Sumter County Community Health Assessment

! Sumter County Community Health Assessment Executive Summary By: Barbara Grogan, Sumter County Archway Professional and Rosanna Cruz, University of Georgia Graduate Student

!!!!!! c! In a collaborative effort with the community, the Sumter County Archway Executive Committee identified public health as a priority need in 2011. Discussions with the Sumter County health board revealed that it had been over 20 years since a needs assessment had been conducted in the County. Thus, the community decided to administer an assessment as a good starting point to gauge Sumter s public health needs. Interviews and focus groups were then conducted to get more in-depth information about the community s biggest health concerns. The Sumter Archway Community Health Team chose participants through a strategic selection process that ensured that key-stakeholders from various fields of public health were able to give their input. The interviews lasted anywhere from 30 minutes to two hours, depending on the respondent.! In Part I of the questionnaire, respondents were asked to identify and share the three most important issues related to health or healthcare that they thought faced the residents of Sumter County. They were further queried on why they felt each issue was important, how they had become aware of each issue in the county, if anyone was currently working to address the issue and if they felt the issue could be addressed through partnerships between local organizations. In Part II of the questionnaire, respondents were asked to rate a list of health issues based on the severity of each issue within the community. Responses from both sections were recorded anonymously. The data was then analyzed to identify common themes among the responses. The information presented below is organized by overarching themes related to health with subtopics listed within each category that summarize the most frequently mentioned health issues facing Sumter County.!Page 1

! Health s Facing Sumter County Part I Lack of access to healthcare and medication because patients do not have transportation Lack of insurance and a resulting inability to afford healthcare services The high cost of services and medications preventing patients from receiving the care they need Limited to no access to medications Lack of support for older adults and their caregivers Need education on how to maintain independence, but also knowing when to ask for help Combating social stigmas against mental health Lack of education on how to treat mental health patients Limited county resources to treat mental health Residents not getting proper nutrition Comorbidities associated with obesity are very complex and often require long-term care Inadequate parent education on children s nutritional needs!page 2

! Sumter County has the highest rate of STDs among middle and high school aged students in the state of Georgia Lack of education and prevention resources for students Abstinence only education is ineffective Having to test patients for illegal and prescription drugs Informing residents on the health resources available to them A need for healthcare provider education to improve coordination and continuity of care Stressing importance of not allowing insurance coverage to lapse (Medicaid, etc., especially for adults with children) Lack of funding for services Lack of adequate staff to provide continuous services Inadequate supply of and overworked nurses Need better early childhood healthcare to improve lifelong health Children seeing the school nurse instead of a physician when sick because of high cost of care Need effective prenatal counseling and caregiver education!page 3

! Illegal immigrants with no insurance coverage (even though many are eligible for benefits) because they are afraid to sign up for fear of being deported Language barriers Part II Biggest s 64% listed Affordable / Adequate Health Insurance as a major problem 52% listed Mental Health as a major problem 55% listed Illegal Drug Use as a major problem Among the other issues respondents labeled as important: - 46 percent listed as a major problem - 42 percent listed as a major problem - 42 percent listed as a major problem - 50 percent listed as a moderate problem!page 4

! Moving Forward The next step in completing the Sumter County Community Health Assessment is allowing local leaders involved in the Archway Partnership through the Archway Executive Committee and the Sumter Archway Community Health Team to review the data. These groups will determine the feasibility of the issues reported and how they can be addressed by utilizing the Archway process of collaboration and connecting higher education with state resources. This information will also be compared with Sumter County Health Indicator data to fully inform their decisions on the direction of Sumter County Archway Health.!Page 5

c Appendix c

Respondent 1 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Lack of funding for services - unable to Lack of staff to stay constant/have provide services due to funding continuity of service issues with clients constraints Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Everything depends on which program the client/parent qualifies to receive. May have one for a service, needs another, always have to focus on program approved for rather than just doing the service Daily work activities Don't know Should be focus of state level organizations Ex: Girls' sex education classes - many do not have good hygiene, don't know proper body terms. When funding runs out, so does staff! Through educating teens about law - evidence through STDs in patients Yes Yes c Page 7

