Our Aging Population

The aging of our population has implications on the health care, public health, and human service systems. As elderly population increase, more services will be required for the treatment and management of chronic and acute health conditions and disabilities. Longevity and an increased number of elderly have increased the prevalence of chronic conditions associated with aging including hypertension, diabetes, end stage renal disease, and cancer, as well as Alzheimer’s disease and other forms of dementia.

In addition, Medicare beneficiaries with multiple chronic conditions, especially the frail elderly with functional or cognitive impairments in addition to chronic medical illness, will need better care coordination.

A good place to begin the study of the American health care system is to look at some demographic data about the United States. According to the U.S. Census Bureau (2010), “The number of older people has substantially increased after the first Baby Boomers turned 65 years old in 2011.” In 2050, the age group 65 years and older is anticipated to be twice as large as in 2010, and will represent nearly 20% of the total U.S. population. The segment that is 85 years old and older will also experience rapid growth from 5.8 million in 2010 to 19 million in 2050.

In recent years, 65 years and older has been the fastest growing segment of the population across the United States and in rural communities. Furthermore, life expectancy at this advanced age is increasing, but not necessarily healthier. But can the current healthcare system afford to take care of our aging population if they are faced with chronic illnesses and do we have an adequate workforce. The general impact that changing demographics may have on the health care market is that the growth of the aging population will increase the supply and demand for health care workers and facilities in the U.S. health care system.

According to the Journal of the American Academy of Nurse Practitioners (2008), “today’s healthcare workforce lacks much of the training required to provide appropriate care to the aging population.” As a result, health personnel in the coming years will also need to develop a broader understanding and competence in geriatrics for the treatment and management of chronic and acute health conditions and disabilities. The reasons why changes in the demographics of this population affect health care is that common health problems such as chronic diseases in the aging population arises from both emotional and physical causes at this stage. The minor problems require little care from others, but the severe ones such as hypertension, arthritis, heart disease, cancer, and diabetes requires increasing amounts of care and professional help. The aging of the population accounts for a significant share of increased health care costs.

The aging populations in many rural communities face numerous barriers in accessing the health and health care related services they need. Many communities can help to address these challenges by providing health education, guidance, and additional basic direct services to the aging population, promoting cost saving prevention, and inequities in care. But we should work together to address these challenges by identifying strategies to allow aging population to live independently as long as possible, providing health care and education for aging population who are self-managing multiple chronic illnesses. Regardless of the cost as it relates to healthcare services, I believe it critical that we must take care of babies and our seniors.

LaShannon Spencer is the Chief Executive Officer at Community Health Centers of Arkansas in Little Rock, Arkansas. LaShannon has several years of experience in hospital and healthcare leadership positions working with clinicians, physicians and hospital staff.

Healthcare carousel 

Over the past few months, the Senate Republicans have been hard at work making every attempt to repeal and replace the Affordable Care Act (ACA). Earlier this week, they voted to open debate on the issue. Then they voted ‘no’ to their own “repeal and replace plan.”

The proposed plan would have eliminated individual and employer mandates, amended some of the taxes attributed to help paying for the ACA and temporarily cut federal funding for Planned Parenthood. According to the CBO, it would have left an estimated16 million people without insurance.

While the ACA is not perfect, it did allow more rural Americans to have access to health care services and help to stabilize the financials of rural and critical access hospitals. But there is still much to debate about what is best for our country, health care organizations, patients, and communities; especially rural America. Arkansas is a rural state with 42 percent of Arkansans residing in a rural county according to 2015 population estimates.

Many rural Arkansans seek medical attention in a community health setting. Therefore, health center leaders must be abreast of the health status of community members.

The health of rural America is failing, and a repeal of the Affordable Care Act without adequate replacement could be catastrophic. Just last year, the Centers for Disease Control and Prevention showed for the first time in 20 years, life expectancy in the United States declined, particularly in small cities and rural areas, where people are dying at much higher rates.

This decline in life expectancy in rural areas is linked to higher rates of chronic illness, obesity, drug overdose, alcoholism, mental illness and suicide.

Health center leaders recognize the distinctive differences and diversity of each of the communities where a health center is geographically located. Each community is comprised of different social, economic and political environments.

