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2011-2012 Community Health Needs Assessment

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We act on behalf of justice and care for the poor and vulnerable. Our work is a ministry through which we are privileged to serve people at some of the most significant moments of their lives. We serve everyone regardless of status, giving priority to persons who are poor. We value our spiritual identity and the heritage of our religious founders. For purposes of definition within this document, Saint Joseph Regional Medical Center (SJRMC) includes the following entities: Saint Joseph Regional Medical Center, Inc. Saint Joseph Regional Medical Center, Mishawaka Saint Joseph Regional Medical Center, Plymouth Saint Joseph Rehabilitation Institute, Mishawaka Saint Joseph Physician Network Sister Maura Brannick, CSC, Health Center, South Bend Family Medicine Center, Mishawaka Saint Joseph Health Center, Plymouth Mobile Medical Unit

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TABLE OF CONTENTS About the Community Health Needs Assessment ........................... 5 2011 Executive Summary.................................................................... 9 Community Survey...................................................................................................... 9 Focus Groups................................................................................................................. 9 Response......................................................................................................................... 9 Process & Methodology......................................................................11 Community Survey Report.....................................................................................11 Survey Reponses:

Key Demographics.......................................................................................11

Insurance Coverage.....................................................................................12

Access to Health Care...............................................................................12

Health Status Rating..................................................................................13

Self-Reported Diagnosis............................................................................13

Deferring Medical Care..............................................................................14

Physician Recommendations & Wellness..........................................14

Top Three Suggestions..............................................................................15

Focus Group Report..................................................................................................16 Focus Group Discussion: Diabetes...........................................................................................................16

Senior Services.............................................................................................17

Prenatal Care................................................................................................17

Action Plans........................................................................................ 18 Community Health Needs Matrix....................................................................... 20

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ABOUT OUR COMMUNITY HEALTH NEEDS ASSESSMENT

We serve together In Trinity Health In the spirit of the Gospel To heal body, mind and spirit To improve the health of our communities And to stewards the resources entrusted to us.

Our Mission is more than ideology. It’s an important standard that we hold ourselves to, in everything we do. Our faith principles are at the core of our business. Our faith demands that we do whatever it takes to have a positive impact on our entire community. Every three years, Saint Joseph Regional Medical Center (SJRMC) performs community needs assessments to evaluate the overall health status of the communities it serves. The information from these assessments is routinely used to guide the strategic planning processes of the organization-at-large. In 2011, the Mission and Outreach Departments were given the task of conducting an expanded Community Health Needs Assessment (CHNA) that met new federal requirements. The March 2010 passage of the Patient Protection and Affordable Care Act (PPACA) introduced new reporting requirements for private, not-for-profit hospitals to maintain 501(c)(3) tax-exempt status. Effective for tax years beginning after March 2012, each hospital must: • Conduct a CHNA at least once every three years on a facility-by-facility basis • Identify action plans to address unmet community health needs • Report the results of each CHNA publicly Using a modified survey tool provided by Trinity Health, SJRMC conducted its CHNA for use in the Primary Care Service Area including the counties of Elkhart, Marshall and St. Joseph in Indiana.

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2007 CHNA Previously, the 2007 CHNA* revealed several needs. The top two were: 1) Accessibility to Healthcare Services (notably on the Westside) 2) Affordability of Healthcare and Medications

Our Response: Over the past 4 years, SJRMC has implemented action plans designed to fulfill these significant community needs. To address the issue of accessibility on the Westside, SJRMC approached Memorial Hospital and the City of South Bend with a request for collaboration to build and fund the Bendix Family Physicians office in South Bend. Regarding the issue of affordability of healthcare and medications, SJRMC provides services at clinic locations including the Sister Maura Brannick Health Center in South Bend, HealthLinc (previously Healthy Family Center), Family Medicine Center and Saint Joseph Health Center in Plymouth. It has also implemented the Medication Affordability Program (MAP).