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is NOT a problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter Have access, it is an affordability issue To what extent is access to healthcare services a problem in Sumter It is NOT a problem transportation is the issue To what extent is access to mental health services a problem in Sumter It is MODERATE problem shortage of services, lengthy process to get accepted Sumter We have, but elderly does not know about them Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter Yes c Page 8

Respondent 2 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Access/ Transportation/ Insurance No psychiatric floor at hospital, no inpatient service. Albany only takes if have insurance - previously there were 12 beds at Sumter Regional Substance Abuse Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) One leads to another, it is a circle. You can't have access without insurance and transportation No detox / No psych - sending clients all over the state. (Albany, Columbus, Valdosta) Played down in community depending on any substance, they treat all as an issue even prescription drugs, they test for 13 different drugs ($5 or free for test) if you test positive for what s prescribed, don't get more as they may be selling it How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Seeing it on a daily basis No Yes People could walk to service before, everything is long distance now Done deal with Phoebe, nothing to be done No Work No/Only Somewhat Working on with Luneda (DFACS), probation services, drug court, but need to do much more c Page 9

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter IT is a MINOR problem To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is NOT a problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter no access if no insurance To what extent is access to mental health services a problem in Sumter must have transportation to get there Sumter because they have Medicare Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 10

Respondent 3 & 4 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Obesity among all ages Access to care Transportation for anything related to healthcare Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) Logistics required and comorbidities that develop and their requirements for longterm care so complex Majority of the public isn t planning ahead and only uses the doctor right when they need it results in not getting care or using urgent care/rx in medical homes If healthcare services are farther than walking distance, they aren t going to go How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Professional experience, long-term observation A few Phoebe Sumter, Parks & Rec Phoebe Sumter, Magnolia Manor - Seniors Professional Experience Not from a community wide perspective Medicaid transportation services are severely lacking Do you feel any or all of these issues can be addressed through a partnership of local organizations? Yes Yes c Page 11

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter ; To what extent is alcohol abuse a problem in Sumter ; To what extent is mental health a problem in Sumter ; To what extent is child abuse a problem in Sumter ; To what extent is safety and security a problem in Sumter ; To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is NOT a problem; It is NOT a problem To what extent is domestic violence a problem in Sumter ; To what extent is sexual assault a problem in Sumter ; ; To what extent is access to healthcare services a problem in Sumter ; To what extent is access to mental health services a problem in Sumter ; Sumter ; ; Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter 4) Strengthening services provided through DFCS- all services a) logistical nightmare, quality of services, educating community on their services & options b) prof. exp./long term c) state d) state/local 5) there is a continually growing need for a skilled labor force to care for the baby boom population...just getting by right now c Page 12

Respondent 5 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Education related to health services, health care, health issues general public and health providers Healthcare costs Labor pool Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) Some health care providers need more education on caring for mental health and elderly patients, need more continuity of care and coordinated care, touch high education students, education Medicare replacement Cost of health care on patient (un and under-insured) and provider (cost of liability insurance) side, Patient issue results in ER situation, Provider issue results in transition to hospitalist model drying up physician population Childcare is a problem for labor pool with employees with limited resources, applicants that we get at healthcare facilities are less adequate, see trends by employees who are working the system (unemployment system), need education to discourage people from making this their career path How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Professional experience, long term observation Not enough (some are trying but not effective or not enough publicity) Yes It s on radars, but no efforts Yes, there could be some impact at local level Professional Experience South GA Tech work ready not sure about effects Yes c Page 13

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is MINOR a problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter Yes, other topics not expanded upon: teen pregnancy and healthcare providers meeting the actual needs in Sumter County c Page 14

Respondent 6 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Mental Health Older adult support / Caregiver support STDs Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Socially it is difficult to deal with. Responders to mental health incidences have difficulty/lack of training to deal with this Behavioral Health through professional experience Middle GA Flint does outpatient treatment. Crisis intervention training needs to be revived Yes The toll that is taken on the caregiver. Chronic disease and disability requires people who are trained to take care of this Professional experience Phoebe Sumter, Middle Flint, Care Net, AARP Karen Cooper and Pam Rochelle Yes, through more awareness and options for sustainability Health and social impacts Has seen data Public health and family connections Yes c Page 15

