Rural Health Network Development Program: Indiana University Health Bedford
The Georgia Health Policy Center recently spoke to Diana Matthews, project director, and Shelly Gilbert, network director, for the Rural Dementia Network (hosted by Indiana University [IU] Health Bedford) about efforts to expand outreach and services in Lawrence County and Orange County in Indiana.
To date, what has been the biggest accomplishment or win for your network planning?
Shelly: Our most significant accomplishment is the buy-in that we are receiving. This includes support from our city government, with the mayor prioritizing having all his staff trained — about 300 city government staff trained in Dementia Friendly best practices. IU Health Bedford Hospital has provided support throughout the whole project. It is the first hospital in the IU Health South Central Region to become dementia friendly certified. We trained about 355 individuals and received feedback from all levels within the hospital about how much they enjoyed this training. It was not ‘just another thing they had to do.’ They really found value in it. We also have had -in for our grassroots project Brain Excellence Education (B.E.E. program). Early results from the B.E.E. pilot program show that among the people that went through the program, nobody had a decrease in cognition, and most improved in at least one area, while the control group stayed the same. We had extensive interest in this community program.
Diana: Another great thing is that our Dementia Friendly Care Partner Development Program has continued to expand. We have been able to give new certified nursing assistants and home health aides tools to better relate to people living with brain change. This will hopefully impact the health care workforce in that there will not be as much burnout, and the care providers will see more positive results in their work. We are also hopeful it will strengthen people’s job satisfaction and longevity in a field where we really need people to stick around.
What is a tip you would share with an organization launching a similar network?
Shelly: We are battling a stigma around brain disease. But we also realize that people are willing to talk about brain health. If we can talk about how to stay proactive, then people are willing to listen and do what they can. We are using this open the conversation.
Diana: One of the things that we learned was to constantly evaluate the program, the services, and receptivity. Then, we must be able to pivot and make slight adjustments along the way for more success. When you are developing a program like ours that involves education, awareness, stigma reduction, and prevention, you may go in and have an idea of what will work. Still, you could miss the mark if you do not constantly evaluate. We identified a couple of things, including that the stigma of brain disease is persistent and not easily addressed. An inflatable medical brain is one of the most extraordinary things we acquired as a result of this grant. We will be able to use this in our rural community, where stigma is high and health care literacy is a little lower just because of a lack of resources and limited awareness. But when we put out a giant inflatable brain, people want to know what that is, which opens that door for education.
Lastly, when hiring for positions like project director and network director, look for diverse skills and qualities they can bring to the table. Shelly and I had solid connections in the community, but we had very different backgrounds, and our links didn’t overlap. We brought different strengths to the table, and this multidimensional, collaborative approach is a powerful dynamic.
How do you see participation in the Federal Office of Rural Health Policy’s Network Development Program impacting your broader health improvement efforts?
Diana: We evolved from an existing program in the Community Health division at IU Health. In 2021 the IU Health Bedford Hospital Community Health Needs Assessment was released. Throughout that needs assessment, it identified that the aging population needs attention and focus, especially regarding cognitive issues and aging in place. The neighboring hospital, IU Health Bloomington, also completed its needs assessment, which mirrors those findings. We are a perfect complement to address that need.
Our overall county population in Lawrence County should stay the same or even decrease slightly from 2020 to 2025 in every demographic age group, except for people over 65. The over 65 demographic is expected to increase significantly, by 10.4%. There is an increasing need for resources to age in place, cope with cognitive issues, and understand normal and not normal brain change in a community with a rapidly growing aging population. There are some significant barriers in rural areas, but our project addresses these barriers head-on. We are positioned in an excellent place for the hospital system and the community to see how vital our work is for our county’s health and future.
What will your organization be doing more of or differently to emerge stronger from the pandemic?
Diana: This grant was awarded in July 2020, and we were hired in September 2020. We started in the middle of the first year of the pandemic. Our nursing facilities were on lockdown, and the impact of that isolation was huge. Plus, the health care workforce was struggling. One thing we learned quickly is that in this rural area, there are two groups of people — people who understand technology and are happy to use it and people who either do not have broadband or technological skills or tools.
We were able to build our network without much problem on Zoom with professionals in the area who were eager to see each other and collaborate. But we also had this large group of people we were trying to support who were typically not accustomed to using technology.
For instance, those who wanted to attend a support group for people caring for people living with Alzheimer’s or related dementia often were uninterested in using technology. We couldn’t beg them to get on a Zoom call. As soon as we could start in-person meetings, the support group grew. Coming out of this pandemic, I think we will move forward with always having a hybrid option when we meet because there are people who have specific preferences, and you cannot necessarily change that.
Shelly: When I am dealing with individuals living with brain changes, like an 85-year-old with no internet access, just picking up the phone and calling and making that contact makes a difference. Sometimes I felt like people did not necessarily care “what” I was saying, but they just needed to hear a voice on the other end of the phone. They needed to know there were still people who cared and were checking in on them. We were a lifeline for a person facing isolation, and even if I could not be in front of them, at least they felt that they had a connection outside their home.