In Arkansas, community needs vary from The Delta to the growing communities in northwest Arkansas and northeast Arkansas. Therefore, health care leaders, such as Brian Thomas, chief executive officer for Jefferson Regional Medical Center, must remain abreast of social and health care issues that continue to plague many of the residents of Jefferson County who frequents JRMC.

I recently had the opportunity to meet with Brian to discuss opportunities in which our organizations could explore strategic partnerships. As we started discussing our career pathway, we discovered we both lived on the West Coast, relocating back to Arkansas, and had a common passion rural health. I knew I was conversing with a servant leader. He's someone who really enjoys serving others, particularly in Jefferson County and surrounding areas in south Arkansas.

I really enjoyed our conversation about the current education system in Arkansas, importance of family and the impact we could create in smaller communities.

Throughout our dialogue, I was able to feel his passion for not only just paying attention to episodic care of the patient but looking to create solutions and partnerships to create a continuous care model. The continuous care model would address population health issues. The model focuses on monitoring the patient’s health status over time and in a meaningful way.

Health care executives who have paved the way for the up-and-coming health care executives, will tell you there are five basic qualities every health leader needs to be successful, 1) Must be an independent thinker who understands the emerging challenges and changes within the market; 2.) Must be passionate about serving others; 3.) Must be the change agent for the organization; 4.) Must have the ability to motivate and inspire staff to believe in the organization’s mission; and 5.) Must have an understanding of providing quality patient care at a cost savings to the organization.

Jefferson Regional Medical Center is fortunate to have such a leader at the helm of an organization with rich history. Under Brian’s leadership, I believe he will serve as the advocate who will foster a strategic partnership with organizations who are passionate for the medically underserved patient population.

LaShannon Spencer is the Chief Executive Officer at Community Health Centers of Arkansas in Little Rock, Arkansas. LaShannon has several years of experience in hospital and healthcare leadership positions working with clinicians, physicians and hospital staff.

Studying dementia

While I enjoy reading the latest studies on chronic illnesses and diseases, I often wonder about the complex evidence-based recommendations or drugs that are often created for cures and to slow down the disease process. I only say that because I recently spent a morning at Petit Jean Mountain with a group of ladies. Ground rules were established before we all went a separate ways on the mountain, no talking, mediate, and make every attempt to listen to God or to connect to your spiritual leader.

To be honest, it was difficult for me to turnoff my brain, because I am always thinking about what ifs, tasks I need to accomplish, and simply just life issues. But on that particular morning, I enjoyed breathing in the fresh air, relaxing my mind and enjoying looking at the river and the green pastures was enjoyable. As I sat and stared into the beautiful sky, I wonder if people where taught and trained at an early age the importance of relaxing and protecting the brain if this would help to decrease the number of people who are diagnosed with Alzheimer’s at an early age, simply the helmet of protection. The helmet today, protect the head and mind from the attacks of the enemy. In my opinion, the enemy can also be considered a disease.

This past Thursday, the Alzheimer’s Association International Conference released a new research that deepened our understanding of the risk factors for Alzheimer disease and other dementias, and highlight the potential to prevent cognitive decline through lifestyle interventions. The Lancet Commission on Dementia, Prevention, Intervention and Care reported that more than one-third of global dementia cases may be preventable through addressing lifestyle factors that impact an individual’s risk. They highlighted nine potentially modifiable risk factors at multiple phases across the lifespan, not just in old age.

Alzheimer’s disease is a progressive, degenerative brain disorder characterized by memory lost, language deterioration, poor judgment and indifferent attitude, but preserved motor function. Over 5.4 million Americans now suffer from Alzheimer’s disease, including approximately one in every eight persons over 65 years of age and nearly half of those persons over 85 years of age. At the current rate of incidence, the number of people aged 65 years and older with Alzheimer’s disease may rise to as high as 11 to 16 million by the year 2050, barring the development of medical breakthroughs.

The aging of our population and significant increases in life expectancy due to medical advance that allow individuals with chronic conditions and severe disabilities to live longer. Yet, the rapid rise is already evident, and is especially dramatic in Arkansas with our aging population.

