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Health + Wellness

Living healthier together.

Winter 2018 | cheshiremed.org

Special Issue: 2016-2017 Report to the Communities of the Monadnock Region

Medical Center Report

Making Healthy Choices

Health Education & Support

Making a Difference

A year in review and a strategic plan for the future

Taking care of your brain

Don’t miss this winter’s line up of program

Volunteer doulas, making a difference one birth at a time

WINTER PROGRAM LISTINGS INSIDE!


2016-2017 Report to the Communities of the Monadnock Region

Reflecting on a year of living healthier together, here in the Monadnock Region. It was a big year for our community medical center. The updates and headlines from the previous months are reminders of our relentless commitment to meeting the health and wellness needs of the Monadnock Region. The core belief that the health and wellness of every member of our community matters fuels our mission and our goals. Last year, we developed a 3-Year Strategic Plan to ensure sustainable, high value care, into the future. You will find an overview of this plan on page 11 of this issue. Priorities of the plan include fostering new partnerships and increased connections in our community; creating an exceptional experience for patients and their family members as they receive high value care; supporting resiliency for the physicians and staff at Cheshire Medical Center; and ensuring that Cheshire remains a viable and sustainable medical center for the Greater Monadnock Region. Our affiliation with the Dartmouth-Hitchcock Health System has changed more than our logo. In the past year, we launched new technologies such as TeleICU, allowing us to care for sicker patients close to home, and a new health record system to streamline and improve the communication of patient information on our campus and with our Dartmouth-Hitchcock Medical Center affiliate partners. Dr. David Finley, Thoracic Surgeon, and Director of the Comprehensive Thoracic Oncology Program at Dartmouth-Hitchcock Medical Center now provides pre- and postoperative care for patients of the Norris Cotton Cancer Center at Kingsbury Pavilion. These are just a few examples of the ways in which our partnership with the larger health system is expanding care close to home. As a Patient-Centered Medical Home, we understand the power of partnerships. Our teams work together with patients and their families, and flex to include additional services to address individual patient’s needs. For over 125 years, we have been partnering with our community to provide compassionate care. We are committed to working with our community partners to address population health and wellness issues and collaborate on solutions. Turn to page 15 to see examples of how our programs and services align with and support the Healthy Monadnock community health engagement initiative. This special Report to the Community issue of Health + Wellness magazine profiles a sampling of the services and programs supporting the health and wellness of patients in the Monadnock Region, and celebrates all the individuals and partnerships that bring them to life.

Don Caruso, CEO/President/Chief Medical Officer

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WORKING TOGETHER FOR THE HEALTH + WELLNESS OF OUR REGION

Here at Cheshire Medical Center We are dedicated to being a sustainable regional healthcare resource focused on high value care, delivered close to home, with compassion for every patient every time.

“

We are committed to collaborating with community partners in the advancement of healthy and resilient living for the populations we serve.

The core belief that the health and wellness of every member of our community matters fuels our mission and our goals.

�

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2016-2017 Report to the Communities of the Monadnock Region

Partnering to address the barriers to living healthier.

Patient-centered care that goes beyond the examination room. Research has revealed new understandings of the drivers of good health. The prevention of chronic diseases is closely linked to lifestyle and environment. Stress, poor nutrition, and social isolation are but a few of the challenges to wellness. Here are a few examples of ways in which physicians and providers are taking a broader view of treating patients with supports through the Center for Population Health at Cheshire Medical Center.

An unconventional “prescription” program Cheshire Medical Center’s pilot program, Prescribe for Health, serves as a bridge connecting healthcare with patients’ social and environmental needs. In addition to quality medical care, researchers define education, jobs, family stability, safety, access to healthy environments, wholesome food, and physical activity as principal components of better health. Through the Prescribe for Health program, Cheshire physicians and providers can identify patients’ areas of need and engage one of the Population Health Workers at the Medical Center. The knowledgeable and compassionate population health workers assist patients in accessing available community resources. Integrating medical care with addressing unmet social needs means truly comprehensive care for patients.

Help leveraging options when the cost of medicine becomes a hindrance For some patients, the cost of long-term prescription medications causes financial hardship. Cheshire’s Medication Assistance Program Coordinator works in partnership with Cheshire physicians and providers, and pharmaceutical companies to help patients access the medications vital to their continued good health. Patients referred to the program by their Cheshire healthcare provider, receive help navigating the complexities of qualifications, financial requirements, deadlines, and fulfillment times. “I work closely with the prescribing physicians,” says Hayley Compos, Medication Assistance Program Coordinator. “I research free options offered through the drug companies’ assistance programs, and the prescribing physician will review with me

As Population Health Workers, we meet people

where they’re at, keeping them in the driver’s seat as we build trusting relationships together. We may first meet a patient to help with resources for transportation to medical appointments or to provide assistance with paperwork to establish more secure housing. That same person may later share that some costly medications are not being covered by their insurance, or that they are feeling a bit lonely and isolated. Then we have opportunities to help further. - Tracy Clark, Population Health Worker, Prescribe for Health, Cheshire Medical Center

Population Health Workers James Duffy and Tracy Clark help patients to access local resources to support their health and wellbeing.

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WORKING TOGETHER FOR THE HEALTH + WELLNESS OF OUR REGION

One of the most frustrating aspects of my job is when patients can’t afford medications they desperately need to maintain or improve their health. So, it’s a wonderful thing when a patient qualifies for one or more medications through the Medical Assistance Program, because I know they are going to get quality medications in a consistent and timely fashion. Hayley does an awesome job making this happen.

- Donald Mazanowski, MD, Family Medicine Team B, Cheshire Medical Center to determine if the medication is appropriate for the patient’s medical needs,” says Compos. “Sometimes, the patient’s condition doesn’t allow for an alternative, or the patient doesn’t meet the pharmaceutical company’s financial guidelines.” Pharmaceutical company financial assistance programs support uninsured patients. However, many patients are under insured and are challenged by the cost of medications. Compos will work with patients to leverage cost reducing options to ease the financial burden. Learn more about the Medication Assistance Program at cheshiremed.og/ medication-assistance.

Prevention, delay, or control: The Diabetes Care Network offers resources and supports The Diabetes Care Network is available with resources and supports to help individuals in the Monadnock Region prevent or manage their diabetes. Among the supports available are: appointments with a registered dietician to provide individual nutrition therapy with personalized meal plans to fit your lifestyle; Appointments for oneon-one instruction with a Diabetes Care Nurse to help set you up for success with the knowledge and skills you need to properly manage your diabetes; an informal monthly support group, Talkin’ Diabetes, led by qualified facilitators;. and the Healthy Living with Diabetes Self-Management training, a series of four 2-hour sessions providing an overview of important diabetes self-management topics, including nutrition, medication, monitoring blood sugar, stress, activity, and preventive care. View the Winter program listing for dates, times, and registration information.

Hayley Compos, Medication Assistance Program Coordinator and Donald Mazanowski, MD, Family Medicine Team B.

Tobacco users can overcome addiction with programs and resources to help More than 50 years ago, the Surgeon General of the U.S. Public Health Service declared smoking is hazardous our health. Over the following decades countless studies have corroborated and expanded on the claim, attributing millions of deaths to smoking. So why do people still smoke? The simplest answer is: because for most people, quitting is really, really hard. The good news is, for those ready to quit, supports and resources are available through the Cheshire Coalition for Tobacco-Free Communities. The Coalition sponsors a broad range of treatment programs for those in Cheshire County who wish to quit using tobacco. Supports like free one-on-one counseling, assistance with nicotine replacement therapies like patches and gum, and tobacco education and support groups. Kate McNally, MS, CTTS, Program Manager for the Coalition for Tobacco-Free Communities, understands the barriers that tobacco addiction creates and the challenges to quitting. On February13th, McNally will host a special pre-Valentine’s Day event for the loved ones of tobacco users, providing education and a better understanding of addiction, as well as strategies to help their loved one quit. Find a full description of the session in the Winter program listing. To learn more about the Coalition and to view a recent video interview with Kate McNally and Keith Clark, participant in the Tobacco Treatment Program at Cheshire Medical Center (see photo on page 14), visit health-wellness.cheshiremed.org/ tobacco-free.

