Keynote: Fine Calls for Community Health Stations Across Rhode Island

Published in the Woonsocket Call on May 20, 2018

Last week, the Rhode Island Minority Elder Task Force (RIMETF) held a Health and Wellness Fair at the Cape Verdean Progressive Center in East Providence to put a spot light on minority health care needs.

Dr. Michael Fine, a primary care physician who formerly was the state’s Health Director, and now serves as Senior Population Health and Clinical Officer at the Blackstone Valley Community Health Care, Inc., gave the keynote address, calling for an overhaul of America’s ailing health care delivery system.

Although RIMETF’s primary mission is to raise money and seek grants to provide limited emergency assistance to low-income seniors in crisis situations, the organization also promotes the advancement of inclusive programs for minority elders, says Susan Sweet, the nonprofit’s founder, a former state official who advocated for, developed and operated programs and services provided to the state’s vulnerable populations, including elders. She continued that work after retirement from the state. “During the last two decades, RIMETF provided more than $53,000 in grants,” she said.

According to Sweet, RIMETF’s $200 grants help low income seniors to pay utility costs, rent, food, medications, clothing, furniture, personal healthcare items and other necessities of life. She says that 80 grants are given out annually, about half going to minority applicants.

But, the decision to host a Health and Wellness Fair on May 11, 2018, was tied to minorities having a lack of access to health care services and to have Dr. Fine outline a better way of providing care to Rhode Island’s minorities, adds Sweet. “To this day the state’s diverse minorities continue to remain in the dark about health care programs and services that they can access and that lack of information has a detrimental impact on their health and well-being,” says Sweet.

Health Disparities in Rhode Island

During his thirty-minute keynote, Dr. Fine, a primary care physician who formerly was the state’s Health Director, and now serves as Senior Population Health
and Clinical Officer at the Blackstone Valley Community Health Care, Inc., provided the details as to how lack of access to health care adversely impacts the health and life expectancy of Rhode Island’s minorities.

According to Dr. Fine, infant mortality in the African American population is about three times as high than in the white population. Diabetes is about two times more common in the African-American population than it is in the white population. He also noted that life expectancy in the United States is 4.5 years less among the African American population than it is among the white population.

Zeroing in on Cape Verdeans, Dr. Fine noted that the Rhode Island Department of Health does not track the health of this minority group separately from other groups. The state’s primary care practices and community health centers don’t have a good way to decide who counts as a Cape Verdean for health tracking purposes, he said. But about half of the Cape Verdean community in Rhode Island live in Pawtucket and Central Falls, so that health information collected using the electronic medical record by Blackstone Valley Community Health Center (BVCHC), Inc, provides the first ever look at the health status of Cape Verdeans in Rhode Island.

It’s difficult to know if that data is complete, because it doesn’t allow us to count all Cape Verdeans at the BVCHC, but only those people who speak Cape Verdean Creole or those who identify themselves as having been born in Cape Verde. “Because we have no complete way to identify the health status of the Cape Verdean population, we have no certain way to identify specials needs and opportunities to provide better health care to this minority group,” says Dr. Fine. In addition, because Cape Verdean Creole is not a written language, “we have no way to certify Cape Verdean medical translators” which means some of the health care needs of Cape Verdeans go unaddressed, he adds.

But, there are better ways to improve the health care of Rhode Island’s Cape Verdeans, says Dr. Fine. “We must make sure that all Cape Verdeans are enrolled in a primary care practice or community health center,” he says, noting that electronic medical systems can provide better measures of the health of this population.

Dr. Fine called for Cape Verdeans to be appointed to boards of health care organizations to represent them in decision of allocation of resources, to demand better translation services, and to improve delivery of health care to Rhode Island’s Cape Verdeans.

As to Rhode Islanders, Dr. Fine noted that 25 to 45 percent don’t get primary care and prevention. As a result, there are 1,200 unnecessary deaths a year from heart disease and stroke. There are 200 unnecessary deaths a year from colon cancer and 65-70 unnecessary cases of HIV. Up to 200,000 Rhode Islanders remain smokers, he says.

