Analysis: Awareness of Services Current Situation: Seniors are often unaware of the services and events that are available to them throughout the county. First Round:

HELPING GOAL HURTING Newspapers* Websites TV Radio* Churches* Nutrition sites Recreation departments Senior centers, including newsletters* and technical trainings Physician offices Libraries and computer services YMCA’s Word of mouth (ambassadors)* United Way 211 Rockingham Community College and Center for Active Retirement

Improve seniors’ awareness of services.

Access to technology Finances Apathy Lack of unity Phonebook doesn’t highlight services Lag time Transportation* No one central location Spread out Frustration with automated systems Isolated seniors Not used to going somewhere else Not sure services are meant for them*

* Prioritized factors Action Steps:

• Initiate a letter writing campaign, working with the Council on Aging and potentially the News and Record, to help make the needs and desires of seniors known

• Contact Home Health Care and Caregivers of Rockingham County as a way of spreading awareness to homebound seniors

• Contact ministerial groups of Eden and Reidsville to investigate working with church groups to increase service awareness

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Force Field Analysis: Alzheimer’s and Dementia Current Situation: Although the county offers some mental health services, adequate care does not exist for the growing concerns surrounding Alzheimer’s and dementia among seniors and support for their families.

HELPING GOAL HURTING Meals in the community (nutrition sites) Caregivers (the organization) Alzheimer’s Association Carolina House Friendship Center Carolina House Monthly Support Group (May 14 @ 7 PM; 2931 Vance Street Extension) Memory Walk – June 3 in Winston-Salem

Daycare arrangement with transportation, in-bed

facilities, and more mental health services.

Lack of knowledge about eligibility and other details of nutrition sites Lack of volunteers Lack of awareness of Alzheimer’s Association Too much privacy in families about Alzheimer’s Waitlists for space in homes with Alzheimer’s units No memory walks in Rockingham County Families need support No relief for caregivers Need for a place for people who can’t afford Carolina House People don’t want to go to homes

Action Steps:

• Heavily advertise an upcoming information session at the Carolina House of Reidsville for those affected by and those interested in learning more about Alzheimer’s

• Acquire a list of county services and distribute at nutrition sites and senior events, specifically the Senior Games, to educate Rockingham County community members about the services that are currently offered in the county for seniors

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Force Field Analysis: Transportation Current Situation: Given Rockingham County’s geographic layout and the shortage of consistent, low cost transportation, seniors have difficulty using transportation to access services and activities. First Round:

HELPING GOAL HURTING Infrastructure and good communication in Rockingham services Existing Council on Aging transportation services for those who want it ($2 in city/$3 city-to-city) Existing event and information Pelham Transportation – can go out of state; can take people after dark; have group rate on a sliding scale; take people shopping or on out of town trips Collaborations on public transportation are possible and some have tangible monetary benefits/advantages $2 cost helps to eliminate the stigma of welfare

This group did not create a goal

Awareness of services available (among seniors and service providers) * Some seniors cannot drive or don’t drive after dark, or have no car Not enough funding coming to the agencies Marketing is not sophisticated – difficulties with outreach Misperceptions about services and who is served City councils not focused on transportation – it’s not a priority $2-$3 cost is not affordable to some

* Selected as current situation for next round

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Current Situation: There is insufficient awareness of available transportation services among seniors and service providers. Second Round:

Action Steps: increasing marketing of available transportation services with service providers and seniors

• Include information on available transportation options/rates for seniors from Council on Aging transportation services in the next Center for Active Retirement newsletter

• Attend and present information about available transportation options at upcoming meetings with both the Service Providers Network and the Rockingham County Planning Meeting for Services to the Elderly

• Call WLOE about a potential radio spot to discuss transportation • Investigate potential advertising options for transportation services in local utility

bills • Contact local newspapers and churches to post transportation information in their

bulletins • Help create flyers to be distributed to advertise Council on Aging transportation

services • Contact the Council on Aging to get information on their transportation services and

to discuss collaboration options

HELPING GOAL HURTING Seminars, events, information, newsletters, pamphlets – marketing on both ends Increased awareness leads to increased transportation which eventually leads to lower costs and expanded services Advertising of the vans being on the road (like a moving billboard) Assistance is available in certain circumstances (through service providers) Existing grants/funding

This group did not create a goal

Lack of awareness about who can ride the public transportation vans Low attendance at events where people might learn about transportation options Cost is still too much for some Misunderstanding of service and eligibility criteria among seniors and service providers Some service providers not advertising available funds Only some higher-level human service employees understand the system Lack of common language Stigma behind needing/asking for help – perception of being “poor”

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Force Field Analysis: Insurance Gap Current Situation: Due to age and income restrictions for current health insurance options, seniors may fall into a gap where they do not have sufficient health insurance to cover medical costs. First Round:

HELPING GOAL HURTING Learning good health habits while you are young Council on Aging referrals for prescription assistance Lower premiums* Education for seniors** Medicare Part D*

Discussion focused on current situation rather than a distinct

goal.