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is MODERATE a problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter Macon County has a unique system for treating health conditions. Sumter is the medical hub for this. c Page 16

Respondent 7 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Lack of health insurance and cost of Lack of Health education resources and Mental health and substance abuse healthcare preventive care Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Socially it is difficult to deal with. Responders to mental health incidences have difficulty/lack of training to deal with this Experience with Middle Flint and potential lack of their services. Also has seen a large number of students on drugs Potentially Middle Flint Yes Economy is not the best, thus leading to a decrease in money. Also a fear of what happens if you do not have insurance Through personal and professional experience No, although George Hooks may be doing something Yes Hospital s absence created a gap. Improving, but needs help Personal and professional Phoebe Sumter, Physicians, Rosalyn Carter Yes c Page 17

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is NOT a problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter Mental health is an issue c Page 18

Respondent 8 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Teen pregnancy / Secondary pregnancy Prenatal counseling and parenting skills STD and Education/Prevention to teen moms for caregivers Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Middle school / high school kids, highest rate in GA Through professional experience Yes, but only by abstinence education Yes High rates Professional experience with long-term observation No Yes Societal impacts on kids who are parented well Data, long-term observation, professional experience Babies can t wait, health department Yes c Page 19

Respondent 9 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 K-12 education: Priorities center on every stakeholder but the child Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Early childhood care; reprioritize our goals Impact of development of children during this age is profound Data, long-term observation, and professional experience Not currently Yes There is no advocate for the child for this Data, long-term observation, and professional experience No Yes Need to change the perception of SES problems dealing with race relations It does not address the fundamental issue of poverty; It also inhibits it from correctly being addressed Data, long-term observation, and professional experience No Yes c Page 21

Respondent 10 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Affordability / Lack of insurance Lack of referral services for patients Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Lack of availability of insurance. If no health insurance or income, cannot afford services. 30-45 year olds are the working poor -> see the stat indicators. Many people cannot afford insurance Professional experience No Yes rally legislators, need political involvement to impact policies for changes Have to go out of town to see specialists Professional experience No Yes, work with PSMC c Page 23

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter : MFBH- follow up / access is very timely To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter : Prevents access to care To what extent is traffic congestion a problem in Sumter It is NOT a problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter : through the schools maybe need to teach basic hygiene, cleanliness, sex education teens and young adults just don t know the Sumter terms or basics Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 24

Respondent 11 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Active community Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) We need a more active community, not a local theme to walk. Need sidewalks, bike lanes, and racks to make it easier. It needs to be encouraged. Adults to do more/move more and help make this possible in the community How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Professional experience No Yes c Page 25

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter : Wait time for the initial appointment is a problem To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter : Biggest problem in the U.S. To what extent is traffic congestion a problem in Sumter It is NOT a problem To what extent is domestic violence a problem in Sumter : Bigger than we know To what extent is sexual assault a problem in Sumter : more than reported To what extent is access to healthcare services a problem in Sumter : Health Department is key asks for help, loses funding and staff To what extent is access to mental health services a problem in Sumter Sumter : Not too bad, some isolated issues Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter Health Department should be a model open 24/7, low-income folks go there for all medical needs, if cannot assist, send directly to specialist c Page 26

Respondent 12 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Old debts to PSMC that cannot be waived, so patients can t use PSMC resources such as the PhoebeCare Card Cost of medication- independent druggists try to help and are creative in tactics, but this is not enough Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Also, Care Card is only for specialists, no primary care doctors, which would eliminate some of the need for specialists Professional experience No Professional experience Yes local drugists More support of local doctors who have been recruited by PSMC and others Ex: Doctor of the month promote them through media and organization features Professional experience- another issue: the chamber has no health related activities no focus on health and wellness of the community at large Yes Yes Yes No c Page 27

