Health + Wellness Magazine Summer 2017

▶ Summer Program Listings Inside!

Health + Wellness

Living healthier together.

Summer 2017 | cheshiremed.org

Caring for a loved one with dementia For caregivers in the Monadnock Region, help and support are available through a network of resources.

Medical Center Update

Making Healthy Choices

Health Education & Support

Making a Difference

New health record system is simply better

The importance of taking care of you

Don’t miss this summer’s line-up of programs

The impact of caring in our community

FROM THE CEO/PRESIDENT/CHIEF MEDICAL OFFICER

Cheshire Medical Center Update ORGANIZATIONAL UPDATE

Jason Vallee, Vice President of Patient Experience

A mission of caring grounded in collaboration, innovation, and partnership.

As the 125th anniversary of Cheshire Medical Center approaches this September, I’ve been considering my own history as a physician. My years of practice have seen amazing advances in lifesaving technologies and research, and some of the lessons learned through the years have changed our approach to medicine. In 2005, the American College of Physicians first endorsed the patient-centered medical home model of care as the future of healthcare. And around the same time, the effort to establish easily transferable electronic health records (EHRs) throughout the country began-and continues today. Over the last century, the role of nursing professionals expanded.

Today, our nurses are highly valued colleagues and partners in patient care.

History is made every day, and what I’ve learned is that change is constant. I enjoy discussing the long history of our nonprofit medical center, but I’m even more excited to talk about who we are today. Today we are no longer a “hospital and clinic”, we are one medical center and a proud affiliate of the Dartmouth-Hitchcock Health system.

Today, we use innovative new technologies and systems to provide high quality care close to home. Today, we are as dedicated as ever to our mission of compassionate care for every patient.

As I work alongside our dedicated providers and staff, I am reminded daily what a privilege it is to partner with individuals and families in their healthcare. Sometimes, that partnership includes navigating a difficult diagnosis such as cancer or dementia, and working with a loved one or caregiver as they move forward in their “new normal”.

This issue’s feature story highlights the resources available in our community for those living with dementia and their care partners, as well as tips and resources to maintain personal health and manage stress.

Cheshire Medical Center is committed to the key components of our community’s health and wellness-quality medical care, healthy lifestyle choices, and personal connections. As you review this issue of Health+Wellness, I encourage you to check out the education and support opportunities available, and meet some of our neighbors and colleagues who are choosing to actively participate in seeking ways to live healthier together.

Don Caruso, CEO/President/Chief Medical Officer

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Jason Vallee has joined our administrative team as Vice president of Patient Experience.

This is a new administrative role at Cheshire Medical Center. Jason’s expertise will help insure that as we work to improve our systems and processes to consistently deliver high value, safe, and compassionate care to every patient, every time, that the human experiences involved in that care are at the center of all we do.

“Over the last 10 years, I have had several opportunities to work with many individuals at Cheshire Medical Center in various ways, . . . Joining the team represents an opportunity to work closely with the dedicated, caring professionals at the Medical Center to achieve excellence in the patient experience” said Vallee of his new position.

Prior to joining Cheshire Medical Center, Vallee was the Director of Service Excellence in the Patient Experience Program for the Dartmouth-Hitchcock Health system. His Ph.D. in Human and Organization Systems, coupled with his 20+ years of experience in organizational development in both the for-profit and nonprofit sectors, make him uniquely qualified to lead our organization’s patient experience initiatives.

TECHNOLOGY UPDATE

New Electronic Health Record System: eD-H A commitment to innovation is part of Cheshire Medical Center’s ongoing mission to provide safe, quality healthcare. That’s why this year we are transitioning to a new integrated electronic health record system (EHR), eD-H. The new system will enhance our ability to have up-to-date health records available to all our providers, with easy-toaccess information for every patient.

Currently, Cheshire Medical Center clinicians may work in three or more information systems while caring for one patient. There are multiple manual processes

in place to ensure that information moves reliably from one system to the next. A single EHR across the Medical Center campus, connected with the DartmouthHitchcock Health system, will help to insure critical health information is available when and where it is needed. It will improve the coordination of our care and streamline many of our business activities.

We are excited that once the transition process is complete, the healthcare experience for our patients and their medical teams will be simply better. Additional information about the transition to eD-H is available online at cheshiremed.org/simplybetter-records.

HEALTHCARE SERVICES UPDATE

Team expands at Cheshire’s Center for Dermatology As our population ages and the instances of the various types of skin cancer increase, expanding the Dermatology Team has been a priority for the Medical Center. We are pleased to announce that Katherina Basic, MD, Dermatologist has joined the team at Cheshire’s Center for Dermatology, located on Railroad Street in Keene.

Dr. Basic provides general dermatological screening and care to patients of all ages. She has a special interest in the identification and diagnosis of inflammatory and melanocytic lesions, more commonly referred to as birthmarks, or in some cases “moles”.

Her skills and services include, diagnosing and treating diseases and disorders of the skin such as acne, skin allergies, dermatitis psoriasis, eczema, dandruff, and rashes. She also treats ailments of the skin, such as skin fungus, bacterial infections, and various types of cysts, growths, and skin cancer. Treatments may include the removal of cancerous or unhealthy lesions from the skin in minor outpatient surgical procedures.

The practice of dermatology blends expert medical care with surgical and

cosmetic procedures designed to keep skin healthy. Staff at the Center for Dermatology offer patients the most current dermatological services and many of the most popular cosmetic procedures in a comfortable and convenient facility with state-of-the-art technology.

Otolaryngology Department announces a new ENT physician Cheshire Medical Center is pleased to welcome Michael Stamm, MD to the Otolaryngology Department (pronounced oh/toe/lair/in/goll/oh/jee). Most commonly known as ENT (Ear, Nose, and Throat), the Otolaryngology Department provides medical and surgical treatment of diseases

of the ear, nose, and throat in both adults and children. Physician services include consultation and evaluation of disorders of the head and neck, minor office surgery, endoscopy, and ongoing follow-up care.