Visit cheshiremed.org/diabetes to learn more about the Diabetes Care Network.

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2016-2017 Report to the Communities of the Monadnock Region

Paying it forward.

Her experience as a Breast Care Center patient prompts Jan Ray-Thompson to join care team.

Having been through the experience in such a positive way, I wanted to help other folks facing a similar diagnosis.

-Jan Ray-Thompson, OT

Jan Ray-Thomspon, OT, stands with some of her colleagues of the expansive multidisciplinary Breast Care Center team at Cheshire Medical Center. For a complete listing of Breast Care Center roles and associated skilled and caring professionals, visit cheshiremed.org/breast-care-center.

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When occupational therapist Jan Ray-Thompson, OT, was diagnosed with breast cancer in June 2016, she was so impressed by the care she received at the Breast Care Center at Cheshire Medical Center, six months later she joined the care team, becoming the rehabilitation team representative. “From the day my primary care physician confirmed the lump I felt in my breast and was able to schedule a mammogram right away, through surgery, chemotherapy, radiation, and physical therapy, every single person who cared for me was just incredible,” Ray-Thompson relates. “They not only were kind and considerate, but their knowledge and expertise were so reassuring. And everything I needed was right here. “They were my team,” she adds, “always there to quell my anxieties, answer questions, soothe my anger. We laughed together a lot, too. Having been through that experience in such a positive way, I wanted to help other folks facing a similar diagnosis.” This sense of partnership—between the care team and patients, as well as within the team itself—underscores why Cheshire’s Breast Care Center earned a full three-year accreditation from the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons.


WORKING TOGETHER FOR THE HEALTH + WELLNESS OF OUR REGION

“I help patients navigate through the care process as seamlessly as “NAPBC accreditation means we have met rigorous national possible, ” explains Kimberly Whitaker, RN. “That can mean meeting standards for providing high-quality breast care,” explains Harrison with the patient right after a concerning mammogram to make a plan E.G. Burman, MD, surgeon and Medical Director of the Breast Care for further imaging or set up an appointment with a surgeon. It can Center at Cheshire Medical Center. These standards ensure that mean addressing a lack of transportation to and from treatment, the patients have access to: need for language interpretation, or financial counseling. Or maybe • A full range of state-of-the-art breast care services someone is alone and could benefit from talking to a counselor. • A multidisciplinary team approach to coordinate the best treatment Education is also a big piece of what I do. options “From diagnosis through treatment to • Information about clinical trials and new survivorship can be a long road,” she adds. “I treatment options can be a resource to help them through this • And, most importantly, quality breast care very difficult time.” close to home “The coordinator’s role is an integral part “More than 20 providers—including of our program,” Dr. Burman notes. “Patients radiologists, radiation oncologists, surgeons, have a single person who’ll guide them, medical oncologists, rehabilitation staff, answer questions and ensure they never feel nutritionists, and social workers—came alone. It frees them to focus on treatment together to ensure that patients in this region and getting well, instead of managing the have access to this comprehensive level of logistics of it all.” breast care, in one convenient location,” “The role of Care Coordinator was so Dr. Burman continues. valuable to me,” Ray-Thompson affirms. “The treatment of breast cancer has “I may understand medical terms because evolved over the years and it is more crucial of my training, but she understood what I than ever to have this multi-modality team was going through, and she was my go-to approach,” says Hematologist-Oncologist whenever I had a question.” Arvind K. Randhawa, MD. “Because all Now, Ray-Thompson is helping to these specialists are available in the same answer questions for other patients, -Harrison E.G. Burman, MD, Surgeon hospital, patients don’t have to worry about specifically with regard to lymphedema, a and Medical Director of the Breast Care consolidating their care.” Center at Cheshire Medical Center potential side effect of breast cancer surgery “By establishing a coordinated group of and radiation therapy that can appear in practitioners from multiple disciplines, we’re some people in the months or even years making sure patients with breast disease are guided along their after treatment ends. journey and getting the care they need, when they need it,” Dr. “I meet with patients in the hospital the day after they have Burman says. surgery and provide education about how to recognize and manage “Through the multidisciplinary team, treatment also addresses lymphedema,” she says. “We also have a physical therapist on our more than the disease,” notes Robert S. Pritchard, MD, MS, team who provides outpatient care for this, and I serve as a liaison Medical Director of Norris Cotton Cancer Center-Kingsbury when survivors need this service.” Pavilion-Keene. “We are caring for the whole person. Patients and Everyone agrees that having someone like Ray-Thompson on the their caregivers receive the highest quality of personalized care and care team further enhances the Center’s capabilities—and capacity attention during and beyond the diagnosis of breast cancer.” for compassion. “Our providers have always delivered excellent breast care,” “Having been through it, I can provide tips on what helps, Dr. Burman adds. “The NAPBC accreditation gives patients even and pay it forward to others who are walking a mile in my greater confidence that they’re receiving world-class care, right in Birkenstocks,” she says. their own backyard.” The role of Breast Care Coordinator is a linchpin of the team’s Learn more about the Breast Care Center at Cheshire Medical Center at cheshiremed.og/breast-care-center. effectiveness.

NAPBC accreditation “means we have met

rigorous national standards for providing high-quality breast care, ensuring that patients in this region have access to a comprehensive level of breast care, in one convenient location.

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2016-2017 Report to the Communities of the Monadnock Region

Cheshire’s Sports Medicine & local school nurse

Teaming up for Keene High School athletes

Food for thought (and body)

Creating a culture of healthy eating Healthy eating and access to wholesome foods are cornerstones of health and wellness. Cheshire Medical Center, together with partners in our community, creates opportunities for people of all ages in the region to enjoy the value of healthy foods.

High quality meals and the Senior Passport Program make the Art Nichols Café a great option

Keene High School nurse, MaryAnn Boyton, BSN,RN with Cheshire Medical Center’s Sports Medicine Athletic Trainers, Ali Bower, MAT, ATC, CAFS, CPT and Kelsie Hennessey, MSEd, ATC.

An innovative partnership between Certified Athletic Trainers from Cheshire Medical Center’s Sports Medicine program and the nurse at Keene High School (KHS) is helping to ensure that student athletes stay as safe and healthy as possible—on and off the field. “We’re on the sidelines for all home contests at KHS (as well as at Monadnock and Fall Mountain regional high schools), providing on-site assessment of any injuries to ensure appropriate management from the outset,” explains Kelsie Hennessey, MSEd, ATC, the Sports Medicine Lead. In fiscal year 2017, the Medical Center’s Athletic Trainers provided services to 838 students, including those with musculoskeletal injuries as well as concussions— for which the trainers provide vital baseline testing at the time of a head injury. “But we Athletic Trainers aren’t there during the school day, so the school nurse plays a huge role in keeping track of a student’s recovery,” Hennessey continues, noting that this oversight is particularly important when it comes to post-concussion care. “Student athletes will often come to us because they’re afraid the Athletic Trainer will keep them out of play,” says KHS nurse MaryAnn Boynton, BSN, RN. “Or parents will talk to us because we’re here every day. So, by maintaining close communication with the Athletic Trainers, we’re able to share information to ensure that kids return to play at the right time. “This partnership also streamlines our ability to get student athletes seen by the right specialists at the Medical Center when more advanced care is needed,” she continues. These specialists include podiatrists, orthopedic surgeons and neurologists, as well as physical therapists. “It’s teamwork of a different sort,” Boynton adds, referring to the partnership between KHS and Cheshire’s Certified Athletic Trainers, “and it helps keep our student athletes as safe as possible.” Turn to page 16 to learn what symptoms to look for if you suspect someone has sustained a brain injury.

