In rural Washington County, getting to the nearest hospitals in Glens Falls, Saratoga, Troy, or even Vermont can take a long time. That’s why the Cambridge Valley Rescue Squad (CVRS) started Community Paramedicine—bringing healthcare right to people’s homes. Paramedics visit patients for non-emergency needs like checking medications, helping manage ongoing health problems, and following up with people who call 911 often. This means fewer long trips to the hospital.

The program began in 2013 when CVRS leaders, including Mark Spiezio, worked with local health partners to start a “Community Check” service for frequent EMS users. With funding from New York State’s DSRIP program, they made over 1,000 home visits by 2019. During COVID-19, EMS agencies were allowed to give vaccines and rapid tests at home. In 2023, a new state law (Article 3018) created a pilot program for up to 55 EMS agencies, including CVRS, to run through 2027. State rules for the program are expected by September 2025.

Today, CVRS is funded by patient payments, small town contributions, and grants like those from the Mother Cabrini Health Foundation. They plan to add services such as medication education, COPD care, potassium testing, and other chronic care checks. All agencies in the pilot share their results with the state to help guide future policy—so that more rural EMS teams can offer this kind of care after 2027.

All the Lonely People, a documentary by the Clowder Group, follows a diverse group of youth and adults as they relate their experiences with loneliness and social isolation, accompanied by expert testimony, exploring various causes, consequences, and coping strategies. From May 7th-14th, NYSARH, Catskill Hudson AHEC, Central New York AHEC, Hudson Mohawk AHEC, Northern AHEC, Western New York Rural AHEC, and the Clowder Group partnered to host film screenings and panel discussions in seven communities across rural Upstate NY as part of the Older Adult Rural Support (OARS) Program. Over 100 people attended the screenings, which were well-received by audiences. This film tour was funded by a grant of the Mother Cabrini Health Foundation.

By Bridget Walsh

Most people don’t know a great deal about oral health. For example, did you know that tooth decay is a communicable disease? Or that it is the most common chronic childhood disease? These facts are largely unknown by the public and policymakers because, despite the terrible human cost and the significant health costs associated with dental disease, oral health rarely garners the same attention as other health issues. 

Oral health—the health of the teeth, the gums and the rest of the mouth—is not usually included in what we traditionally consider health care. Think about it for a moment. Most people receive their dental care outside the usual medical setting and pay for care with dental, not medical, insurance. Payment systems are largely separate, services are not integrated and there is not always an association between medical and dental providers. And yet, the mouth is connected to the rest of the body in significant ways. It allows us to eat and speak. It communicates our feelings. It protects us from germs. In fact, more and more research indicates that the health of the mouth impacts conditions such as lung and heart disorders, diabetes, pregnancy and obesity.

Good oral health is “not just” the absence of disease, but the full ability to use the mouth for everyday functions such as eating, smiling, speaking. While oral health focuses specifically on issues presenting in the mouth—including the teeth, tongue, gums, and the entire oral cavity—oral health is inseparable from physical and mental health.

There are many examples of how oral health effects, and is affected by, the health of the whole body. When oral health is compromised, it can lead to increased risk for diseases such as cardiovascular disease or stroke. Oral disease has been linked to complications in pregnancy and childbirth and to respiratory, gastrointestinal, rheumatologic, and immunological issues. The influence goes the other way, too: other health conditions can affect the mouth, as when medication side effects lead to a dry mouth and thereby increase the risk of cavities or gum disease. Furthermore, oral health has unique psychological and social elements. Because the mouth is a prominent part of personal appearance, people with visible signs of oral disease are negatively judged and socially stigmatized, with consequences for their mental health as well as other influences on well-being, such as employment outcomes.

The 2021 report by the National Institute of Health, Oral Health in America, makes the point that the benefits of good oral health extend beyond the individual to families and communities. When considering oral health from a population perspective, it becomes clear that the burden of oral disease falls most heavily on subgroups that have limited economic resources, low levels of educational attainment, poor access to dental care, and lower levels of social influence or political capital. This leads to recognizable oral health disparities and inequities that are the result of differences in the availability of social and economic health-promoting resources that are largely avoidable and amenable to policy action—including access to affordable, healthy foods, professional dental prevention and treatment services, and dental insurance.