With over 24 years of experience in Otolaryngology, Dr. Stamm’s area of expertise is Head and Neck. This specific area of expertise in Otolaryngology treats cancerous and noncancerous tumors in the head and neck such as the nose/ sinuses, mouth, throat, voice box, and upper esophagus, including the thyroid and parathyroid.

Prior to joining the Medical Center, Dr. Stamm practiced at Pioneer Valley ENT Surgeons, LLC in Florence, Massachusetts.

UPDATE FROM THE CENTER FOR POPULATION HEALTH AT CHESHIRE MEDICAL CENTER The Center for Population Health at Cheshire Medical Center (Center) is engaged in multiple efforts to identify and understand the needs of those in our communities who are caregivers and in need of help to locate and navigate resources for someone with dementia. We place high value on communication and social connectedness, which is why the Prescribe for Health program through the Center is so important. The Center’s Population Health Workers establish connections with community members and assist in accessing available resources.

This issue of Health+Wellness addresses important issues related to the increasing number of people with dementia, and the challenges family members encounter to safely maintain their loved one’s quality of life as dementia emerges and progresses.

I learned firsthand, after both of my elderly parents were diagnosed with dementia in the past two years, requiring increasing amounts of healthcare and social support. As their primary caregiver, I experienced uncertainty of what to do and what would be best for each of them. A person with dementia may lose cognitive abilities, but human interaction—talking, touch, a smile—can elicit meaningful emotional engagement which supports their well-being.

Together with other Healthy Monadnock initiative partners, the Center is offering two workshops, featured in the Programs Listing of this issue, designed to educate and support caregivers.

Shawn LaFrance, Vice President of Population Health & Health Systems Integration

Health + Wellness | Summer 2017 3

Cheshire Medical Center FEATURE STORY

Caring for a loved one with dementia:

You’re not alone.

Cheshire County leads our state in the percentage of residents diagnosed with dementia.

More than 15% of the Medicare recipients over age 65 in Cheshire County are living with Alzheimer’s Disease or another form of dementia, greater than both national and New Hampshire county averages.* For caregivers in the Monadnock Region, help and support are available through a network of resources. *(according to 2015 reports from the Centers for Medicare & Medicaid Services)

“M

y mom had a stroke three years ago, when she was 85,” relates Robyn Nattila. “As a result of that she was left legally blind, with diminished hearing, and it started her down the road with dementia.

“Mom was born and has lived in Gilsum her whole life,” Nattila continues.

“She and her significant other have lived in a small house here for many years, and it’s a source of comfort for her.”

But last November—after her mother fell yet again and couldn’t make it up the stairs to bed—Nattila moved in with her temporarily, until her mom was better able to navigate the stairs. Or so she thought.

“I got a good dose of reality when I understood how much she was wandering at night,” Nattila says.

“It would have been easier for me to bring her to my home,” she admits, “but with the dementia, it’s important to keep things consistent and offer her the familiarity of her own home. I want her

days to be as comfortable as they can be.”

Nattila works full time, so she relies on a private company that provides in-home care to tend to her mother five days a week while she’s at work. Nattila is her mother’s primary caregiver the rest of the time.

“My husband is a saint,” she says. “He knows this is something I have to do.”

66,000 caregivers in New Hampshire alone It’s something that tens of thousands of other New Hampshire residents also have to do. The Alzheimer’s Association estimates that, in 2016, there were 66,000 Alzheimer’s and dementia caregivers in our state who provided 75 million hours of unpaid care valued at $954 million.

What’s more, the number of older adults with Alzheimer’s and other forms of dementia will only continue to grow as our population ages—increasing the demand for care. In 2017, 24,000 New Hampshire residents 65 and older are estimated to have Alzheimer’s alone—a number expected

4 Summer 2017 | Health + Wellness

to reach 32,000 by 2025. That’s a 33.3% increase.

In response to this burgeoning need, Cheshire Medical Center has assembled an array of resources for people with dementia and their caregivers (see pages 6-7.)

After an initial diagnosis of dementia from a patient’s primary care provider (PCP), the PCP often will refer the patient’s caregiver to a nurse care coordinator on Cheshire’s Family Medicine team.

A first line of support for patients and caregivers “We’re the first line of support,” explains RN Care Coordinator Sue Szydlo, RN. “I meet with the patient and caregiver as soon as possible after referral. Among the first questions I ask are, ‘Are you safe?’ and ‘Is your loved one safe?’ Are they wandering, unable to manage their medications, falling, trying to drive or use the stove? These are all risks for harm.”

Szydlo then seeks to identify where help is needed—medication management

Families living with dementia can find peace and stability.

or meals, for example, or personal care (dressing, bathing). Or is the person with dementia exhibiting aggressive behavior, depression, or anxiety?

Szydlo also promotes the caregiver support group offered by local partner organization, Home Healthcare Hospice & Community Services (HCS). HCS offers a wealth of community-based supportive services including home care, Meals on Wheels, private-duty services, and medical social work—all aimed at helping people remain at home as long as possible while supporting the caregiver.

“Caregivers often don’t prioritize their own needs,” she says, “which is unfortunate, because how they care for themselves directly impacts their ability to care for their loved one.”

The Castle Center: adult day care, peace of mind for caregivers Another important resource offered

by HCS is the Castle Center, an adult day care facility that offers a Life Enrichment

Program—therapeutic activities tailored to the individual with mild to moderate dementia in a safe, structured setting.

“This provides peace of mind for caregivers who are still working outside the home, and respite for others who just need some time to themselves,” says Catherine Braught, RN, BSN, Director of Customized Care at HCS. The Castle Center is open MondayFriday, 8:00 a.m. - 5:00 p.m., and participants may attend as many days as they wish. A sliding scale fee is available, private pay options, VA benefits, and Medicaid are accepted. Transportation within Keene is also provided.

Geriatrics: a medical specialty focused on older adults Szydlo also refers patients to Cheshire’s Geriatrics team. Geriatrics is a medical specialty that focuses on the unique needs of older adults.