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Guests in the Art Nichols Café can always find fresh, healthy, affordable, options and flavorful homemade entrées. The salad bar is a focal point and gem of the Café, where diners can build their salad for the discounted price of $4.00 per pound, a cost lower than most grocery store produce prices. Multiple times a day, the salad bar is stocked with fresh leafy greens, vegetables, proteins, and legumes, as well as special offerings, like quinoa cranberry salad and super slaw. To help make good nutrition more accessible for local seniors, the Medical Center offers the Senior Passport Program, a discount meal program for individuals age 60 years and older. Discounts are available in the Art Nichols Café every day from 4:30pm-6:30pm, and an additional mid-day meal is available Saturday and Sunday, 11:30am-1:30pm. The program also provides opportunities for social connection, through participation in the free programs on the Medical Center campus. The Winter program listings offers programs and classes timed to meet prior to, or after meal times. See the Winter program listings on page 18. To sign up for a Senior Passport meal card, call (603) 354-5460 or visit health-wellness.cheshiremed.org/senior-connections.

Farmer’s Market offers fresh produce

Local farmer’s markets are a tradition in the Monadnock Region. Colleen Barry, RD, CDE, Director of Nutrition Services at Cheshire Medical Center understands the bright, fresh produce is


WORKING TOGETHER FOR THE HEALTH + WELLNESS OF OUR REGION

essential to good nutrition. Which is why she has partnered with The KSC Dietetic Interns work in collaboration with Cheshire Medical Center staff to develop classes and programs to bring the latest Angel Wing Farm in Sullivan, NH to establish a regular farmer’s information in nutrition to residents of the Monadnock Region. market at the Medical Center. The interactive programs provide nutrition education on a broad Growers from Angel Wing Farm bring their fresh, local produce range of topics. Participants of the recent Farm to Table two-part to sell in the Art Nichols Café each Wednesday. Thanks to the series discovered how food is farm’s green houses, visitors and grown, packaged, and distributed employees of the Medical Center in New England, and the benefits of can shop the Farmer’s Market, supporting our local food system in finding unique offerings, such as the Monadnock Region. Part two mineolas, clementines, and Meyer gave participants the opportunity lemons. to apply what they learned, using “It’s rewarding and fun for us to produce from the Monadnock sell at the Medical Center, our Region’s farms to create seasonal customers there know the value dishes. of good food,” says Carol Sullivan Families are discovering the fun of Sullivan Center for Sustainable of cooking together with the Kids Agriculture (SCSA). Angel Wing From quinoa to shaved Brussel sprouts, in the Kitchen series. Seasonal Farm is the organic farm of SCSA. classes feature healthier options to you can always find fresh, unique items on our traditional candies and treats that will To learn more about SCSA and what’s salad bar. And at $4.00 per pound, we have growing at Angel Wing Farm, visit tempt even picky eaters. Parents learn sullivancsa.com. creative ways to encourage kids to eat certainly made it affordable for everyone. Last healthier. Education classes year we sold 30,000 pounds of food off the Other programs have included bring participants of Cooking for a Small Gathering, salad bar. DIET is a Four-letter Word, all ages “to the table” -Colleen Barry, RD, CDE, Nutrition 101, and innovative classes Cheshire Medical Center and Director, Nutrition Services such as Kombucha and Fermented the Keene State College Dietetic Foods. The program offerings are Internship Program collaborate Colleen Barry, RD, CDE, Director, Nutrition Services with diverse, bringing participants of all to provide relevant and engaging Amanda Conant, Nutrition Services staff member in the Art Nichols Café ages and interests “to the table”. programs to support healthy eating.

Laurel Witri, Marsha Cook, and Carol Sullivan of Angel Wing Farm with their Farmer’s Market offerings in November.

Five-year-old Miranda Pipitone of Rindge, NH, carefully measures ingredients as she and her mother, Elizabeth, prepare Zucchini-Carrot-Apple Muffins at the Kids in the Kitchen-Halloween Treats class in October. Find the recipe on page 17.

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2016-2017 Report to the Communities of the Monadnock Region

PROUD TO BE PART OF THE DARTMOUTH-HITCHCOCK HEALTH SYSTEM

The power of affiliation. The need to adapt tertiary care. Together we are ensuring that Quality healthcare and patient safety have long been primary areas of focus for our patients receive the right care, at the right time, to the unparalleled medical center. Thoughtful, well-planned as close to home as possible. changes we are strategies and hard work have earned Cheshire Below are a few of the enhancements to experiencing in an “A” grade safety rating for two years in a row. care at Cheshire Medical Center this year, healthcare is undeniable Yet, we know from the feedback we’ve received made possible by our affiliation with the for hospital and from patients and employees, that we still have Dartmouth-Hitchcock Health System. healthcare organizations much work to do in other important areas. Our journey to sustainability is more than throughout our country. The number of We are excited to share the 3-Year Strategic affiliation. We must continue to evolve and healthcare organizations joining integrated Plan established to guide our work ahead. improve as your local community medical networks and care systems is only growing. center. Our mission and vision statements, Cheshire’s decision to become an affiliate grounded in our commitment to the health member of the Dartmouth-Hitchcock Health and wellness of our community, guide our system was not taken lightly. However, the plans for the future. Chris Schon, Chief Operating Officer quality and breadth of services provided by DartmouthAffiliation has enabled us to expand our capabilities in the continuum of care. Hitchcock, and our shared commitment to advancing Norris Cotton Cancer Center TeleICU expands capabilities myD-H Patient Portal empowers population health, made our (NCCC) partnerships improve in critical care patients with more information access for local patients partnership the right choice. Through this advanced system, Cheshire’s transition to the The NCCC-Kingsbury Together, we are finding a team of critical care specialists Dartmouth-Hitchcock Health Pavilion is partnering with innovative and sustainable ways works in partnership with system’s myD-H patient portal Dr. Finley, Thoracic Surgeon, Cheshire ICU staff using state-ofmeans one convenient place to meet the healthcare needs of Director, Comprehensive the-art video conferencing and for patients to view health the communities we serve. Thoracic Oncology Program monitoring-providing an extra information related to visits Through the support of the at Dartmouth-Hitchcock in layer of observation for critically at Cheshire Medical Center health system, Cheshire has Lebanon, and Associate ill patients and additional in Keene, Cheshire’s satellite Professor of Surgery, Geisel increased inpatient capacity and support for staff around the offices in the Monadnock Region, School of Medicine, Dartmouth. expanded our capabilities in clock. TeleICU is expanding our and visits at all DartmouthDr. Finley provides pre- and capabilities in the continuum Hitchcock facilities. Features critical care. Cheshire’s ability to post-operative care close to of critical care and is made include appointment requests, care for patients requiring acute home at Kingsbury Pavilion in possible through Dartmouthprescription refills, messages to care keeps beds available at Keene for our oncology patients Hitchcock Connected Care. providers, billing statements and Dartmouth-Hitchcock Medical undergoing Thoracic Surgery at payments. D-H in Lebanon. Center for patients requiring

Cheshire Medical Center

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WORKING TOGETHER FOR THE HEALTH + WELLNESS OF OUR REGION

CHESHIRE MEDICAL CENTER’S 3-YEAR STRATEGIC PLAN

The guideposts for our future. OUR MISSION: To lead our community to optimal health and wellness through our clinical and service excellence, collaboration, and compassion for every patient, every time.

