Community Health Needs Assessment Report
The Health of Aitkin County
Riverwood Healthcare Center, Aitkin, Minnesota
September 30, 2013
1
Community Health Needs Assessment
Riverwood Healthcare Center
Table of Contents
Introduction…………………………………………….page 4
Acknowledgements…………………………………...page 5
Executive Summary…………………………..………page 6
Community Assessment Process……………….…..page 7
Description of Process and Methods………….page 7
Data Sources…………………………………….page 8
Public Health Input………………………………page 9
Community Description……………………………….page 11
Demographic Data…………………………………….page 13
Population Trends
Household Trends
Ethnicity
Age
Workforce
Socioeconomic
Community Systems Data……………………….…..page 19
2
Healthy Community Data Key Indicators…………….page 20
Bridge to Health Survey
Prioritization Process of CHNA Needs……………….page 23
Community Input
Communication of Results……………………………..page 39
Strategies for Implementation…………………….……page 39
Riverwood’s Addressing of Needs
Conclusion……………………………………….………page 42
Attachments:
Community Health Resources
Attachment A
Riverwood Wellness Resources Attachment B
3
Introduction
The Health of Aitkin County is a Community Health Needs Assessment (CHNA) developed by
Riverwood Healthcare Center, in partnership with other health and wellness organizations. This
document fulfills the requirements for community hospitals, as set forth by the Patient Protection
and Affordable Care Act (PPACA).
The Patient Protection and Affordable Care Act set additional criteria for community hospitals to
maintain their tax exempt 501c (3) status. This requirement applies for tax years beginning after
March 3, 2012, and must be completed at least every three years, with input from the broader
community including public health experts. This plan meets the requirements of IRS Notice 201152, which specifies information that needs to be included in the CHNA, including implementation
strategies that address the issues identified by the assessment. The required information is
contained in sections in this report, as summarized below.









Community Assessment Process
Community Description
Demographic Data
Community Systems Data
Healthy Community Indicators
Prioritization Process of CHNA Needs
Communication of Results
Strategies for Implementation
Conclusion
4
Acknowledgements
Special thanks to the many individuals and organizations that assisted with the completion of the
Community Health Needs Assessment process. Most specifically to the Core Project Team who
provided input and guidance on the project. Thanks also to the many Riverwood Healthcare
Center staff who assisted during various phases including Arlene Wheaton and Connie
Gretschmann. Special thanks to Shelli Urness Consulting, HBH Associates, and Health Planning and
Management Resources, Inc. for their expertise and involvement. I especially want to thank the
many community members who provided input via the Community Feedback Sessions and
Telephone Interviews. An engaged community has contributed to the success of Riverwood
Healthcare Center since our inception in 1955, and we have partnered with the community to
meet the health and wellness needs of the residents and visitors of Aitkin County and the
surrounding area. This assessment has been a true community endeavor.
Chad Cooper
CEO, Riverwood Healthcare Center
CHNA Core Project Team Members:
Jayne Anderson, Riverwood Healthcare Center, Aitkin, Minnesota
Cynthia Bennett, Aitkin County Public Health, Aitkin, Minnesota
Liz Dean, Riverwood Healthcare Center, Aitkin, Minnesota
Mike Hagen, Riverwood Healthcare Center, Aitkin, Minnesota
John Hodson, Aitkin ISD #1 Community Education, Aitkin, Minnesota
Lisa Kruse, McGregor ISD #4 Community Education, McGregor, Minnesota
Beth Leaf, Aitkin County CARE, Aitkin, Minnesota
Alison Matalamaki, Aicota Healthcare Center, Aitkin, Minnesota
Heidi Olesen, Aitkin ISD #1, Aitkin, Minnesota
Dan Schletty, Riverwood Healthcare Center, Aitkin, Minnesota
Judy Turner, Riverwood Healthcare Center, Aitkin, Minnesota
Shelli Urness, Shelli Urness Consulting, Brainerd, Minnesota
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Executive Summary
Riverwood Healthcare Center (RHCC) operates a 25-bed critical access hospital serving Aitkin
County and surrounding communities in north central Minnesota, with full service primary care
clinics in Aitkin, Garrison and McGregor. Patients can access urgent care and a wide range of
specialty care at our integrated hospital and clinic in Aitkin.
Our facility has achieved several designations that demonstrate our commitment to outstanding
delivery of medical care. These include Level III Trauma Center, Level I Heart attack program
protocol in affiliation with the Minneapolis Heart Institute at Abbott-Northwestern Hospital, and
Comprehensive Advanced Life Support Hospital.
Riverwood delivers top quality medical care delivered with a team of caring healthcare
professionals. Since 1955, we've been committed to providing our community with a
comprehensive array of medical services close to home. Since 1955, we have expanded our
portfolio of clinical services, added medical staff members, as well as increased the programs and
number of sites to access care. Despite this growth in the range and extent of services, we have
long realized that the full measure of accountability to the communities we serve is to improve
and maintain health and wellness.
The Health of Aitkin County report is a comprehensive community health needs assessment
(CHNA). The report outlines community health needs based on primary and secondary data
sources. This report is intended to give Riverwood, our staff, and our community information on
county health indicators that will serve to guide strategic activities and programs, and chart the
course for future community health initiatives. Improving and sustaining community health is a
collaborative effort that integrates many stakeholders including county public health, school
districts, nonprofit organizations, and many other public and private entities. This CHNA report is
the product of an 18-month process that sought community input, medical staff input, involved
key representatives such as public health, and selected primary and secondary data sources to
identify target areas and implementation plans.
Health and wellness is an issue of concern for all of us, and we hope that the information in this
report creates conversation and action among the private and public sector, so that we all work to
improve the health of our county.
It is Riverwood’s intention to continue to use research and data on a three-year rotating cycle, as
this allows time to make some changes, recruit any needed personnel, develop more services, and
communicate to the community the services available.
6
Community Assessment Process
In order to fulfill the new requirements set forth by the IRS, Riverwood Healthcare Center has
undertaken a community health needs assessment (CHNA), the purpose of which is to gain input
on community health needs and identify gaps and barriers to service, with the ultimate goal of
better serving the health and wellness needs of Aitkin County.
Description of Process and Methods
RHCC enlisted the services of Shelli Urness Consulting to design a project plan and coordinate the
construction of the CHNA and report.
Project Overview
The Community Health Needs Assessment is a new federal requirement for private, non-profit
hospitals including Riverwood Healthcare Center (RHCC). Part of the Patient Protection and
Affordable Care Act (ACA), the Community Health Needs Assessment is the requirement of
additional criteria for Riverwood and other hospitals to maintain their tax-exempt, 501(c) (3)
status. This requirement applies for tax years beginning after March 23, 2012. A CHNA must be
completed at least every three years with input from the broader community, including public
health experts. The CHNA describes how Riverwood will address needs identified in the
community health needs assessment as well as identify any needs not being addressed and
explain why not, and contain an implementation strategy. Riverwood Healthcare Center has
contracted with Shelli Urness Consulting to facilitate the CHNA Project in conjunction with a
Project Team of Riverwood Healthcare Center staff and other key stakeholders previously
identified.
In addition, Riverwood regularly conducts specific research on its services and community
awareness. Health Planning and Management Resources, Inc. (HPMRI) conducted primary
research in both 2008 and 2011 to help RHCC Management better understand the needs of the
communities they serve. HPNRU completed telephone surveys-one in 2008 and one in 2011- of
400 randomly selected households in the market area. Because the related questions were asked
for all household members, information was obtained for well over 500 persons residing in the
market area. The telephone calls and analysis of the results were completed by professional
market research firms. RHCC’s management has used this information in the development of its
strategic plan, including development of new services to serve the community needs.
HBH Consultants obtained input from residents in Riverwood’s primary service communities:
Aitkin, Garrison and McGregor. Through community input sessions telephone interviews and
email questionnaires, we have evaluated perceptions regarding health and wellness resources
available through both Riverwood and the wider community and have identified some missing
links. Details of community input are detailed later in this report.
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Project Approach
RHCC took a phased approach to the CHNA.
- Phase 1 – Planning
- Phase 2 – Compiling/collection
- Phase 3 – Strategy analysis
- Phase 4 – Action/execution
- Phase 5 – Evaluation and measurement
Flow Diagram of Riverwood’s CHNA Project
•Phase 5– Execution
•Step 11– Evaluate
Progress and Means
for sustainability
Phase 1
Phase 1 - Planning
•Step 1- Engage Shelli
Urness Consulting
•Step 2-Compile
Project Team
•Step 3 – Inventory
of Existing Resources
3
Phase 5
Phase 2
Phase 2Compiling/Collecting
•Step 4‐ Defining
scope of Needs
Assessment
•Step 5 – Collecting
data/information
Phase 4– Execution
•Step 9 – Reporting
•Step 10 –
Implementation
Phase 4
Phase 3 - Strategy
•Step 6- Prioritize
Needs
•Step 7- Determine
response to needs
•Step 8- Determine
Implementation Plan
8
Phase 3
CHNA Riverwood Healthcare Center – Timeline
█__________█___________█___
Begin
Project
April 2012
___█____________█___________█__
_______█
Phase 1
Phase 2
Phase 3
Phase 4
Phase 5
April./May/June
2012
July/August/
September/October
2012
November/
December
2012
January 2013
February/March
2013
April/May
2013
CHNA
Required
October 1,
2013
Data Sources
In addition to the primary data sources noted earlier (surveys, community input sessions, phone
contact), extensive secondary data was utilized as a reliable basis of information. The list of data
sources used includes:
 Minnesota Department of Health
 US Census Bureau
 Minnesota Hospital Association, Community Health Needs Assessment Requirements,
Matt Anderson Vice President, Regulatory/Strategic Affairs, January 12, 2012
 County Health Rakings and Report 2012
 Bridge to Health Survey, Northeastern Minnesota and Northwestern Wisconsin Regional
Health Status Survey, Aitkin County Data Tables 2010
 Riverwood Healthcare Market Study 2012, Maureen Swan, MedTrendInc.
 Community Health Needs Assessment (CHNA) Done Right: A Practical Guide, 10/2011,
RSM McGladrey, Inc.
 Consumer Survey Regarding Health Services in the Aitkin Market Area, Patricia
McCollough, Health Planning and Management Resources Inc. Edina, MN September 2011
 Healthy People 2020, Association for Community Health Improvement
 IRS Form 990 and attachments, including Schedule H (Hospitals) – page 4
 Riverwood Healthcare Center Strategic Plan 2012-2014
 Aitkin County Wellness Initiative Information
Public Health Input
Community Health Boards
The Community Health Board (CHB) is the legal governing authority for local public health in
Minnesota, and CHBs work with the Minnesota Department of Health in partnership to prevent
diseases, protect against environmental hazards, promote healthy behaviors and healthy
communities, respond to disasters, ensure access to health services, and assure an adequate local
public health infrastructure.
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