SJRMC continues to dedicate many resources to community benefit in several different areas. Millions of dollars have been spent in the past for clinical, community support and educational purposes. In the upcoming 2013 fiscal year, SJRMC has committed: • $2,719,331 for clinics that benefit the underserved, such as the Family Medicine Center, Sister Maura Brannick Health Center and the Saint Joseph Health Center. • $3,204,318 for community support in the areas of Patient Financial Support, HealthLinc Federally Qualified Health Center, Community Health Partners of South Bend and others. • $2,363,405 for medical residencies and other educational opportunities for both clinicians and non-clinicians. SJRMC’s past efforts to satisfy the needs of the community have met with success, and there is no doubt that future endeavors will do the same. While not able to fulfill every need identified through the 2011 CHNA, SJRMC will make every effort to address the defined and redefined priorities that are in keeping with its Mission. *A summary of the 2007 CHNA is available upon request. Contact Michelle Peters at 574.335.3897.

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EXECUTIVE SUMMARY Realizing the importance of and desiring to respond to the needs of the communities in the service areas of SJRMC, its Community Benefit Council was determined to align the Mission of SJRMC with the vocalized needs of the community by creating a document that would serve as one of the key components of the system’s FY 2013-2015 Strategic Plan. The findings of the Community Health Needs Assessment will also assist leadership in stewarding resources entrusted to SJRMC by providing services where assistance is most needed. Community Survey The methodology for conducting the community survey involved deployment of the survey both online and on paper during the months of August through October 2011. For survey topics, prior analysis was conducted and SJRMC identified three important community-related issues: • Diabetes:

There is a large contingent of diabetic patients in the community who do not know how to manage their disease in a healthy manner. • Senior Services: The community would like to see a greater offering of wellness programs for senior citizens. • Prenatal Care: A prominent issue in the community is low birth weight babies. The survey takers were asked: “What three areas should SJRMC most improve?” They were then given a list of options from which to select multiple answers. The important issues identified by the survey takers were: Awareness, Education and Accessibility Focus Groups The Council then brought together people of different ages, socioeconomic status, occupation, and ethnic/cultural backgrounds. The ten groups represented: • Leadership Alumni • Business Leaders in South Bend, Mishawaka • Young Professionals & Plymouth • Seniors • Expectant & New Mothers • Clinics • Latino Community Leaders The focus groups were asked to discuss issues that had been identified as important by SJRMC and by the survey results. Response Generally speaking, the needs expressed throughout the assessment were common to the people of St. Joseph and Marshall Counties. Subcommittees were formed to address the concerns and suggestions brought forth by the focus groups. The subcommittees met to discuss ideas for improving the areas they were assigned (senior services, diabetes, and pre-natal care). After discussion, the ideas of the subcommittees were formalized into action plans and reevaluated to determine feasibility. Once the action plans were approved, the budgeting process began. Combining the assets of the local communities with the Mission, energy, and insight of SJRMC, the council members have great belief in the potential to address many of the needs identified by community members.

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PROCESS & METHODOLOGY Community Survey Report The methodology for conducting the community survey involved deployment of the survey both online and on paper from August to October 2011. The online methodology was used to ensure a wide distribution of the survey. This survey was delivered via invitation based on a stratified random sampling of the community-at-large using a third-party database. This data included names and addresses of patients, donors, and associates of SJRMC as well as the population at large that had no prior contact with SJRMC. The stratification process included a randomized selection of 50% non-patients and 50% former SJRMC patients, associates and donors. The survey consisted of a series of 60 questions designed to gather information about the individual’s health, insurance coverage, how to help the community, and general demographic information. Survey Responses The total number of surveys collected numbered 2,026 responses. Some were not usable due to problems with scanning. The amount of information collected and number of usable surveys completed was impressive at 1,925. Nearly all the surveys analyzed (92%) included answers to every question on the survey. The survey was offered in Spanish when necessary. Returned and completed surveys: 2,026 Surveys that could be analyzed: 1,925 The resulting sample was then divided based on population age to reflect the sample in the community. To further ensure that the sample reflected a wide variety of socio-economic levels, the online survey URL was printed on a postcard and offered to community groups who were approached by Outreach & Mission staff and volunteers directly for their help with the survey. The paper copy of the survey was also used with community groups to facilitate broad based representation of the elderly 65+ and underserved populations. Key Demographics • 80% of the sample identified their gender as female, while 20% indicated their gender as male. • 72% of the sample responding were homeowners and 25% were renters. • 80% of the sample identified their race as Caucasian, 13% African American and 4% Hispanic. Native Americans made up 1% and Asians less than 1%. These percentages mirror the population within the communities surveyed with the exception of the Hispanic population, which was underrepresented. • 38.5% of the respondents lived in South Bend, 22.9% in Mishawaka, 10.1% in Granger, 5.8% in Elkhart and 4% in Plymouth. The typical survey respondent was a Caucasian female: age ranging from 40-55, a homeowner with employer provided insurance, living in South Bend or Mishawaka, donates to charity and is likely to volunteer her time with a social service organization.