QUALITY AND PATIENT SAFETY are central to Cheshire’s mission, vision, and strategic goals.

MISSION

QUALITY

SAFETY

VISION

OUR VISION: To continually improve the health outcomes of the people we care for through our role in providing high-value health care; remaining a sustainable resource for our region.

4 KEY FOCUS AREAS of our 3-Year Strategic Plan:

Patient Experience Among the initiatives to improve our patients’ interactions across all areas of our organization, Cheshire has introduced a Vice President of Patient Experience to the Medical Center’s leadership team. Working in partnership with Cheshire’s Patient and Family Advisory Council, the Medical Center is committed to developing actionable plans to ensure Cheshire is providing a healing environment that is accessible, welcoming, and respecting of our patient population, and developing comprehensive and useful information through an improved web presence and on-campus experience.

Community Health Cheshire is focused on continued collaboration with community partners to deliver seamless service, building on our clinical integration activities. And we are dedicated to empowering our community to identify and participate in opportunities to live healthier. Key to this effort is communicating the social determinants of health in our community and identifying gaps in services, connecting community members with local resources through the Medical Center’s Center for Population Health, and engaging community members with helpful information and opportunities to live healthier in the Monadnock Region.

Organizational Sustainability

Staff Resilience Cheshire physicians and staff share a common purpose in our daily work. The Medical Center continues to seek ways to support physicians and staff to be champions of change, understand how their contributions make a difference in the health and wellbeing of our community, and find joy in their work. Providing training and initiatives to highlight the importance of resilience, identify barriers, and increase individuals’ range of resilience, offering opportunities for staff to engage in employee forums, and enhancing recognition programs are among the planned components of improvement.

Cheshire strives to anticipate and quickly adapt to changes in the healthcare environment and the evolving needs of the populations we serve. Achieving this involves the continued expansion of our capabilities in the continuum of care to support sicker patients in the Greater Monadnock Region close to home. A focus on leveraging increased access to clinical and business resources through our affiliation with the Dartmouth-Hitchcock Health system and developing process improvement strategies within the Medical Center are also reflected in plans for the long term sustainability and health of our organization.

Today, Cheshire Medical Center is one of the five affiliates of the Dartmouth-Hitchcock Health system, including New London Hospital, Mount Ascutney Hospital and Health Center, Alice Peck Day Memorial Hospital, and Visiting Nurse and Hospice for Vermont and New Hampshire.

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2016-2017 Report to the Communities of the Monadnock Region

Sustainability requires keen business decisions and a vision for the future Affiliations are common across all industries and generally occur to create strength. Despite good intentions, the outcomes of affiliations can be mixed. The vision of the Cheshire Medical Center Board of Trustees was to align with a partner that shares our commitment to delivering value-based care; like us, is committed to the communities they serve; and places an emphasis on a meaningful and fulfilling work life for employees. In reflecting on our decision to join the Dartmouth Hitchcock Health (D-HH) system, I can state with confidence that our system affiliation is a success and we are stronger today as a result. This partnership creates the means for Cheshire Medical Center to care for patients in the greater region when their local hospital is not equipped to meet their needs. In addition to creating a better model for delivering high quality healthcare, we reinforce Cheshire Medical Center’s sustainability. Though more work is necessary, we are well on our way to meeting this goal. As our affiliation plans developed, I heard concerns from our community that we would lose our local focus and identity. On the contrary, the affiliation has provided for Cheshire Medical Center and Dartmouth-Hitchcock Keene to be united as one Cheshire Medical Center, with a predominantly local Board of Trustees. However, as a member of D-HH, it makes good business sense to share systems and align our processes. A prime example is our recent transition to a shared electronic health record system, Epic, which will advance quality care for our community. This would not have been possible without the support of D-HH. The value of quality healthcare close to home in the rural Monadnock Region is immeasurable. Healthcare is complex and operating a community medical center takes the commitment of administrators, physicians, staff, board members, and community members. I invite you to join me in supporting this community asset. Visit cheshirehealthfoundation.org to learn about ways you can help to ensure that we’ll remain strong for generations to come.

Gregg R. Tewksbury Chair, Board of Trustees

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Statement of Operations Twelve Months Ending June 30, 2017 (in thousands of dollars)

Billed for services to our patients: Care for inpatients.............................................................................. 110,424 Services for outpatients...................................................................... 467,414 Received from other sources..................................................................... 3,471 (Includes income from incidental services, investments of previous charitable gifts and unrestricted gifts from hospital donors)

Total from all sources:.............................................................................. 581,309 Amounts billed but not received: Government programs and commercial contractual agreements.... 359,690 From patients unable to pay and bad debt........................................ 18,008 Therefore, we actually received revenue from patient care and other services of:............................................................................... 203,611

Our costs included amounts: To pay our employees and physicians..............................................129,333 To pay our suppliers and vendors......................................................53,571 To operate the building, depreciation, and pay interest..................16,554 Resulting in total costs for patient care and other services:.............. 199,458

Residual earnings:............................................................................................. 4,153 Payment of the state Medicaid Enhancement Tax.............................7,793 Net loss from operations.............................................................................(3,640)

epic

ep-ic \’e-pik\ 1 noun: simply better electronic health record 2 adjective: impressive or remarkable, heroic Synonym: eD-H


WORKING TOGETHER FOR THE HEALTH + WELLNESS OF OUR REGION

A YEAR IN NUMBERS Twelve Months Ending June 30, 2017

234,689 4,154 Physician and Professional Provider appointments

Admissions

Surgical procedures

4,600 Emergency Department visits

133,352

Meals served

463,978 25,294

Physical therapy and other outpatient treatments

Pain Clinic procedures

Respiratory therapy treatments

391

Imaging exams

94,054 Volunteer hours

22,964

18,329 Walk-In Care visits

1,839 Newborns

1,016,045 Pounds of laundry processed

EKG/EEG tests

15,261 14,831

1,247,168

Patients’ information involved in the Epic transition

During the early weeks of the Epic transition, employees providing help and support to fellow staff could be identified by their orange and blue t-shirts.

Laboratory tests

1,599,321 Hospital average daily census

52.5

Endoscopies and colonoscopies

5,166

The myD-H portal, connected to the Dartmouth-Hitchcock Health system, provides Cheshire patients one convenient portal to view health information related to visits at Cheshire Medical Center, Cheshire’s satellite offices in the Monadnock Region, and visits at Dartmouth-Hitchcock locations. To learn more about myD-H and to create an account, visit myD-H.org, or call Dana Carley, Patient Portal Concierge at (603) 354-5454 ext. 2446.

L to R: Dana Carley, myD-H Patient Portal Concierge at Cheshire Medical Center, stands with transition steering committee members Deb Chamberlain, RN, Clinical Informatics Coordinator; Val Collins, RN, Director, Clinical Informatics; Sandeep Randhawa, MD, Hospital Medicine.