There is no question that for the last century, and particularly in the last few decades, the oral health of New Yorkers has improved substantially. The decline in dental disease is a testament to the efforts of health professionals and individuals, public health investments, government policies, educational institutions and health care organizations. However, the improvements are not uniform and some populations continue to experience a high degree of oral health problems.

Poor oral health is largely reserved for low-income and marginalized residents of the United States – including New York. People of color, Tribal, low-income, uninsured, immigrant, individuals with disabilities, and rural communities all have significantly less access to dental care and, unsurprisingly, more oral health problems – problems that can be so severe they can turn lives upside down. Poor oral health is so readily preventable there is no justification for children, seniors, and adults to have to live with the pain, disfigurement, and stigma of preventable, treatable disease. In 2021, fewer than 30% of adult New Yorkers covered by Medicaid saw a dentist and only 25% had a preventive dental visit. Only 50% of Medicaid-enrolled children saw a dentist and 40% had a preventive visit. 

We know what causes oral health problems such as tooth decay, and there are also many programs that have shown promise in preventing disease and improving health. However, there are many factors keeping families and individuals from accessing these programs or even accessing regular dental care from an appropriate provider. A recent study by the Center for Health Workforce Studies found that over 2.8 million New Yorkers live in dental health professional shortage areas, and majority live in rural areas. 

The Schuyler Center for Analysis and Advocacy is a statewide, nonprofit, policy analysis and advocacy organization working to shape policies to improve health, welfare and human services for all New Yorkers, especially children and families experiencing poverty and impacted by inequity. For many years we have focused our attention on dental disease in children and programs to prevent disease and promote the integration of medical and dental care. However, it became apparent from oral health policy conversations in recent years that it is time for a thoughtful, data-informed, multi-stakeholder conversation about improving access to care through workforce changes. 

Recently, the Schuyler Center was awarded a grant from the CareQuest Institute for Oral Health to support work focused on developing workforce recommendations to address the tremendous unmet need for preventive and routine oral health care among much of New York’s population, especially low-income New Yorkers. During 2024, the project is incorporating the experience of consumers, particularly historically marginalized New Yorkers and others impacted by provider shortages into a final report of recommendations to reduce unmet need by expanding and strengthening the oral health workforce. The project has also allowed for the development of data from the Oral Health Workforce Research Center at the University at Albany Center for Health Workforce Studies.

The project is presenting a series of webinars on oral health and potential ideas to ease workforce shortages. Anyone is invited to attend the webinars. All the webinars and materials, including the data, are available on our webpage, Oral Health Workforce | SCAANY.  We will publicize that report and additional materials at the end of the year.

Recognition of the importance of good oral health has been growing among policymakers, medical providers, and human service providers as it becomes more evident that the lack of access to regular dental care increases costs for the health system, contributes to consumer medical debt, reduces the economic productivity by limiting participation in the workforce and results in unnecessary suffering. Focusing on prevention is key as is developing a diverse, accessible workforce that meets the needs of individuals. 

Resources:

• Oral Health Workforce | SCAANY
• NYS Early Childhood Oral Health Summit | SCAANY
• Oral Health Workforce Research Center
• Oral Health in America: Advances and Challenges | National Institute of Dental and Craniofacial Research (nih.gov)
• Oral Health Data and Resources – Community Catalyst
• COHSII | National Maternal and Child Oral Health Resource Center (mchoralhealth.org)
• Oral Health Data and Statistics (ny.gov)
• The Barriers to Oral Health Care Illustration | CMS
• Health Policy Institute (HPI) | American Dental Association (ada.org)
• Oral Health Data | Division of Oral Health | CDC

Historic Appointment Signals Enhanced Leadership and Commitment to Rural Health

(Albany, N.Y.) — The New York State Association for Rural Health (NYSARH) proudly announces the appointment of Liz Urbanski-Farrell, MBA, MS, as its first employed Executive Director. This landmark hiring marks a pivotal transition from a volunteer-driven organization to one poised for even greater impact under experienced leadership.