Nattila and her mother were referred to geriatrician Kathleen Miller, MD, who

stresses the need for an accurate diagnosis when patients present with dementia symptoms.

“It’s important to understand whether the patient has Alzheimer’s disease, another type of dementia, or a secondary cause of cognitive changes that may be correctable,” she notes. These diagnostic resources, which include blood work, advanced imaging, and neuropsychological testing, are all available at Cheshire.

“When it comes to treatment, we not only address the dementia itself but also mood issues such as anxiety and depression, and related behavioral issues,” Dr. Miller continues.

It’s a comprehensive approach that makes a world of difference to patients and their caregivers.

“I feel part of a team now” “Once Mom and I started seeing Dr. Miller and her nurse, Jane [Bridges, RN], we were no longer alone,” Nattila says.

“Instead of treating Mom’s symptoms, Dr.

Health + Wellness | Summer 2017 5

Navigating the journey of diagnosing, treating, and living with dementia.* Family members are critical in the diagnosis and treatment of dementia.

They are commonly the first to identify that a person is having difficulty, and the ones to take the first step of bringing their loved one to their Primary Care Provider.

Patient & Family Members PCP

RNCC Geriatrics

The Geriatrics Team assess all aspects of health and wellness as they relate to the treatment of dementia, including the individual’s ability to function day-today, their physical and emotional health, and their social wellbeing. They work in partnership with PCPs to develop treatment and care plans, and insure that patients and caregivers understand the illness and all components of the plans.

Care plans include referrals for support of care givers as well as patients.

HCS

Primary Care Providers (PCP) may be a Family Physician or Internal Medicine Physician, or a Nurse Practitioner (APRN). They are the first line of support, providing a diagnosis and developing a treatment or care plan for someone who may be developing dementia. They lead the Family Medicine team and collaborate with you and other members of your team to address specific health concerns. If a diagnosis of dementia is reached, the PCP may initiate a referral to a geriatrician through the RN Care Coordinator on the Family Medicine team.

RN Care Coordinators (RNCC) are Registered Nurses who work with PCPs on a Family Medicine team. They provide education and support for patients who have special health care needs or a long-term illness, such as Alzheimer’s Disease, and for their caregivers. They provide referrals for care and financial assistance, and can help facilitate the transition to a skilled nursing facility or a nursing home.

They are a communication hub between the healthcare professionals involved in the care plan.

The staff at Home Healthcare, Hospice & Community Services (HCS) work in partnership with Cheshire’s Family Medicine and Geriatrics teams. HCS provides extensive programs and supports for those living with dementia and for their caregivers, including caregiver support groups, visiting nurses, Meals on Wheels, and adult day care.

Miller treated Mom. She doesn’t just look at medications; she looks at the situation holistically to figure out how she can contribute to creating quality of life for Mom. Jane and I speak so often that she recognizes my voice. I feel part of a team now.”

“I’m an advocate for our patients and their families,” says Bridges of her role on that team. “I listen, clarify when necessary, and share information with the health team and community resources in order to get answers for people.”

“Mom is lucky that we have a great support system in addition to her medical care,” Nattila says. “In addition to Mom’s fabulous caregivers, my husband and niece are lifesavers. My niece relieves me one night a week so I can have date night. My

employer has been very supportive with family medical leave and allowing me to work from home when necessary.

“Mom’s partner is extremely good with her,” she continues. “Mom also has some special neighbors who treat us very well, and a church and community that remind her she’s not forgotten. And she has family that visits every week—including a nine-year-old great-grandson who, with a simple hug, makes all of Mom’s issues for the moment just slip away.

“Without all of these pieces of the puzzle falling into place, we wouldn’t be able to do this for Mom,” she adds.

“You don’t think you’ll need these resources until you do,” Braught says, urging family members to not wait until

6 Summer 2017 | Health + Wellness

Additional Resources Included here is a limited listing of local resources for caregivers. Please ask any of the partners listed in this diagram to provide information for additional resources for care and support. *These descriptions are specific to this topic. Services and treatment beyond the care of dementia are provided by the teams and resources listed.

there’s a crisis to seek help. “Understand what’s available, know that you’re not alone, and ask for help when you need it.

That’s why we’re here.”

“And say ‘yes’ anytime someone offers help,” Nattila says. She also offers this advice to others who are caring for a loved one with dementia: “Have patience—much easier said than done. Be flexible—because nothing will ever go as you plan. And celebrate every happy moment!”

Family Medicine at Cheshire Medical Center is your Patient-Centered Medical Home: a coordinated team led by your Primary Care Provider working in partnership with you to provide personalized care. To learn more visit cheshiremed.org/medical-home.

Healthier Together SPOTLIGHT

Teaming up to make a difference in dementia, for patients and their families

“Taking care of dementia patients is truly a team

The comprehensive, patient-centered care of dementia patients requires a collaborative, multidisciplinary approach that recognizes caregivers as key partners on the team. For individuals with dementia and their loved ones, quality of life is improved when healthcare professionals across disciplines and organizations provide a network of support and communication.

Here are some of the team members featured in this story:

effort. No one entity can provide all of the support needed for patients and caregivers.�

- Sue Szydlow, RN Care Coordinator

SOME LOCAL RESOURCES: Comfort Keepers (Keene, NH) 603-352-2227 In-home care for seniors and other adults in need of assistance with daily activities. comfortkeepers.com The Castle Center Life Enrichment Day Program (Keene, NH) 603-355-8281 Adult day care facility offering therapeutic activities tailored to the individual with mild to moderate dementia, in a safe, structured setting. hcsservices.org/longtermcare/castle-center Home Healthcare, Hospice & Community Services (Keene, NH) 603-352-2253 Community-based supportive services helping people remain at home as long as possible; caregiver support groups. hcsservices.org Monadnock Adult Care Center (Jaffrey, NH) 603-352-2427 Structured care during the day to adults with physical, emotion, or social challenges. mfs.org/monadnock-adult-care-center Monadnock Family Services (Keene, NH) 603-357-4400 Offering programs including services for seniors and treatment for individuals and families confronting mental illness. www.mfs.org ServiceLink (Keene, NH) 603-357-1922 Providing services for individuals of all ages and income levels; programs and services such as Information Referral and Assistance, Options Counseling, NH Family Caregiver Program, State Health Insurance Assistance Program (SHIP), and Senior Medicare Patrol (SMP). www.servicelink.nh.gov/locator/keene The River Center (Peterborough, NH) 603-924-6800 Providing assistance and referral services connecting individuals with local, regional and statewide services for issues such as housing, food, family support, disability, legal, physical and mental health, etc. rivercenter.us

