LACONIA — A health needs survey of the Winnepesaukee region points to priorities that have become more urgent during COVID, including access to affordable medical and mental health care, primary physicians, addiction treatment, and support for families.

The 2020 Community Health Needs Assessment by LRGHealthcare, the Partnership for Public Health, Health First Family Care Center and Central New Hampshire VNA and Hospice will guide future services for Lakes Region residents, including for the increasing number of older adults who live here. The report pointed to differences in needs and demographics between towns, as well as mounting pressure to create more affordable housing.

“It’s enormously help for us,” said Cass Walker, chief human resources officer and director of administrative and support services for Lakes Region General Healthcare, which includes hospitals, clinics and primary care practices in Laconia, Franklin, Belmont and Meredith. “LRGH will use this with our community partners.  We need to be agile in our services, and pivot where we need to acclimate to these changes. We need to start construction and build to react to the community needs assessment.”

Walker send it’s too early to predict which special services LRGH will provide, with the merger with Concord Hospital still working through the legal and financial aspects of bankruptcy and acquisition, but the hospital intends to remain comprehensive provider of essential and first-line care in this area. “We’re working very hard with everyone involved in the process to expedite this acquisition so the community has the stability of health care here,” Walker said.

“Do I have a vision at this point in time? No. But I do feel confident that the footprint here as it exists today will continue to react to our local community needs,” said[R1]  Walker. “The pandemic  has taught us to do niche collaboration, including with getting vaccines as quickly as we can to communities” including when one doesn’t have enough.  “In order to meet community needs, we have to be able to adjust to them.” 

Better access to primary care remains a critical gap, cited as a major need by 40 percent of survey respondents.  Audrey Goudie, communications and marketing director for Health First, with clinics in Laconia and Tilton, said the federally-funded medical service provider can take new patients who need a primary care provider now, and can service people quickly with same-day appointments at the end of each weekday – which means it can substitute for a visit to urgent care.  Health First has laboratory, mental health and substance misuse counseling and family care under one roof, and is currently providing medical care to patients of retiring physician Dr. Joseph Mishcon at his Tilton office, Goudie said.

Attracting new medical providers to the Lakes Region and north has been a perennial challenge, especially as area doctors retire.  But COVID has sparked an exodus of many city dwellers to suburban and rural areas, which have lower rates of infection and  disease transmission, and Lakes Region care providers hope to capitalize on that to attract more doctors and nurses to this area.  In the past, “Unless they love skiing and the outdoors and a more rural setting, it’s been a challenge,” Walker said.

Identified in the survey was expanding help for families – services and programming that morphed during COVID to  online meetings and teleconferences which allowed homebound parents with young children to receive support easily without leaving home.

Erin Pettengill, vice president of the Family Resource Center of Central New Hampshire, said in-person gatherings still remain a important service, especially for home visits and parent education.  But online platforms have increased the ability to reach more families, and will continue when in-person sessions resume.

In keeping with the needs identified in survey, ACERT, which links children who’ve experienced trauma  to the supports they need, will expand to Sanbornton, Tilton, Northfield, Belmont and Gilford, with Sanbornton and Northfield starting in the several weeks, Pettengill said.  The program follows successful efforts in Laconia, Concord and Manchester, which enabled police officers responding to domestic violence, robberies, fires and car accidents and othe incidents to get permission from parents to connect their children to mental health help and services.

“Meeting the needs of children in real time, when they’re having adverse childhood experiences, gives them the tools to be resilient and successful as adults,” Pettengill said. “ACES affect so much. If we can mitigate them in real time, we give children and families a better chance.”

The report indicated that in Northfield, 51 percent of households responding consisted of single parents with children.  Parent education are early childhood programming remains a priority to boost outcomes for children and caregivers.

After access to affordable health insurance and health care, increasing the availability of mental health services was cited as a priority by 52 percent of  survey respondents.

Those interviewed invariably said COVID increased their stress and anxiety, and reports from mental health and social service agencies statewide indicate that the pandemic has spiked depression and substance abuse as people became isolated at home.

Roughly 75 percent of survey participants said the pandemic and its social and economic effects ramped up their stress and anxiety. “People don’t usually talk about that.  To get so many people to say that, it’s probably their number one burden,” especially as COVID continues for more than a year, was truly telling, said Kimbly Wade, mental health and substance misuse authority for the Partnership for Public Health in the Lakes Region. “Left untreated, it could lead to further mental health problems,” Wade said.

“It really has impacted people that are in recovery or going through it,” said Tamera Carmichael, executive director at the Partnership for Public Health.  Essential to the healing process is “talking and having that support system. They vocalized being affected by isolation.  As much a people are trying to do it virtually, it’s still not the same as in person support.”

Although telehealth increases access and reduces barriers including transportation, financial burdens, and travel time, people who rely on peer support for selfcare and making positive choices often “don’t find virtual options as effective for keeping them in that good state of mind,” said Wade. Simple at-home therapies such as going for a walk or sitting outside in the sun drop in winter cold and snow, adding to isolation and curtailing easy, fresh-air stress-busting options.

While the number of mental health providers needs to increase, the Partnership for Public Health can help by providing self-care tips to give people direction, and online tutorials and support groups are also invaluable, said Wade.

“Access to health care and mental health care is a concern. It’s something we’re going to have to work on as a collaboration going forward,” said Carmichael. She added that the area’s strong level of networking between providers remains a powerful magnet to bring new care workers here, and an online referral system recently purchased by the state reduces duplication of services, enables patients to get help more swiftly, and allows providers to see more patients without wasting time.

It’s important to maintain optimism that the COVID will soon end, and local health care will emerge stronger, Carmichael said.  She said her father, who has lived through the small pox and polio quarantines, has the healthy and lived perspective that this is a phase that will pass, and life will return to a healthier normal.

Important lessons and options have been spotlighted as a result – including telehealth, which is here to stay, said Wade.

“We need to break down the barriers that are preventing people from getting services,” which include available time and transportation, said Wade.  For mothers who can’t get to doctor’s appointments with kids, seniors with mobility issues, and people who fear stigma and being judged for walking into a mental health facility, telehealth is a boon to health preservation, she said. “Telehealth is beneficial for certain populations and personalities who have had barriers to getting important care.”

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