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Is Your

County Healthy?

 

Orleans County Department of Health

1996/1997

Forward

The Orleans County Community Health Assessment for 1996 - 1997 is an update of the assessment previously conducted and distributed in 1992. The County Health Department develops the assessment in keeping with its responsibility to do so under state and local law. The overall goal of the assessment is to stimulate participation in, and/or development of, programs addressing key local needs.

We hope to accomplish this by:

Issuing a report card on health and health care in Orleans County

Developing public awareness of key health issues facing the community

Advising Orleans County residents of services provided through Orleans County government

Furnishing the public, community organizations, health care practitioners and organizations and health care benefits insurance companies with a ready reference for health care needs and health- and health care-related statistical data for Orleans County.

Good health is a challenge to the entire community - not just government, doctors, clinics, hospitals and insurance companies, but schools, landlords, parents, local businesses, teenagers, and senior citizens.

 

 

 

Orleans County Legislature

1996-97

Marcia B. Touhey, Chairman
Ronald R. Radzinski, Vice-Chairman
John W. Beedon
Lyndon D. Billings
Richard Bennett
George R. Bower
David B. Callard
 

Orleans County Public Health Board

1996/97

Eric Brown, President
Carol Heiligenthaler, Vice-President
Thomas Madejski, MD
Eileen Kosieracki, DO
Alfred Daniels, MD
George Bower
Allen Lofthouse
 

Orleans County Health Department

1996/97

Andrew Lucyszyn, Public Health Director
Jeanette Welsh, Budget Director
Beverly Parmele, Director of Patient Services
Mary Jane Sahukar, Supervisor - Home Care Division
Wayne Dickinson, Supervising Sanitarian - Environmental Division
Nola Goodrich, Public Health Educator
Christine Covell, Coordinator for Children with Special Needs

Your comments on the assessment or any health related matters are requested and welcome.

Contents

Foreword

Accomplishments

Health Report Card - Orleans County

Programs

I. Family Planning, Maternal and Infant Health

II. Child Health

III. Dental Health

IV. Lead Poisoning Prevention

V. Nutrition

VI. Injury and Suicide Prevention

VII. Sexually Transmitted Disease

VIII. Tuberculosis

IX. Communicable Disease

X. Immunizations

XI. Chronic Diseases

XII. Human Immunodeficiency Virus (HIV/AIDS)

XIII. Local Health Care Services

Data and Analyses

I. General Demographics - Orleans County and its Ten Townships

II. Pregnancy Related

III. Mortality Related

IV. Outpatient Care Needs

V. General Trends

This assessment was prepared by

HMS Associates, Getzville, NY.

Accomplishments

The Orleans County Health Department has two major functions: protect the public health and promote health programs vitally needed by the community. The County Health Department and the County Public Health Board are the County's first line of defense against the spread of disease throughout the community. A broad scope of programs, some operated by the County and others by local health care providers, is overseen by the County and designed to accomplish those broad goals. Programs range from educational classes to administration of vaccines, to monitoring health-related environmental conditions throughout the county. Program accomplishments of the past several years, listed below, will convey the depth of service provided, the extensive relationships with local health care providers, and the importance and complexity of the public health mission.

Child Health

The health and well-being of young County residents is a prime concern of the County Health Department and the Public Health Board. Numerous programs target children and adolescents because of age-related vulnerabilities and the importance of the development of healthy life-styles and behaviors at early ages. Many childhood diseases are prevented with immunization; many health problems of infants and mothers are averted through active prenatal care and the development of parenting skills and nutritional programs supply the building blocks of healthy young bodies. The County Health Department directly operates or oversees local program addressing these needs. Specific information on County and local health care providers' efforts concerning the health of Orleans County children are described in subsequent program summaries.

New Challenges

Like many other Medicaid-eligible people in New York State, the County's Medicaid-eligible population will be enrolled in managed care programs in 1997. The Health Department will assume additional responsibility for assuring that insurance companies' Medicaid managed care plans are meeting the needs of these individuals.

The challenge to the County Health Department and Public Health Board of protecting and ensuring public health is expanding, and yet fundamental to the overall well-being of the community.

  I. Family Planning and Maternal and Infant Health

"Partnership" was the watchword in the County's efforts to disseminate family planning information. The Public Health Educator organized a Health Educators Network, encouraging input from all community health educators in an effort to strengthen existing family planning programs. Links were strengthened with Family Life Education teachers in all five school districts. The Health Department maintained a close working relationship and formal linkage agreement with Planned Parenthood, referring patients to the agency as well to private providers. Department representatives sit on the Planned Parenthood Board and on its education subcommittee. The Health Department was also active in ACT (Alternative Choices for Teens). This group, comprised of the Health Department, the Department of Social Services, Planned Parenthood, Mental Health, Cooperative Extension, and Special Friends, allows for strong connections and collective input into programs for teens at high risk for pregnancy.

County Health Department nurses increased their efforts to identify, track and screen infants and toddlers at risk of physical and developmental disabilities. Early Intervention Service Coordination (EISC) was initiated to provide case management to developmentally delayed children. The Health Department also continued its Infant Health Assessment Program (IHAP), visiting and linking all referred clients as needed. Also of note:

   II. Dental Health

The Health Department's efforts to promote dental health have a dual focus: to teach preventive tooth care, primarily to children, and to compensate for the lack of fluoridation in sixty percent of the County water supply. Preventive efforts included visits to Head Start Day Care, migrant day care centers and private nursery schools to teach brushing and flossing; showing a "Snoopy" cartoon teaching these skills at a wide variety of sites; and providing dental care education during home visits by nursing staff and to parents of developmentally delayed children. The Department also provided technical assistance to, and approved completion of, six projects expanding the four water districts in the County that provide fluoridated water. In addition, the Department sponsored Oak Orchard Health Care's successful effort to fund a dental sealant program for the children of migrant workers - one hundred of whom received dental sealant treatment.