Lack of education surrounding prevention strategies People are unaware of available resources People don’t understand the health insurance system High insurance premiums* Rising cost of health care* Physicians too busy for referrals*

* somewhat important/changeable ** selected as current situation for next round

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Second Round:

HELPING GOAL HURTING People in the community who are willing to help Children who can advocate on behalf of their parents Senior service agency collaboration Council on Aging Local pharmacies are willing to help seniors find prescriptions that are affordable and/or covered by insurance Senior line Health and human services directory

Need to increase education about, advocacy for, and communication of health insurance information for

people of all ages.

Seniors may not know how to advocate for themselves Seniors (as well as young people) may not know about early retirement problems; they may be unaware of the nature and extent of the problem Seniors have worked for many years and want to retire before 65 Seniors may not have been proactive about their health insurance while they were working, and may be caught off guard when they end up not qualifying for Medicare or Medicaid People do not take enough personal responsibility for their health and health care Senior line may not be comprehensive enough to meet seniors’ needs Advocates may not know who to call for assistance

Action Steps:

• Take this theme to the Rockingham Senior Service Providers meeting • Create a resource guide focusing on insurance issues and advice for seniors • Distribute resource guide at churches, physician’s offices, Meals on Wheels,

pharmacies, and through home health services • Create a resource team to present information about resources at local organizations

such as churches, Meals on Wheels, pharmacies, and home health services • Vote for candidates who want to address the insurance gap

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Force Field Analysis: Streamlining Services Current Situation: While many service providers work together efficiently and productively, communication and service delivery is not always streamlined. First Round:

HELPING GOAL HURTING Existing meetings ¾ of senior centers are certified and are required to keep their certifications up to date Some internet use (saves time) Community calendars in local newspapers 211 service available in the county

To streamline services Lack of awareness (from all) Not looking for services Bureaucracy Service providers overwhelmed lack of time Internet not used enough Seniors don’t have access to computers People read different papers or no paper Automatic answering systems at agencies Lack of money Agencies’ primary focus isn’t communication No centralized information resource *

* Selected as current situation for next round

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Current Situation: There is no centralized information resource Second Round:

HELPING GOAL HURTING County list of services 2 county meetings Computers available at library and other community locations Newer seniors more computer savvy Community college computer classes at main campus and satellite campuses Existing volunteer networks Close-knit community Organizations open to helping (i.e. Wal-Mart)

Create a centralized information resource

Lack of money People don’t like change Change is slow Seniors sometimes afraid of the internet Lack of using volunteers or volunteer organizations to disperse information Communities spread out

Action Steps:

• Contact Region G Agency on Aging to host an online resource • Look into creating a free Rockingham community page, network, and bulletin

board online • Create a list of resources that promote, advertise, and publicize events for seniors • Create a senior newspaper • Secure funding for the senior newspaper

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Vendors and Agencies with Booths at the Forum Health Fair

1 American Red Cross

2 Arbor Ridge at Eden

3 Area Agency on Aging (Greensboro)

4 Caregivers

5 Carolina Apothecary

6 Carolina House (for food)

7 Consumer Credit Counseling

8 Council on Aging

9 Health Department

10 Hospice of Rockingham County, Inc.

11 Huffman Medical, Inc.

12 Morehead Memorial Hospital

13 NC Cooperative Extension

14 Partnership for Health Management

15 Pelham Transportation, Inc.

16 Reidlawn Cemetery

17 Rockingham County Healthy Carolinians

18 Rockingham County Senior Games

19 Joy A. Shabazz Center for Independent Living

20 Unified Healthcare

21 Western Rockingham Family Medicine

22 Whitt Insurance Agency Inc.

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Community Forum Evaluation Please circle your response: 1. I am glad I attended the senior community forum.

Strongly Agree Agree Disagree Strongly Disagree

2. At the community forum, I developed personal and professional connections with other service providers and community members.


3. After the community forum, I am more aware of the resources available to seniors in Rockingham County.


4. After the community forum, I have a better understanding of the strengths and challenges of seniors in Rockingham County.


5. After the community forum, I feel empowered to actively improve the quality of life for seniors in Rockingham County.


6. Which small group did you participate in? please circle one a. Service Awareness b. Alzheimer’s c. Streamlining Services d. Transportation e. Insurance Gap

Other comments: ______________________________________________________________ ____________________________________________________________________________________________________________________________

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Appendix E: Community Forum Planning Materials Appendix E1 Community Forum Information Sheet

p.118

Appendix E2 Radio Q&A

p.119

Appendix E3 Short Radio Call-In Spot

p.122

Appendix E4 Donation Letter

p.123

Appendix E5 Display Space Reservation Form

p.124

Appendix E6 Forum Planning Committee Invite Letter

p.125

Appendix E7 Methods Summary

p.126

Appendix E8 Summary of General Themes

p.127

Appendix E9 Community Forum Challenge Themes Voting Sheet

p.128

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Community Forum Information Sheet

What is a Community Forum? A community forum is an interactive event attended by any interested community members and service providers that:

Reviews the senior community assessment process and the themes generated from our interviews

Identifies priorities for the community to address using small group discussion techniques

Generates feasible next action-steps based on group discussions Creates mechanisms to ensures follow-up of next actions

What does a Community Forum look like? A community forum could include all of the following elements:

Door prizes Entertainment Time to socialize Food, drink, and dessert Presentation of senior community assessment process Break-out groups to discuss themes with facilitators for each group Group discussion using empowerment education Creation of action steps Report-back on group discussions

What are some issues to consider when planning a Community Forum?