Several studies have reported that racial inequities in numbers of people with Alzheimer’s disease and other dementias in the US even after the age of 90 and point to growing evidence that stressful life experiences and neighborhood conditions contribute to dementia risk in late life, and disproportionately impact African Americans. I can remember years ago when relatives who were once vibrant and had a less than active life started losing their memory, it was often stated they were going crazy or memory lost was contributed to age. But they were often misdiagnosed due to the lack of research and evidence to understand dementia as Alzheimer’s.

It is past time that a cure is developed for dementia and Alzheimer’s disease. Additionally, we need to make Alzheimer’s and other dementias a community priority by:

Driving awareness of Alzheimer’s disease to increase community focus and actions; Empowering providers to recognize and deliver an Alzheimer’s centered continuum of care; Serving as a catalyst to create a robust, interconnected Alzheimer’s providers community, and strengthen the health professional network to ensure Arkansans impacted by Alzheimer’s receive the best care, support and access to research.

LaShannon Spencer is the Chief Executive Officer at Community Health Centers of Arkansas in Little Rock, Arkansas. LaShannon has several years of experience in hospital and healthcare leadership positions working with clinicians, physicians and hospital staff.

Ethical issues in healthcare opioid

Recently, I observed a situation while sitting in the waiting room of my physician’s office. The phone kept ringing because the receptionist was away from her desk. I believe it was an office assistant who answered the phone.

I could hear this irritated person on the phone requesting a prescription refill today because he had a flight to catch later that evening. The caller continued explaining how he was a close friend of the physician and he would be okay if the person who answered the phone could just call the local pharmacy to refill the prescription.

I turned my head around to glance over to the desk because I thought about all the potential ethical issues and how the caller could potentially be a drug seeker. This employee could expose herself as well as well as the risk of medical malpractice if she calls in the patient’s refill.

Since health care in the United States has undergone major changes during the past 20 years, today’s health care professionals are immersed in an ever-changing environment. As a result, health care professionals must have a good understanding of the legal system for a variety of reasons.

The advanced state of medical technology creates new legal, ethical, moral and financial problems for the consumer and the healthcare practitioner. Although patients have become more aware of their legal rights, it is a health care professional’s job to realize how the law impacts the physician’s practice when paying attention to the wishes of the patients they serve.

The laws don’t change for personal circumstances and are put in place to ensure that welfare of the patient and providers alike. Has the medical community enforced safeguards to ensure patients do not become addicted to prescription opioid pain relievers?

It was in the late 90s when pharmaceutical companies assured the medical community that patients would not become addicted to prescription drugs, yet providers began to prescribe them at a greater rate.

According to the Centers for Disease Control and Prevention (CDC), in 2015, more than 33,000 Americans died as a result of an opioid overdose, including prescription opioid, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid. They also estimates that the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.

The misuse and addiction of opioids is an ongoing and rapidly evolving health care crisis. Millions of Americans are currently suffering from the opioid use disorder, and millions more are suffering from chronic pain. Was the caller at the physician’s office been one who was clearly seeking drugs to assist with pain or solely pleasure?

Regardless of the nature, this health care crisis is affecting many communities as well as families. We have a moral and ethical responsibility to our community to develop solutions to address this plaguing issue. Ethical dilemmas can lead medical professionals such as the caller’s to question what is right, wrong, good, and bad when making ethical judgments. The decision maker must always be objective when making ethical decisions.

Health care practitioners and organizations are faced with many ethical challenges from disagreement between patients and health care professionals on a daily basis. To help establish ethical principles in the professional organization, codes are established that set forth values and principles to guide professionals in their professional activities.

All employees must understand that there are limits to their authority when it comes to healthcare decisions.

The ultimate decision always rests with the physician or individuals who have the authority to write prescriptions, provided it does not violate their professional practice. It is easier to prevent negligence than it is to defend it, therefore, every effort should be made to provide a quality of care for patients legally, ethically, and morally that will not only help them to recover their health but will also avoid lawsuits.

LaShannon Spencer is the Chief Executive Officer at Community Health Centers of Arkansas in Little Rock, Arkansas. LaShannon has several years of experience in hospital and healthcare leadership positions working with clinicians, physicians and hospital staff.