Sue Szydlo, RN

RN Care Coordinator, Family Medicine Team C Cheshire Medical Center

Jane Bridges, RN

Department of Geriatrics Cheshire Medical Center

M. Kathleen Miller, MD Geriatrician, Department of Geriatrics Cheshire Medical Center

Catherine Braught, RN BSN

Director of Customized Care Home Healthcare, Hospice & Community Services (HCS)

Health + Wellness | Summer 2017 7

Making Healthy Choices TIPS & TOOLS

Bringing intention and ownership to how we self-care

Advance care planning can lessen stress and be a gift to your loved ones.

Advance Care Planning: It’s not too soon

can plan and prepare ourselves and loved ones for another of life’s major events.

Advance directives are instructions you We plan for the major events in our lives, give regarding your future medical care such as weddings or having a baby. We which becomes effective if you lose your plan for retirement and for decision-making capacity. our children’s educations.

Discussing your endWe even plan for the not The majority of of-life wishes with loved so major events, such as people say they ones is understandably holidays and vacations.

What we don’t generally plan would prefer to die at difficult. Sharing your home, yet only about wishes early, before a crisis, for is the unexpected, such as a sudden illness or serious one-third of adults can help to minimize emotional distress. Even if injury. The very nature of have an advance being “unexpected” explains directive expressing you are young and healthyall adults over the age of 18 why. their wishes for can benefit from having an Hopefully, for many of end-of-life care. advance directive. us, the unexpected illness or (Pew 2006, AARP 2018) Equally important to injury will not occur. But we establishing an advance all age, and are likely to come care plan is sharing it. Written advance to a time when medical care is needed to directives are free, legal documents to sustain our life. What is the plan then?

Having an advance care plan in place, such be shared with family or friends and your healthcare providers, so they can as an advance directive, is a way in which we

8 Summer 2017 | Health + Wellness

understand and honor your wishes. The process helps to define your values and what matters most to you regarding the healthcare choices that may need to be made in the future.

As adult patients, we take for granted that choices related to our medical care are within our control.

However, it is important to recognize that there may come a time when we do not have the ability to make those choices. For example, we may lack consciousness, or our ability to make decisions is diminished due to a form of dementia.

A complication of diseases such as Alzheimer’s is that the person may lack or gradually lose the ability to think clearly. People can live with diseases such as Alzheimer’s for years, so it can be hard to think of these as terminal diseases. It is important to insure there is an advance care plan in place as early in the diagnosis as possible.

The circumstances that surround a major illness or life-threatening injury can create extreme stress for families, often related to disagreements regarding health care decision-making at the end of life. Having an advance care plan in place can lessen that stress, and be a gift to your loved ones as it allows you to specify your wishes while easing the decision-making burden.

To learn more about this important topic, check out the workshop featured in the Programs Listing of this issue; Advance Care Planning: It’s About the Conversation! Starting the conversation can help to establish a plan of your own.

Healthier Together SPOTLIGHT

Setting health goals to reflect our personal values Filling our own tanks when we are taking care of others The word “should” can dominate the day for many caregivers. And although our “shoulds” may include self-care, sometimes our attitudes and habits can marginalize its importance and become roadblocks.

Create movement of these roadblocks with a compassionate self-assessment.

Reflecting on the following questions and considering the importance of holding space for ourselves, giving ourselves permission to focus on personal health and wellness, and seeking the support we need.

■ Do I believe I deserve self-care?

■ Can I take time for myself without feeling guilty?

■ Am I okay with slowing down sometimes?

■ Do I have a routine that includes doing something every week that replenishes me?

■ Am I willing to seek and accept help from others?

■ Do I have a small group of people I can call on for support?

■ Have I been setting appropriate limits in my work and personal life?

■ Do I have opportunities to talk through my dilemmas and concerns with a trusted friend or relative?

■ Do I have a spiritual practice and/or use stress reduction techniques, such as deep breathing or meditation?

■ Am I including exercise in my schedule?

■ Do I generally nourish my body with nutritious food?

■ Am I resting when I am tired?

■ Do I attend to my health care needs, such as getting preventative care and regular checkups?

When it comes to health and wellness, Sonya LeClair embraces a philosophy that is both simple and profound—let what you value as part of a rich and meaningful life be at the center of your goals, and then ask yourself what your body and mind need to be capable of in order to make that possible.

Being able to explore and delight in nature, especially the beauty of this region, is what Sonya holds dear. And those values play a big part in why she’s devoted to Sonya LeClair, The Reluctant Enthusiast working with others to boost their health to enable them to hit the nature trails and enjoy life off the sidelines.

The name of Sonya’s business as a certified health coach, The Reluctant Enthusiast, is inspired by a quote from author and environmentalist Edward Abbey. It reflects her philosophy of wellness that puts less emphasis on looks and more on supporting your body’s ability to do what it is meant to do by taking a sensible and nonjudgmental approach to setting goals.

“Though our weight and body composition are relevant to our well-being, we’ve become so preoccupied with how our bodies look that we’ve forgotten what they do,” says Sonya. “And what they do is provide the one and only vessel we have to experience the world around us. We’re fortunate, in the Monadnock Region, to have so many remarkable outdoor spaces to help us get active, reduce stress, connect with others, and savor extraordinary views.”

As a lifestyle coach for the Cheshire Diabetes Prevention Program (CDPP) at Cheshire Medical Center, Sonya helps provide a supportive environment in which participants learn ways to incorporate healthy eating, moderate physical activity, strategies for stress reduction, and coping skills into their daily lives.