How should we structure the agenda of the Forum? How many people do we think will come? How should food be served? How should we solicit donations? What themes should be included in small group discussions? What are the role of Community Forum Planning Advisors before, during, and after

forum How can we ensure action steps are addressed AFTER the forum?

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Radio Q&A with Amanda Moore

1. Please tell me a little bit about yourselves and why you are here in RC. • We are part of a five person team • At the UNC School of Public Health (Chapel Hill) - masters students and this project is

part of our masters curriculum • Working with the health dept to learn about the strengths and challenges of the senior

community in RC • The health dept is going to include our findings in the 2008 RC health assessment

2. How did you come to work with the Health Department?

• We actually have one of our colleagues from the Health Dept here today - Brittan Williams - maybe she can tell you a little bit about that

3. What kind of work have you been doing here in the county? • We have been conducting a series of interviews with senior community members and

service providers • We have also conducted a few focus groups, which are like group interviews or group

discussions

• Have you had the chance to explore RC and attend any events? 1. We started last semester attending community events (Eden Apple Festival,

Hispanic Health Fair, Christmas Craft Fair, etc) 2. We have also been trying out local restaurants, like Mom’s Kitchen and Short

Sugars 3. We have also been attending service provider meetings

• How has your experience been so far?

• Well, we’ve loved working here - everyone we’ve met has been very welcoming, open to participating in our work and talking with us - and we feel like we’ve developed genuine connections with the people we’ve already met

• What has been your favorite part about working in the county? i. I think for me it’s been the welcoming feeling we’ve received from everyone -

it makes me feel like we’re doing something worthwhile. ii. It’s also been nice to explore a new part of North Carolina.

4. Can you tell me a little bit more about what type of information you are gathering?

• We’ve been asking about strengths and challenges of the senior community • We’ve also been asking about basic elements of seniors’ lives such as recreational

activities, transportation, access to food, housing, health care, health issues, services they use, etc.

• We’ve also collected general information from the local newspapers and websites, as well as referring to the past county health assessment

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5. How will you let people know what you find out? • Well, there will be several ways that we plan to disseminate the information we

gather, but the main way is by holding a community forum, which is really a lunchtime discussion.

• It’s an event that is open to seniors and anyone to cares about seniors here in Rockingham.

• When is the forum? Where? i. It’s going to be held on Friday, April 20th at the Rockingham County

Cooperative Extension in Wentworth - it’s just down the road from the Community College.

ii. We will be serving lunch and the whole event will last from noon to 2:30p. iii. And did I mention that attendance is free of change and welcome to everyone

who has an interest in the lives of Rockingham seniors

6. Can you talk a bit about what people might expect at the forum? • First of all, we want the forum to be fun! We already mentioned that we will be

offering a free lunch - we will also have some entertainment, speakers, raffles, and door prizes

• The main point of the forum is to discuss our findings and come up with ways that the community can work together to make Rockingham an even better place for seniors to live

• After we present the major themes that have emerged throughout our interviews, we will have everyone break into small groups for discussions in which they will brainstorm about ways to overcome the challenges that we’ve found

• We also hope the forum will be a great way for seniors to meet other seniors, as well as people who provide services to seniors throughout the county

• How do you plan to arrive at the themes that will be presented? i. With input from the community, we will choose from among the most

important themes that come up most often in our interviews

• What will the small groups talk about? What will the small groups do? i. Each group will have a facilitator who will lead a discussion about the causes

and potential solutions for each theme or challenge.

7. What do you hope will be the outcome of your forum and your work? • We hope that the action steps developed during the small group discussions will

lead to changes in Rockingham that will benefit the senior community • In addition, we see the forum as an opportunity to recognize and celebrate the

strengths and resources already available to the senior community

8. What happens after the forum? • Our hope is that the community (both senior members and service providers) will

carry out the action steps generated in the small group discussions and that those

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action steps will lead to tangible changes in the community

• Will your results be available for the community? i. Yes - we will write up the results of all of the interviews, focus groups and

discussions at the forum into a report that will be available online and through the Health Dept - the results will also be included in the Health Department’s 2008 County Health Assessment

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Short Radio Spot April 17, 2007

• Hello Rockingham County – My name is Whitney Davis, and I’m Andi Kravitz and we are

here to tell you about an exciting event for seniors (and people who care about seniors) which will take place this coming FRIDAY APRIL 20, from 12-2:30pm --- It’s called the Rockingham County Senior Community Forum!