Liz Urbanski-Farrell brings a wealth of expertise in health care management, policy, and leadership, having earned dual master’s degrees in healthcare leadership and healthcare research and policy from Cornell University. Her diverse experience spans various roles where she has significantly contributed to health care initiatives and strategies, particularly within rural settings.

Mike Pease, President of the NYSARH Board, expressed his enthusiasm about the appointment, stating, “We are thrilled to welcome Liz to NYSARH. Her deep expertise and passion for rural health will undoubtedly invigorate our organization. Liz’s leadership is exactly what we need to advance our mission and enhance our advocacy and educational efforts across New York”.

Liz Urbanski-Farrell commented on her new role, saying, “I am honored to join NYSARH and deeply respect the mission that has guided its remarkable work thus far. I am eager to begin a listening tour to connect with our members and partners, and to further our mission of improving rural health across the state.”

The appointment has been met with praise and anticipation from industry leaders. Alan Morgan, MPA, the Chief Executive Officer of The National Rural Health Association (NRHA) said, “I am delighted to congratulate Liz Urbanski-Farrell on her new role as Executive Director of the New York State Association for Rural Health. Liz brings a wealth of expertise and a deep passion for improving rural health that will undoubtedly drive NYSARH to new heights. Her leadership will be instrumental in fostering sustainable health advancements for rural communities across New York, and I look forward to the impactful work she will lead.” Sarah Ravenhall, Executive Director of the NYS Association of County Health Officials, added, “Liz’s leadership marks a significant step for NYSARH. We look forward to seeing how her innovative approaches will advance rural health initiatives and are eager to continue our collaboration with NYSARH.”

Liz Urbanski-Farrell will begin her role immediately and is reachable at liz@nysarh.org and 716-228-2884.

About the New York State Association for Rural Health. The New York State Association for Rural Health (NYSARH) is a member-driven 501c.3 founded in 2004 to uniquely bridge the gaps between care, community, and policy. NYSARH is more than advocates; they are partners in progress, educators, and a support system, deeply attuned to the voices of our diverse members. NYSARH’s holistic approach ensures that every dimension of rural health is addressed, making it the essential ally for anyone committed to fostering sustainable rural well-being. www.nysarh.org.

by Elana Sitnik

Across New York State, rural communities face a critical shortage of primary care physicians, hindering access to essential healthcare. Although New York State trains more medical residents than any other state, there are very few residency programs located in rural communities. A 2019 report by the Primary Care Development Corporation highlights the dwindling number of primary care physicians in rural communities, leaving rural New Yorkers with longer wait times for medical appointments and limited access to life-prolonging and cost-saving preventative care. (1,2)

The solution lies not only in attracting doctors to these areas but also in developing a sustainable source of future physicians who understand the unique needs of these underserved rural communities. Smaller residency programs, which are often located in rural communities struggling with primary care access, can play a vital role in improving access to healthcare in rural communities. Research shows that doctors who train in programs serving rural populations are far more likely to choose to practice in those areas after residency. 

Dr. Caleb Atkins is one of only two second-year family medicine residents at Samaritan Medical Center in Watertown, NY. A native of Jefferson County, Dr. Atkins grew up just 20 miles away in the small town of Carthage, NY. His interest in practicing rural family medicine stems from witnessing his parents’ poor health outcomes due to limited healthcare access during his upbringing. Dr. Atkins appreciates his training environment, stating, “Training in the Family Medicine Residency at Samaritan Medical Center provides me with unfettered access to a wide variety of diseases in a close-knit residency setting.” He describes his medical training as indispensable. However, he expresses concern about the future of programs like his, noting, “The program’s inability to secure more federal funding for expansion is worrisome.” He emphasizes, “Without additional doctors being trained in my area, healthcare outcomes will continue to suffer.”