Fireworks safety 

Roadside firework stands and red, white and blue colors stringing along displays of all the condiments and food items nicely arranged in local grocery stores are a sign. It’s time for Fourth of July celebrations. While celebrating the Fourth of July with family and friends, we must be mindful to be safe. Many will use fireworks to help celebrate Independence Day. The Fourth of July is considered one of the most dangerous holidays. Therefore, it is important to use caution when handling fireworks.

In 2015, the U.S. Consumer Product Safety Commission (CPSC) estimates that 8,500 persons in the United States are treated in emergency departments each year for fireworks-related injuries. Of all fireworks-related injuries, 70 to 75 percent occur during a 30-day period that surrounds the July 4th holiday (June 23-July 23). Seven of every 100 persons injured by fireworks are hospitalized, approximately 40 percent of those injured are children under 14 years old, and males are injured three times more often than females. The injury rate is highest among boys aged 10-14 years. Most commonly, injuries from fireworks affect the hands (34 percent), face (12 percent), and eyes (17 percent). Injuries are more frequent and more severe among persons who are active participants than among bystanders.

According to the Consumer Product Safety Commission, please follow these safety tips when using fireworks: 

Never allow young children to play with or ignite fireworks. Avoid buying fireworks that are packaged in brown paper because this is often a sign that the fireworks were made for professional displays and that they could pose a danger to consumers. Always have an adult supervise fireworks activities. Parents don't realize that young children suffer injuries from sparklers. Sparklers burn at temperatures of about 2,000 degrees - hot enough to melt some metals. Never place any part of your body directly over a fireworks device when lighting the fuse. Back up to a safe distance immediately after lighting fireworks. Never try to re-light or pick up fireworks that have not ignited fully. Never point or throw fireworks at another person. Keep a bucket of water or a garden hose handy in case of fire or other mishap. Light fireworks one at a time, then move back quickly. Never carry fireworks in a pocket or shoot them off in metal or glass containers. After fireworks complete their burning, douse the spent device with plenty of water from a bucket or hose before discarding it to prevent a trash fire. Make sure fireworks are legal in your area before buying or using them.

This weekend local emergency departments will be fully prepared throughout to treat patients’ fireworks-related injuries. Please be careful and enjoy the holiday safely.

LaShannon Spencer is the Chief Executive Officer at Community Health Centers of Arkansas in Little Rock, Arkansas. LaShannon has several years of experience in hospital and healthcare leadership positions working with clinicians, physicians and hospital staff.

Understanding the Affordable Care Act

This past Thursday, I kept my eyes glued to the national news waiting patiently with anxiety about the possible changes of the Affordable Care Act to what is presently known as the Better Care Reconciliation Action of 2017. With the passage of the Affordable Care Act, millions of people in the United States, and in Arkansas, had access to health insurance coverage. But there were problems with the ACA as well. Such as many people seeking primary care had to wait for months to see a primary care doctor due to wait times increased, shortage of primary care physicians who accepted Medicaid and individual and employer mandate.

I personally struggle at times as a health care executive and a patient advocate when it comes to the proposed legislative changes. To me, it should not be about politics. Elected officials should focus on ensuring we have healthy communities, healthy individuals. I believe everyone should have access to quality health care services but, I know health care services come with a price tag.

Prior to the Affordable Care Act, many hospital emergency departments were in crisis due to the significant overcrowding waiting rooms, unreimbursed care and long waiting times. Many Emergency departments in Arkansas struggled with balancing the roles of serving as the safety net for uninsured and underinsured patients; basically meeting the larger public health needs. As a health executive, I pay attention to the data related to hospital and health center’s operations, patient care scores, funding formula and rates, hospital core measure, and workforce development, and chronic disease number. Most importantly,I am concerned about the proposed bill language as it relates to health centers’ funding, workforce development infrastructure, individual and employer mandates, pre-existing conditions, Traditional Medicaid, and Medicaid expansion.