As part of the support she provides her CDPP groups, she posts a weekly e-newsletter to participants, recapping their session and the discussions about the successes and challenges of that week. Each post ends with encouragement for the action plan of the week. A recent post ended with words that reflect her down-to-earth approach, “...Whether it’s putting one of these strategies into action or taking a step back to start tracking some of your triggers so you know where to start-begin wherever you happen to be, in a way that works best for you.”

She strives to live by that wisdom every day. In fact, Sonya signed her business on as a Healthy Monadnock Organizational Champion to remind herself that she deserves the same good care and consideration for wellness that she recommends to her clients.

Learn more about Sonya’s 8-week training program, Zero to Monadnock designed to give you the confidence and endurance to hike America’s favorite mountain at thereluctantenthusiast.com/zero-to-monadnock.

Learn more about the Cheshire Diabetes Prevention Program at cheshiremed.org/diabetes.

Health + Wellness | Summer 2017 9

Health Education & Support SUMMER PROGRAM LISTINGS

Please join us!

Health Education and Support for the Monadnock Region

At Cheshire Medical Center, we believe that the health and wellness of every member of our community matters.

And we are committed to being community partners in support of healthy and resilient living for all.

Please join us for one or more of this Summer’s line-up of programs designed to provide learning opportunities and supportive connections with others on similar paths to optimal wellbeing.

Together, we can be our healthiest.

These classes and programs are brought to you by the Center for Population Health (Center) at Cheshire Medical Center and are part of the many ways we are working to help our community be one of the nation’s healthiest.

Cheshire Medical Center established the Center for Population Health as a department dedicated to guiding and facilitating the implementation of community-based health and wellness projects and policies, integrating our clinical care into these efforts, and providing resources for education, outreach, and support to individuals, families, work-sites, schools, and the community.

The Center for Population Health is part of the Council for a Healthier Community, a group of 30+ individuals representing schools, organizations, coalitions and businesses that oversees the Healthy Monadnock Community Engagement Initiative. All of the Center’s project priorities align with the Healthy Monadnock Initiative and Cheshire Medical Center is a proud member of the Healthy Monadnock Organizational Champions program.

All programs are held at Cheshire Medical Center, 580-90 Court St., Keene, NH unless otherwise noted.

All programs require registration and are free, unless otherwise noted.

If special accommodations are required for you to attend any of our programs, please call The Center for Population Health at (603) 354-5460.

REGISTER Reserve your place by calling

TODAY! 10 Summer 2017 | Health + Wellness

(603) 354-5460 or visiting events.cheshiremed.org.

Summer 2017

Programs

Our Summer programs are listed in chronological order and fall into two major categories: + Healthy Living with a focus on topics that support our overall health

+ Resilient Living with a focus on topics that support our overall wellbeing

Please note if a program is suited for either seniors in our community or families with children.

Icons at the end of listings help you find a perfect fit: S = open to all, but may be of interest to seniors N = special focus on nutrition

+ Healthy Living

Advance Care Planning: It’s About the Conversation!

Jennifer McCalley, MSW, ACHP-SW Program Coordinator, Honoring Care Decisions or Nicole Boudle, RN, and Lori Guyette, RN, Collaborative Care Nurses, Cheshire Medical Center What if a sudden illness or injury left you unable to speak for yourself? Who would you want to speak for you? What would you want them to know about your values and wishes? Advance care planning is a process that helps any adult at any state of health think about your values and goals; consider health care choices you may have to make in the future; talk about your choices with your doctor and your loved ones; and make or update a written plan for the future (advance directive). Join us in a thought-provoking conversation to help make your wishes known. Learn vocabulary, reflect on your values, choose a healthcare agent, explore goals for treatment, and take the first steps toward completing an advance directive. You will have the opportunity to complete or update your advance directive if you are ready, or sign up for a 1:1 meeting with a trained Honoring Care Decisions facilitator for a more in depth conversation. S Choose a date:

+ Resilient Living

Resilient Living Book Group Jennifer Begley and Tom Stearns, Ph.D., Cheshire Medical Center Resilient Living Team Book selection: Self-Compassion: The Proven Power of Being Kind to Yourself by Kristin Neff, Ph.D. It’s time to “stop beating yourself up and leave insecurity behind.” In her book, Neff offers expert advice on how to limit self-criticism and offset its negative effects, enabling you to achieve your highest potential and a more contented, fulfilled life. This book offers exercises and action plans for dealing with emotional struggles, be it parenting, weight loss, or any of the numerous trials of everyday living. Please come prepared having read the book.

Tuesday, August 15 5:30-7:30 p.m.

North Conference Rooms 1 and 2

Tuesday, July 11 4:00-5:30 p.m.

Keene Public Library--Ruth Huntress Auditorium Tuesday, July 25 6:00-7:30 p.m.

North Conference Room 2 Wednesday, August 23 3:00-4:30 p.m.

North Conference Room 2 Tuesday, September 26 12:00-1:30 p.m.

North Conference Room 2

Continued on page 12

Health + Wellness | Summer 2017 11

Health Education & Support SUMMER PROGRAM LISTINGS

Imagine a map of your community where each red dot on this map represents an act of powerbased personal violence (physical or sexual violence, stalking, bullying, child abuse, or elder abuse).

Now imagine adding a green dot in the middle of all those red dots on your map.

Green Dot is a violence prevention strategy, supported by a research grant from the Centers for Disease Control, being implemented in Keene to reduce the incidence of dating and domestic violence, sexual assault and stalking by engaging individuals as leaders and active bystanders who step in, speak up, and interrupt potential acts of violence.

The intent of Green Dot is to stimulate changes in the community’s culture to ensure that power-based violence is not tolerated and that everyone has a role in working toward that goal. The effort includes empowering bystanders, using social media and community events to communicate the community’s values.