By strengthening Medicaid funding for these rural and safety-net hospital residency programs, the New York State legislature can solve three of our state’s public health challenges in just one move: the physician shortage, increasing access to care for rural communities, and keeping physicians who train in New York in the state once their training is complete. Increased funding would allow these programs to expand residency slots, directly addressing the physician shortage in New York. Additionally, more residency positions in rural settings will translate into a larger pool of physicians qualified to address the specific needs of rural communities, and studies show that increased exposure to rural healthcare during residency has potential to encourage graduates to consider practicing in rural areas (3).

Dr. Jocelyn Young, Designated Institutional Official at Chenango Memorial Hospital is leading the creation of a rural family medicine residency program in the community of Norwich, in Central New York. She highlights that recruitment of primary care physicians to the small community is very challenging. CMH has embarked on creating a residency program that seeks to recruit, train, and retain the next generation of family physicians who will serve the area. “Through creating a program that allows residents to train in the environment that we hope they will practice in, this rural farming community will be served by dedicated family physicians for generations to come.” One of the challenges in creating a new residency program is finding the financial resources to offset the cost of creating and running an excellent quality residency program. As a sole community hospital, CMH is limited in access to Medicare funding for residency training. “Increased medicaid funding within the state that is focused on institutions that are training rural primary care physicians would ease the burden being shouldered by small hospitals.” The team at CMH is boldly striding forward despite these challenges and Dr. Young plans to continue advocating to increase NYS Medicaid funding for rural residencies and their hospitals. 

In essence, investing in rural residency programs isn’t just about creating more doctors – it’s about creating doctors who are invested in serving the very communities that need them most. Doctors, hospital administrators, and lawmakers all have a stake in ensuring equitable access to healthcare across New York State. By prioritizing funding for rural residency programs, we can cultivate a future generation of physicians dedicated to these underserved communities. This isn’t just about healthcare, it’s about fostering healthy and thriving communities throughout our state. Let’s write the prescription for a healthier rural New York by investing in the doctors who will serve these communities for years to come.

1. Rural access to primary care in New York State: 2019 Report. https://www.pcdc.org/wp-content/uploads/Resources/Rural-Access-to-Primary-Care-in-New-York-State-_-2019-Report.pdf
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690145/ 
3. Recipe for more rural physicians: More exposure in residency training. American Medical Association. Published September 27, 2022. Accessed February 23, 2024.https://www.ama-assn.org/medical-residents/transition-resident-attending/recipe-more-rural-physicians-more-exposure

Food insecurity is a pressing issue in many rural communities, where access to resources is limited. However, a beacon of hope is on the horizon for residents of Black River and Evans Mills as a new initiative aims to address this challenge head-on. In a pioneering move, a mobile food pantry is set to roll into these north country communities, providing much-needed relief to those facing hunger. Spearheaded by the Community Action Planning Council (CAPC) and supported by Jefferson County, FX Caprara, and Cornell Cooperative Extension, this innovative project is poised to make a significant impact.

Mayor David Leonard of Black River expressed his optimism about the initiative, stating, “I really think that this is going to be tremendous in helping people.” The mobile pantry, housed in a 2023 Ram ProMaster van, is a testament to the power of collaboration and community-driven solutions. The primary objective of the mobile pantry is to extend resources beyond the confines of traditional brick-and-mortar food pantries. Caroline Feasler, CAPC Family Center Director, emphasized the importance of reaching rural areas, stating, “To spread the resources outside the city of Watertown.”

Starting on April 1, the mobile food pantry will commence its monthly visits to Black River and Evans Mills, providing essential sustenance to those in need. Mayor Leonard highlighted the convenience of this approach, noting, “We’re almost like one-stop shopping where they can get the help that they need.”

Equipped with the capacity to transport approximately 150 boxes of food per day, the van will serve as a lifeline for many families grappling with food insecurity. The first stop will be at the Jack Williams Community Park in Evans Mills before heading to the gazebo near the public square in Black River.

This endeavor marks a significant step forward in the fight against hunger in rural communities, demonstrating the power of collective action and community support. As the mobile food pantry sets its wheels in motion, it symbolizes a ray of hope for those in need.