   III. Lead

The Health Department vigorously promoted lead screening for children under 5, and received lead blood test results for 1,001 children from primary care providers. Twenty-seven children with potentially problematic blood lead levels (above 9 micro grams per deciliter) were identified. For these children, County Public Health Nurses conducted 24 case conferences and 37 home visits. Also of note:

   IV. Nutrition

The Department undertook a broad range of nutrition-education efforts:

   V. Injury Prevention and Control

The Public Health Educator continued to maintain a working coalition of agencies to provide a variety of safety and injury prevention programs. Educational material on highway safety and drunk driving was provided to the five county school districts for use in driver education courses. Information on infant and child car seats was distributed to families with new babies by Public Health nurses. The County cosponsored Bicycle Safety Rodeos promoted by Medina Memorial Hospital's Industrial Health Program. Selected in 1993 as a bicycle helmet distribution site by the NYS Department of Health, the County Health Department has distributed approximately 200 bicycle helmets to income-eligible children.

   VI. Sexually Transmitted Diseases
The Health Department handed out information and provided direct instruction concerning sexually transmitted diseases in a wide variety of settings in an effort to reach at-risk groups at every opportunity. Information was provided at sites throughout the County, including the Pregnancy Counseling Center and the BOCES youth conference; to all men and women at immunization clinics; and to teen parents at immunization and blood lead testing clinics. Educational materials and presentations were made available to all school districts for use in health classes. Classes were provided to paroled inmates at the Orleans Correctional Facility, to the Association of Retarded Children's Community Living clients, and to several other groups.

   VII. Tuberculosis
Health Department efforts to control Tuberculosis focused on testing at-risk populations, particularly those in institutions, and vigilantly monitoring and treating all those infected with the disease. Approximately 150 people were treated for this disease in the County from 1992 through 1995. Many of these patients were monitored through a formalized Tuberculosis Clinic every Thursday morning. Also of note:

   VIII. Communicable Disease

Communicable disease investigations continued to be conducted in a timely manner. Most investigations were completed within a week of receiving the case report.

Follow-up investigations of each reported case entailed contacting the medical provider and patient to confirm the diagnosis and institute programs concerning other people who may have been infected or susceptible to infection.

Cooperative relationships with a wide range of health and social service providers were strengthened. Joint ventures were undertaken with other county health departments, the State Health Department, hospital infection control nurses, laboratories, physicians, school nurses from the 5 local school districts, correctional facilities including the County Jail, Iroquois Job Corps, the Migrant Day Care Center, Head Start, and Association for Retarded Children.

   IX. Immunization

The Health Department vigorously pursued all available avenues to provide immunization and immunization information to all County children and other at-risk groups. Immunization services included the following:

   X. Chronic Disease

Diet, exercise, and the dangers of smoking were the focal points of broad-based Health Department efforts to promote lifestyle choices that prevent such chronic diseases as heart disease and lung cancer. A new function was to monitor compliance on the part of merchants, vendors and the general public with the Adolescent Tobacco Use Prevention Act (ATUPA). The Department distributed detailed information on the Act, while environmental personnel maintained a compliance log and investigated all alleged violations. Also of note:

   XI. H.I.V.

The Health Department maintained an all-out effort to inform at-risk groups of high-risk behaviors and HIV preventive measures. The Department distributed HIV/AIDS material to local Chemical Dependency Treatment Centers, Department of Social Services waiting rooms, employment offices and libraries, BOCES Health Education classes, Retarded Citizens Medina apartments, and many other sites. HIV material was made available to all participants in the Hepatitis B immunization clinics, tuberculosis and SAD programs. The Department also provided information to soon-to-be paroled inmates of the Orleans Correctional Facility, women residents of the Iroquois Job Corps, the Orleans Cooperative Extension parenting class, and a range of other groups. Five staff nurses and the public Health Educator completed the three-level HIV/AIDS counseling certification course. The Health Department also continued to take a lead role in interpreting the confidentiality law for the community.

   XII. Health Care Services

Throughout the past several years, the County's Certified Home Health Agency program treated over 100 County residents each year. The program required expansion at times due to demand for home care for acutely ill county residents.

Through its involvement with the Lake Ontario Rural Health Network (LORHN) - a State-supported rural health network - the County determined that the closure of Arnold Gregory Hospital in Albion, NY in 1989, had not reduced access to inpatient care for that community. In 1993, residents of the Albion area were admitted to hospitals more frequently than people residing in Brockport or Medina. In addition, no major unmet needs for hospital services were identified for that the Albion community. Also of note:

Health Report Card - Orleans County

Is Orleans County a healthy place to live?

As people become increasingly conscious of the dependence good health upon environmental and lifestyle factors, they seek information about the health of their community and its health care system. This Report Card is the County's response to growing interest in health, the environment, life-styles and local health care systems. The Report Card is intended to recognize local strengths - and perhaps more importantly, to galvanize health care practitioners, providers and the community to address key problems and augment their services accordingly.

The County's overall grade is B.

Orleans County is a healthy place to live in that it has low rates of major health care problems. At the same time, the County is among the five lowest ranked counties in New York State in several areas. In some cases, programs have already been started or expanded to deal with key health care concerns.

The Report Card integrates two types of information:

  1. Data on County residents from statistical reports on death, pregnancy, birth, hospital use, or other factors.
  2. Assessments of local health care practitioners and agencies of health status problems previously referenced.

The combination of these two elements produced a letter grade.

It must be noted that the data in some instances is not current enough to reflect any changes in health that would result from new programs offered since 1994. Consequently the positive impact of recent local advances in prevention programs for chronic disease, accidental deaths, or problems associated with teen pregnancies are not reflected in the data. Yet, the data available thus far strongly support the maintenance of those programs and close monitoring of new information as it becomes available.

A comment section follows each area and grade. These comments help to explain the rationale for the grade and in some instances point toward specific areas which require attention and remediation. Please refer to the corresponding section of the assessment for more detailed information.