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Insurance Coverage 92% answered the question regarding insurance coverage: 83% of the sample responded that they had insurance coverage, while 17% responded that they did not have coverage. Most of the sample obtained their coverage through their employer or their spouse’s employer, evidenced by 61% of cases. An additional 9% of cases were covered under Medicare and 7% under Medicaid, while 5% cited other and 4% purchased insurance privately. 73% sample received their care from a private physician’s office, 4.5% said they received care from the Emergency Department or the Healthy Family Center and 5% from another source. The family medicine residency centers operated by the two hospitals were sites of care as well: Saint Joseph Family Medicine Center at 3% and Memorial Family Medicine at 2% of the sample. Another 3.1% reported using the Sister Maura Brannick Health Center and 2.6% named an urgent care or a walk-in clinic. Most of the sample reported coverage for physician office visits at 88% and prescription drug coverage at 80%. Deductibles were reported for 57% of respondents although a sizeable percent of the sample (11%) was not sure whether they had a deductible. The insurance deductible rate reported most frequently by the respondents was less than $1,000, however very few respondents could answer this question, only 15% of the sample. When asked how many people the deductible covered, only 23% of the total sample could answer the question and 8% of those chose the answer “not sure.” For those with a valid answer (n=449), 33% said their deductible was for one person, 22% said Family, 9% indicated two people, and 36% were not sure. Our Response: SJRMC provides millions of dollars in Charity Care every year. This includes costs for unpaid Medicare and Medicaid expenses. Sister Maura Brannick Health Center and the Saint Joseph Health Center in Plymouth provide free care to those who are without insurance and are ineligible for Medicare or Medicaid. The Family Medicine Center caters to Medicare and Medicaid patients by employing medical residents and faculty practitioners. SJRMC has initiated and sustained collaboration with Memorial Hospital and the City of South Bend to create the Bendix clinic on the Westside. SJRMC also subsidizes HealthLinc, a federally qualified health center. Access to Health Care When asked if respondents were having trouble getting health care for themselves or their family: • 77%

No

• 23%

Yes

• Of the 23% who said yes, 53% had healthcare coverage and 47% did not. On the other hand, 84 people who said they were not having trouble getting health care did not have insurance coverage. When asked what the biggest problems were in getting access to health care, 17% noted that it was the cost of care in general. Since the respondent could select all answers that applied to their situation, this represented 25% of all responses. The next highest response was accessing dental care at 11% of respondents who had difficulties, and 16% of all responses. The cost of insurance

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received 14% of all responses, while getting specialist care represented 9%. These responses represented people who reported that they were having trouble with access to care as well as some of those who said they weren’t having trouble. Our Response: As mentioned earlier SJRMC and our Saint Joseph Physician Network offer multiple locations, which include early morning and late evening appointments. For more information on these locations, please call 866-757-6248. SJRMC intends to expand access for Medicare and Medicaid patients in South Bend through development of a new clinic. While this initiative is in the beginning phases, SJRMC realizes the importance of access and will move swiftly to offer a comprehensive medical home for patients. Health Status Rating Respondents were asked to rate their current health status on a scale of 1-5: 1 = Excellent 5 = Not Good Most frequent responses of those who answered the questions were either Very Good (34.4%) or Good (33.9%). Another 14% rated their health as Okay, while 12% said Excellent and 5% Not Good. Those who indicated that they were having problems with accessing health care rated their health status more negatively. Those who reported themselves as smokers also rated their health status more negatively. Self-Reported Diagnosis Survey participants were asked if they had ever been told by a physician or health professional that they had a specific health problem. They could choose from a list of conditions and select all that applied to their situation. The level of responses on average was 1.42 responses or diagnoses per person. The most frequent diagnosis selected was high blood pressure, with 29% of the total sample responding to the question. Other diagnoses selected included:

• Obesity • Arthritis • Stroke • High Cholesterol

21% 17% 15% 14%

The lowest health ratings by self-reported diagnosis were diabetes, lung disease (COPD) and cancer.