CHBs have statutory responsibility under the Local Public Health Act and must address and
implement the essential local public health activities. Additionally, CHBs must assure that:
- A community health assessment and plan are completed on a regular cycle.
- Community health needs are prioritized in a manner that involves community participation.
- Needed public health services are developed and implemented.
The Local Public Health Act requires each CHB to serve a population of at least 30,000 people. If a
single county doesn’t meet the population requirement, it can form a CHB with one or more
neighboring counties. If a CHB serves three or more contiguous counties, the minimum population
requirement does not apply. The number of CHBs in the system has varied over time and is
subject to change; MDH maintains a map of current CHBs online. CHBs in Minnesota take a
number of forms:





Single-County
Multi-County
Statutory (City-Based)
Human Services Board
Contracted Services

CHBs are required to have a community health services administrator and a medical consultant,
and may appoint an advisory committee. Members of the CHB are either elected themselves or
appointed by elected officials. Due to local control and local investment of resources, the
membership, composition, and business practices of CHBs vary throughout the state. This
flexibility is a great strength of the state’s public health system; it helps ensure public health
activities are aligned with community need.
Organizational and Governance Changes
Over the past decade, several counties and CHBs have made changes to their public health
organizational and governance structures, and more changes are being considered as local elected
officials look for ways to address significant budget concerns, create efficiencies, and anticipate
the retirements of public health leaders. Between May 2009 and May 2010, 28 percent of county
boards and 28 percent of CHBs considered, proposed, or decided to change their organizational or
governance structure. Some top public health officials expressed satisfaction with current
structures, whereas others identified limitations with current structures or concerns about the
motivation for changing structures.
The CHB for the Aitkin County region is Aitkin-Itasca-Koochiching Community Health Board
includes and includes:
 Aitkin County
 Itasca County
 Koochiching County
Cynthia Bennet, Aitkin County Public Health Supervisor, was a member of Riverwood’s CHNA Core
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Project Team. Tom Burke, Human Services Director from Aitkin County, also participated in a
telephone interview. Aitkin County Public Health is also conducting a Community Public Health
Assessment as a requirement to Minnesota’s Local Public Health Act, which requires local health
departments to conduct a comprehensive assessment and planning process ever five years. They
are working in collaboration with other Public Health groups in their region and expect
completion of the report in 2014.
In 2012 Dr. Ed Edhlinger, Minnesota Commissioner of Public Health, also commented on the
County Health Rankings and Roadmap for Aitkin County (referenced later in this report). He said:
“We spend only a fraction of the amount on prevention that we spend on medical care in this
county. We need to do a better job of investing in disease prevention within communities if we
really want to improve the health of Minnesotans and get a handle on rising health care costs.”
Community Description
The CHNA identifies the Community as primarily all of Aitkin County for the purposes of this
report. Riverwood Healthcare’s Aitkin Clinic and Hospital, the Specialty Clinic, and the McGregor
Clinic are all located in Aitkin County. It should be noted that a portion of Crow Wing County is
also served by Riverwood Healthcare’s Garrison Clinic. Community input was solicited from the
entire service area.
It can be reasonably expected that the hospital and clinics can serve the majority of the health
needs of Aitkin County. It includes a primary population served of approximately 18,000 people.
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Riverwood Healthcare Center Market Area
Riverwood Healthcare Center Service Area Definitions
Zip
Code
Community
2011
Population
56431
56444
Aitkin
Deerwood
8,615
3,227
55760
56469
McGregor
Palisade
2,887
1,439
55748
55787
Hill City
Tamarack
1,192
672
Total
18,032
Zip
Code
Community
2011 Population
56401 Brainerd
56441 Crosby
29,050
4,370
56342 Isle
56450 Garrison
2,556
1,158
Total
Primary Service Area
37,134
Secondary Service Area
Total Primary and Secondary Service Area 2011 Population: 55,166
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Demographic Data
Population Trends
Aitkin County population in July 2011: 16,220 (all rural); it was 15,301 in 2000. The population
density was 8.9 people per square mile (3/km²). As of the census of 2010, there were 16,202
people, 7,542 households, and 4,458 families residing in the County.
Low Growth, 2.5% in the Riverwood TSA Market
2011 – 2016 Projected Population Change
The total market is projected to grow by 1,392 or 2.5% over next five years
Population Change 2011-2016
-0.9%
Garrison
(63)
Isle
(132)
Deerwood
(112)
Brainerd
(881)
Palisade
(39)
Crosby
(70)
McGregor
(36)
Tamarack
(7)
Aitkin
(63)
Hill City
(-11)
-1% 0%
6%
5.4%
5.2%
3.5%
3.0%
The PSA will grow by
246 or 1.4%
2.7%
1.6%
1.2%
1.0%
0.7%
1%
2%
3%
4%
5%
6%
Percentage Change and
absolute growth in ( )
Source: Claritas, 2011
-1%
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CHNA Riverwood Healthcare Center
Household Trends
There were 6,644 households out of which 22.60% had children under the age of 18 living with them, 57.50%
were married couples living together, 6.30% had a female householder with no husband present, and 32.90%
were non-families. Of all households, 28.70% were made up of individuals and 14.00% had someone living
alone who was 65 years of age or older. The average household size was 2.28 and the average family size was
2.76.
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CHNA Riverwood Healthcare Center
Average household size:
Aitkin County: 2.0 people
Minnesota: 2 people
Estimated median household income in 2009: $36,760 ($31,139 in 1999)
Aitkin County: $36,760
Minnesota: $55,616
Median contract rent in 2009 for apartments: $420 (lower quartile is $273, upper quartile is $576)
Aitkin County: $420
Minnesota:
$683
Estimated median house or condo value in 2009: $170,582 (it was $86,200 in 2000)
Aitkin County:$170,582
Minnesota: $200,400
Lower value quartile - upper value quartile: $106,009 - $272,433
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CHNA Riverwood Healthcare Center
Mean price in 2009:
Detached houses: $199,468
Aitkin County:$199,468
Minnesota: $247,637
Townhouses or other attached units: $2,568,324
Aitkin County:$2,568,324
Minnesota: $193,158
In 2-unit structures: $20,230
Aitkin County: $20,230
Minnesota: $233,138
In 5-or-more-unit structures: $242,671
Aitkin County:$242,671
Minnesota: $177,950
Mobile homes: $121,465
Aitkin County:$121,465
Minnesota: $34,666
Occupied boats, RVs, vans, etc.: $318,878
Aitkin County:$318,878
Minnesota: $94,976
Median monthly housing costs for homes and condos with a mortgage: $1,233
Median monthly housing costs for units without a mortgage: $309
Institutionalized population: 195
Ethnicity
The racial makeup of the county was 95.63% or 15,494 people White, 0.35% or 57 people Black or African
American, 2.4% or 390 people Native American, 0.17% or 27 people Asian, 0.025% or 4 people Pacific Islander,
0.13% or 21 people from other races, and 1.29% or 209 people from two or more races. Of the population
with two or more races, 0.9% of the population were Hispanic or Latino of any race. 29.5% were of German,
14.3% Norwegian, 13.0% Swedish, 6.2% Irish, 5.3% United States or American and 5.2% Finnish ancestry.
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CHNA Riverwood Healthcare Center
Age
According to the US Census Bureau (2010) In the county the population was spread out with 20.90% under the
age of 18, 5.50% from 18 to 24, 21.60% from 25 to 44, 29.10% from 45 to 64, and 23.00% who were 65 years
of age or older. The median age was 46 years. For every 100 females there were 101.60 males. For every 100
females age 18 and over, there were 99.90 males.
This trend has changed slightly demonstrating the aging of the population, according to July 2011 data (CityData.com) the average age and gender is as follows:
Median Aitkin County resident age:
Minnesota median age:
Males: 8,205
Females: 7,997
51.0 years
37.0 years
(47.6%)
(52.4%)
Workforce
The median income for a household in the county was $44,139, and the median income for a family was
$58,290. Males had a median income of $51,604 versus $30,633 for females. The per capita income for the
county was $21,848. About 5.20% of families and 7.60% of the population were below the poverty line,
including 15.50% of those under age 18 and 11.00% of those age 65 or over.
Industries providing employment: Educational, health and social services (20.8%), Arts, entertainment,
recreation, accommodation and food services (14.4%), Retail trade (11.1%), Manufacturing (10.5%),
Construction (10.3%).
Type of workers:
 Private wage or salary: 73%
 Government: 15%
 Self-employed, not incorporated: 12%
 Unpaid family work: 0%
Socioeconomic
County owner-occupied with a mortgage or a loan houses and condos in 2010: 3,412
County owner-occupied free and clear houses and condos in 2010: 2,717
County owner-occupied houses and condos in 2000: 5,666
Renter-occupied apartments: 1,170 (it was 978 in 2000)
Mar. 2012 cost of living index in Aitkin County: 89.4 (less than average, U.S. average is 100)
Percentage of residents living in poverty in 2009: 13.9%
(12.4% for White Non-Hispanic residents, 2.6% for Black residents, 52.9% for Hispanic or Latino residents,
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CHNA Riverwood Healthcare Center
51.4% for American Indian residents, 78.3% for other race residents, 32.9% for two or more races residents)
Median age of residents in 2010: 51 years old
(Males: 51 years old, Females: 52 years old)
(Median age for: White residents: 52 years old, Black residents: 37 years old, American Indian residents: 25
years old, Asian residents: 31 years old, Hispanic or Latino residents: 21 years old, Other race residents: 49
years old)
Residents with income below the poverty level in 2009:
This county: 11.6%
Whole state:7.9%
Residents with income below 50% of the poverty level in 2009:
This county: 3.6%
Whole state:3.2%
Fair market rent in 2006 for a 1-bedroom apartment in Aitkin County is $424 a month.
Fair market rent for a 2-bedroom apartment is $557 a month.
Fair market rent for a 3-bedroom apartment is $695 a month.
Cities in this county include: Aitkin, Hill City, McGregor, Palisade, McGrath, Tamarack.
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CHNA Riverwood Healthcare Center
Community Systems Data
Attachments B and C provide information on the assets and resources available in Aitkin County to address
community health is presented in list/directory format. It is a comprehensive listing of identified potential
health resources and assets in Aitkin County. It’s likely that some resources have been missed, or may be
duplicative in some manner.
Riverwood Healthcare Specific Services
Riverwood Healthcare Center and Clinic operates a 25-bed critical access hospital serving Aitkin County and
surrounding communities in north central Minnesota, with full service primary care clinics in Aitkin, Garrison
and McGregor. Patients can access urgent care and a wide range of specialty care at our integrated hospital
and clinic in Aitkin.
Our facility has achieved several designations that demonstrate our commitment to outstanding delivery of
medical care. These include Level III Trauma Center, Level I Heart attack program protocol in affiliation with
the Minneapolis Heart Institute at Abbott-Northwestern Hospital, and Comprehensive Advanced Life Support
Hospital.
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CHNA Riverwood Healthcare Center
Riverwood Healthcare Center's Specialty Clinic brings the specialist to the community. Riverwood patients
can consult and visit with a specialist without traveling far from home. The Specialty Clinic in Aitkin, MN,
brings highly skilled medical specialists to Riverwood in Aitkin. These specialists treat a wide variety of diseases
including:
 Allergies & Asthma
 Cardiology/Heart Heath
 Ear, Nose & Throat
 Gastroenterology
 Mental Health/Psychiatry
 Neurology
 OB/GYN
 Orthopedics
 Urology
Riverwood Healthcare Center – McGregor Clinic
Riverwood's McGregor Clinic in Northern Minnesota, provides much of the care found at the Aitkin Clinic,
from routine exams to specialized services
like cardiopulmonary, physical therapy and nutrition therapy –
located right in downtown McGregor.
Riverwood Healthcare Center - Garrison Clinic and Pharmacy
Riverwood's Garrison Clinic, in Northern Minnesota, offers a full range of primary healthcare services to the
Garrison area, including same-day scheduled appointments, as well as a full retail pharmacy with a drive-up
window. The clinic offers personalized healthcare that includes family practice physicians, nurse practitioners,
and lab and radiology services, including mammography.
Healthy Community Data Key Indicators
Introduction
A thorough secondary data review was conducted utilizing documents available through the internet. A
multitude of resources were utilized and were listed previously in this report. The primary data sources
included the U.S. Census Bureau, County Health Tables and other documents available through the Minnesota
Department of Health, the Minnesota Department of Human Services, The County Health Rankings (through
the University of Wisconsin) and the Minnesota Student Survey. Additional information was utilized from
other sources. The secondary data was grouped into several subsections based on whether they were
aggregate data (County Health Rankings, the Community Health Status Indicators, some U.S. Census Bureau
Reports, etc.), specific demographic data, financial information, and student/school district information,
unemployment data, violence information, etc. There may be sources of additional information, which were
not discovered after a fairly exhaustive search.
Aitkin County – County Health Rankings (The County Health Rankings & Roadmaps program is a collaboration
between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute).
We know that much of what influences our health happens outside of the doctor’s office—in our schools,
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CHNA Riverwood Healthcare Center
workplaces and neighborhoods.) According to this report, Aitkin County is ranked 77th in health factors - those
things that influence the health of a county, out of 87 counties.
Areas to Explore
On
Off
Aitkin
County
Aitkin
County
Error
Margin
Error
Margin
Minnesota
Minnesota
National
Benchmark*
National
Benchmark*
Trend
Trend
Rank
(of 87)
Rank
(of 87)
Health Outcomes
77
Mortality
72
Premature death