● A green dot is any action that promotes safety for all our citizens and communicates utter intolerance for violence. ● A green dot is pulling a friend out of a high risk situation, displaying an awareness poster in your room or office, or putting a green dot message on your facebook page. ● A green dot is striking up a conversation with a friend or family member about how much this issue matters to you. ● A green dot is simply your individual choice at any given moment to make our world safer. How many green dots will it take to make a difference and begin to outnumber and displace those red dots?

+ Healthy Living

+ Healthy Living

Carolyn Crane, Green Dot Trainer What can you do to end violence in our community? We all play a role in preventing personal violence. Join us for this overview of the Green Dot Program to learn more about how you can become part of the solution and how to recognize the behaviors that may constitute sexual assault, dating violence, or stalking as well as how to effectively intervene.

Carolyn Crane, Green Dot Trainer This 5-hour Bystander Training is designed to equip participants with the necessary connection, knowledge, and skill to increase their proactive and reactive bystander behaviors. Appropriate for anyone age 16 and over, the training uses video, role-plays, and other exercises to maximize the level of engagement of participants and help them apply the concepts in the curriculum to their own lives and practice the skills they need to be proactive bystanders.

Lunch and snacks will be provided.

What’s Your Green Dot?

Tuesday, August 15 5:30-7:00 p.m.

Auditorium A The Green Dot initiative invites you to become part of the community solution to preventing power based personal violence.

To learn more, register for one or both of the workshops listed above or visit facebook.com/keenegreendot.

12 Summer 2017 | Health + Wellness

Green Dot Bystander Training

Saturday, September 23 9:00 a.m.-3:00 p.m.

North Conference Room 1

Summer 2017

Programs + Healthy Living

“Cholesterol Park” Rudy Fedrizzi, MD, Center for Population Health at Cheshire Medical Center Cardiovascular disease is the number one cause of death in the United States. Cheshire County is no different with more than 150 residents of the Monadnock region dying each year from heart disease and stroke. However, it is important to know that many of these conditions are preventable. By eating healthier foods, being more physically active, avoiding tobacco and excessive alcohol, and following medical advice, including taking medications correctly, you can extend the length and quality of your life. Join us for this fun-filled game designed to raise your health and well-being by setting simple health goals and working in partnership with your healthcare provider. Participants will receive an informative health guide to take home that reinforces the game’s activities. S N Thursday, August 17 3:00-4:30 p.m.

North Conference Room 2

+ Healthy Living | Family & Parenting

Bedtime Blues

Jamie Champney, Certified Human Behavior Specialist Are most nights a challenge to get your children to settle down and go to bed? If so, you are not alone. Technology, busy schedules, societal and social demands, and work commitments are all barriers to a consistent and successful bedtime routine.

This session will provide helpful ways and strategies to create a calm, soothing environment to help guide you toward creating and maintaining a bedtime routine for your family.

Tuesday, August 22 6:00-7:30 p.m.

North Conference Room 1

Continued on page 14

Health + Wellness | Summer 2017 13

Health Education & Support SUMMER PROGRAM LISTINGS + Healthy Living

Healthy Living with Diabetes: Self-Management Training Patti Schuman, RDN, LD, CDE, Cheshire Medical Center Learn more about diabetes—each session covers different aspects of diabetes self-care, including but not limited to diabetic complications and how to avoid them, what to eat, activity and diabetes control, stress management, and goal setting. Get practical self-care tips along with support and suggestions from others with diabetes. Spouses and significant others are encouraged to attend. S N Call 354-5454 ext. 3815 for more information or to register.

Preregistration is required.

4-week series: Tuesdays, September 12*- October 3 9:00-11:00 a.m.

North Conference Room 2 (*first meeting will be in Central Conference Room 6)

+ Healthy Living

Understanding and Responding to Dementia-Related Behaviors Melissa Grenier, Regional Manager, Alzheimer’s Association, MA/NH Chapter During the stages of dementia, the person diagnosed often will experience changes in behavior that can be confusing for a caregiver. Behaviors are a form of communication and are essential to understanding the needs of the person with dementia. Attendees will learn to identify common triggers for behavior changes, assess and identify challenging behaviors, and understand strategies to address common behaviors. S Thursday, September 14 10:00-11:30 a.m.

Auditorium A

+ Healthy Living

How to Lower Blood Pressure Naturally!

Patti Schuman, RDN, LD, CDE, Cheshire Medical Center Did you know that high blood pressure can silently damage your heart, brain, and kidneys for years? Learn how to choose and prepare nutritious foods that taste good while increasing your chances of lowering or eliminating the need for blood pressure medication. N Thursday, September 21 1:00-2:00 p.m.

Central Conference Room 6

+ Healthy Living

First Steps in Preventing Type 2 Diabetes Registered Dietitian/Diabetes Educator and Exercise Physiologist,Cheshire Medical Center During this free one-hour informative program learn what steps can be taken to delay or prevent the onset of type 2 diabetes. Practical tips are provided. S N Monday, September 25 1:00-2:00 p.m.

Central Conference Room 6

+ Healthy Living | Senior Connections

Senior Medicare Patrol

Kim Lauer, Senior Medicare Patrol (SMP) Counselor, Monadnock ServiceLink Medicare fraud, errors, and abuse can all result in higher out-ofpocket costs. Learn how to protect, detect, and report suspected errors, fraud, or abuse to protect you and other people from becoming victims and help save Medicare dollars. S Thursday, September 28 6:00-7:30 p.m.

North Conference Rooms 1&2

+ Resilient Living | Family & Parenting

Compassionate Parenting

Sherry Jennings—Early Childhood Educator; Conversation Coach; Nonviolent Communication Facilitator Would you like to model for your children the peace and compassion you want them to bring to the world? There are skills to be learned to bring these dreams into reality, to transform challenging moments into ones filled with joy, calm, hope, and caring. Join us to learn new ways to speak and listen compassionately so that you can create the harmony, connection, and aliveness in your family.

Tuesday, September 19 5:00-6:30 p.m.

Auditorium A

14 Summer 2017 | Health + Wellness

REGISTER TODAY!

Reserve your place by calling (603) 354-5460 or visiting events.cheshiremed.org.