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Deferring Medical Care Respondents were asked if they had deferred or skipped medical, dental or other health care appointments or prescriptions within the past year. Of the respondents who answered the questions, up to 37% of the sample had deferred or skipped needed medical care. The two highest response percentages were delaying buying needed prescription drugs or dental care. Only 22% responded, “Yes” to the more general question of deferring medical care due to cost. As the questions became more specific, the percentage deferring care increased. The lowest “Yes” response percentages are 6.7% for skipping preventive immunizations and 10.6% for sharing medications. Respondents were also asked about deferral of mental health treatment. The most frequent reason for deferring mental health treatment was “Cost,” at 48% of the sample with valid responses. This is followed by both “Availability” and “What others might think” at 26%. Only about one-third of the sample answered this question. Physician Recommendations & Wellness When asked how often respondents follow the advice of their physicians:

• 59% Most of the time • 35% All of the time • 4% About half the time • 1% Less than half the time

When asked how often respondents follow physician prescription recommendations: • 62% All of the time • 34% Most of the time When asked how often respondents receive a routine checkup: • 68% Within the past 12 months • 26% Within the past 5 years • 1% Never When asked if respondents wish to quit smoking: • 67% Who smoked said “Yes” • 80% Aware of programs to help them quit smoking When asked where respondents obtain information on nutrition:

• 22% Radio • 16% Internet, Relatives & Friends • 15% Television • 11% Health Provider • 12% Newspapers & Magazines

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When asked about the top barriers to exercise: • 31% Don’t see the need • 30% Can’t afford membership • 20% Unwilling to spend the time Top Three Suggestions One of the most anticipated results was the “Top Three Suggestions” from the survey respondents on how to improve the health of the community. As the table below indicates, this question was a multiple response question for which respondents chose 2.71 responses per person, or their top three. The community has identified improving access to health care, improving nutrition and increasing physical activity as their top three ways to improve the health of our community. Improving access to medication is a close fourth. Top 3 - Multiple Response Responses N a

Top 3

Group

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Cases

875

18%

50%

Educate on Healthcare Issues

592

12%

34%

Improve Nutrition

880

18%

50%

Increase physical activity

733

15%

42%

Improve air quality

200

4%

11%

Improve water quality

122

3%

7%

Improve Access/Quality Medication

668

14%

38%

Access to Dental Care

399

8%

23%

Access to Mental Health

243

5%

14%

58

1%

3%

4,770

100%

271%

Total

Percent

Improve Access

Other a

Percent of

Responses per Person

2.71

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Focus Group Report Upon the survey’s conclusion, a series of questions were assembled based on a preliminary review of the data collected. These questions were then presented to ten focus groups composed of community members. The groups represented:

• Leadership Alumni • Young Professionals • Seniors • Business Leaders in South Bend, Mishawaka & Plymouth • Clinics • Expectant & New Mothers • Latino Community Leaders

The groups varied in the number of participants from two to more than 20, but the average was around nine or ten per group, and totaled more than 70 individuals. The focus group participants were asked to consider the information given to them and discuss possible actions that could be taken by SJRMC to improve the health status of the communities. The questions focused on topics viewed to be critical to various members of the communities. Focus Group Discussion Diabetes The focus groups all agreed that education was the most important resource to help people that live with diabetes, or are at risk for developing diabetes. The programs currently in place are providing the right information; however, the information is not reaching everyone who needs it. The participants believe SJRMC should offer additional classes or education opportunities for community members in locations that are more easily accessible. All of the classes need to cover prevention, warning signs and nutrition. They also need to cover management of the disease with cooking classes, lifestyle changes and fitness classes. The participants also suggested that the hospital attempt to reach children through their parents. While school programs might be helpful in the education process, parents are responsible for meals at home. It is possible that we can organize many of these programs through local churches.