PROGRAMS:

Family Planning, Maternal and Infant Health

Infant health is shaped largely by prenatal factors, including the health care a woman receives when she is pregnant, her environment, and her nutrition. The life-style of a pregnant woman also has a direct impact on the health of her baby. Proper diet, exercise, and the avoidance of illegal substances and alcohol, are crucial to the health of the 625 babies born to Orleans County mothers each year. Family planning and preparation for parenthood, especially among young parents, also play a decisive role in the well-being of infants and children.

Target Groups

Approximately one out of every four Orleans County residents is female and of child bearing age. In 1999, there are projected to be 12,271 women and girls between the ages of 10 and 40 in the County:

1,818 females from age of 10 to 14

1,013 females from age of 15 to 17

2,063 females from age of 18 to 24

3,429 females from age of 25 to 34

3,948 females from age of 35 to 40

The Towns of Albion and Clarendon have higher than average proportions of females of child bearing age, whereas the Town of Yates has a very low proportion of females of child bearing age. Poverty is more prevalent in most western and central towns and villages, whereas the towns located on the eastern corridor of the County are more affluent.

With the exception of infant deaths, family "characteristics" of the County are relatively stable. During the 1989-1993 period, the County's live birth level fluctuated from a low of 578 births or 13.9 live births per 1,000 people in 1989 to a high of 652 births or 15.6 live births per 1,000 people in 1990.

 

 

Marriages have fluctuated from a low of 304 or 6.9 per 1,000 people in 1993 to a high of 348 or 8.3 per 1,0000 people in 1990. Divorce rates varied from a low of 106 per 1,000 people in 1990 to a high of 144 in 1991.

Infant death rates, however, changed by more than 100%, having ranged from a low of 3 or 5.2 per 1000 live births in 1989 to a high of 7 or 10.9 per 1,000 live births in 1992. This level of variation - may be explained largely by the small numbers involved. An increase or decrease of two deaths which can occur by chance alone can result in an extremely high rate.

County teen birth rates warrant attention. In 1993, teen birth rates were almost 50% higher than the Upstate New York Average. During that year, seven out of every 100 teenage females in the County became pregnant; teens gave birth to 72 babies. New pregnancies declined from 113 in 1992 to 98 in 1993. The decline occurred in younger teenagers, females 15 to 17 years of age, dropping from 54 to 39. The rate among "older" teens remained unchanged, 59 in both 1992 and 1993.

Fertility ratios - the number of births compared to the number of women of a given childbearing age range - also indicate that teenagers are a major target group for family related services. The County's fertility ratio in 1993 was 66 births per 1,000 women of child bearing age, a rate slightly higher than the Upstate norm. Yet, fertility ratios for 15 to 17 year-old females and 18 to 19 year-old females from Orleans County are more than 50% higher than the Upstate County "norm".

One out of every three babies were born out of wedlock and/or received Medicaid public assistance. These rates were also significantly above those of other Upstate counties.

Lack of prenatal care also warrants attention. A high percentage of women did not receive prenatal care at appropriate times. Twenty-seven pregnant women had no record of medical care or had their first medical care just before they gave birth.

In 1993, 61 babies, or one out of every ten, weighed less than 2500 grams - the standard for healthy birth weight. This rate is almost 50% higher than the Upstate norm. Seven of 31 babies borne by teens 15 to 17, or approximately one out of every four, weighed less than 2500 grams. Low birthweight levels have been increased steadily between 1991 and 1993, rising from 36 in 1991, to 50 in 1992, to 61 in 1993.

Pregnancy-related information by age and minor civil division over the years 1990 - 1992 demonstrated that the Town of Albion has a high concentration of pregnancy-related problems for the 15-to-17 year-old of age population. This apparent concentration may be exaggerated by the small numbers involved, yet a pattern was apparent. The Village of Medina was also high in this area.

Many participants in the interview process conducted by the Lake Ontario Rural Healthcare Network noted significant concern over the teen pregnancy problem in the area. These individuals basically felt teen pregnancy is a cultural phenomenon, fostered in part by a change in family values in which children borne out of wedlock are no longer ostracized or stigmatized, by a social service network which has aided single moms in taking care of their children rather than causing them to become "outcasts". The availability of "public assistance" to financially support unwed mothers was viewed by some individuals as a major contributor to the growth in this life style. Some individuals talked about the need for the development of parenting classes to help young people deal with the trials of childbearing.

No babies have been born with HIV in Orleans County.

A variety of nutritional programs are available to women, infants, and children. These are listed in the Nutrition section of this report.

Existing Services

The Oak Orchard Health Center, which has offices in Albion and Brockport, provides prenatal care for women with low incomes who are not eligible for Medicaid. This Prenatal Care Assistance Program (PCAP) focuses on the special needs of women during pregnancy. The Oak Orchard Health Center provides prenatal care as part of its range of services. It also operates the Womens, Infants, and Children Program which provides services to pregnant women, nursing mothers, infants and children.

Planned Parenthood provides pregnancy testing and referral to appropriate sources for prenatal care.

The Orleans County Health Department makes home visits to pregnant women identified as in need of such services. Health Department nurses work with families to anticipate the future needs of the infants and mothers. They assess the mother's preparedness for, and provide her with instructions on, labor and delivery. They also evaluate how ready the home and family are to care for that child, and help to prepare for the child's arrival at home.

Prenatal care services are also available at Medina Memorial Hospital and intensive care services for newborns are available in Erie and Monroe Counties.