• But let me give you some background about the event: • We are part of a five person team of graduate students at the UNC School of Public Health

in Chapel Hill • We have been working with the Rockingham County health dept and Rockingham County

Healthy Carolinians to learn about the strengths and challenges of the senior community in Rockingham

• Over the last several months, we have conducted a series of interviews with senior community members and with organizations that provide services to seniors – totaling almost 40 interviews in all!

• Now, it’s time for us to report back to the community about our findings and that’s where the Senior Community Forum comes in – why don’t you give them the details about the event.

• The Senior Community Forum will take place this coming FRIDAY, APRIL 20. • The forum will be held from 12-2:30pm at the Cooperative Extension in Reidsville on

Highway 65 (you might know it as the old Wentworth Elementary School) • The main point of the forum is to talk about ways that the community can work together to

make Rockingham an even better place for seniors to live • After we present the major themes that have emerged throughout our interviews, everyone

break into small groups for discussions in which they will brainstorm about ways to overcome the challenges that we’ve found

• The forum will not only be informative, but promises to be lots of fun for everyone as well – it will include free food, entertainment, speakers, and raffles

• We have also invited several organizations who provide services to seniors to join us for a mini-health fair so that seniors can learn about some of the great, existing services available to them here

• We also hope the forum will be a great way for seniors to meet other seniors, as well as people who provide services to seniors throughout the county

• And did I mention that attendance is free of change and welcome to everyone who has an interest in the lives of Rockingham seniors.

• Just in case you missed the details the first time, the Senior Community Forum will take place this coming FRIDAY, APRIL 20

• The forum will be held from 12-2:30pm at the Cooperative Extension in Reidsville on Highway 65 (also known as the old Wentworth Elementary School)

Please come join us on Friday and be a part of celebrating the many strengths of Rockingham County’s senior community, as well as making a good place for seniors to live even better

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The University of North Carolina at Chapel Hill School of Public Health

Department of Health Behavior and Health Education

302 Rosenau Hall T 919.966.3761 Campus Box 7440 F 919.966.2921 Chapel Hill, NC 27599-7440 www.sph.unc.edu/hbhe

March 22, 2007 Dear Friend of Rockingham County seniors, We are graduate students at the University of North Carolina at Chapel Hill. In conjunction with the Rockingham County Health Department, we are working with the senior community in Rockingham to highlight strengths, address needs and concerns, and promote health and wellness among senior citizens. We are fortunate enough to have spent the last 7 months attending Rockingham events, interviewing local residents and service providers, and frequenting local restaurants and stores. On April 20th, we will be presenting our findings at a community forum that will be held at the Cooperative Extension at the Agricultural Center in Rockingham County. One of our goals is to promote community ownership and involvement in the forum, including members of the business community, and we would like to have your business represented. To that end, we would welcome a donation from your business, either in the form of a monetary gift or donation of goods, such as food, raffle prizes, or gift cards. We will have a list of donors displayed at the forum to give you recognition and would also be happy to display your promotional materials (see attached form to reserve a display space). Any donation, small or large, will not only contribute to the success of our forum but to improving the lives of the senior community in Rockingham County. Your donation is tax deductible. The Federal Tax ID number for UNC-CH is 56-600-1393. Should you have any questions, please do not hesitate to contact us by phone toll-free at (866) 610-8273 or by email at [email protected]. We thank you for your donation and we hope you will be able to join us in April! Sincerely, Whitney Davis, Andi Kravitz, and Christine Nielsen Community Forum Planning Committee, Co-Chairs

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Display Space Reservation Form Thank you for expressing an interest in displaying your organization’s materials at our upcoming senior community forum. To ensure that we have a reserved space to display your materials, please answer the following questions and return this form to [email protected] – Name of organization: _________________________________________________ Preferred contact information (phone or email): ___________________________ Please check ONE of the following: _____ I represent a for-profit organization and would like to display my organization’s materials – requires a $25 donation and we would also welcome door prizes (see below for payment details). _____ I represent a non-profit organization and would like to display my organization’s materials – no donation required and we would welcome door prizes. Please check ONE of the following: _____ I would like to have a representative from my organization present at the display. _____ I would like to drop off materials and will not have a representative present. The forum will be held on April 20th from 12-2:30 p.m. at the Cooperative Extension at the Agricultural Center in Rockingham County. Please arrive at the site no later than 10:45 a.m. to set up your materials (or contact me at [email protected] or (866) 610-8273 to make other arrangements to deliver your materials). Please note that the space provided for your display will be on a table approximately 4 feet long and 3 feet deep. If you are making a monetary contribution, your donation is tax deductible. The Federal Tax ID number for UNC-CH is 56-600-1393. Checks should be made payable to: “Health Behavior and Health Education” – please also include “Rockingham County Community Forum” in the memo field. Monetary donations should be sent to: Attn: Whitney Davis c/o UNC School of Public Health – HBHE 302 Rosenau Hall CB# 7440 Chapel Hill, NC 27599 Thank you for your participation in what we hope will be an exciting and dynamic event spotlighting the strengths of Rockingham’s senior community and identifying ways to make it even better. Should you have any questions, please do not hesitate to contact me, Whitney Davis, by phone toll-free at (866) 610-8273 or by email at [email protected].