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter It is a MINOR to MODERATE problem To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is a VERY MINOR problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter It is a MODERATE (issue of not knowing) problem Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter The elderly generation does not ask for help 1. Holding on to independence, 2. Dignity issue, 3. Generation taught to deal with pain/problems Big generational impacts c Page 28

Respondent 13 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Healthcare services for the elderly Goal is to keep people out of nursing homes as much as possible people in their 60s now are not preparing to pay for at-home services so when 80, most won t qualify for Medicaid and don t have the savings to afford home care Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? The fastest growing population, not enough trained workforce to provide services, lots of people and the workforce is not prepared Professional experience Yes Baby boomers, need to look at long-term care insurance education to stay in their community / environment Professional experience Youth- no drive, self-dependence or responsibility/ambition Children at church, own children this will not be good as they age Professional/personal experience Unknown Yes Yes Yes c Page 29

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter not bothered by it, but it is seen To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter It is a MINOR to MODERATE problem To what extent is child abuse a problem in Sumter It is NOT a problem To what extent is safety and security a problem in Sumter - if no aid, 70% or more would get no help with bathing, dressing, etc. To what extent is gang activity a problem in Sumter It is NOT a problem It is a MODERATE to MAJOR problem- burial policy issues and need drug To what extent is affordable/adequate health insurance a problem in Sumter plans, Council on Aging supplies everything Medicaid allows, but they usually don t have a supplement To what extent is traffic congestion a problem in Sumter It is NOT a problem- not an issue at all To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter - Medicaid allows no dental for adults, have denture issues - Very limited, but it is due to lack of knowing about To what extent is access to healthcare services a problem in Sumter COA services, Limited marketing budgets need to market services not the business To what extent is access to mental health services a problem in Sumter It is NOT a problem- Population served (elderly) has access through MFBH Sumter - Education a BIG problem - Again, due to knowing about it Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter The Council on Aging has a wide array of services and can offer lots of great help. The problem is that clients don t know about them. No funds or time for marketing, and what is done is through the River Valley Regional Commission (housed in Columbus). All brochures have a 706#, long distance, elderly don t relate. Big connection issue here! c Page 30

Respondent 14 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Home maintenance Education Help with handicapping a house, Why do you feel like this would be wheelchair ramps, grab bars, etc. also considered one of the most pressing basic things like a leaking faucet. Helps Elderly not aware, afraid to ask, think it issues? (target group affected, financial people stay in homes longer because might impact benefits, don t want impact, health impacts, social impacts, deterioration of home is managed etc.) How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Professional experience Not aware Yes Professional experience Don t know Yes c Page 31

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter It is a MINOR to MODERATE problem To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter - fairly prevalent, not severe though To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter - not adequate if no Medicaid To what extent is traffic congestion a problem in Sumter To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 32

Respondent 15 Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. Question 1 2 3 Obesity in all ages and all of the issues that go with it. High blood pressure, Diabetes, etc. Drug use, test med levels to determine if taking right amount. Not a big issue, just mention Why do you feel like this would be considered one of the most pressing issues? (target group affected, financial impact, health impacts, social impacts, etc.) How have you become aware that this is a priority issue in our county (professional experience, long term observation, targeted research on the issue, media, word of mouth, etc.)? Are there entities in Sumter County currently working to address these issues? Do you feel any or all of these issues can be addressed through a partnership of local organizations? Domino it causes Always as a doctor Not aware of any Elderly not aware, afraid to ask, think it might impact benefits, don t want c Page 33

Part II is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is NOT a problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter - not if have Medicare, though a pain to approve Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 34