The Orleans Parenting Council, a group of providers of parenting services in Orleans County, offers a variety of programs, some of which may be used as an adjunct to prenatal care. Some of the programs have fees, either sliding or fixed, or have eligibility criteria. Transportation issues are addressed by each group individually. These organizations include:

"Help Yourself" - Adult & Adolescent Basic Education, Albion

Albion Central School - "Project Open Door" (school age), Albion

Alternative Choices for Teens (ACT) (teens), Albion

Orleans Co. Assoc. for Retarded Citizens (develop. disabled), Albion/Medina

Community Free Library, Holley

Cornell Cooperative Extension in Orleans County, Albion

Daisy Marquis Jones Family Wellness (fee), Brockport

Orleans EPIC - Effective Parenting Information for Children (children), Albion based/countywide

Genesee-Orleans Ministry of Concern, Albion

Orleans County Action Committee Head Start (children, low income)

All Orleans Community Action Committee, Inc. (low income), Albion

Orleans County Department of Social Services (low income), Albion

Orleans County Health Department, Albion

Orleans County Mental Health, Albion

Monroe 2 - Orleans BOCES (education), Holley

Orleans-Niagara BOCES Single Parent Program, Medina

Rape Crisis Service of Planned Parenthood, Albion

Special Friends Program, Inc., Albion

Swan Library, Albion

WE-MO-CO Occupational & Technical Center, Holley/Spencerport

Yates Community Library, Lyndonville

Young Parent's Network, Albion

Orleans County "Youth At Risk", Albion

The Orleans County Department of Health public health nurses provide post partum and newborn care health guidance to most women and newborns (particularly first-born), especially when indicated by local hospitals. The OCDOH publicizes clinic schedules and lead screening programs.

 

 Community Priorities for 1997/98

Family Planning, Maternal and Infant Health

  • The extremely high teen birth and fertility rates coupled with excessive low birthweight babies born by teens should be a priority concern of the County Health Department and local providers. Causes should be examined. Particular attention pertaining to teen reproductive health to be directed at the Town of Albion.
  • The increase in low birth weight babies needs to be watched very closely and potentiality discussed with obstetricians/gynecologists.

 

 Programs:

Child Health

Approximately one out of every four County residents is under 14 years of age. In 1999, it is estimated that there will be over 11,000 children in the County who will need many types of health care services to help to assure healthy adulthood.

Most communities in the County are expected to experience a growth in young residents between 1994 and 1999. The number of children in the Towns of Albion and Kendall is projected to increase by as much as 40%. Conversely, the childhood population in the Towns of Carlton and Gaines is expected to decline in some age groups by as much as 50%.

Many factors can affect the need for health care services or programs. Poverty levels for Orleans County children exceed the number for Upstate New York as a whole. In 1991, 2,100 children lived in poverty. This 18% poverty rate is 20% higher than the rate for comparable counties and generally indicates a higher-than-expected demand for publicly supported programs. Children from families with low incomes - especially the working poor who do not qualify for traditional Medicaid programs - are particularly susceptible to problems accessing healthcare. Programs such as the Child Health Plus Program have helped to reduce this potential difficulty, yet many families are unaware that this type of healthcare assistance is available to them.

The County also has a higher crime record than comparable counties. In 1992, nine youths, aged 13 to 15 were arrested in the County for violent crime such as robbery or aggravated assault. On educational measures, the County compares favorably. The ratio of County youth qualifying for regents diplomas was greater than that of youth from other rural counties. Orleans also had a lower drop-out rate, and performed equally well on comprehension, mathematics, and reading tests.

Childhood diseases can have staggering personal and economic consequences. Proper treatment of illnesses in the earliest stages often prevents serious medical problems. Medical care for pregnant women, proper vaccinations, and the early detection of toxins in the blood such as lead reduce the need for more intensive and costly health care services. The County's public health mission to a significant degree is directed specifically at this segment of the population.

Recognizing that in 1993 , one out of every three babies born to County residents (208 total) qualified for Medicaid, the County intends to monitor the utilization of Medicaid managed care enrollees in this age group very carefully.

The County has identified several priorities for children for 1997/98. They address a broad spectrum of preventive and treatment programs from dental health, to immunization, to communicable disease, to prenatal care. The successful implementation of new programs depends on the many healthcare practitioners and agencies and schools in the community as well as on the County Health Department. Greater detail regarding these priorities for children and youth is contained in later sections of this report.

Community Priorities for 1997/1998

 

 Programs:

Dental Health

Regular toothbrushing, flossing, and routine dental checkups and cleanings lay the foundation for dental health. Pain, infection, tooth decay and subsequent loss of eating pleasure and self-esteem can be avoided by proper care of teeth and gums. Regular dental care for children is crucial to the development of the good self-care habits that promote lifelong dental health. Also essential is fluoridation of drinking water, which prevents tooth decay and gum disease, especially in children and teenagers.

Target Groups and Existing Services

In 1999, the County will be home to an estimated 11,380 children and teenagers under fifteen--a prime target group in need of regular dental care.

Youth from families with low incomes and especially those who reside in areas of the County without fluoride are particularly susceptible to poor dental hygiene habits. An estimated 15% of County youth (1,700) live in families with incomes below the poverty line (compared to a statewide average of 12%). During growing season, the number of youth from low-income families resident in the County, increases by 500 to 1,000 people due to the arrival of seasonal workers.

Only 2 of 5 Orleans County residents--those residing in Medina, Lyndonville, Albion water systems, and a small section of Shelby--have fluoridated water supplies.

No school system in Orleans County employs a dental hygienist.

Most of the County's eleven dentists will not accept new Medicaid patients. Most residents with low incomes must go to the Oak Orchard Clinic in Brockport, NY for dental care.

In 1998, Medicaid eligible County residents will be enrolled in managed care programs. Access to dental services needs to be maintained for this population.

Community Priorities for 1997/1998

Dental Health

 

 Programs:

Lead Poisoning Prevention

The danger of lead poisoning is most acute for children under 5 years old, of whom there will be 3,156 in Orleans County in 1999. Abnormally high concentrations of lead in paint, water pipes, soil or air, can invade the body's blood supply and can hamper the development of vital organs such as the brain, liver and kidney. In rare cases, acute lead poisoning can be lethal.

Lead poisoning can be identified by a simple test of blood obtained through a pin prick. The presence of more than 10 micro grams per deciliter of blood is regarded as a significant risk to the child's health and development. High lead levels warrant immediate identification and removal of the source of contamination, as well as treatment of the affected child to reduce the presence of lead in the blood.

Lead poisoning is most common to residents of areas near landfills, dumpsites, and sources of environmental pollution, as well as in older housing, where lead paint and pipes may still be present.