6,611
5,009-8,213
5,126
5,317
Morbidity
70
Poor or fair health
17%
9-28%
11%
10%
Poor physical health days
3.0
1.8-4.2
2.9
2.6
Poor mental health days
3.4
1.5-5.4
2.7
2.3
Low Birthweight
5.7%
4.3-7.2%
6.5%
6.0%
Health Factors
78
Health Behaviors
23
Adult smoking
13%
8-21%
17%
13%
Adult obesity
29%
23-35%
26%
25%
Physical inactivity
23%
18-29%
19%
21%
Excessive drinking
16%
9-26%
20%
7%
Motor vehicle crash death rate
18
11-28
10
10
Sexually transmitted infections
56
276
92
Teen birth rate
31
26
21
25-38
Clinical Care
73
Uninsured
13%
Primary care physicians**
12-15%
10%
11%
1,352:1
1,140:1
1,067:1
Dentists**
8,249:1
1,660:1
1,516:1
Preventable hospital stays
61
52-70
51
47
Diabetic screening
80%
68-93%
88%
90%
Mammography screening
82%
67-97%
73%
73%
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CHNA Riverwood Healthcare Center
Aitkin
County
Error
Margin
Minnesota
National
Benchmark*
Social & Economic Factors
Trend
Rank
(of 87)
78
High school graduation**
85%
Some college
63%
Unemployment
8.9%
Children in poverty
23%
Inadequate social support
77%
57-70%
72%
70%
6.4%
5.0%
16-30%
15%
14%
14%
8-24%
14%
14%
Children in single-parent households
29%
22-35%
27%
20%
Violent crime rate
131
248
66
Physical Environment
80
Daily fine particulate matter
9.7
Drinking water safety
9.6-9.7
10.0
8.8
65%
1%
0%
Access to recreational facilities
0
11
16
Limited access to healthy foods**
12%
6%
1%
Fast food restaurants
26%
47%
27%
* 90th percentile, i.e., only 10% are better.
** Data should not be compared with prior years due to changes in definition.
Note: Blank values reflect unreliable or missing data
2013
2013
* 90th percentile, i.e., only 10% are better.
** Data should not be compared with prior years due to changes in definition.
Note: Blank values reflect unreliable or missing data
Aggregate Data
Many governmental agencies and private organizations collect health data and produce summaries of the
results. These reports may include “rankings” and are referred to as aggregate data in this CHNA. The
following subsections discuss the aggregate data and their implications in regard to the health of Aitkin
County.
2013 County Health Rankings
The County Health Rankings & Roadmaps program helps communities create solutions that make it easier for
people to be healthy in their own communities, focusing on specific factors that we know affect health, such
as education and income.
Having health insurance and quality health care are important to our health, but we need leadership and
action beyond health care. Ranking the health of nearly every county in the nation, the County Health
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CHNA Riverwood Healthcare Center
Rankings illustrate what we know when it comes to what’s making people sick or healthy. The County Health
Roadmaps show what we can do to create healthier places to live, learn, work and play. The Robert Wood
Johnson Foundation collaborates with the University of Wisconsin Population Health Institute to bring this
groundbreaking program to cities, counties and states across the nation.
The County Health Rankings (CHR) are based on two overall measures—Health Outcomes and Health Factors.
In the most recent (2013) CHR, all 87 Minnesota counties were ranked according to their scores on the Health
Outcomes and Health Factors. In the Health Outcomes category, Aitkin County ranked 77 out of the 87
counties.
Prioritization Process of CHNA Needs
Based on analysis of primary and secondary data, the CHNA Core Project Team identified several community
health priorities. The major health priorities are chronic disease conditions.
The Core Project Team ranked these key health needs in priority order using a weighted method:
 Mental health issues and access
 Diabetes issues
 Heart disease issues
 Behavioral health issues
 Insurance coverage
 Aging issues
 Cancer mortality
 Dialysis services
Community Input
Introduction
In order to fulfill new requirements set forth by the IRS, Riverwood Healthcare Center has undertaken a
Community Health Needs Assessment (CHNA), the purpose of which is to gain input on community health
needs and identify gaps and barriers to service, with the ultimate goal of better serving the health and
wellness needs of Aitkin County.
Riverwood’s strong focus on health and wellness has been recently augmented by selection for participation in
a three-year program called the Healthy Communities Partnership. This $475,000 grant from the George
Family Foundation and Allina Health has made possible implementation of a community-wide wellness
initiative, which includes the services of a full-time wellness coach and a part-time wellness coordinator, all
free to the public.
HBH Consultants (HBH) has been asked to obtain input from residents in Riverwood’s primary service
communities: Aitkin, Garrison and McGregor. Through community input sessions, telephone interviews, and
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CHNA Riverwood Healthcare Center
email questionnaires we have evaluated perceptions regarding health and wellness resources available
through both Riverwood and the wider community and have identified some missing links. This report
incorporates the collective insights gathered during this information-gathering process.
Executive Summary
This report contains summaries of the two community input sessions held in McGregor and Aitkin in late July
2013. HBH also solicited opinions via email and telephone from community and health industry leaders of
Aitkin County, the results of which will be shared later in the report.
After analyzing the input received from all of the sources included in this assessment, we have arrived at the
following observations and recommendations for Riverwood Healthcare Center:
Email is the preferred method of communication: Overwhelmingly, community session participants expressed
an interest in receiving Riverwood communications via email. While Riverwood’s quarterly direct mail Healthy
Living Newsletter is appreciated, participants felt that frequent, as-needed email communication would be
more effective in keeping upcoming events and health and wellness opportunities fresh in the public’s mind.
Participants agreed that email is available to most community members and that a fairly comprehensive
contact list could be obtained by list-sharing with other community organizations and asking for an email
address at each clinic/hospital check-in. Advertising through local newspapers, flyers at community meeting
places, and the NewsHopper should be continued to reach those without e-mail access.
Location makes a difference: McGregor participants voiced concern that many of Riverwood’s health and
wellness offerings are located in Aitkin, making distance and transportation an issue for McGregor citizens.
Attendees repeated the running joke: “while Aitkin is 20 miles from McGregor, McGregor is 100 miles from
Aitkin.” Many hoped that Riverwood would make an effort to more evenly distribute its health and wellness
events among the communities. Video conferencing was also mentioned as another alternative for
participating in presentations originating from the Aitkin campus.
Tailor communications/programs to a specific audience: McGregor has a relatively large retiree population,
which was reflected in the attendee demographics present at the McGregor community input session. By
contrast, Aitkin’s session attendees were generally significantly younger. As such, the conversations at each
meeting were quite different. McGregor participants were more interested in talking about issues of aging and
aging in place, while Aitkin participants focused heavily on healthy lifestyle and health and wellness education.
Riverwood staff should be aware of these population differences and target their offerings accordingly.
Evening/weekend clinic hours needed: Participants agreed that lack of evening/weekend clinic hours is a
barrier to service, especially in the summer when the tourist population increases.
The public is unaware of Riverwood’s free resources: Attendees at both community meetings were unaware
that the biometric screenings and wellness coaching are free services and do not require a previous patient
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CHNA Riverwood Healthcare Center
relationship with Riverwood. Because cost is often an issue with healthcare, the fact that these resources are
free should be continuously emphasized in order to increase participation.
Education/awareness is key: Both McGregor and Aitkin attendees felt that a good portion of the population
was simply not aware of the importance of preventative health and wellness strategies to overall health or not
yet willing to work toward health and wellness goals. For this segment of the population, education will be of
utmost importance, and Dan Schletty’s wellness coaching services, because they are free to the public, will be
an excellent vehicle for delivering this message.
People living in poverty are possibly not being reached: Though only one interviewee described marketing
efforts as being aimed at “middle class and above,” it is important for Riverwood to seek avenues for reaching
community members in poverty. Partnering with organizations that serve people experiencing financial
hardship may prove beneficial in these outreach efforts.
Dialysis access and transportation are major issues: It seems everybody knows somebody who has to travel to
Brainerd three times a week for dialysis treatments, and they recognize the toll it takes on these patients and
their caregivers. If a dialysis center at Riverwood is not a viable option, perhaps a closer look needs to be taken
at a more organized transportation solution.
An array of mental/behavioral health services is available, but awareness lacks: Aitkin County’s Department of
Health and Human Services provides access to private clinicians of mental health, counselors, and referrals for
intensive treatment. However, some participants perceived a shortage of mental/behavioral health services,
and Health and Human Services also believes this is a common public misperception. A solid working
partnership between Riverwood and Health and Human Services would make a well-rounded approach to
addressing the mental/behavioral health needs of the area.
Community Input Sessions
McGregor session attendees, July 22, Fireside Inn:
 Bob Lewis, former Riverwood board member
 Artie Lewis, McGregor resident
 Lowell LaBerge, McGregor resident
 Kathy LaBerge, McGregor resident
 Linda Farah, McGregor resident
 Lois Meachum, McGregor resident
 Ramona Hooper, Taking Off Pounds Sensibly (TOPS)
 Beth Leaf, Aitkin County CARE
 Three others, names not recorded
Lisa Kruse, Riverwood Healthcare Center Wellness Coordinator, also attended the McGregor session.
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CHNA Riverwood Healthcare Center
Aitkin session attendees, July 24, The Beanery:
 Lee Ann Hohenstein, Bremer Bank
 Ruth Hamman, southern Aitkin County resident
 Shanda Meager, Aitkin schools paraprofessional
 Linda Weimer, Mille Lacs Energy Cooperative
 Jesse Peterson, Aitkin elementary school principal
 Amy Wyant, Bremer Bank and Fit City Aitkin
 Judy Christy, holistic fitness instructor, massage therapist
 Lynn Mizner, farmer, DNR forester, mediator, firefighter
 Julie Miller, Children’s Center, Aitkin City Council
 Stacy Westerlund, County Assessor
 Matthew Hill, Aitkin Furniture, Riverwood Foundation board chair, Chamber of Commerce board
member
 Amber Hunt, Aitkin schools fourth grade teacher
 Penny Harms, Aitkin County Veterans Service Office
 Michele Plagman, Aitkin County Health & Human Services Council, Aitkin high school teacher
Also in attendance in Aitkin were Lisa Kruse, Riverwood Healthcare Center Wellness Coordinator; Liz Dean,
Riverwood Healthcare Center Marketing Manager; and Shelli Urness, Shelli Urness Consulting.
First off, attendees were asked to review two health and wellness resource lists – one with resources available
at Riverwood and one with resources available community-wide in Aitkin, McGregor, Garrison and
surrounding areas. Attendees were asked to mark resources of which they were aware and also those
resources they had used. The following charts display those results, with separate charts for each list and each
community.
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CHNA Riverwood Healthcare Center
Riverwood Health and Wellness Resource
Awareness and Use - McGregor
Aware of Resource
Have Used Resource
11
10
9
8
7
6
5
4
3
2
1
0
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CHNA Riverwood Healthcare Center
Community Health and Wellness Resource
Awareness and Use - McGregor
Aware of Resource
Have Used Resource
11
10
9
8
7
6
5
4
3
2
1
0
Of McGregor’s 11 attendees, less than half were aware of these Riverwood health and wellness resources
(except for the health education seminars, of which slightly more than half had knowledge), and even fewer
had actually taken advantage of these resources. Awareness of community health and wellness resources was
slightly better, perhaps because of greater visibility, and usage was greater for resources in or very near
McGregor. Interestingly, many Aitkin-based resources were not used at all by McGregor attendees, which may
be indicative of a general unwillingness to travel for access to health and wellness resources.
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CHNA Riverwood Healthcare Center
Riverwood Health and Wellness Resource
Awareness and Use - Aitkin
Aware of Resource
Have Used Resource
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
Awareness and use of Riverwood offerings among Aitkin attendees was also fairly low. At most, only 5 of 14
attendees were aware of available resources. Highest use was for the Family Health Manager, which only 3 of
14 participants had accessed. Community health and wellness resources had a much higher rate of awareness
and use. Around two-thirds of attendees were aware of most community resources, and on average, about
one-third had used many of them.
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CHNA Riverwood Healthcare Center
Community Health and Wellness Resource
Awareness and Use - Aitkin
Aware of Resource
Have Used Resource
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
The answers to the following questions are a compilation of responses from both community meetings.
How do you learn about Riverwood Healthcare opportunities?
 Flyers
 Word of mouth
 NewsHopper (delivery area should be checked as southern tip of Aitkin County may not receive it)
 Newspapers
 Healthy Living Newsletter
 Website
 Facebook
What more can we do to increase awareness of Riverwood health and wellness resources?
 E-mail. Almost all attendees reported they had e-mail and checked it regularly.
 Aitkin radio station
 Church bulletins. The newly formed ministerial group could be a useful resource.
 VFW newsletter
 Clinic waiting rooms
 Accent, Aitkin’s community education bulletin (delivery area should be checked as southern tip of
Aitkin County may not receive it)
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CHNA Riverwood Healthcare Center