Focus Group Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. s facing Sumter County - Services for aging population - School nurses - Knowledge of services available - Transportation - Teen pregnancy - Teenage Pregnancy - Lack of meds for minor illnesses - Parents don t always have transportation available, not always a priority to keep appointment - The importance of illnesses to parents/guardians (It s not considered serious) - Transportation to appointments - Rate of importance of illnesses to parents/guardians - Sick children and health care - Parents working all the time or parents not having work - Transportation - Transportation - Prescription medicine not being refilled - Lack of access to medication - Proper nutrition - Medication (lack of) - Lack of medical treatment ($$$) - Language barrier common Migrant - Transportation to doctor population, undocumented - Services to help with medication - Affordable healthcare - Outside agencies for mental health issues - Proper nutrition - Lack of access to medication - Lack of quality medical staff - Mental health - Healthcare - Proper nutrition - Arts incubator - Encouraging - Medication - Being able to ensure children and youth are able to get what they need - Transportation - Nutrition c Page 35

Focus Group Part II Respondent 16 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is NOT a problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 36

Focus Group Part II Respondent 17 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter It is NOT a problem To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter It is NOT a problem Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 37

Focus Group Part II Respondent 18 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 38

Focus Group Part II Respondent 19 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is NOT a problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 39

Focus Group Part II Respondent 20 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 40

Focus Group Part II Respondent 21 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter It is NOT a problem To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter It is NOT a problem To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 41

Focus Group Part II Respondent 22 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter It is NOT a problem Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 42

Focus Group Part II Respondent 23 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter It is MODERATE a problem Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 43

Focus Group Part II Respondent 24 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter It is MODERATE a problem Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 44

Focus Group Part II Respondent 25 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter It is MAJOR a problem Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 45

Focus Group Part II Respondent 26 To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter To what extent is child abuse a problem in Sumter To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter To what extent is access to mental health services a problem in Sumter Sumter is a major problem, /Not applicable) Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 46

Respondent 27: Brought personal list of health issues facing Sumter County Part I Please think of the 3 most important issues related to health or healthcare that you think are facing the residents of Sumter County. - This list includes some basic needs encountered by our patients and their family members and their family members. Most of these needs are contributed to families either having no funds or being underfunded. Georgia s rural communities are plagued with families who have no health insurance, limited resources due to either no income or possibly low fixed income and poor means of reliable transportation. Some patients have complications with transition back to home simply because they lack basic support. Most family members must either return to work immediately or are too elderly and weak to provide adequate assistance - Medication assistance (purchase, monitor) cost $10k or more to resolve Diabetes situation, get under control ONE OF THE BIGGEST PROBLEMS, raise funds to address this - Language translators need has increased in last few weeks s facing Sumter County - Home assistance - Sitters - DME (Durable medical equipment) medical supply assistance (wheelchairs, walkers, canes, glucometers, glucose test strips, etc.) help out and try to give 30 day supplies to get them going noncompliant ONE OF THE BIGGEST PROBLEMS, raise funds to address this - Temporary housing or assistance with house expenses (utility bills, rent, minor home repair) - Meals - Assistance for family whose family member has been transported to an out of town facility (gas, lodging, meals, home allowance if out of work and transportation) - Dental (across from BK, across from VA) and vision check-up - Transportation - Home wheelchair ramp Who does this on a regular basis? Utility company formerly, but not as many resources as in past - Assistance returning to foreign country c Page 47

Focus Group Part II Respondent 27 is a major problem, /Not applicable) To what extent is illegal drug use a problem in Sumter To what extent is alcohol abuse a problem in Sumter To what extent is mental health a problem in Sumter don t see as much To what extent is child abuse a problem in Sumter no longer admit pediatric patients: ER report and then transferred referred elsewhere To what extent is safety and security a problem in Sumter To what extent is gang activity a problem in Sumter To what extent is affordable/adequate health insurance a problem in Sumter To what extent is traffic congestion a problem in Sumter To what extent is domestic violence a problem in Sumter To what extent is sexual assault a problem in Sumter To what extent is access to healthcare services a problem in Sumter - Can t afford, leave work, $ for gas, copays/med $ To what extent is access to mental health services a problem in Sumter - MFBH Sumter - low-income need receptive, easily available Do people really want to know? If so, they learn It is MODERATE a problem good services, but limited $ to provide source and council on aging Is there anything else that we have not mentioned that you think is important to improving the health and happiness of residents in Sumter c Page 48