Target Groups

Conditions must be closely monitored in Orleans County towns and villages that have high rates of poverty, high concentrations of children under five, older-than-average housing stock, or landfills or dump sites near residential areas.

While lead is the identified contaminant in the FMC landfill in Shelby Township, there is no evidence at present of abnormally high lead levels for residents of areas near the landfill site. Extra vigilance in screening Shelby's children for lead poisoning remains warranted, however, as test results are inconclusive. Other target areas for lead screening include the Town of Kendall and the Villages of Albion and Lyndonville, whose populations include a high percentage of babies and young children, and the Villages of Medina, Holley, part of Albion, and the Town of Gaines, where housing stock is older than the County average (slightly over 60% of the County's housing was built before 1960). Particular vigilance is indicated for Gaines, which has the County's highest concentration of children below the poverty level.

Existing Services

The Orleans County Health Department operates a lead screening program, offering two clinics per month and following up with additional testing when high blood levels are found in any child. The Health Department also provides education materials to preschools as well as pamphlets, distributed during home visits, which describes lead poisoning prevention activities. The Oak Orchard Health Center in Brockport lead-screens all children under five among its clientele. Lead testing is required for children in the Head Start Program, and for children living in subsidized housing. The Orleans County Health Department tests for lead in the environment (housing, soil, etc.), sending paint and soil samples to Albany for analysis and receiving test results within six to eight weeks.

It is in the private sector, and among more affluent populations, that extra vigilance is necessary. While family physicians in the County provide lead screening, their compliance with a State requirement to screen all children two years of age and under, and provide test results to the County Health Department warrants improvement. At a minimum, an estimated one out of every two children are not being monitored appropriately for lead poisoning. Because of this lack of proper monitoring, there may be more than 27 untested children in Orleans County whose lead counts place them at risk of damage to the brain, kidney, liver and other vital organs.

 

Community Priorities for 1997/1998

Lead Poisoning Prevention

 

 Programs:

Nutrition

The food we eat has a strong influence on our well being, particularly at life's most vulnerable points. Inadequate or improper diet can impair the physical and mental development of fetuses if the mother's diet is inadequate and of infants and children. It can also hasten debility in the elderly. Awareness of the importance of diet to maintaining health is growing but has not firmly taken hold in the County.

Target Groups

The primary groups in Orleans County in need of special dietary and nutritional assistance include people with low incomes, infants and schoolchildren, pregnant women, and the elderly. These groups together comprise approximately 35% of the total population of the County.

Although there is no data pertaining specifically to nutritional needs in Orleans County, the results of statewide surveys warrant attention locally. The latest nutritional survey completed in New York State indicates the following problem areas: Children and teenagers ­­ low iron, calcium, and vitamin A and C intakes, as well as obesity.

Women of childbearing age ­­ low levels of iron, calcium, and vitamins A and C; high fat or cholesterol intake; and elevated blood pressure.

Adults ­­ high fat intake and obesity contribute to heart disease, adult-onset diabetes, and cancer. Hypertension is common in adults with high sodium intake.

Over 65 ­­ inadequate levels of meats, legumes and eggs.

The County is faced with an apparent underutilization of nutritional programs for low-income children. The Orleans County percentage of children below poverty, 15%, is 25% higher than the rate for Upstate New York as a whole (12%). These poverty level suggests that the County should have comparably "high" Food Stamp, School lunch Program, and School Breakfast Program enrollment levels.

Existing Services

The Oak Orchard Health Center in Albion, with a nutritionist on board, administers a prenatal care assistance program addressing the nutritional needs of pregnant women, including migrants. A Nutrition Network made up of human service agencies shares information and develops preventive and remedial nutrition services for the County. Nutrition programs in the County for the Elderly include a Meals on Wheels Program, which delivers two meals a day and has frozen foods for weekend use; and the Orleans County Nutrition For the Elderly Nutrifare Program which offers meals at the following locations:

  1. First Presbyterian Church - Albion
  2. Maple Ridge Estates - Medina
  3. Eastern Orleans Community Center - Holley
  4. Kendall Town Hall - Kendall
  5. Yates Town Hall - Lyndonville
  6. Carlton Manor - Carlton

Other Nutritional Programs and their selected eligibility criteria, include:

  1. Food Pantry offered by the Medina Area Association of Churches and the Orleans County Community Action Center - Medina and Albion,
  2. Senior Citizens of Western Orleans, Inc. - Medina,
  3. Cooperative Extension of Orleans County - Nutrition Education (nominal fee for material and classes) - Albion,
  4. The New York State Department of Health Nutritionist, who is available through the Orleans County Health Department to assist with dietary planning - whole County,
  5. The Cancer Society, which provides nutritional information for clients (free) - Buffalo,
  6. The American Heart Association, which provides nutritional information (fee for some pamphlets) - Rochester,
  7. Medina Memorial Hospital (free - Medina) and Lakeside Memorial Hospital - Wellness Program (charge - Brockport) provide nutritional information to clients - services available both to patients and the general community,
  8. Rural New York provides nutritional programs for migrant workers - Medina/Rochester,
  9. Private physicians treat individuals with nutritional deficit,
  10. Head Start offers lunch and nutritional education (for financially eligible people) - Albion/Medina.

School lunch programs are also available at all schools. These programs include nutritional, low cost meals to all students, and the free lunch program to those who are financially eligible. The Food Stamp Program which provides vouchers for purchasing foodstuffs, is available to children and families who meet the financial criteria. Orleans County Department of Health nurses give instruction in preventive and remedial diets. This service is available on a home visit basis with clients and family work groups as needed. These services are available to all people served by the County Department of Health.

Community Priorities for 1997/1998

Nutrition

 

 Programs:

Injury Prevention and Control

Information regarding accident risks and precautionary measures can significantly reduce accidental injury and death rates. Dissemination of information is a particularly effective preventive measure when targeted at groups known to be vulnerable to a specific type of accident.