Greater presence in social media: Facebook, Twitter, LinkedIn. About 80% of Aitkin attendees reported
using Facebook. A quick check of the Riverwood Facebook page yielded page “likes” of 340, yet the
population of Riverwood’s service area is over 16,000. Though clearly not every person uses Facebook,
Riverwood could still have a much larger following on this platform.
Text messaging
Radio
Local cable network
Referrals from other community agencies and organizations
Electronic signs
Wellness fairs
Chamber of Commerce
Community bulletin boards
What currently available services are missing from the Riverwood Resources and Community Resources
lists?
 Taking Off Pounds Sensibly (TOPS)
 Community seminars on health topics
 Hospice, which still serves this area but is not well known
 Recover Health, a home health service
 Diabetic foot care
 Caregiver support groups
 Farmers’ market and CSA
 Alcoholics Anonymous and Al-Anon
 Aitkin City Park, including walking trail, disc golf, baseball field, and ice skating
 Serenity Center in Crosby
What services would you like to see in this area that do not currently exist?
 Meals on Wheels. Currently, it only exists inside Aitkin city limits, though there is a “Frozen Meals on
Wheels” for greater Aitkin County.
 Faster lab service. It is stressful waiting so long for test results. Riverwood’s Wellness Coordinator,
suggested using the Patient Portal for easier access to results. A show of hands revealed about half of
McGregor attendees had used this online feature.
 Availability of specialists could be better.
 More seminars/health education in McGregor and Garrison rather than having to travel to Aitkin for
those opportunities.
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CHNA Riverwood Healthcare Center