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2016-2017 Report to the Communities of the Monadnock Region

Integrating and supporting efforts to live healthier together. The Center for Population Health (CPH) at Cheshire Medical Center was established to support and integrate efforts toward health and wellbeing into the daily lives of those residing in the Monadnock Region. There are many aspects to achieving health and wellness community wide, but key to these efforts are shared goals and strong partnerships across organizations to meet them. Through CPH, Cheshire Medical Center is working toward eliminating the barriers to good health, developing new opportunities for collaboration with local partners and resources, and supporting the organizational needs of the Council for a Healthier Community and the Greater Monadnock Public Health Networkboth focused on population health. Dedicated staff at CPH support the Council, a group of 30+ representatives of schools, organizations, coalitions, and businesses that oversee the Healthy Monadnock community engagement initiative. Our CPH staff help meet the Council’s operational needs and implement the Healthy Monadnock Organizational Champions program, supporting local schools, businesses, and organizations in their efforts to make the healthy choice the easy choice. We are excited to see local Organizational Champions make strides to align their efforts, such as healthy food choices at their facilities, flex time to support employees, smoke-free environments, and commitment to a living wage. As a medical center, it is natural that, through partnerships, we offer a variety of programs and services aligned with the Healthy Monadnock initiative. You see here a sampling of these. Find out more about them at health-wellness. cheshiremed.org. I also encourage you to review the Winter program listings for opportunities to learn, connect, and live healthier together in this new year. Understanding the health concerns of the people in the Monadnock Region is our responsibility as your nonprofit medical center, and a key element in developing strategies to address those challenges together with community partners. This is an ongoing process of analyzing data from multiple sources, including our most recent bi-annual telephone survey of individuals in the Monadnock Region. Comparing these survey results to previous years helps us to understand where programs have been successful, and in what areas we need to work to create more movement. These activities, in addition to the quality clinical care provided at Cheshire Medical Center every day, are referred to as community benefits. The information shared will help shape future community benefit activities to support better health. We are grateful to those who participated in the survey this fall, and to the individuals, groups, and organizations who have dedicated their efforts to improving aspects of health and wellbeing for the communities of the Monadnock Region.

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

14 Winter 2018 | Health + Wellness

Photo of Kate with client who is tobacco free and support group Kate McNally, Program Manager for the Cheshire Coalition for Tobacco Free Communities, with Keith Clark, participant in the Tobacco Treatment Program at Cheshire Medical Center. Visit health-wellness.cheshiremed.org/tobacco-free to hear Kate’s interview with Keith as he shares how he found the willingness to be tobacco free, and the resources supporting him on his journey.

COMMUNITY BENEFITS STATISTICS Twelve months ending June 30, 2017 Tobacco Cessation referrals

838

579 1,008 Participants in Health and Wellness Programs

201 413

Local students received medical services from Cheshire Medical Center’s Sports Medicine Athletic Trainers

33

Participants in Cheshire Diabetes Prevention Program

28

5,409

Children that received Cheshire Smiles oral health screenings

1,323 361 Children that received Cheshire Smiles preventative services

60

Cheshire Walkers

Senior Passport meals served

“Let No Woman Be Overlooked” breast and cervical cancer screenings

318

Prescriptions supplied through Medication Assistance

$368,384

Value of prescriptions supplied through Medication Assistance

504

Newborns, children, and adults aided by Family Resource Counseling

15

Pulmonary Rehabilitation Program participants

78

Participants in the Prescribe for Health Initiative

Hearing aids provided to patients through a partnership with the Lions club of Cheshire County

Educational session attendees: School Nurses & Providers Program coordinated by Cheshire Medical Center


WORKING TOGETHER FOR THE HEALTH + WELLNESS OF OUR REGION

How do we, as a Healthy Monadnock partner, support the initiative?

Here are a few examples of Cheshire Medical Center’s activities. In addition to being a Healthy Monadnock Organizational Champion, supporting health and wellness within our organization, Cheshire Medical Center, as one of several partners of Healthy Monadnock, extend our efforts into the community. Below are a few examples of ways in which Cheshire is actively engaged in that partnership.

Aligned Efforts: • Prescribe for Health Program • Tobacco Cessation Program • Free Health and Wellness Programs • Mothers in Recovery Program • Employee Wellness Programs • Medication Assistance Program • Diabetes Care Network

Our Shared Vision: For the Monadnock region to be the healthiest community in the nation where all individuals reach their highest potential for health.

Supportive Contributions: CPH provides infrastructure and staff support to:

Our Shared Goals: • Increased healthy eating • Increased active living • Increased educational attainment • Increased income and jobs • Improved conditions and skills that support mental well-being • Improved access to quality healthcare • Increased social connections • Increased tobacco free environments • Increased regional capacity to prevent substance misuse

• Council for a Healthier Community • Healthy Monadnock Champions program • The Greater Monadnock Public Health Network

• Senior Passport Discount Meal Program • Free breast and cervical cancer screenings for under and uninsured women • Free skin cancer screenings for under and uninsured individuals • Fresh salad bar at reduced cost in the Art Nichols Café • Monthly Farmer’s Market

Healthy Monadnock is a community engagement initiative designed to foster and sustain a positive culture of health throughout the Monadnock Region.

Collaborative Involvement: • Cheshire Diabetes Prevention Program • Family Resource Counselor • Sports Medicine Athletic Trainers Program • Cheshire Walkers Program

The Healthy Monadnock initiative is overseen by the Council for a Healthier Community, of which Cheshire Medical Center is a member. To learn more about Healthy Monadnock visit healthymonadnock.org.

The Council for a Healthier Community invites community members to advance our shared vision of optimal health and wellness for all in the Monadnock Region through three basic types of engagement: • Aligned Efforts: creating environments and leveraging capabilities to support the shared goals of Healthy Monadnock • Supportive Contributions: dedicating resources to advance the mission of Healthy Monadnock

Aligned Efforts

Supportive Contributions

Collaborative Involvement Attainment of

Shared Vision

Shared Goals

• Collaborative Involvement: engaging in partnerships to create Overseen by theopportunities Council for aforHealthier Community, the Healthy Monadnock Initiative movement toward our shared goals

is built upon community ownership and commitment to goals.

Health + Wellness | Winter 2018 15


Making Healthy Choices TIPS & TOOLS

Taking care of your brain. Heads up: facts about brain injury and concussion Even a minor bump to the head can cause serious problems with thinking, memory, movement and emotional health. The effects of a brain injury can last for a few days or months—or for a lifetime. More than 170,000 kids and teens are treated in emergency room departments each year for sports- or recreational-related traumatic brain injuries, including concussions.

Watch for symptoms Symptoms can appear right after an injury, a few hours later or days later. Know the symptoms and seek medical attention right away if you suspect a brain injury. Symptoms include: • Headache or “pressure” in head • Nausea or vomiting • Balance problems or dizziness • Double or blurry vision • Sensitivity to light or noise

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• Feeling sluggish, hazy, foggy, or groggy • Concentration or memory problems • Confusion • Just not “feeling right” or is “feeling down” Signs observed: • Appears dazed, stunned, or confused • Forgets an instruction • Moves clumsily • Answers questions slowly • Loses consciousness (even briefly) • Shows mood, behavior, or personality changes • Can’t recall events prior to hit or fall

Protect yourself from brain injury Wear a helmet when biking, skiing, or

playing contact sports like hockey and football. Helmets should fit properly and be: well-maintained, age appropriate, worn consistently and correctly, and appropriately certified for use. While there is no concussion-proof helmet, a helmet can help protect you from a serious brain or head injury. Even with a helmet, it is important to avoid hits to the head. Seek medical attention. Timely recognition and appropriate response is important in treating a mild traumatic brain injury (MTBI) or concussion. Play it safe after a concussion. Rest is very important after a concussion because it helps the brain to heal. You’ll need to be patient because healing takes time. Only when the symptoms have reduced significantly, in consultation with your doctor, should you slowly and gradually return to your daily activities, such as work or school. Source: The Centers for Disease Control and Prevention. To learn more about how to recognize, respond to, and minimize the risk of concussion or other serious brain injury to go to cdc.gov/HeadsUp.