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A major challenge offered to SJRMC was that of informing people about the diabetic information/ education programs it already offers. The hospital should increase its marketing efforts by running ads on TV, on the radio, in church bulletins, in the El Puente newspaper and through social media like Facebook and Twitter. Information about education programs or upcoming events must be spread through any and all media possible. Some members of the senior focus group suggested that SJRMC: • Provide free diabetic screening at its presently sponsored health fairs • Increase the number of health fair locations so as to increase access to them • Provide testing strips or insulin to persons unable to afford them • Help eligible diabetics apply for pharmaceutical assistance programs • Distribute information about where and how to get affordable diabetes supplies • Sponsor seminars/classes for people interested in learning how to cope with diabetes with minimal or no usage of medication Senior Services While Senior Services have continually focused on insurance and medication assistance, it is important to also consider other services that seniors need: • Transportation to/from health centers and hospitals. Many seniors can no longer drive and do not have reliable transportation. Special mention was made of the difficulty people face with the bus system to the Mishawaka Campus. Seniors suggested that SJRMC provide them with a free van service. Assistance with taxi fare was also mentioned. • Signage at the hospitals and on the campuses is unclear and not well placed. Individuals in the focus groups who had been to the Mishawaka facility stated that the layout is confusing, the parking lots are difficult to navigate, and the walking distance is too great. • Presence of/assistance from caretakers and social workers was discussed. Many seniors have trouble getting needed services; some will not go to a health care facility even if they need a routine visit and would benefit from having someone check on them regularly. It was suggested SJRMC assist in creating a program wherein individuals regularly check on seniors via in-person home visits or with a 24-hour phone line that connects callers with nurses, RNs, or doctors volunteering their time.

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• Seniors would like to see an increase in the frequency of Meals-on-Wheels in order to give availability to more people who need it. • Great concern was voiced about the care given to seniors in nursing facilities. Several members of the focus groups had heard the care provided by area nursing homes was not satisfactory. They wanted an investigation of the nursing homes to see how/if SJRMC could improve the care in the facilities. • Seniors are often in need of insurance information and assistance understanding how to get the needed services. Information on how to get medication can be obtained through the SHIIP program; however, many seniors had never heard of the program. • There is a need for a patient navigator for seniors. SJRMC should provide a “navigator” to assist seniors in finding the best ways to get their health care needs met and understanding the importance of the power of attorney, living will, etc. SJRMC and its clinics/physician offices should begin to inform people about the proper way to declare a power of attorney. Prenatal Care SJRMC offers several prenatal classes. However, few people know about the programs, resulting in low attendance. Members of the prenatal care focus group suggested that SJRMC promote the classes in areas with high foot traffic like malls and grocery stores. Educational offerings for prenatal care should include: • Patient advocates at SJRMC sites. Many women go to the sites and do not know what questions to ask or they are anxious and scared. If SJRMC were to provide an advocate or a “navigator” to women at the time of their appointments, questions and concerns could be easily addressed and anxiety reduced. • Nutrition & Fitness • Smoking Cessation • Alcohol Consumption • Classes in Spanish • Other health care settings such as area hospitals, clinics and schools

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ACTION PLANS At Saint Joseph Regional Medical Center, we strive to fulfill every element of our Mission Statement through actions, not just words. Using the results of the Community Health Needs Assessment, we seek to improve the health of our community by empowering people with information, knowledge and awareness. We will incorporate the suggested areas for improvement into the strategic plan. Our action plans are the result of a new economic commitment on behalf of SJRMC, in addition to the Community Benefit Ministry in which we already participate. While we cannot realistically address every issue, we will endeavor to resolve those that most heavily affect our service areas.