Summer 2017

Programs Ongoing Programs and Support Groups

Cheshire Medical Center offers a variety of ongoing programs and support groups. To learn more about these offerings, including contact information, visit www.cheshiremed.org/health-wellness.

Ongoing Programs

Prenatal Education Classes

• Cardiac Rehabilitation—Phase II (Physician referral needed) • Pulmonary Rehabilitation (Physician referral needed) • Tobacco Treatment Programs for Adults • Family Resource Counseling Program

Visit cheshiremed.org for applicable fees or call (603) 354-5454 ext. 8388.

• Childbirth Education 4-Week Series • Childbirth Express Class • Beyond Birth - Caring for Baby • Breastfeeding 101 • Introduction to Baby Wearing • Keeping Baby Safe • Prenatal Yoga • Prenatal Aquatic Exercise Class • Prenatal Smoking Cessation Education and Support Group

Support Groups • • • • •

Cancer Support Group Prostate Cancer Education and Support Group Parent Networking Group Talkin’ Diabetes Discussion Group Tobacco Free or Trying to Be Support Group

Senior Connections • Senior Passport Program (Discount meals at the Art Nichols Café for senior citizens 60 years and older) • Cheshire Walkers Program

1892-2017

E

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YEARS OF CARING

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Sibling Class “Moms” Club Mom & Baby Exercise Class Breast Pump Rentals and Car Seat Checks

Celebrating our Elliot and Cheshire Babies

SHIR E

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Postpartum Classes Resources

AL CEN

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Were you born at Elliot Community Hospital or Cheshire Medical Center?

Please share your baby photo for a special anniversary display!

Email photos to galexander@cheshire-med.com, or make and leave a copy of your photo at the Volunteer Services department at the Medical Center, MondayFriday, 8 am to 4:30 pm. Please include the baby’s name and year of birth.

Health + Wellness | Summer 2017 15

Making a Difference NEIGHBORS HELPING NEIGHBORS

Cheshire CareGivers make a local impact Bald is Beautiful fundraiser helps local cancer patients For many participants, going into work or school on the Monday after the Bald is Beautiful event prompts both cheers and questions.

And often they explain that their newly shaved heads are gestures of solidarity with loved ones who are currently in or have completed cancer care, or as a memorial to someone special.

But that’s not the only reason nearly 100 people participate by shaving their heads, donating their hair, or fundraising.

They do it to make a difference in the lives of others in this community by supporting the Patient Relief and Cancer Care Funds.

William Robinson participated this year for the first time. A graduate of Keene High School, he had seen students and staff participate at the school’s Bald is Beautiful event for several years, but had never

shaved his head. However, this past April, William’s mother, Felicia, passed away from cancer. In her memory, William raised over $1,300 and shaved his head.

Funds raised by William and other participants support the Patient Relief Fund, which provides financial assistance to local patients receiving care at the Kingsbury Pavilion who have difficulty covering daily living costs like gas, heating fuel, and groceries. It also supports the Cancer Care Fund, which funds equipment and items at the Kingsbury Pavilion, such as television monitors for chemotherapy infusion chairs and blanket warmers.

Recently, a local patient with cancer needed a chest tube while in her final days of hospice care. Her insurance stopped paying for the device required to drain her lungs to make her breathing easier. The Patient Relief Fund helped assure that she had what she needed to stay at home and be comfortable.

This year, funds raised by Bald is Beautiful totaled $32,000, proving that bald

William Robinson, Keene Sentinel 2017 Readers’ FUNDRAISER Choice Award

2017 Bald is Beautiful participant

16 Summer 2017 | Health + Wellness

is not only beautiful-it’s generous and caring. We thank all who contribute and hope you will consider joining us for next year’s 10th anniversary event on Saturday, May 5, 2018.

10th annual Sports Medicine 5K benefits local schools and families For ten years, members of our community have lined up each Spring for the Annual Sports Medicine 5K Walk/ Run & Kids’ Fun Run. They are there for the exercise and for a chance to test their abilities, but also to help ensure that we can treat our local student athletes with state-of-the-art rehabilitation equipment and supplies to prevent and treat injuries, including access to ImPACT computerized concussion testing.

ImPACT testing is utilized as part of Cheshire Medical Center’s Sports Medicine Department’s head injury care plan provided to local student athletes.

Each year, Sports Medicine’s Certified Athletic Trainers (ATCs) go through the sports rosters at local schools to determine which student athletes need a baseline test.

“When or if an athlete sustains a concussion, our ATCs put the athlete through the ImPACT computer test again and compare post concussive results to baseline results,” says Kelsie Hennessey, MSEd, ATC, N.H.LAT, Sports Medicine Lead, “This gives us measurable data on brain function that is often not visible comparatively to a musculoskeletal injury.

After test results have been evaluated by our licensed healthcare professionals, we use international guidelines to return our local athletes to play and school. With the ImPACT computerized testing and return-

Healthier Together SPOTLIGHT

to-play guidelines, we feel we are putting our concussed athletes back to play and school in a safe manner.”

This year’s event raised over $11,000 to benefit the Sports Medicine program. We would like to thank all the participants and volunteers and encourage you to save the date for next year-Saturday, April 14, 2018.

Rose, the Border Collie brings her calm, cheerful energy to patients and visitors as a pet therapy volunteer

“I am very thankful for the ImPACT testing.

My daughter’s first concussion was a mild one. After the shock of the collision wore off she had no visible symptoms. It seemed minor, but the comparison to her baseline scores didn’t allow her to return to the basketball court for two days. I learned once your brain has suffered trauma, it is more easily injured, so it’s important to fully recover.

Her second concussion that same season was severe. Her lasting symptoms included dizziness and sensitivity to lights. She could only do a few minutes of homework and could not handle TV, mobile devices, or noise. After two days she went back to school, but still had to leave classes often to lay in the dark in the nurse’s office. It took 14 days before her ImPACT scores matched her baseline.

My advice to parents of active children: have their baseline done and help them keep their recovery in perspective—a few days or even a few weeks of not being able to play while their brain recovers is far better than the potential long-term damage.”