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Date

Invitee Address Line 1 Address Line 2 City, NC Zip Code

Dear Invitee,

Thank you for taking the time to talk with us about the senior community in Rockingham County. We appreciated your time and helpful information. As you know, our team is planning to share the information we have gathered at a community forum and lunchtime discussion on Friday, April 20th. The forum will be held from 12pm - 2:30pm at the Rockingham County Cooperative Extension (enclosed you will find a flyer). The purpose of the forum is to discuss our findings and brainstorm about ways that the community can work together to make Rockingham an even better place for seniors to live. However, our goal is not only to communicate this information, but to make certain that forum is a community-owned and fun event. In order to create what we hope will be a helpful and successful event, we welcome the expertise that you can offer as a community member in the planning process. Therefore, we would like to invite you to participate in any or all of the forum planning meetings, which will take place between now and the day of the forum. The planning meetings will be held on the following dates: March 22nd,, March 29th, April 5th, and April 12th. Each meeting will take place at 1:00pm at the Rockingham County Health Department. We value your time and know that you may not be able to attend all of the meetings. Any time and input that you can provide will be helpful and meaningful to our planning efforts. Please feel free to contact us with any questions or ideas you may have. Thank you again for your involvement in our work in Rockingham!

Best,

Andi Kravitz, Christine Nielsen, and Whitney Davis Forum Planning Team

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Methods Summary 1. The team conducted interviews with 21 community members and 17 service providers from January to March. 2. In order to collect information, every interview was recorded and one team member took notes. 3. After each interview, we filled in the notes taken during the interview with information from the recording. 4. Based on the interview questions and responses in early interviews, we created a codebook. The codebook gives alphanumerical values (codes) to ideas. As an example, here are the codes and the definitions for the large topics of “group transportation” and “personal transportation.”

A. Group Transportation - how seniors move from one place to another using transportation available to more than one individual A1. Cost - the fee for using any group transportation service A2. Access - how seniors are able to get to and utilize a transportation

source A3. Quality - the nature of the experience with a particular group

transportation source AX. Other B. Personal Transportation - transportation used by one individual senior B1. Self - a senior can drive himself or herself B2. Family and friends - a senior uses friends or family to travel B3. Senior carpooling - seniors use other seniors to move around BX. Other

5. One member of the team then read through each interview and matched up sections of text with codes in the codebook. For example, a statement such as “I drive myself everywhere” would receive the code B1. 6. Then, the team counted up the frequency for each code (the number of people who had discussed each topic). 7. Based on these numbers, we decided which topics to concentrate on. 8. We then reread through the coded information to come up with initial theme statements, or summary statements of what had been said.

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Summary of General Themes General data points of interest • Here’s a few of positive things people said about life in Rockingham County:

o “The general, overall comfortable feeling” o “Champions for causes are well known. There are a lot of people working

together.” o “It’s wonderful and best place in world to live”

• Here’s a few of the challenging things they noted: o I just wish we could keep our younger people here. o It’s a great place to grow up in and a great place to retire in, but in between you

almost need to go somewhere else to make a living for yourself. o Life is very hard here… We have seen that a lot - people who have worked

themselves to death just to support their family. • Seniors no longer consider age 65 to be the starting point for becoming a senior. They report considering themselves there before that age and that there are also gradations of being seniors- younger seniors, older seniors, etc. Summary of strong points to report • Family and senior relationships emerged as strong positive elements. Many people report that they look to each other for support and socialization and strongly value the interactions they have with family members who remain in the area. • Religion plays an important part in the lives of Rockingham’s seniors. Many seniors participate in church activities. • We’ve heard a lot about caring- service providers who really care about their clients, and community members who look out for each other, checking in and making sure to help each other when needed. We have heard seniors described as generous and hardworking. • A lot of activities are offered in the county for seniors. There are opportunities for physical activity groups, social groups, artistic groups, and many others. Many seniors report that they are volunteers in some capacity and give back to the community in that way.

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Community Forum Challenge Themes Voting Sheet (Note: This is an initial voting sheet. With the assistance of the FPC, the themes were revised to

read as they are presented in the main document) We will have 45 minutes to talk about these themes in breakout groups. The goal is to present something specific enough that it can be boiled down to concrete action steps. ____1. Seniors have difficulty consistently accessing transportation in a way that suits their individual needs. ____2. Seniors have difficulty finding doctors who accept Medicare. ____3. Seniors who are unable to qualify for Medicare have difficulty affording healthcare. ____4. Seniors have difficulty paying additional medical costs not covered by Medicare or other

health insurance.

____5. Cardiovascular disease is a specific physical health problem facing seniors in Rockingham County.

____6. Although the county offers some mental health services, there is a lack of adequate

Alzheimer’s and dementia care services. ____7. Although service providers communicate regularly through a variety of channels, service providers need to streamline the communication process. ____8. While Rockingham County has many activities for seniors, for a variety of physical, social, or economic reasons, seniors may not have the motivation to become involved in the larger community. ____9. Seniors face significant financial challenges in their retirement. ____10. The spread out geographic layout of the county is a challenge to seniors as they try to access services and activities. ____11. Seniors are often unaware of the services and events that are available to them throughout the county.