Target Groups

Accident and suicide rates in Orleans County markedly exceed those of Upstate New York as a whole. County mortality rates exceed Upstate averages by 51% for accidental deaths and by 19% for suicides. Each year, approximately 25 Orleans County residents die from injuries sustained in accidents, homicides, or suicides. Motor vehicles account for approximately 55% of all accidental fatalities.

In 1990-92, the accidental mortality rate for males was 2.5 times the rate for females (14 male deaths per year, or 65/100,000 people as opposed to five female deaths, or 26/100,000). Females, on the other hand, were approximately twice as likely to become victims of homicide. The accident mortality rate for people over 60, 110/100,000, was more than double the overall rate of 45/100,000. Suicide rates for the over-60 age group were also more than double the rate for all groups, and more than twice as high for males as for females. Hospitalization rates for certain injury categories also significantly surpassed Upstate averages. Motor vehicle injury rates exceeded the Upstate average by 95%, spinal cord injuries by 47%, and pedestrian injuries by 17%. Hospital admission rates for poisoning were "very high" in the western half of the County.

A 1996 Community Health Assessment by the Lake Ontario Rural Health Network (LORHN) raised concern that the County has only one hospital emergency room. LORHN raised the possibility of converting the closed hospital in Albion into an Urgent Care Center. Insurers noted that since Emergency Medical Services (EMS) the County's most accessible medical service, is not only overused, but often used inappropriately, and is therefore not cost effective. Medina Memorial is working with Genesee and Wyoming hospitals on an 800 number with a voice box that would answer emergency medical questions and inform callers of the closest hospital. The nurse manning the phone could resolve acute simple illnesses, thereby eliminating unnecessary ER visits. Managed care callers would be reminded to contact their primary care physicians.

Existing Services

Several types of injury prevention programs are offered in the County by a wide spectrum of community agencies:

  1. Primary Prevention Programs

The Five School Districts in Orleans County offer safe driving instruction as part of their driver education curriculum in the summer. Fire prevention and safety programs are mandated in the primary grades. (services school children)

The Orleans County Health Department offers educational material regarding home safety and accident prevention, and participates in the local Emergency Medical Services Council. They also provide educational material on the dangers of driving while chemically impaired, and in poison prevention, control, and early treatment. (Services the entire community - located in Albion)

The American Red Cross East and West branches provide first aid and life saving classes.

The Community Action group provides a safety seat program for children. (services the entire County - located in Albion)

The Orleans County Cooperative Extension provides a tractor and farm safety course for area youth through its 4-H Program. (services youths <19 - located in Albion but operative throughout the County).

 The Office for the Aging addresses the safety of the elderly.

The Sheriff's Department manages the county DWI program and operates the DARE program for teenagers.

McDonalds Restaurants participate in a fire safety information program by making pamphlets available on that topic (services the entire community - located in Albion/Medina).

  

  1. Secondary and Tertiary Prevention Programs

The Orleans County Sheriff's Department patrols County highways and arrests individuals for traffic violations. In instances when mental health needs or alcoholism treatment needs are a part of the violations, the Sheriff's Department refers to the Orleans County Mental Health Department. (services everyone - operative throughout the County) The Police Departments perform similar services on a local level in the villages of Holley, Albion and Medina.

Volunteer ambulance and fire companies (13) in each village and township provide fire and ambulance services. Emergency medical technicians are required on all ambulance calls. Several fire companies present fire safety programs in County schools. (services everyone).  

  1. Suicide prevention related programs

In the five Orleans County School Districts, school nurses, health teachers and counselors provide referrals to appropriate sources.

Through the Youth at Risk Program the DMH and the Youth Bureau provide case workers for the school systems. Young people at risk for pregnancy, dropping out of school etc. are identified; intervention and referrals are designed to deal with anticipated problems in a preventive rather than reactive mode.

The Orleans County Mental Health Department operates a mental health clinic between 9 a.m. and 5 p.m. - Monday through Friday, and evening hours on Wednesday. 24 hour emergency service is available. The clinic offers individual psycho-therapy, family therapy, marital counseling, group therapy and medication therapy. In addition, psychological, psychiatric, social, and vocational assessments are available. Therapeutic groups presently include two adolescent groups, a men's violence group, and a victim's group. Community mental health nurses conduct in-home mental health evaluations of the elderly and home-bound individuals upon referral.

Friendship House offers a continuing treatment program to help emotionally disabled persons 18 years of age or older who are currently functioning in the community. The service includes individual and group counseling, medication therapy, crisis intervention, social and living skills training, and social recreational activities. The program is available Monday through Friday, 9 a.m. to 5 p.m. in Albion.

The County Mental Department provides a prevention/education program on the nature and prevention of mental illness. A youth at risk program is available at Albion High School to help identify and counsel troubled young people before their problems evolve into crises. There are also plans to expand this program into Medina.

The Orleans County Association for Retarded Children (ARC) provides Family Support Services. This program serves approximately 98 clients, and gives support to many families who have a developmentally disabled family member. The program includes a respite sitter-companion program in which trained volunteers give care while family members have time for themselves. The program also offers parent skills training programs. The ARC coordinates its services with BOCES and various school systems to meet the needs of school age children. Developmentally disabled parents can also receive guidance regarding activities of daily living and parenting skills. Group sessions are held to improve decision-making, management of behavioral problems, and social skills. Legal advice is available for guardianship services.

BOCES of Niagara and Orleans County offers behavioral modification programs.

Community Priorities for 1997/1998

Injury Prevention and Control

Motor Vehicles

Spinal Cord Injuries

Suicide

The Elderly

Poisonings

 

 PROGRAMS:

Sexually Transmitted Diseases (Excluding AIDS)

Sexually transmitted diseases such as syphilis, gonorrhea, and herpes can have devastating effects upon the body. If left untreated, some of these diseases can cause sterility, paralysis and death. Prevention of the spread of these diseases can only be accomplished through education and identification and treatment of infected or at-risk individuals.