Most people are not aware of the measures that were added to the ACA such as primary care workforce. In 2010, the Health Resources and Services Administration distributed $168 million to expand the number of medical school graduates entering primary care residencies and $75 million to increase training for physician assistants and nurse practitioners. These funding streams were allocated to produce additional physicians. In addition, the ACA revitalized the workforce development infrastructure by establishing a National Health Care Workforce Commission. These funds were essential to help address the workforce shortage that will continue to face in rural Arkansas.

President Donald Trump’s plan would keep the Affordable Care Act requirement that insurers accept everyone and charge the same rates, with few exceptions. But it would allow states to waive other insurance requirements, including rules for what benefits insurers must cover that could weaken protections. Also, it would eliminate the mandate that requires people to purchase insurance.

The Better Care Reconciliation Act of 2017, makes major changes to the Medicaid program, which covers nearly half of all patients served by community health centers. Unfortunately, the Senate bill represents a major step backward, damaging this important source of coverage for millions of health center patients. The bill rolls back the Medicaid expansion and makes even deeper cuts to the entire Medicaid program than those included in the House bill. Each of these changes would have a significant and detrimental impact on health centers and the patients they serve.

According to a 2015 study produced by Capital Link, Inc., community health centers provide high-quality, cost-effective, patient-centered care to vulnerable populations. Health centers serve one in seven Medicaid beneficiaries, almost one in three individuals in poverty, and one in five low-income, uninsured persons. Nationally, two-thirds of health centers patients are members of racial or ethnic minorities which place health centers at the center of the national effort to reduce racial disparities in health care. Recent studies show that, on average, each patient receiving care at a health center saved the health care system 25 percent annually.

It is time for our elected officials to understand we must have real solutions to fix our health care system, and it is my belief it can be achieved through a bipartisan approach. Regardless of your political party, consider the importance of improving the health of your community and the residents of the community.

LaShannon Spencer is the Chief Executive Officer at Community Health Centers of Arkansas in Little Rock, Arkansas. LaShannon has several years of experience in hospital and healthcare leadership positions working with clinicians, physicians and hospital staff.

Here's to our fathers' health this Father's Day

Throughout communities across the United States on the third Sunday in June, many wives, sons, and daughters celebrate or pay tribute to their husband, father, brother or a male parenting figure in recognition of Father’s Day. The celebration of Father’s Day is traced back to the early 20th century to complement Mother’s Day. It was President Richard Nixon who signed the proclamation making Father’s Day a federal holiday.

Besides celebrating Father’s Day, the month of June is recognized as Men’s Health Month by the U.S. Department of Health and Human Services’ Office of Minority Health. The purpose of Men’s Health Month is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. According to the U.S. Department of Health and Human Services, men in the United States, on average, die nearly seven years younger than women and have higher death rates for all 15 leading causes of death. Yet, there are many social determinants of health and lack of access to healthcare services that can contribute to the early death rates for men. These social determinants can be compounded based upon gender differences, education, economic status and ethnicity. Yet, social determinants have been ignored in effort to truly understand and address poor outcomes among underserved men.

Social determinants among African–American men are staggering when compared to other racial, ethnic and gender groups in the United States. Social scientists and researchers often focus on changing health behavior for underserved men and vulnerable populations. But have you ever pondered why African-American males continue to struggle with accessing quality healthcare services as well as trusting the institution of medicine? Today, I stop to reflect on the continued struggle of why individuals continue to face adversities with having access even when research illustrated how the Affordable Care Act helped to reduce disparities for some communities while helping to address the surmountable debt hospitals were faced with due to the number of uninsured patients seeking care in an emergency room setting.

Yet, I applaud the state of Arkansas, hospital and health systems, community health centers, churches and nonprofit organizations in their effort working together to help combat health disparities and raise awareness about health disparities that affect men and the continued dialogues on efforts to ensure that every man can achieve better health outcomes.

As we celebrate Father’s Day and Men’s Health Month, let us reflect on the purpose of these celebrations and the strides that have been made to decrease health disparities within our communities. Men, especially African-American men, have long been subjected to racism within communities and in the health care sector across the United States. The racism and lack of trust among African-American men regarding the health care system can be dated back to the Tuskegee Experiment. As health care governing bodies make it mandatory for patient/physician’s relationships to improve and individuals developing a greater understanding of cultural competency, so is the trust factor among patients.