Read More Here 

In response to a lack of additional funding from Congress, the Wireline Competition Bureau of the Federal Communications Commission (FCC) has issued an Order detailing wind-down procedures for the Affordable Connectivity Program (ACP). The program, aimed at providing discounted internet services to low-income households, faces termination due to funding depletion. The Order outlines significant dates, impacts on consumers and providers, and guidelines for the transition period.

The Affordable Connectivity Program, which has been instrumental in providing discounted internet access to over 22 million low-income households across urban and rural areas, is set to exhaust its $14.2 billion funding. The FCC projects that April 2024 will be the last month for which the program can fully reimburse providers for benefits provided to enrolled households. However, if additional funding is not secured, the program will cease, and providers will discontinue offering discounts to enrolled households.

To facilitate an orderly transition, the FCC has laid out wind-down procedures, including notifying enrolled households about the program’s termination’s impact on their broadband service and bills. New enrollments into the ACP have been frozen since February 8, 2024, with existing enrollments set to continue receiving benefits until funding depletion.

Providers are directed to send multiple notices to ACP households, informing them of the program’s end and providing information on alternative broadband service plans, including low-income internet offerings. The FCC also emphasizes the importance of providers helping ACP households transition to their own low-income internet programs.

Furthermore, the FCC has waived certain advertising and awareness requirements effective February 8, 2024, to prevent consumer confusion during the wind-down period. Additionally, outreach efforts under the Affordable Connectivity Outreach Grant Program and ACP Pilot Programs will cease focusing on enrollment activities due to the enrollment freeze.

The full text of the Order and further information can be accessed on the FCC’s website.

For further inquiries, contact Benjamin Nashed at Benjamin.Nashed@fcc.gov or 202-418-7400.

Read the full document here.

In 2023, the United States witnessed a tragic milestone as more than 50,000 Americans took their own lives, marking the highest yearly rate of suicide on record. Among the most affected are farmers, who face unique challenges that often go unnoticed. According to the National Rural Health Association, farmers are 3.5 times more likely to die by suicide than the general population.

Special correspondent Megan Thompson sheds light on this issue, reporting from Wisconsin, where farmers grapple with immense pressure and isolation. Brenda Statz, who runs a 300-acre farm with her family, recounts the struggles her husband, Leon, faced. Leon, like many farmers, battled depression, feeling the weight of financial burdens and the demands of farm life.

The story of the Statz family is not uncommon. Randy Roecker, another dairy farmer in the area, shares his own journey through financial hardship and mental health challenges. Despite investing in modernizing his farm, Roecker found himself overwhelmed by debt and depression.

However, amidst these struggles, a beacon of hope emerges. Brenda Statz and Randy Roecker, along with other concerned individuals, have formed the Farmer Angel Network. This grassroots initiative aims to raise awareness about mental health issues among farmers and provide resources for support and intervention.

Through community outreach, educational programs, and partnerships with organizations like the Wisconsin Farm Center, efforts are underway to destigmatize mental health discussions and ensure farmers have access to counseling and support services. Telehealth options have proven particularly valuable, offering privacy and convenience for farmers seeking assistance.

The increasing demand for mental health vouchers in Wisconsin reflects a growing awareness and acceptance of the need for support. Brenda Statz, drawing from her own experience, hopes that by sharing her story and reaching out to others, she can prevent more tragedies and offer hope to those struggling in silence.

As the nation grapples with alarming suicide rates, initiatives like the Farmer Angel Network serve as a reminder of the power of community support and solidarity in addressing mental health challenges. To those in need, help is available. Whether it’s through a hotline, online resources, or local support groups, no one has to face these struggles alone.

For the full transcript of Megan Thompson’s report and more information on suicide prevention resources, visit PBS News Weekend.

Notice:
If you or someone you know is experiencing thoughts of suicide, please reach out to the National Suicide Prevention Lifeline at 988 or visit 988lifeline.org for immediate assistance and support.