Target Groups

Orleans County meets Healthy People 2000 Objectives of gonorrhea rates below 225 cases per 100,000 people, primary and secondary syphilis rates below 10 cases per 100,000, and congenital syphilis rates below 50 cases per 1,000 live births. Nonetheless, recent increases in the incidence of gonorrhea bear monitoring. Gonorrhea rates have been climbing steadily since 1991, and the rate of 107.1 per 100,000 recorded in 1994 and 1995 is almost double the average rate for the period 1985-1990, though lower than the average rate for Upstate. The syphilis rate has also increased in recent years, averaging 5.7 per 100,000 from 1991-95, with two to three cases reported in each of those years. Though this rate exceeds that of Upstate New York as a whole, it is inflated by inclusion of cases among inmates and job corp people, who accounted for five of the 12 cases reported in this period. In the same period, there were no reported cases of congenital syphilis in Orleans County. The increase in reported cases of gonorrhea appears to be concentrated in females 10 to 19 years of age. Fully 60% of the 76 reported cases among females were in the 10 to 19-year age group--a proportion nearly 50% higher than the Upstate norm of 41% for this age group. Among males, 55% of reported cases were in the 20 to 29-year age group, 20% higher than the Upstate norm; the figure for men over 39 years of age was 18% above the Upstate norm. Education and preventive measures should therefore concentrate on teenage girls (10-19) and young men (20-29) and men over 39 years of age.

 

Existing Services

The Orleans County Department of Health offers walk-in services for counseling with treatment referral to the Department's Medical Consultant.

Planned Parenthood of Rochester and the Genesee Valley, Inc. offers services in Albion, including gynecological examinations, testing for sexually transmitted disease, HIV testing, state- funded counseling, and referrals for follow-up care.

Private physicians also provide treatment for sexually transmitted disease.

Community Priorities for 1997/1998

Sexually Transmitted Disease

 

Programs:

Tuberculosis

Tuberculosis is a bacterial disease spread by contact with an infected person, animal, or food substance. A severe disease which destroys lung tissue, TB is generally fatal if it remains untreated. Because it is easily detectable, the spread of the disease has been kept in check.

Target Groups

In recent years incidence of tuberculosis in Orleans County has been on the rise, with an average of 3.4 new cases reported per year from 1989--1995. Reported cases have been concentrated mainly in the prison population, where close contact and the presence of AIDS render inmates highly susceptible. In 1989, four of the five new cases reported in the County were among inmates. In 1993, the "peak" year to date, all seven new cases were inmates. Yet cases have also been reported in the County's non-prison population. Six new cases were reported in 1995.

Prison workers, who come in close daily contact with inmates, are at risk of contracting TB and spreading infection to the community at large. Approximately one out of every twenty adults work at correctional facilities: 390 at the state facility in Albion, 500 at the Orleans state facility, and 25 at the Orleans County Jail. Other populations at risk of tuberculosis include the elderly, those in poor health, HIV- and AIDS-infected individuals, and those who work at or reside in such institutions as hospitals and nursing homes.

Existing Services

The Orleans County Health Department offers skin testing for TB to all citizens on a walk-in basis, and skin testing clinics to any group upon request. Infected persons are offered the choice of follow-up by their own physicians or by the Health Department Medical Director. The Health Department arranges for local pharmacies to provide medications to infected persons. A Community Health Nurse makes home visits to patients unable to come to the Health Department. The Department closely monitors individuals undergoing treatment for potential multi-drug-resistant strains of TB. The Department also administers and observes chemotherapy , mandating such therapy for noncomplying patients.

   Within 48 to 72 hours of a reported instance of TB, the Department contacts by phone, by mail or in person all individuals who have been exposed, offering TB screening at the contacts' convenience. All contacts with negative skin tests are retested after three months. A Community Health Nurse follows active TB cases monthly for medicine, compliance, sputum, etc.; assesses appropriate therapy; makes visits to the home; assists with medication via directly observed therapy; informs patients of their medication's side effects and monitors the effects of medication monthly.

HIV testing and counseling is available at the Oak Orchard Community Health Center and at the Orleans branch of Planned Parenthood. TB cases are referred for HIV testing, and Community Health Nurses offer pre- and post-test counseling. The County provides TB screening and information for corrections officers and other institutions in the County.

Community Priorities for 1997/1998

Tuberculosis

 

 Programs:

Communicable Diseases

Communicable diseases are most commonly spread by contact with infected people, eating utensils, food, or water. The County Health Department routinely tracks the incidence of these diseases, since outbreaks can be prevented by targeting information and preventive measures at any disease that shows increased incidence.

Target Groups

Of the eleven major diseases that the County routinely monitors, seven, excluding gonorrhea, syphilis, and tuberculosis, have infected at least two County residents in one of the three years 1993-1995. (Please see separate sections of this Assessment for discussion of Sexually Transmitted Diseases, Tuberculosis, and AIDS.) Among these diseases, only Giardiasis has increased markedly and bears monitoring. Following a four year period averaging seven new reported cases per year, incidence increased to 13 in 1994 and 16 in 1995. Of the four infectious diseases for which data was compiled in the NYSDOH Preventive Health and Health Services Block Grant Needs Assessment of June, 1994, only the Pertussis rate was "above average" in Orleans County, ranking in the second highest quartile for the state. This rate has declined in 1993-95 Lyme Disease rates were lower than the Upstate average from 1991-93, with four new cases reported in 1992 but none in 1991 or 1993. Hepatitis B has been increasing in the population. 1995 levels exceeded previous highs which occurred in 1989/90. Rabies incidence was also below the Upstate rate. Raccoon rabies, which has been moving northward from the New York-Pennsylvania border for the past several years, did not hit Orleans County in force until 1994; one case among animals was confirmed in 1991, none in 1992 or 1993. In 1994 rabies in Orleans County peaked at 47 reported animal cases and 62 cases of human prophylaxis. In 1995, figures dropped to 30 confirmed animal cases and 15 human prophylaxes.

The 925 individuals who work in correctional facilities in Orleans County are at high risk of contracting communicable diseases. These workers pose a major target group for educational and preventive efforts because they can spread infections from the prisons to the general community.