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Appendix F: Data Coding and Analysis Appendix F1 Codebook

p.130

Appendix F2 Code Frequencies

p.133

Appendix F3 Additional Challenge Themes

p.136

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Codebook

A. Group Transportation- how seniors move from one place to another using transportation available to more than one individual A1. Cost- the fee for using any group transportation service A2. Access- how seniors are able to get to and utilize a transportation source A3. Quality- the nature of the experience with a particular group transportation source AX. Other B. Personal Transportation- Transportation used by one individual senior B1. Self- a senior can drive himself or herself B2. Family and friends- a senior uses friends or family to travel B3. Senior carpooling- seniors use other seniors to move around BX. Other C. Health- any issue relating to the health of seniors C1. Healthcare- how seniors take care of their health or how they are taken care of

C1a. Quality- ways in which the services meet the mental or physical needs of seniors

C1b. Affordability- cost of healthcare relative to what seniors can afford C1c. Accessibility- the ease with which seniors can get to and utilize medical care

available in the county C1d. Advocacy for seniors- activities promoting improved healthcare for seniors C1x. Other C2. Physical Health- health of the body C2a. Elder abuse- physical abuse of seniors C2b. Diabetes C2c. Cancer C2d. Arthritis C2e. Cardiovascular disease C2x. Other C3. Mental Health- mental health issues facing seniors C3a. Elder abuse- mental health challenges as a result of elder abuse C3b. Depression C3c. Dementia C3d. Alzheimer’s C3e. Suicide C3x Other D. Networks- relationships through which seniors operate

D1. Family- relationships with family, including parents, children, grandchildren D2. Church- relationships fostered by and within a church setting D3. Other senior community members- senior relationships with other seniors and how

those relationships operate D4. Community role models- individuals respected by the community and the ways they

work together D5. Between service providers- the ways in which service providers connect with each

other, the nature of the relationships, and the ways in which they work together DX. Other

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E. Religion- the roles religion may play in an individual’s life or in the community as a whole F. Caring- nurturing and supportive relationships between individuals who work or live in the county F1. From service providers to seniors- care expressed from service providers to seniors F2. Family members to seniors- caring expressing from family members to seniors F3. Between seniors- caring demonstrated between seniors FX. Other G. Senior activities- daily or intermittent ways in which seniors spend their time G1. Volunteerism- activities done by seniors without monetary compensation G1a. Organized- established volunteer activities in which seniors can participate G1b. Informal- ways in which seniors give of their time which may not be set up

or established by others or by groups G1x. Other G2. Church organizations- activities engaged in through church G3. Physical activity groups- activities that involve exercise or other movement G4. Senior games- activities pertaining to the senior games G5. Active/not-active dichotomy- mention of two distinct type of seniors- those that

engage in activity and those that choose not to or cannot GX. Other H. Isolation- seniors who do not regularly interact with other members of the community H1. Spousal death- seniors who do not interact following the death of a spouse H2. Access to seniors- how those providing care reach seniors who are isolated H3. Senior access to services- how isolated seniors meet their needs H4. Lack of motivation- seniors who choose not to engage with the community H5. Isolation by physical limitation- seniors who are isolated for physical reasons HX. Other I. Economy- economic functioning I1. County level- economic health or capacity of the county as a whole I2. Personal finances of seniors- how seniors manage their personal money I2a. Financial scams- scams aiming to gain money from seniors

I2b. Retirement- retirement plans of seniors, including how they manage retirement plans or make financial decisions during retirement

I2x. Other I3. Socioeconomic status I3a. Financially secure/ comfortable- able to live without major financial worries I3b. Financially insecure I3x. Other- alternate financial situation IX. Other J. Food- how seniors obtain their food J1. Congregate meals- group meals at a nutrition site J2. Meals on Wheels- food delivery system in the county that takes seniors their food JX. Other K. Housing- where seniors live

K1. Facility- seniors live in a nursing home, an assisted living facility, or an independent living facility

K2. Personal home- seniors live in a private home, by themselves or with family

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KX. Other L. Strengths- particular assets of the senior community L1. Volunteerism- involvement of seniors in volunteer activities L2. Friendship- camaraderie among seniors LX. Other identified strengths- strengths explicitly identified as such that do not include

volunteerism and friendship M. Community Challenges- important issues facing the senior community M1. Community divisions- something that acts to partition the community M1a.Geographic- physical aspects of the community that keep individuals apart M1b. Political- differing political opinions M1c. Racial- divisions associated with race M1d. Economic- divisions associated with economic factors M1x. Other M2. Advertising events or services- challenges with making seniors aware of existing

events and services MX. Other N. Definition of seniors- at what age a person is considered a senior N1. 65 and older N2. Including younger age groups- individuals younger than 65 NX. Other O. Nature of life in Rockingham- general day to day feelings of living or working in Rockingham County O1. Current observations- individual’s viewpoints about living or working in the county O.2 Changes- observations on how living in Rockingham has been altered for whatever

reason OX. Other P. Demographics- comments on the demographic composition of the county, including racial and ethnic composition, gender, or other demographic classifier Q. Great Quote- a quote that stands out as particularly meaningful

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Code Frequencies The following table is a tally of how many individuals, whether service providers (SP) or community members (CM), mentioned a particular domain, code, or sub-code during an

interview or focus group.