With McGregor’s relatively large retiree population, would like to see more emphasis on health care
for the elderly. One Aitkin attendee brought up end-of-life issues and would like to see Riverwood
offer more education and support.
Free or reduced-fee student sports physicals.
It should be noted that one McGregor attendee voiced generally high satisfaction with Riverwood’s local
service and referrals, and the rest of the participants agreed.
What do you see as barriers to accessing services?
 Lack of insurance/cost
 Lack of awareness of availability of services
 Distance and lack of public transport
o Arrowhead Transport’s timetable and routes are inconvenient.
o Could faith communities help? Churches sometimes shuttle for medical appointments, but this
is limited and based on availability of volunteers.
 Health/wellness not yet viewed as a priority for many
o Education is key.
o People are not willing/ready to change.
o The mindset shift often starts at the clinic with the provider.
o Simple steps, one at a time, may be another key to changing mindsets. The road to wellness for
many is overwhelming and may seem unobtainable.
o Example of success: Rippleside School’s garden, part of the Farm-to-School Initiative, is teaching
kids to use fresh/homegrown foods in daily meals.
 Lack of weekend/evening clinic hours, especially in the summer when the tourist population increases.
 Infrequent dental care, especially in younger generations, perhaps due to lack of insurance/funds to
pay for it.
 Traditional medicine’s resistance to alternative/holistic perspectives and vice versa.
Staff shared with both groups information about the biometric screening events that had taken place in May
and June 2013. Most attendees had not heard about this opportunity and did not know that the screening was
free to the public. Some questioned if a biometric screening would be beneficial to someone who gets a yearly
physical, and staff said it would not. As such, the biometric screening should be aimed at those not currently
receiving regular healthcare. Advertisements emphasizing that the screening is free and that one need not be
a current Riverwood patient to take part could help boost participation. Other suggestions included:
 Sending an e-mail announcing the screening
 Making the screening ambulatory so as to market to employers as an employee benefit
 Resurrecting the health fair, which has not been done for a few years, and adding the screening to it
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CHNA Riverwood Healthcare Center