New study shows taking care of your heart helps your brain How you treat your heart in your 20s may help your brain when you’re in your 40s and 50s. That’s the finding of a new study that looked at data of 518 participants from a long-range study on heart health. According to researchers, young adults who followed the American Heart Association’s (AHA) Life’s Simple 7 (LS7) guidelines had brains with more volume, so their brains looked more than 10 years younger in middle age than did the brains of others who didn’t follow the LS7 guidelines. Following the guidelines of LS7, not only in early adulthood but at any time, can have a positive impact on your overall health.

AHA’s Life’s Simple 7 Guidelines 1. Manage blood pressure. Keeping blood pressure below 120/80 mm Hg lowers your risk for heart disease and stroke. 2. Control cholesterol. Avoiding plaque buildup in the arteries, called atherosclerosis, can reduce your heart attack or stroke risk. Your health care provider will consider your HDL (good cholesterol), LDL (bad cholesterol) and triglyceride levels with other factors to assess your risk. 3. Control blood sugar. Managing your blood sugar levels can delay or prevent type 2 diabetes, which does damage to your heart, kidneys, eyes and nerves. If you’re age 45 or older, get tested for diabetes and get retested at least every three years. 4. Be active. Engaging in activity on most days of the week helps your overall cardiovascular health. Aim for 150 minutes of moderateintensity activity each week.


Healthier Together SPOTLIGHT

Helping families with teens find ways to stay connected. 5. Eat better. Choosing healthy foods such as a variety of fruits and vegetables, fat-free or low-fat dairy, whole grains and lean meat, fish or poultry gives your body energy and helps fight disease. 6. Maintain a healthy weight or lose weight, if needed. Shedding extra pounds reduces the burden on your heart, lungs, blood vessels and skeleton, and helps lower blood pressure. 7. Stop smoking. Quitting lowers your risk of atherosclerosis, which can lead to heart disease and stroke. Schedule a checkup with your provider to learn your risk factors for cardiovascular disease and steps you can take to get or stay healthy.

Easy + Healthy Recipe

ZUCCHINI•CARROT•APPLE

MUFFINS

A perfect morning snack! Prep:10 min Cook Time: 25 min Serves: 12 INGREDIENTS ¾ cup shredded zucchini (excess water removed) ½ cup shredded apple (excess water removed) ½ cup shredded carrot (excess water removed) 4 Tbsp butter, melted ¼ cup applesauce ½ cup sugar 2 eggs 1 tsp vanilla 1½ cups white whole wheat flour ½ tsp baking soda ½ tsp baking powder 1 tsp cinnamon ½ tsp ginger INSTRUCTIONS • Mix first 8 ingredients in a large bowl and stir until well combined. • Add remaining ingredients and stir until just mixed. • Scoop into greased muffin tins. • Bake at 350 degrees F for 20-25 minutes or until inserted toothpick comes out clean. One of the recipes featured in the Fall 2017 Kids in the Kitchen class series offered by Cheshire Medical Center and Keene Sate College. Source: www.theleangreenbean.com

Julie Yerkes from the NH Teen Institute will facilitate an upcoming 5-week interactive workshop series offering parents and caregivers opportunities to explore ways to mindfully navigate communication during the tween/teen years. Parent Education Coordinator at the New Hampshire Teen Institute, Julie Yerkes, is familiar with the challenges of connecting and communicating with tweens and teens. For twenty years, she has been dedicated to helping adolescents and their families navigate those challenges. This special focus began to take shape for Julie when, as a teacher, she saw a need among her students and their parents to have tangible tools Julie Yerkes, Parent Eduction Coordinator at the and support during a time of changing New Hampshire Teen Institute family dynamics. “I often hear parents and grandparents say that the parenting education and support available during the early childhood years hasn’t always been as easy to find as their kids get older,” says Julie. “And with the complex and sometimes contentious issues that new technologies and social media bring to the table, today’s families need to learn new ways to communicate around the ear buds and screens rather than just battling against them.” This winter, Cheshire Medical Center is partnering with the New Hampshire Teen Institute to offer families in the Monadnock Region Staying Connected with Your Teen, a 5-week workshop series that provides communication tips and tools to take home and try with their families. “We’ll explore activities and suggestions for ways to invite your teen into problem-solving the roadblocks and working together through emotional processing. And we’ll share with each other in a supportive environment what’s working and what isn’t.” says Julie. She stresses that for many, there is great benefit in talking through the issues in a safe, candid space with parents going through the same thing. “This series offers an opportunity to dedicate intentional time to building your parenting toolbox and to learn from others facing similar challenges.” Turn to page 19 to get more details about this free 5-week series starting on January 22 and to find out how you can reserve your spot.

Health + Wellness | Winter 2018 17


Health Education & Support WINTER PROGRAM LISTINGS

Health Education and Support for the Monadnock Region Please join us for one or more of this Winter’s line-up of programs designed to provide learning opportunities and supportive connections with others on similar paths to optimal wellbeing. Our Winter programs are listed in chronological order and fall into two major categories:

All programs are held at Cheshire Medical Center, 580 Court St., Keene, NH, unless otherwise noted. All programs require registration and are free, unless otherwise noted. If you require special accommodations to attend any of our programs, please call The Center for Population Health at (603) 354-5460. + Healthy Living with a focus on topics that support overall health + Resilient Living with a focus on topics that support overall wellbeing

Please note if a program is suited for either seniors in our community or families with children. Also, look for icons help you find a perfect fit:

S = open to all, but may be of interest to seniors N = special focus on nutrition

= consider enjoying a healthy, affordable meal at the Art Nichols Café after the program. If you are 60 years or older use your senior passport for a discounted meal. To find out more about the Senior Passport Program, call The Center for Population Health at (603) 354-5460.

+ Healthy Living

+ Healthy Living

Patti Schuman, RDN, LD, CDE, Cheshire Medical Center

Carolyn Crane, Vicky Pitman, D’Vorah Kelley and Lesley Johnson, Green Dot Trainers

Healthy Living with Diabetes: Self-Management Training 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. Choose a 4-week series: Tuesdays, January 16 – February 6 9:00-11:00 a.m. North Conference Room 2 Wednesdays, March 21 – April 11 5:30-7:30 p.m. North Conference Room 2

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Green Dot Bystander Training Imagine a map of your community where each red dot on this map represents an act of power-based 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. 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 striking up a conversation with a friend or family member. A green dot is simply your individual choice at any given moment to make our world safer. 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


Winter 2018

Programs

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. Choose a date: Saturday, January 20 9:00 a.m.-3:00 p.m. North Conference Room 1 Saturday, February 3 9:00 a.m.-3:00 p.m. North Conference Room 1 Saturday, March 3 9:00 a.m.-3:00 p.m. North Conference Room 1

+ Resilient Living | Family & Parenting

Staying Connected with Your Teen Julie Yerkes, Parent Education Coordinator, New Hampshire Teen Institute Are you worried about keeping your teen safe as s/he gains more independence? Are you unsure how to talk about what lies ahead and how to keep the bond that you have with your tween into the teen years? Do you think your teen is not listening—or does not care what you have to say about the risks that they face? This 10 hour workshop for parents and caregivers of teens age 12-17 is a science-based, interactive workshop that provides tools to enhance communication and family management practices and decrease conflict in order to maintain bonds and help prevent youth from taking unhealthy risks. 5-week series: Mondays, January 22-February 19 6:00-8:00 p.m. North Conference Room 1