Please take the time to have the conversations with your father, husband, brother and males about the importance of preventive healthcare services, such as getting an annual wellness checkup which includes medical, dental and vision. Also, it is critical to start having conversations about life-ending decisions. As you enjoy spending time today with your family, husband or brother, please have the conversation and let’s create having conversations with our fathers about their health and their wishes.

A community health center is a great place where men can seek primary care services. Health centers serve as the medical and health care home for over 24 million people nationally and in Arkansas to over 186,000 people. Health centers provide high-quality, affordable primary and preventive care, as well as dental, mental health and substance abuse and pharmacy services.

LaShannon Spencer is the Chief Executive Officer at Community Health Centers of Arkansas in Little Rock, Arkansas. LaShannon has several years of experience in hospital and healthcare leadership positions working with clinicians, physicians and hospital staff.

Good health must be part of Pine Bluff's renaissance  

As the chief executive officer for Community Health Centers of Arkansas, I have the opportunity to assist and work with many leaders throughout the state to improve access to healthcare services in rural communities as well as Arkansas’ Delta. Recently, I became aware of Go Forward Pine Bluff and how the residents of the city of Pine Bluff were excited about coming together to drive change for the betterment of the community. Pine Bluff was the home for several of my family members who attended what is now the University of Arkansas at Pine Bluff.

I recall sitting around the dinner table listening to the conversations of my elders discussing how in the early 1960s Pine Bluff was a vibrant area and filled with many opportunities for career and economic advancement. It was great place to plant roots, raise a family, strive for career pursuits, and it also boasted of a top notch educational institution for The Delta.

Pine Bluff was once the mecca city where small businesses thrived; job opportunities abounded, iconic restaurants and businesses encompassed what the city represented. Pine Bluff was a city where many would travel to see music artists such as Elvis Presley, Little Richard, B.B. King and Dionne Warwick.

The greatness of the city can once again be brought to the forefront and Pine Bluff can once again be a bustling metropolis. But in order to recruit industry and businesses back to Pine Bluff, we must consider the importance of ensuring we have a healthy, vibrant workforce and healthy community.

Health care has not been mentioned throughout this campaign. Chronic illnesses are increasing across many cities in Jefferson County, especially in the Pine Bluff area. According to the 2011 County Health Rankings report from Robert Wood Johnson Foundation, the southern and eastern parts of Arkansas are generally less healthy than other parts of the state.

The socioeconomic status of individuals, neighborhoods and communities are linked to one’s health status because the local economy can have a significant impact on access to jobs, commerce, schools and other resources that enables families to enjoy an enhanced quality of life. The health status of individuals and households within an area can greatly affect the civic and economic vitality of communities.

Communities must have a collective obligation to support and foster healthy environments. One must think about how chronic illness such as coronary heart disease, hypertension, diabete and obesity can all have an effect on a community’s workforce and an employer’s group health insurance plans for employees. In order to help address chronic illness of community residents, we must educate and promote preventive care.

Often residents of communities think they do not have a place to go or limited choices for preventive health care services. Preventive primary care services can be sought within a local community health center. Community Health Centers are located in 70 of the 75 counties in Arkansas.

Today, we can select where we want to work, play, live and send our children to school; simply a wonderful place we can call our community. Fostering healthy communities with access to healthy foods, walkable sidewalks, child-friendly playgrounds, and community parks must be a shared responsibility. Every person in the community has a role to play in helping to decrease chronic illness, creating vibrant communities and practicing healthier lifestyle choices.

Within the coming days, we will know the results of the election for Go Forward Pine Bluff. The seven-year tax increase will help support new infrastructure, increased education opportunities, economic development and improve quality of life for the residents. Regardless of how you cast your vote, we must make sure to keep the health of individuals and communities a priority.

Community Health Centers of Arkansas is a not-for-profit organization’s whose mission is to be an innovative leader, promoting improved health care outcomes and equal access to the highest quality health care for all Arkansans.

LaShannon Spencer is the Chief Executive Officer at Community Health Centers of Arkansas in Little Rock, Arkansas. LaShannon has several years of experience in hospital and healthcare leadership positions working with clinicians, physicians and hospital staff.