– Parent of Former Keene High School Student Find out more about concussions and what you can do to protect our children and teens from brain injury, go to cdc.gov/HEADSUP.

To learn more about the various ways you can support the care of patients in our community, visit CheshireHealthFoundation.org.

I am a CHESHIRE CAREGIVER!

The sight of a friendly, four-legged canine friend walking through the halls at Cheshire Medical Center is sure to turn heads. Smiles greet the wagging tail and blue bandana of one of our certified pet therapy dogs, ready to go to work.

And whether it’s providing TLC at the bedside of a patient, greeting visitors with a toothy grin, or providing a little comic relief to the staff, Rose loves to help others by volunteering alongside her human companion, Liz Shaw.

“Although Rose lives on a farm with over 40 sheep, she is a flunk-out sheepdog because she likes people more than she likes sheep-which makes her ideally suited for therapy work.” says Liz,“Therapy dogging and visiting people are her favorite activities. Playing with puppies comes in a close second. She’s so good at it that friends from far and wide bring their puppies to her because she is so kind and patient with them.”

Research has shown that the love and affection that therapy dogs like Rose provide can help reduce stress, make social connections, invite conversation, or give the profound healing of touch. They are all specially trained and registered as pet therapy dogs and our volunteers are selected and screened based on their attentiveness, good health, affection, and sensitivity to people.

Please join us in thanking Rose and her fellow volunteers for the many ways they help us live healthier together.

To learn how you can become a volunteer at Cheshire Medical Center, contact our volunteer office at (603) 354-5499.

Health + Wellness | Summer 2017 17

Making a Difference NEIGHBORS HELPING NEIGHBORS

Career and caregiving: a balancing act Employers are recognizing the benefits of adopting policies that support flexible schedules

“When an employer can find creative ways to support the needs of staff and their families, then they offer more than a job for an employee.

They’ve created a supportive work culture, and that goes a long way for employee well-being, morale, and retention.”

Maryanne Ferguson, Center, stands with a group of Monadnock Collaborative/Pilot Health staff.

Employees are often caught between providing care for a loved one and keeping up with work commitments. For some, being a caregiver is a conscious choice and commitment to a loved one, for others, it evolves over time as an illness takes hold in someone’s life.

Jen Seher, an employee at Monadnock Collaborative, found herself in the role of caregiver unexpectedly when her father was in a serious accident. But because the organization allowed her to telecommute, the impact on operations was greatly reduced.

“By working remotely, I could maintain communication with my staff and keep my program on track,” said Seher, adding that the support of her organization allowed her to prioritize personal obligations and professional responsibilities without stress.

More and more employers are recognizing the benefits of adopting policies that support flexible schedules. Flextime has been shown to boost productivity while supporting employee well-being.

Maryanne Ferguson, Executive Director of Monadnock Collaborative/Pilot Health, adopted a policy for flextime because she feels it is best for the organization.

“Offering flextime supports our organization’s most valuable assetour staff. The service we provide often requires our staff to meet with community members during regular business hours, not unlike the work of many other businesses. This can create challenges for flextime policies. But when an employer can find creative ways to support the needs of staff and their families, then they offer more than a job for an employee. They’ve created a supportive work culture, and that goes a long way for employee wellbeing, morale, and retention. We’re really a family here, and our staff recognize that we have their best interests at heart-both at work and at home.”

Monadnock Collaborative/Pilot Health employs approximately 25 people and serves the community by connecting individuals

18 Summer 2017 | Health + Wellness

- Maryanne Ferguson, Executive Director of Monadnock Collaborative/Pilot Health

with resources and assistance to overcome challenging circumstances. Flextime is only one of the variety of ways they support the health and wellness of their employees.

Healthy Monadnock Organizational Champions Program Flexible schedule policies are an important aspect of worksite wellness. Worksite Wellness Advisors are available to assist Organizational Champions to development policies and environments that support the wellbeing of their employees.

For more information, please contact worksitewellness@cheshire-med.com.

Monadnock ServiceLink While caregiving for a loved one may be one of the most important and rewarding roles anyone can undertake, it may also be the most difficult.

Monadnock ServiceLink offers support groups and resources for Caregivers.

Please contact 603-357-1922.

Healthy Monadnock:

Making the healthy choice the easy choice!

When nutritious options are more available to us, it is easier for us to choose them. The Farm to Family Buying Club does just that.

In partnership with Cheshire County Conservation District and Monadnock Menus, Keene Housing has made it easy for residents to procure and buy the freshest produce and farm products at prices that are often lower than they would be in a retail setting.

Pictured: Jori Johnson of Keene Housing with Kelly White and Tracy Lake from Monadnock Menus, the local food procurement and delivery service for the Farm to Family Buyers Club, at Keene Housing’s Forest View Apartments on delivery day.

“When you see or hear the appreciation of a resident receiving a basket of fresh, local produce, something they might not otherwise have had the ability to go out and get, you know you are providing a needed and impactful service.”

-Jori Johnson Manager of the Farm to Family Buying Club at Keene Housing

As Healthy Monadnock Champions, we support making the healthy choice the easy choice in the places we live, learn, work, and play.

For more information on becoming the healthiest community, visit healthymonadnock.org.

healthymonadnock.org healthymonadnock.org

COMING THIS NOVEMBER!

Improved patient-centered care with a new integrated electronic health record system. [ In other words, simply better health records. ] Simply complete myD-H patient portal

“

Our patient-centered team-based model of

Simply streamlined billing and payment options Simply supported team-based approach

care is successful in delivering personalized care because of our collaborative partnerships. This new system will support our communication, providing seamless sharing of information with our patients

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and our colleagues.

-Troy Chaput, LPN Cheshire Medical Center Pediatrics

This new system will enhance our ability to have up-to-date health records that are available to all our providers, with easy-to-access information for every patient.

Learn more at cheshiremed.org/simply-better-records.

Caring for the health and wellness of our community for 125 years and counting. cheshiremed.org