Offering the screening on different days and times and perhaps weekends. Past events were scheduled
to start at 7:00 a.m. to accommodate fasting for cholesterol screening, but that time is not very
convenient for working individuals.
Staff also spoke about Family Health Manager, another screening tool that is free to the public and can be
followed up with Riverwood’s wellness coaching, also at no charge. Again, most attendees were unaware of
this service and were particularly happy and surprised to hear it was free. Two participants, one from
McGregor and one from Aitkin, were new patients of our Wellness Coordinator and spoke very highly of his
knowledge, caring nature, and listening and motivating skills. Ideas for increased use of the Wellness
Coordinator/Coach as a resource included:
 Health education seminars
 Civic group presentations
 Support group appearances
What services do you think are needed to help people “age in place?”
 Affordable healthcare/services
 Alzheimer’s resources
 Dementia-ready communities
 Caregiver respite care
Other comments:
 There sometimes seems to be a disconnect in communication between the hospital and clinic.
Participants would like to be able to schedule all services on one day.
 There was general agreement that the billing process is confusing. Participants would like to see a
streamlined billing process rather than receiving separate bills from physician, hospital, clinic, lab, etc.
 One participant was particularly frustrated with the phone system. She likes to call the McGregor clinic
and talk to staff members who know her because they are familiar with her health issues. She does not
like the current system in which a call is shuffled from one clinic to another in order to shorten the wait
time to speak with a scheduling representative. This participant would rather be placed on hold to wait
to talk to someone from her home clinic.
 Some attendees were unaware of Riverwood’s farmers market with SproutMN.
Telephone and E-Mail Interviews
Several area community and health industry leaders were interviewed by phone and email to gather their
opinions regarding community health needs identified by the CHNA Core Project Team. Interviewees included:
 Tom Burke, Aitkin County Health and Human Services
 Jan Cherry, ANGELS of Aitkin County
 Kim Clement, Kinship of Aitkin County
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CHNA Riverwood Healthcare Center





Greg Erickson, Garrison Fire Chief
Sue Foster, Garrison City Council
Sarah Johnson, Aitkin Health Services
Tricia Martin, Aitkin County CARE
Ann Schwartz, Aitkin County Habitat for Humanity
The following questions were posed to each interviewee:
These are the health needs identified by the community ranked in
priority order:

Mental health issues and access

Diabetes issues

Heart disease issues

Behavioral health issues

Insurance coverage

Aging issues

Cancer mortality

Dialysis services
Do you agree with these needs and rankings? Why or why not?
Though all participants agreed that items on the list were definite priorities, many disagreed with the order
and, perhaps not surprisingly, ranked issues according to their particular area of work or other viewpoint.
Respondents from both Garrison and McGregor, towns with high retiree-age populations, suggested aging
issues, heart disease and diabetes could top the list. Another issue that kept surfacing as a top-tier item was
the lack of dialysis services and, linked to that, scarcity of transportation for those who have to travel to
Brainerd for dialysis. One participant mentioned that Medi-Van had been in place at one time but is no longer,
and another described Rides for Health as being overloaded with transport requests.
Also at the forefront was lack of insurance coverage in a high-poverty area and the health consequences that
follow: “Some people don’t seek medical help for any of these health needs because it costs too much, or they
feel they won’t get the same quality health care as those who have insurance. This causes people to wait too
long and they don’t receive a diagnosis until it becomes an emergency.”
Mental and behavioral health issues were also consistently ranked high on the list as areas in need of
improvement. One interviewee’s organization turns to Lakewood Health System in Staples for their clients
with mental and behavioral health issues, which is a long way to travel. She said they do have one provider
who comes to their facility for counseling services, but she sees a need for more mental/behavioral health
professionals in their facility. Another participant felt there should be a “one-stop shopping place” for mental
health needs in Aitkin County, and another added that it is a real challenge to get people the help they need.
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CHNA Riverwood Healthcare Center
Of note, one Aitkin respondent said that because there is no mental health center in Aitkin, people assume
there are no mental health services in the community, when nothing could be further from the truth: “Health
and Human Services has developed a service array for use by citizens of the county that includes access to
private clinicians of mental health and chemical health, in-home providers of counseling and skills-building,
and referrals to more intensive treatment options.” Perhaps a working partnership between Riverwood and
Health and Human Services with a focus on publicizing these existing services would be of benefit.
More than one interviewee questioned why mental and behavioral health were listed as separate issues,
envisioning them more as a single entity, unless chemical health was viewed as part of behavioral health.
Chemical/behavioral health issues were viewed as contributors to physical health problems: “People with
diabetes or heart issues might do things to make their conditions worse, or not take care of themselves
because of behavioral issues (I’m thinking alcoholism, drug addiction, smoking, etc.)”
Is anything missing from this list?
Transportation (especially as it relates to dialysis), dementia issues, chemical health, general physical fitness,
and obesity were mentioned as items that could be added to the list of concerns. One interviewee spoke
about her work with Alzheimer’s and dementia patients and their families who are working to keep them
living in their homes. She sees a need for dementia-capable communities and provided information from ACT
on Alzheimer’s (www.ACTonALZ.org), a statewide collaboration preparing Minnesota for the impacts of
Alzheimer’s and related dementias.
How would you suggest these issues be addressed in the community?
Unfortunately, no one interviewed offered a “magic wand” solution. Lack of funding was repeatedly named as
a constant obstacle with no quick fix. General awareness of available resources continues to be a confounding
factor, and “the people who need the information the most are usually the ones who are unaware.”
However, interviewees did offer suggestions to help manage different pieces of the health and wellness
puzzle. As it relates to the general fitness of Garrison citizens, one participant hoped to see more effort by city
leaders and the Garrison Commercial Club to host community events promoting fitness and perhaps to
consider creating a bike trail in the park south of town.
In terms of improving access to mental/behavioral health services – and this could also be extended to other
branches of health care – one idea was to consider the development of telemedicine. Additionally, the
Minnesota Collaborative Psychiatric Consultation Service, a state initiative that allows private physicians to
access psychiatric consultation services for their work with their mental health patients (especially pediatric
patients), was also mentioned as a resource that should be promoted to area physicians.
What is currently in place that could be better publicized and utilized by community members?
One person mentioned the various support groups could be better publicized and utilized. A Garrison
respondent felt their community center was underutilized, though she did recall a group of seniors had used it
for walking at one point. Another was under the impression that Aitkin County Health and Human Services
headed up a mental health coalition of some sort, but she did not know much about it and would like to.
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CHNA Riverwood Healthcare Center
One participant said, “I love [Riverwood’s] marketing program for the prevention. It has been outstanding and
has been a real asset. People are responding and engaged.” Another expressed a sentiment that also came up
at the community meetings: “The resources are out there, but until you need to know about it, who keeps
track of everything?”
What resource gaps presently exist around these issues that should be addressed?
A couple of participants expressed concern about the relatively high rate of people living in poverty in the
county and whether or not they are being reached. One felt that Riverwood’s programs target “middle class
and above, but there is a large number in our community living below the poverty line. That’s where the true
mental health issues are, where the children without proper nutrition and proper medical care are.” Another
participant who works with a lot of low-income seniors reports that many are fairly isolated and withdrawn
from their community: “They don’t get the newspaper; they don’t listen to the radio as much as they would
watch TV. Sometimes the families of seniors need to be targeted, but often our seniors have no family
around.”
Conclusion
The general consensus is that, between Riverwood’s health and wellness offerings and the wider community
resources, the menu of services in the area is fairly comprehensive. However, everyone has a wish list, and
those items have surfaced during this community input and interview process, including dialysis access or
better patient transportation solutions; dementia-ready communities; and additional or improved access to
mental, behavioral, and chemical health resources.
Additionally, this process has brought to light several barriers to service. There is still a portion of the
population that is unaware of the importance of making healthy lifestyle choices, or perhaps some who are
aware but are not ready or able to take the first step. There is also a general lack of awareness of the health
and wellness resources that are available through Riverwood and the greater community.
HBH has identified some areas in which Riverwood can work to create better awareness and encourage
people to become proactive in their own health and wellness journeys, including:




Creating an email list-serve
Building the social networking contact base
Offering health education opportunities in various formats (community seminars, video conferencing,
support groups, etc.), and
Partnering with other local health entities, charitable organizations, and businesses to more effectively
publicize existing services.
Building increased awareness about Riverwood’s two very significant free resources--the biometric screenings
and wellness coaching--could also help make a dent in those perpetual barriers to service including lack of
insurance or financial means, and fear and anxiety around seeking healthcare services.
Included on the next pages are the invitation to the community input session, and the session agenda.
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CHNA Riverwood Healthcare Center
Invitation to Community Input Session
July 5, 2013
[NAME]
[ADDRESS]
[CITY, STATE, ZIP]
Dear [NAME],
As a community leader in the Aitkin area, your opinion is important to us. That’s why we are extending a warm
invitation for you to join us for a 90-minute community input session at 11:30am on Wednesday, July 24 at The
Beanery in Aitkin. Riverwood Healthcare Center has asked HBH Consultants to assist with the session.
We promise to make good use of your time and serve a healthy lunch. We will also gift you with a free pedometer as a
small token of thanks.
The purpose of our time together is to gain feedback from you on your perceptions of health and wellness resources
that are available in your community. You will not be asked to join any committees as a result of participating in this
short session.
Your candid input is extremely valuable to help us identify gaps so that we can continue to enhance the health and
wellness of your community. We very much appreciate your time and are looking forward to meeting with you in person
to learn more about your needs.
Please RSVP to Connie Gretschmann by July 18 at 218-927-2121 or CGretschmann@riverwoodhealthcare.org. Thank
you for considering attending and bringing forth your opinions, experiences and ideas.
Sincerely,
Chad Cooper, CEO
Riverwood Healthcare Center
Community Health Needs Assessment Core Project Team
Michael Hagen, Riverwood Healthcare Center | Shelli Urness, Consultant
Liz Dean, Riverwood Healthcare Center | Judy Turner, Riverwood Healthcare Center|Dan Schletty, Riverwood Healthcare
Center|Jayne Anderson, Riverwood Healthcare Center| Cynthia Bennett, Aitkin County Health Department|Beth Leaf, Aitkin County
CARE| Allison Matalamaki, Riverwood Healthcare Center Board of Directors|John Hodson, ISD #1 | Lisa Kruse, McGregor Community
Education
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CHNA Riverwood Healthcare Center
Agenda for Community Input Sessions
Riverwood Healthcare Center Community Input Session
Monday, July 22, 2013│11:30 a.m. – 1:00 p.m.
Fireside Inn, McGregor
AGENDA
1. Welcome and Overview
 Introductions

Purpose for the session; review the agenda
2. Discussion Questions
 What are the local health and wellness services and resources of which you are aware?

Among these resources, which do you utilize on a regular basis?

What are the barriers to taking advantage of these resources?

How do people learn about the availability of these resources? What more could be done to promote them or
make them more accessible to a greater number of residents?

Are you aware of any particular health or wellness resources that are missing in the community?

What health and wellness services or resources do you access in other communities? Where?

Riverwood intends to make available annual health screenings for community members. Would you participate
in these? Why or why not?

Riverwood is promoting the use of an online web tool that will help individuals and families better manage their
health. Do you think you will utilize this tool? Why or why not?

Are you interested in working with Riverwood wellness coaches? Why or why not?

What is required to make this a community for a lifetime (age in place)?
3. Wrap Up

Final go-around
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CHNA Riverwood Healthcare Center
Communication of Results
The results of the CHNA Assessment process will be made available to the public via several means. Riverwood
Healthcare Center’s Marketing Department will do a news release announcing to the public that the results
are available. They will make the report available online at their website www.riverwoodhealthcareorg, and
via a hardcopy in the Administrative Department at Riverwood.
Strategies for Implementation
The mission of Riverwood Healthcare Center is to provide quality inpatient and outpatient care. The
implementation strategy is designed to address the health care needs of the people of Aitkin County, and their
unique characteristics and healthcare needs. The implementation strategies are based on Riverwood’s current
programming, survey data, and community input. Riverwood’s strategic plan is developed by its leadership
team and reviewed annually. The implementation strategy also identifies how existing and planned Riverwood
services, partnerships and programs will be utilized to help address community health needs.
The implementation strategy for The Health of Aitkin County CHNA is the hospital/community plan for
addressing the community health needs. IRS Notice 2011-52 dictates the contents of an implementation
strategy, and states that the hospital must address how it both intends and does not intend to address the
identified community health needs. Riverwood Healthcare Center’s implementation strategy is described in
this section of the report. We will continue to stay the course and follow our strategic plan. We will create the
future we seek by focusing on six critical strategic goals:
(1) Quality: Our customers are demanding more efficiency, better quality, and superior safety. We will
lead in delivering on these requirements through improved data, reporting and process improvements.
(2) People: Our people are key. We will inspire their trust, improve their skills, and develop leadership and
engagement that leads us into a stronger future.
(3) Care Delivery Model: Redesigning for the care model of the future will ensure readiness in a post
reform world.
(4) Growth: We will grow our primary care services and share of our market. We intend to build the
confidence of our community in their ability and desire to stay local for care and know that when they
need specialized or tertiary care we will make the transition easy.
(5) Technology: We will install platforms and systems that ensure we maximize efficiency, productivity and
support the improvement of quality.
(6) Finance: We will achieve operating margins that ensure long term financial strength and the capacity
to continue to invest for the benefit of patients and families.
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CHNA Riverwood Healthcare Center
In addition we will continue to build community health partnerships and initiatives and programs such as:
Health and Wellness Screenings
Asthma Screenings
Diabetes Seminars
I can Prevent Diabetes Programs
Women’s Health Programs
Grief Support
Continue to pursue a redesigned Care Delivery Model (Medical Home Model)
Explore additional/niche services (dialysis, dermatology, etc.)
Continue to Partner with other providers (CRMC, Minneapolis Heart Institute etc.)
Continue Market Research and Surveys, and CHNA to monitor needs
Investigate transportation Partnerships
Continue to build awareness around our physicians and services to ensure residents stay local.
Continue to recruit/retain more doctors, including female doctors, as needed by 2016(general surgery,
OB/GYN, Orthopedics)
Evaluate ways to grow surgical services
Through the dedication of our board, staff, physicians, and managers, this plan will result in a future filled with
new opportunities and new accomplishments for Riverwood Healthcare Center.
Riverwood’s Addressing of Needs
Riverwood’s implementation strategy will address all the identified priorities. Except on a limited scale, the
strategy will not address the provision of dialysis services due to cost-effectiveness, too few local patients to
cost justify the program, and inability to expand that service line via equipment and staffing.
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CHNA Riverwood Healthcare Center
Riverwood’s Current Services: Allergies & Asthma
o Allergies and Asthma
o Audiology
o Birthing Center
o Breast Health
o Cancer/Oncology
o Cardiology/Heart Heath
o Dermatology
o Diabetes
o Ear, Nose & Throat
o Emergency
o Family Medicine
o Flight Physicals
o Gastroenterology
o Hospital
o Intensive Care
o Internal Medicine
o Maternity/Birthing Center
o Mental Health/Psychiatry
o Wellness Screenings
o Neurology
o Nutrition
o OB/GYN
o Orthopedic
o Palliative Care/Hospice
o Pharmacy
o Podiatry
o Radiology/Diagnostic Imaging
o Rehabilitation
o Respiratory Care
o Sleep Health
o Support Groups
o Surgery
o Urgent Care
o Urology
o Wellness
o Wound Care
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CHNA Riverwood Healthcare Center
Riverwood’s strong focus on health and wellness has been recently augmented by selection for participation in
a three-year program called the Healthy Communities Partnership. The $475,000 grant from the George
Family Foundation and Allina Health has made possible implementation of a community wide wellness
initiative, which includes the services of a full-time wellness coach and a part-time wellness coordinator, all
free to the public.
Conclusion
In addition to specific strategies and mission driven programs, Riverwood Healthcare Center will continue to
build its Patient-Centered Medical Home (PCMH) as it addresses community needs. It is what aligns with the
hospital strategic plan and with the CHNA. We know that the PCMH is not only the wave of the future, but will
positively impact the health of the people of Aitkin County.
RHCC builds evaluative measures and goals into all of its programs and services. In addition, the CHNA plan
will be reviewed and rewritten every 3 years. RHCC’s management team will continue to play a leadership role
in the implementation strategies and monitor its progress, and make adjustments to strategies as needed.
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