+ Healthy Living

Advance Care Planning: It’s About the Conversation! Jennifer McCalley, MSW, ACHP-SW Program Coordinator, Honoring Care Decisions, Trained Honoring Care Decisions Facilitators, 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: Wednesday, January 24 3:00-4:30 p.m. North Conference Room 2 Thursday, February 22 3:00-4:30 p.m. Auditorium A Wednesday, March 21 3:00-4:30 p.m. North Conference Room 2

+ Healthy Living

Learn How to Navigate myD-H Cheshire Medical Center’s Patient Portal Dana Carley, Patient Portal Concierge Cheshire Medical Center has an online patient portal that makes managing your health information and communicating with your doctor and health care team easy and convenient. In this Information session we will answer questions about our recent electronic health record transition in relation to myD-H. We will also walk you through how to: 1) request a myD-H account, 2) access your information, and 3) use the features within the portal. If you already have an account bring a laptop or tablet to have hands on experience navigating your portal. You will see that viewing your records, requesting appointments and medication refills, asking questions of your healthcare team, receiving appointment reminders and viewing test and lab results are just a few of the features you’ll enjoy as a myD-H portal user. Choose a date: Tuesday, January 30 11:00 a.m.-12:30 p.m. Central Conference Room 6 Tuesday, February 13 2:00-3:30 p.m. Auditorium B Wednesday, March 14 6:00-7:30 p.m. North Conference Rooms 1&2

REGISTER TODAY!

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

Health + Wellness | Winter 2018 19


Health Education & Support WINTER PROGRAM LISTINGS

+ Resilient Living

Mindfulness-Based Strengths Practice Jennifer Begley, Director of Resiliency and Wellbeing, Cheshire Medical Center This 6-week program combines the practice of mindfulness with the development of our personal strengths. Throughout the program, we will blend ‘strong mindfulness’ in which strengths such as curiosity, self-regulation and gratitude are utilized to establish mindful practice, and ‘mindful strengths’ wherein mindful practice is used to enhance awareness and development of personal strengths. Preregistration is required. Wednesdays, February 7-March 14 4:30-6:00 p.m. Auditorium A

+ Healthy Living

Get Ready for Valentine’s Day! Kate McNally, MS, TTS, Center for Population Health at Cheshire Medical Center Are you looking for an original, meaningful Valentine’s Day gift? Give your valentine or someone you love the gift of freedom from tobacco. In this session participants will learn the importance of tobacco treatment for healthy living and evidence-based strategies to help tobacco users quit. Learn what works and what doesn’t when addressing tobacco addiction with those we love. Participants will have a better understanding of addiction, dependence and the habit associated with tobacco use and will leave with action steps to assist tobacco users with taking the first step to freedom from tobacco. Tuesday, February 13 6:00-7:30 p.m. Auditorium A

+ Resilient Living | Family & Parenting

“20 Things Adopted Children Wish Their Adoptive Parents Knew” Book Club Carol Sullivan, RN (retired) and Sylvie Rice, Community Health Coordinator, Center for Population Health at Cheshire Medical Center Filled with powerful insights from children, parents, and experts in the field, plus practical strategies and case histories that will ring true for every adoptive family, Twenty Things Adopted Kids Wish Their Adoptive Parents Knew (by Sherrie Eldridge) is an invaluable guide to the complex emotions that take up residence within the heart of the adopted child--and within families formed through adoption.Together, Carol and Sylvie, who are both adoptive mothers, will facilitate a discussion based on the book and share their own journey of adoption. This book and group discussion is the right fit for you if: your life has been touched by adoption, you are interested in creating a family through adoption, or you

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would like to know more about the adoption triangle, and the love, joy, grief, and loss that come with adoption. Although we highly recommend that you read this book beforehand, you are welcome to attend to find out more. Thursday, February 15 6:00-7:30 p.m. Auditorium A

+ Healthy Living

Healthy Living for Your Brain & Body: Tips from the Latest Research Melissa Grenier, Regional Manager, Alzheimer’s Association, Massachusetts/New Hampshire Chapter For centuries, we have known that the health of the brain and the body are connected. But now, science is able to provide insights into how to optimize our physical and cognitive health as we age. Join us to learn about research in the areas of diet and nutrition, exercise, cognitive activity and social engagement, and use hands-on tools to help you incorporate these recommendations into a plan for healthy aging. S Tuesday, February 27 2:30-4:00 p.m. Auditorium A & B

+ Healthy Living

Many Faces of Recovery Natalie Neilson, Continuum of Care Facilitator, Monadnock Voices for Prevention Compared to many other medical and psychiatric illnesses, Substance Use Disorder has a good prognosis. It is estimated that between 42%-66% of people with substance use disorder achieve full remission, although it can take time to do so. Currently, there are 25 million Americans in recovery from a Substance Use Disorder. There are several validated treatments to help people recover successfully, including pharmacological, social, and psychological treatments, as well as self-initiated recovery. Come and learn about the pathways to recovery available in our region, the common barriers and how to face them, as well as how to help someone find their path. Tuesday, February 27 6:00-7:30 p.m. Auditorium A

+ Resilient Living

Resilient Living with Chronic Medical Conditions Tom Stearns, Ph.D., CMC/DH Resilient Living Team When diagnosed with a serious and oftentimes chronic medical condition we are faced with the reality of the diagnosis but also the many challenges associated with managing the condition. We developed The Resilient Living with Chronic Medical Conditions program in order to help patients improve their resilience and physical and emotional wellbeing through the development of skills and self-management or coping skills associated with


Winter 2018

Programs

better health and quality of life. We consider a chronic medical condition as one that is likely to be ongoing, often requires significant lifestyle change, has a degree of “treatment burden” (having to take medications, self-monitor health status, visits with your healthcare team, etc.) and may affect your overall quality of life. Common examples include diabetes and prediabetes, heart-related problems such as congestive heart failure (CHF) and high cholesterol/hypertension and pulmonary problems such as COPD. Preregistration is required. 4-week series: Tuesdays, March 6-27 5:30-7:00 p.m. North Conference Room 1

+ Healthy Living

+ Resilient Living

+ Healthy Living

Jennifer Begley, Director of Resiliency and Wellbeing, Cheshire Medical Center and Leaf Seligman, Writing Guide and Author

Shawn LaFrance, MS, MPH, Vice President, Population Health & Health System Integration, Cheshire Medical Center; Jennifer McCalley, MSW, ACHP-SW Program Coordinator, Honoring Care Decisions; Certified Advance Care Planning Facilitators

Resilient Living Book Group

Book Selection: The Gifts of Imperfection by Brené Brown Each day we face a barrage of images and messages from society and the media telling us who, what, and how we should be. We’re led to believe that if we could only look perfect and lead perfect lives, we’d no longer feel inadequate. In her ten guideposts, Brené Brown engages our minds, hearts, and spirits as she explores how we can cultivate courage, compassion, and connection on the lifelong journey from ‘What will people think?’ to ‘I am enough.’ Brown’s unique ability to blend original research with honest storytelling makes reading The Gifts of Imperfection like having a long, uplifting conversation with a very wise friend who offers compassion, wisdom, and great advice. Please come prepared having read the book. Thursday, March 8 7:00-8:30 p.m. North Conference Rooms 1 & 2

+ Healthy Living

Living with Alzheimer’s: For Caregivers–Late-Stage Melissa Grenier, Regional Manager, Alzheimer’s Association, Massachusetts/New Hampshire Chapter In the late stages of Alzheimer’s disease, caregiving typically involves new ways of connecting and interacting with the person with the disease. Join us to hear from caregivers and professionals about resources, monitoring care and providing meaningful connection for the person with late stage dementia and their families. S 2-week series: Mondays, March 12 & 19 2:00-4:00 p.m. Main Conference Room at Home Healthcare, Hospice and Community Services 312 Marlboro St., Keene