Dr. Fine continued to detail the negative impact on the health of Rhode Islanders if they did not visit a primary care physician. More than 1,500 babies are born to teenagers, more than a third to minorities. Not to mention that there are 330 to 400 avoidable deaths from influenza every year due lack of immunization (500,000 Rhode Islanders are currently not immunized every year). And there are 330 deaths a year from prescriptions and other drug overdoses, he says.

It’s Time for a Change

Dr. Fine warns that major changes must be made to the nation’s health care delivery system to reduce spiraling health care costs and to provide better access. This solution can be modeled after his Central Falls Neighborhood Health Station (CFNHS), he says. It’s a multi and interdisciplinary approach, bringing a wide variety of health care professionals together, from physician, nurses, physician assistants, mental health workers, nutritionists, substance abuse workers and midwifes, to rehabilitation professionals, CFNHS’s must also provide urgent care and primary care services, be open on weekends and have “sick today access appointments.” Says Dr. Fine.

Fine has documented early successes in the CFNHS’s delivery of health care. Adolescent pregnancy was been reduced by 24 percent in 2016 and emergency medical service runs were reduced by 5 percent in just 12 months.

Dr. Fine envisions a Neighborhood Health Station in every community of 10,000 persons. When up and running, “we’ll increase life expectancy, reduce infant mortality and revitalize the local economy,” he says, by reducing health care costs.

Concluding the Health and Wellness Fair, Director Charles J. Fogarty, of the Rhode Island Division of Elderly Affairs, who will be retiring next month, was recognized by RIMETF for his 40 years of public service and his support for the work of the Minority Elder Task Force.

For more details regarding the work of the RI Minority Elder Task Force or to make a donation, write RIMETF, 5 Leahy Street, Rumford, RI 02916 or call Lori Brennan Almeida, Chairperson, at 401-497-1287.

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Tips on Finding an Age-Friendly Fitness Center

    Published on November 16, 2012, Pawtucket Times

           With the cold frigid weather approaching, that 30 minute daily walk around the block may well fall by the wayside in the winter months. While this activity is just what the doctor ordered to help keep you physically fit and feeling good, many aging baby boomers and seniors ‘look inward’ by turning to a local gym, by bringing their regular exercise indoors.

Seeking that Perfect Age-Friendly Fitness Center

            According to the Vancouver, British Columbia-based International Council on Active Aging (ICAA),aging baby boomers and seniors are joining health and wellness facilities faster than any other age group today, however many of these facilities are ill-prepared or not equipped to serve those in their later years.

While older “adult-focused” small gyms like ‘Nifty After Fifty’ are available, “even the large 24 Hour Fitness chains seek to attract older adults”, says Patricia Ryan, ICAA’s Vice-President of Education, noting that “over 70 percent of YMCAs had older adult programs according to a stat cited in ICAA Active Aging in America, Industry Outlook 2010.

Ryan recommends that when shopping around for a fitness center that caters to older baby boomers and seniors, always compare and contrast information gathered, using the following checklists, created by ICAA, to identify age-friendly fitness center.

            Become a savvy shopper when touring your local fitness center, by making sure it gears its amenities and organizational philosophies towards your needs – those age fifty-something and beyond.  ICAA, the world’s largest senior fitness association, has created a check list to help older persons to rate and compare local fitness facilities so they can choose one that meets their age-specific needs.

Some specific questions to consider can ultimately ensure that the center you choose meets your specific physical needs:

  1. Are the locker rooms clean, accessible and monitored by staff?
  2. Do you feel comfortable in the atmosphere of the facility?
  3. Are the membership contracts and marketing materials available in large print?
  4. Are signs visible and easy to understand?
  5. Does the facility’s cardiovascular equipment have the following age-friendly features – a display panel that is easy to read, easy to change and easy to understand?
  6. Is the music acceptable and set at a reasonable level?
  7. Do the facility’s treadmills start slowly, at 0.5 mph?
  8. Do the recumbent bikes or steppers have a wide and comfortable seat with armrests?
  9. Does the facility’s strength-building equipment have instructional placards that have simple diagrams, easy-to read text and font, and correct usage information.
  10. Does the facility’s strength-building equipment have a low starting resistance, less than five pounds?
  11. Does the facility offer programs designed to meet the needs of those with a variety of chronic conditions (specifically osteoporosis, cardiovascular, disease, diabetes, balance abnormalities, muscular weakness)?
  12.  Do the group exercise classes have different levels of intensity, duration and size?
  13.  Is there an extensive screening and assessment process (for balance, functional   abilities, osteoporosis)?’
  14.  Is the staff certified by a nationally recognized organization to work with people who have various health issues that may arise with age (specifically osteoporosis, hypertension, arthritis)?
  15. Is the staff knowledgeable about the impact that medication can have on exercise?