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Saint Joseph Regional Medical Center Community Health Needs 3-Year Action Plans July 2012 - June 2015 Recognized Need

All Groups

Awareness

Education

Accessibility

Participate in health related programs and fairs with other organizations in Marshall County; Collaborate with local supermarket to tag healthy options in stores with the SJRMC logo; Create a calendar through Krames Staywell with health tips and specific SJRMC events, as well as the Community Health Needs Assessment report; Distribute plastic tubes allowing patients to store important medical information in the refrigerator for easy access by EMS

Distribute monthly calendar of SJRMC diabetic events via Internet and mail to key organizations and physician offices

Provide diabetic-friendly food preparation classes, recipes, and other educational materials; SJRMC will provide diabetic education and empowerment classes in English and Spanish

Create designated areas in Marshall and St. Joseph County food banks with diabetic-friendly foods. Offer classes at various locations in the community

Pre-natal Care

Employ a Pre-natal Navigator who will provide information about relevant SJRMC and community programs

Engage appropriate professionals in the creation, development and operation of a prenatal consortium; Create a Facebook page where expectant mothers can find pre-natal care information

Engage the Pre-natal Navigator who, as a member of the Pre-natal consortium, will assist expectant mothers wishing to obtain services in SJRMC’s tri-county area

Senior Diabetes Prevention

Expand the current “Senior Fit” program to accommodate 100 more participants and reduce the risk of seniors developing diabetes; Provide more class times and locations for ease of access and awareness

Diabetes

Senior Services

Create a membership loyalty awareness program by providing a menu of Senior Services available to inpatients, outpatients and Physician Network patients; Collaborate with a local mall to create a Mall Walkers Club

Engage the Senior Services Employ a Senior Services Navigator/Coordinator in assisting Navigator/Coordinator and patients obtain services in SJRMC’s a Culturally Competent tri-county area; Provide for Navigator; Host classes transportation of seniors in need and seminars for Seniors of assistance; Periodically provide through the Mall Walkers health screenings at Mall Walkers Club Club events

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For more information about this report and our action plans, please contact Michelle Peters, Community Benefit Ministry Officer, at 574.335.3897.

Population Served

Expected Outcomes

Community Partners

25,500+ in Marshall and Saint Joseph Counties

Increase loyalty to SJRMC and awareness of services; Increase awareness of healthy food choices and purchase of those items; Promote Community Needs Assessment; Provide tips for health living; Increase usage of Advance Directives

Marshall County agencies, local supermarkets, Fire Departments and EMS in Saint Joseph, Marshall and Elkhart counties

2000+ in Marshall and Saint Joseph Counties

Provide a location to obtain healthy foods for diabetics who cannot afford them; Increase visits to the SJRMC website and attendance at events

Ancilla College, DEEP, Indiana Latino Institute, Marshall County Neighbor Center, Northern Indiana Food Bank, Purdue University and Extensions, Select Health, “Senior Fit”, United Way, Visiting Nurses Association

1100+ in Marshall, Saint Joseph and Elkhart Counties

Increase participation in pre-natal care programs provided by SJRMC; Decrease in the number of early deliveries and low birth weight babies; Create a pre-natal care consortium; Increase “likes” on Facebook page

Healthy Babies, consisting of: AARC, DCS, Family and Children Center, First Steps, Head Start, Healthlinc, Hope Ministries, Memorial Hospital, Minority Health Coalition, Notre Dame, Prevent Child Abuse, Saint Joseph County Health Department, Saint Mary’s College, Women’s Care Center and 20 other agencies

100+ in Saint Joseph County

Increase availability of “Senior Fit” program by increasing number of classes and locations

Cardio Pulmonary Rehabilitation, Occupational Therapy, Physical Therapy, Saint Joseph Physician Network

4500+ in Marshall, Saint Joseph and Elkhart Counties

Increase satisfaction among seniors that use SJRMC health services; Increase awareness of and participation in SJRMC senior programs; Encourage Senior wellness and exercise through the Mall Walkers Club

Holy Cross College, Marshall County Council on Aging, REAL Services, South Bend Parks and Recreation, United Way, Visiting Nurses Association

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At Saint Joseph Regional Medical Center, our values of respect, social justice, compassion, care for the poor & underserved and excellence give us strength. That character guides every decision we make – even when those decisions are complicated, costly or hard. We honor our mission to heal body, mind and spirit by investing in technology, people and capabilities that allow us to set the standards for quality care. Because we answer to a higher calling. This is healthcare, inspired by faith.

Saint Joseph Regional Medical Center Mishawaka Campus 5215 Holy Cross Parkway Mishawaka, IN 46545 574.335.5000

Plymouth Campus 1915 Lake Avenue Plymouth, IN 46545 574.936.3181

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2011-2012 SJRMC Community Health Needs Assessment