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, March 19 1:00-2:00 p.m. Auditorium A

Planning for What Matters Most

Join us for a 4-part series to help you reflect, understand, and discuss what matters most to you about the life you’re living right now and how that informs your healthcare decision-making. S Attend one or all of the following sessions: PART 1: “Being Mortal” Please join us to watch the FRONTLINE documentary which follows Dr. Atul Gawande as he explores the relationships doctors have with patients who are nearing the end of life. You are encouraged to read Dr. Gawande’s book, Being Mortal, so that we can discuss both the film and book. Wednesday, March 7 3:00-5:00 p.m. North Conference Room 1 PART 2: Hello Conversation Game Hello is a conversation game to facilitate thought-provoking conversation about your values and goals. It is the easy, non-threatening way to start a conversation with your family and friends about what matters most to you. Wednesday, March 14 3:00-4:30 p.m. Auditorium B PART 3: Advance Care Planning: It’s About the Conversation! 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? This workshop is also offered monthly (see the full description on Page 19). Wednesday, March 21 3:00-4:30 p.m. North Conference Room 2 PART 4: Free 1:1 Conversations will be available to complete or update your documents with a certified advance care planning facilitator. Wednesday, March 28 2:00-4:00 p.m. Auditorium A

Health + Wellness | Winter 2018 21


Making a Difference NEIGHBORS HELPING NEIGHBORS

Celebrating 2,000 volunteer doula assisted births. The birth of a healthy baby is always a happy occasion. Arthur Alexander Johnson’s birthday on Monday, October 16, 2017 was an extra special birthday, representing the 2,000th doula assisted birth at Cheshire Medical Center. Cheshire Doula, Darline Harris, of Troy, NH, assisted the birth. The Cheshire Doula volunteers have been supporting birthing mothers at the Medical Center since 1999. As trained professionals, at the request of a woman in labor, they provide non-medical support to birthing women and their families and work in partnership with the Medical Center’s labor and delivery team in providing family-centered care. They attend the mother throughout her labor and delivery and into the first hour or so after the birth, to help new families enjoy some quiet and important bonding time. The word “doula” comes from the Greek word meaning “a woman who serves”. During labor, doulas provide continuous physical, emotional, and informational support. They are skilled in a wide range of comfort and relaxation techniques such as massage, visual imagery, and aromatherapy. They understand labor and assist even with cesarean births, providing reassurance and assisting with immediate skin-to-skin bonding time between mother and newborn. Marilyn Buck, Cheshire Doula Coordinator, has been a certified Cheshire Doula since the program’s inception in 1999. She provides certification and on-going training to the Cheshire Doulas. “Most of us [the Cheshire Doulas] agree this is one of the most rewarding experiences we’ve ever had, other than having our own children,” shares Buck. “Our goal is to give mothers the best birthing experience possible.” Fellow residents of Troy, NH may recognize Harris from her “day job” as

22 Winter 2018 | Health + Wellness

the Assistant Director of the Gay-Kimball “It would be easy to say the actual birth Library. When asked how she came to be a is the most rewarding part of being a doula, Cheshire Doula, Harris responds, “Marilyn but for me, it is more than that,” relates Harris [Buck] is a friend of of the experience, “It’s mine, one day she the journey I take with asked me if I had each new mom-to-be. ever thought about I sync myself with being a doula. I hadn’t her emotions, her thought of it, but I discomfort, her fears have four sons and and help her find the thirteen grandchildren, power and the strength so helping a mother to do this-the hardest during her labor was work of her life. When very exciting to me.” we’ve taken that Harris completed journey together, and the doula training delivery happens, we program at Cheshire aren’t just celebrating Medical Center, in the arrival of that exchange for a twonew baby-we’re also year commitment to celebrating the newly the program, and in empowered mom.” -Darline Harris, November of 2016 In addition to Cheshire Doula Harris became a connecting with certified doula. families, Cheshire

we’ve taken “thatWhen journey together,

and delivery happens, we aren’t just celebrating the arrival of that new baby-we’re also celebrating the newly empowered mom.


Healthier Together SPOTLIGHT

Together, preventing type 2 diabetes is possible Cheshire Doula, Darline Harris, with parents Ben and Heidi Johnson of North Swanzey, NH, with sons Henry James and newborn Arthur Alexander. Together, Harris and the family marked the 2,000th doula assisted birth at Cheshire Medical Center.

Leaders at Keene Senior Center, Keene Family YMCA, and Cheshire Medical Center work together to make it easier for people in the Monadnock Region with prediabetes to participate in a high-quality lifestyle change program to reduce their risk of type 2 diabetes.

CDPP partners Cameron Tease, Executive Director, Keene Senior Center; Jocelyn Frain, Member Services Director, Keene Family YMCA; and Jennifer Begley, Director, Resiliency and Wellbeing, Cheshire Medical Center.

Doulas are a support network to each other, “In addition to sharing tips and tricks that we learn and develop, we relieve each other as one shift ends and another begins. This involves sharing a lot of information about the mom’s state of mind and how the labor is progressing, helping the on-coming doula be prepared,” shares Harris,“This milestone birth wouldn’t have happened without my sister doulas.” To learn more about how you could become a Cheshire Doula, call Marilyn Buck at 603-354-5400 ext. 2270 or email her at MBuck@Cheshire-Med.com.

Efforts throughout the region to live healthier have made some movement in the prevention of diabetes in our community. But if we’re looking at numbers, the Centers for Disease Control and Prevention (CDC) reports that one in three American adults has prediabetes. That means of the approximately 56,100 adults in Cheshire County, 3,646 are living with prediabetes. Three community organizations are partnering to help reduce that number. Cheshire Medical Center, The Keene Family YMCA, and the Keene Senior Center are combining resources to once again offer the Cheshire Diabetes Prevention Program (CDPP) to individuals at risk for type 2 diabetes in the Monadnock Region. The CDPP is part of the National Diabetes Prevention Program, led by the CDC. Participants in this year-long program meet in groups with a trained lifestyle coach to learn the skills they need to make lasting changes such as losing a modest amount of weight, being more physically active, and managing stress in an effort to prevent type 2 diabetes. The program’s group setting provides a supportive environment with people facing similar challenges and trying to make the same changes. “Lifestyle change is best when you can share your journey and success with someone else,” explains Jennifer Begley, Director, Resiliency and Wellbeing at Cheshire Medical Center, “Members of the [CDPP] groups have developed friendships that have helped participants be successful in this journey to better health.” CDPP groups meet once a week for 16 weeks, then monthly for 8 months to maintain healthy lifestyle changes. Groups are open to individuals age 18 and over who are at risk of developing type 2 diabetes or who have been identified as prediabetic. Two new groups for the program begin January 22 and 23, 2017. For more information, visit cheshiremed.org/diabetes or call (603) 354-6866.

Health + Wellness | Winter 2018 23


Your health + wellness matters to us. That’s why we’ve created a new source of local inspiration and information supporting healthy and resilient living in the Monadnock Region. Visit health-wellness.cheshiremed.org to find out more and sign up to receive a monthly e-mail full of helpful tips and tools, along with information about local learning opportunities and support offerings to help you live your healthiest.

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Living healthier together.

Health + Wellness Magazine Winter 2018  
Health + Wellness Magazine Winter 2018  

This special issue contains our 2016-2017 Report to the Communities of the Monadnock Region.