To download the complete checklist, visit the ICAA website,  www.icaa.cc/checklist.htm.

Getting Healthy, Building Closer Relationships   

It’s no secret to Maureen Wilcox, 45, of the need to cater to an aging population.  Wilcox,  a certified Personal Trainer at the Attleboro YMCA located across from the City’s Public Library on South Main Street in Attleboro, MA estimates that 30 percent of the nonprofit group’s membership is age 50 and over.  Many of these members are seeking advice on how to better manage or prevent age-related health concerns, the most common being: arthritis, high blood pressure, diabetes, cardiac health and obesity.

Wilcox notes that this large constituency finds value in the Attleboro YMCA’s wide variety of programs that are geared towards baby-boomers and seniors.  These programs include resistance and strength training, aqua classes, Zumba classes, chair exercises, yoga and Tai Chi. “These classes will help you to manage a healthy body weight, stimulate your immune system, increase strength, improve posture, increase your flexibility and balance and help prevent chronic illnesses”, she adds. 

             According to Wilcox, a fitness center can also be a place to build friendships among older persons.  “A supportive community can enhance camaraderie among the participants, keeping them motivated and committed to meeting their exercise goals,” she says, adding that commitment to an exercise regime may well be more important than pushing weights around..

Over the years working, Wilcox has seen many new members in their later years forge new friendships at the Attleboro YMCA.  “Seeing people regularly allows them to develop meaningful relationships where they ultimately become an extended family,” she says.

“Relationships developed by participating in exercise classes also builds a small community among the senior age group members,” Wilcox notes, adding that they often participate in social trips and group outings outside of the Attleboro YMCA.  She notes, some seniors while exercising on their stationary bikes, read a big print book, To Kill Mocking Bird, adding health and wellness to an already established community literacy initiative.

Finally, in addition to personal training, various group exercise classes, including a running club,  LIVESTRONG is also offered at the Attleboro YMCA, says Wilcox.  It’s a free 12-week personal training program that provides a place where cancer survivors can come together.   Along with specially-trained staff to safely work in small groups,  participating members receive one-to-one attention while working toward maintaining or regaining their independence, everyday fitness, and overall health & wellness.  These participants share a bond that only cancer survivors can relate to.  “This is an inspirational program and one which we are all proud to be a part of,” prides Wilcox.

Getting to the Bottom Line

             Outdoor walking or the gym? That depends on personal preference and time availability.  “Brisk walking is beneficial, emphasizing ‘brisk,’ “says ICAA’s Ryan. “Faster walking to increase intensity has been reported in several studies in ICAA Research Review, to enhance your health, rather than the frequency,” she noted.

In addition, Ryan adds that scheduled classes in a fitness center help a person plan physical activity into their days and there should be equipment and classes for variety. There is expertise available in many (but not all) cases, especially in gyms targeting older adults and medically integrated fitness centers, a.k.a hospital wellness programs. There is recognition among most fitness clubs that older adults are not only a huge population to attract, but also a very good customer because of expendable income, she says.

“Exercise plays a vital role in healthy aging,” says Michael Fine, MD, Director of the Rhode Island Department of Health.  “Regular exercise is an important weapon in the battle against chronic diseases, such as heart disease and diabetes.  Exercise also helps us maintain flexibility, balance and mobility.  It isn’t necessary to join a gym or buy expensive equipment; a brisk walk around the block is a great place to start if you’ve been sedentary. The key is to find an activity you enjoy and to make time for it each day.”

Ryan strongly agrees with Dr. Fine. “The most important message for those late in life is to MOVE, and to add physical activity into each day.  Physical activity is the magic pill. Whether walking, raking and hauling leaves, playing soccer or even going to a fitness club, it’s the right thing to do for healthy aging.

Herb Weiss, LRI ’12,  is a Pawtucket-free lance writer who covers aging, medical and health care issues.  He can be reached at hweissri@aol.com.