Domain Code Description Frequency SP Frequency CM Total A- Group Transportation A1 cost 6 11 17 A2 access 10 12 22 A3 quality 4 6 10 AX other 8 4 12 B- Personal Transportation B1 self 4 10 14 B2 family/friends 5 6 11 B3 carpooling 1 2 3 BX other 3 6 9 C-Health C1a quality 7 3 10 C1b affordability 10 12 22 C1c accessibility 9 11 20 C1d advocacy 2 0 2 C1x other 2 1 3

C2a elder abuse (physical) 2 8 10

C2b diabetes 4 2 6 C2c cancer 2 9 11 C2d arthritis 1 2 3 C2e CVD 7 8 15 C2x other 7 11 18

C3a elder abuse (mental) 3 5 8

C3b depression 4 2 6 C3c dementia 1 4 5 C3d Alzheimer's 2 13 15 C3e suicide 0 0 0 C3x other 2 2 4 CX other 3 2 5 D-Networks D1 family/friends 6 13 19 D2 church 4 4 8 D3 seniors 3 6 9 D4 role models 2 0 2

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Domain Code Description Frequency SP Frequency CM Total

D5 service providers 9 1 10

DX other 5 6 11 E- Religion n/a religion 11 6 17 F-Caring F1 sp to senior 6 3 9

F2 family to senior 2 1 3

F3 between seniors 5 10 15

FX other 1 4 5 G- Senior Activities G1a organized 5 14 19 G1b informal 3 4 7 G1x other 0 1 1 G2 church 4 5 9 G3 physical 6 16 22 G4 senior games 5 6 11 G5 dichotomy 7 1 8 GX other 4 8 12 H- Isolation H1 spousal death 3 3 6

H2 access to seniors 6 1 7

H3 access to services 5 3 8

H4 motivation 5 5 10

H5 physical limitation 4 5 9

HX other 9 6 6 I- Economy I1 county 10 8 18

I2a financial scams 0 2 2

I2b retirement 12 6 18 I2x other 6 3 9 I3a secure 0 1 1 I3b insecure 8 7 15 I3x other 3 0 3 IX other 2 0 2

J- Food J1 congregate meals 5 4 9

J2 meals on wheels 7 5 12

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Domain Code Description Frequency SP Frequency CM Total JX other 5 6 11 K- Housing K1 facility 8 9 17

K2 personal home 7 7 14

KX other 0 8 8 L- Strengths L1 volunteerism 4 3 7 L2 friendship 1 1 2 LX other 9 5 14 M- Community Challenges M1a geographic 6 3 9 M1b political 0 3 3 M1c racial 6 2 8 M1d economic 3 0 3 M1x other 2 1 3 M2 advertising 6 11 17 MX other 4 1 5 N- Definition of seniors N1 65+ 2 1 3 N2 younger 9 6 15 NX other 1 1 2 O- Nature of life in Rockingham O1

current observations 8 15 23

O2 changes 5 3 8 OX other 1 4 5 P- Demographics n/a demographics 8 10 18

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Additional Challenge Themes Summary of Themes not Selected by the Forum Planning Committee

Medical Providers

“[Seniors access health care] by scratching, searching, and just landing in the right place after a while.”

Seniors are an aging population with numerous health concerns, and service providers

discussed healthcare as an important consideration for the community. They stated that

Medicare Part D has successfully increased seniors’ access to prescription medications and

reduced conservation habits such as taking medication at lower than the prescribed dose in order

to extend each month’s supply. One continuing struggle, however, is a lack of providers in the

county that meet seniors’ needs. The county has 59 general practitioners, and several

interviewees reported there were only two gerontologists in the county19. Additionally,

interviewees discussed the difficulty of finding doctors who would take seniors and reported that

many doctors popular with the senior community were not taking new patients. Seniors often

must travel to Greensboro to see specialists. Service providers cited basic medical specialties

available within the county but noted that seniors must still travel for advanced medical care.

Cardiovascular Disease

“I live way out in the county - If I have a heart attack or if I fall out in the country, who will come get me?”

Service providers and community members both cited cardiovascular disease as one of

the most common illnesses in the community. Both groups identified the disease as a natural

part of aging but also discussed concerns about how it affected individuals in the community.

How do seniors with cardiovascular disease access adequate healthcare, how do they manage the

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disease, and how do they live with the disease? These were all questions posed by interviewees,

to answers to which did not become apparent through the interview process. Additionally, the

cardiovascular disease rate in Rockingham County is higher than the rate for North Carolina as a

whole: 251.1 per 100,000 individuals in the county, compared to 245.9 per 100,000 individuals

in the state10. Diseases of the heart are the leading causes of death in the county10.

Inactive Seniors

“My vision of senior community is one of two – they’re either very active and alert or they’re very sickly and isolated.”

During interviews, community members frequently cited a division between active and

non-active seniors. Some seniors, such as those interviewed, are very active in the community

and activities and take full advantage of the many opportunities available. On the other hand,

interviewees also stated that there were seniors who did not participate in activities. Community

members cited a number of reasons for this lack of participation. First, many felt that inactive

seniors may have a lack of desire to participate in events or do not want to leave the house.

Other explanations mentioned included illness, both physical and mental, and a lack of

transportation. Some community members expressed animosity towards those who did not

participate in activities, stating that these seniors were simply lazy or stuck in a rut. Service

providers noted many of the same concerns with the inactive portion of the senior community

but most often framed these concerns in terms of reaching these seniors for program purposes.

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Financial Challenges

“Our local economy is definitely going to affect our seniors within the next 20 years and beyond.”

Service providers discussed financial concerns for seniors in several interviews. Seniors

under the age of 65 have no access to federal or state resources designated for older adults.

Additionally, low to middle-income seniors have too much money to qualify for many income-

dependent services but do not have sufficient resources to live well. In order to reduce personal

costs, for example, seniors may keep the heat or air conditioning low to minimize energy use. At

the supermarket, they carefully budget in order to determine which products they can afford each

week. Service providers noted the special ability of older seniors to save and conserve since they

lived through the Depression. Although financial concerns are prevalent in the community,

financial challenges may not be immediately apparent as seniors may be used to saving or

scrimping. Service providers expressed concerns, however, that adults currently working may

not be as experienced in saving money or planning for retirement and that financial challenges

will only increase over time.

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Appendix G: Community Resources Appendix F1 Resources for Seniors Living in Rockingham County

p.140

Appendix F2 Community Results Brochure

p.142

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Resources for Seniors Living in Rockingham County Rockingham County Senior Line: 342-9999 Referral line for all senior services in the county Rockingham County Human Services Directory http://www.co.rockingham.nc.us/hsdirect/alphalist.htm North Carolina 211 Dial 211 for community health and human service resources. Available 24 hours a day, 7 days a week.

Type of Service Phone Number Town

General Senior Services Caregivers of Rockingham County 361-0971 Reidsville Council on Aging 349-2343 Reidsville Social Security Administration 342-7796 Reidsville United Way of Rockingham County 342-7768 Wentworth Veterans Services 342-8449 Wentworth

County-Level Government Services

Department of Social Services 342-8316 Wentworth Healthy Carolinians 342-8258 Wentworth Rockingham County Health Department 342-8140 Wentworth

Meal and Food Assistance

Meals on Wheels 349-2343 Reidsville Reidsville Soup Kitchen 349-5071 Reidsville Nutrition sites:

Bethany Nutrition Site 951-2567 Reidsville Draper Nutrition Site 635-1910 Eden Huntsville Nutrition Site 427-5206 Madison Leaksville Nutrition Site 623-5343 Eden Madison-Mayodan Nutrition Site 548-2789 Mayodan Meadowgreen Nutrition Site 349-3544 Reidsville Oregon Hill Nutrition Site 939-7140 Ruffin Reidsville Senior Center Nutrition Site 349-9757 Reidsville Stoneville Nutrition Site 573-2148 Stoneville

http://www.co.rockingham.nc.us/hsdirect/alphalist.htm

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Type of Service Phone Number Town

Medical Services and Medical Supplies

Annie Penn Hospital 951-4000 Reidsville Carolina Apothecary 342-0071 Reidsville Free Clinic of Reidsville and Vicinity 349-3220 Reidsville Hospice of Rockingham County 427-9022 Wentworth Huffman Medical Supply 627-0750 Eden Morehead Hospital 623-9711 Eden Unified Home Care 616-1955 Reidsville White Cane Program 349-6221 Reidsville

Mental Health and Elder Abuse

Department of Social Services 342-8316 Wentworth Help, Inc 342-3331 Wentworth

Recreation and Senior Centers

Center for Active Retirement 342-2163 Wentworth Eden Parks and Recreation Department 623-2110 Eden Eden YMCA 623-8496 Eden Garden of Eden Senior Center 623-2110 Eden Madison Mayodan Recreation Center 548-2789 Mayodan Mayodan YMCA 427-9622 Mayodan Reidsville Parks and Recreation Department 349-1090 Reidsville Reidsville Senior Center 349-1088 Reidsville Reidsville YMCA 342-3307 Reidsville Rockingham County Senior Games and Silver Arts 548-2789 Mayodan Western Rockingham Family YMCA 427-9622 Mayodan

Transportation

Pelham Transportation, Inc. 939-3058 Pelham Council on Aging 349-2343 Reidsville

the rockingham county senior community assessment...

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