Existing Services

Numerous institutions, health care practitioners, and the County Health Department offer a broad range of services for the prevention, identification and treatment of communicable diseases. Please see the sections "Sexually Transmitted Diseases" and "Tuberculosis" for a detailing of such services offered by the County and by other public and private agencies.

Physicians in Orleans County currently either treat or make referrals for treatment of communicable diseases.

Community Priorities for 1997/1998

Communicable Diseases

 

 Programs:

Immunization

Some types of bacteria or germs cause disease. The body creates antibodies to fight and overcome these bacteria. Once antibodies are produced, people are no longer susceptible to most of the problems these diseases cause. The process of developing these antibodies is called immunization. Some people become immune without the assistance of modern medicine. However, most people develop immunities by receiving shots which help their bodies produce bacteria or toxin fighting antibodies.

Target Groups

Many diseases can now be prevented by the immunization process. It is most effective when it occurs at the preschool level. Some vaccinations need to be repeated every ten years. Flu vaccines are the most common type needed by adults, especially the elderly, and they should be obtained at the start of each flu season. Women of child bearing age should be vaccinated against rubella or German measles. This disease can cause serious problems in developing fetuses. Residents of nursing homes, clients at day-care programs, prisoners and prison personnel need to be vaccinated routinely due to close contact. Migrant workers and their families are in need of immunization because they often do not obtain routine medical care due to their low income and lack of immunization in the countries from which they come.

In general, the data show that the Town of Kendall and Village of Albion contain the highest proportion of babies; the Villages of Medina and Albion the highest proportion of Elderly; the Town of Gaines the highest proportion of children in poverty, and the northern and central portions of the County, exclusive of the Towns of Ridgeway and Albion, the highest concentrations of people of all ages below poverty. Those areas represent the target areas for immunization services for those groups.

Immunization level data shows that on average children enrolled in Orleans County schools have immunization levels consistent with those enrolled in Upstate New York schools. However, comparatively "low" levels of immunization occur for grades 7 - 12 and prekindergarten. Rates for kindergarten and special education are high in comparison to upstate levels. Comparatively low levels appear to be occurring in the Kendall School District area. Immunization levels of new pre-school and elementary and high school students are consistently below levels for longstanding County residents.

As Medicaid managed care is implemented in the County, the County Health Department will monitor immunization levels of managed care enrollees.

At LORHN meetings, representatives of Medina Memorial Hospital noted that levels of immunization for flu dropped off at their "free" sites when a modest co-pay was required.

Existing Services

Immunization clinics are offered one day per month both in the morning and afternoon at the Orleans County Health Department. The service is offered at no charge to residents and is always well utilized. Private physicians in Orleans County provide immunization or referrals.

Immunization services are also available at the Oak Orchard Health Center site in Albion. When there are outbreaks of vaccine preventable illnesses in Amish communities in western New York, the County Health department staff visit Amish families to discuss preventive techniques, especially if these families have recently visited those with infected children.

Community Priorities for 1997/1998

Immunizations

 

Programs:

Chronic Disease

Chronic diseases - those that afflict the body over a long period of time and require lifetime or long-term treatment - chiefly affect individuals 45 years of age and older. Nationally, the three major causes of death are heart disease, cancer, and cerebrovascular disease.

Target Groups

In the 10 year period 1983-1993, deaths from heart disease, cancer, and cerebrovascular disease ranged from a low of 240 in 1987 to a high of 301 in 1988. During 1992/1993, an average of 265 people from Orleans County died from these causes each year. Two out of every three deaths in the County were due to one of these three causes.

Death from these diseases have fluctuated over the 1983 - 1993 time period. Yet, deaths from cerebrovascular diseases are declining from highs of 150 deaths per 100,000 people in the early 80s to a 1993 low of, 50 per 100,000 people.

In Orleans County, death and hospitalization rates significantly exceeded those of Upstate New York for a variety of specific chronic diseases. In 1992/93, the County's death rate for acute myocardial infarction (heart attacks) was the highest of any County in New York State. Seventy people from the County died from heart attacks on average each year and the death rate was 68% higher than the Upstate norm. During that same time period, deaths from genital cancer ranked 61st highest in the state - 18 deaths per year of Orleans County residents, 78 % higher than the Upstate "norm". Deaths from cerebrovascular diseases, ranked 53 highest in the state - 27 deaths, a rate 17% higher than the Upstate norm.

The County's Diabetes related lower extremity amputation rate in 1989-91 outpaced the Upstate rate by 39% (14.4 per 100,000 people to 10.5). Hospitalization rates for adult asthma were 20% higher than Upstate norms. County hospitalizations in 1992 and 1993 for circulatory disorders were significantly higher than expected. During those two years, an average of 1,090 individuals were admitted annually for these disorders.

The analysis of data by township and village was complicated by small case size for many of the variables studied. For this reason, most statistical variation by township could be attributed to chance. The Village of Lyndonville and Town of Bates, however, had enough "high" death rates to warrant additional prevention and treatment capacity.

 

Existing Services

The American Heart Association (AHA) offers primary prevention education on heart disease risk factors, nutrition factors, and the value of exercise and stress reduction as preventive measures. Pamphlets are the primary means of education, but the AHA does make presentations to groups. It also operates blood pressure testing clinics, followed up by counseling for clients with borderline and elevated blood pressure.

The Orleans County Health Department offers tertiary prevention to clients recovering from acute myocardial infarction or other forms of heart disease. Community health nurses assess needs and teach, counsel, and refer people to ancillary services needed to maintain activities of daily living. For Diabetes patients, the Department conducts skilled nursing assessments, provides assistance with insulin therapy, instructs patients regarding medications, diet and life style management and coordinates with other services. Public health nurses perform blood pressure screening at all health fairs for the elderly in Holley, Kendall, Albion, and Medina.

The Medina Memorial Hospital offers various types of inpatient and outpatient care for patients with chronic disease. MMH has mammography equipment for early detection of breast cancer and opened a kidney dialysis station in 1996. Smoking cessation seminars are offered at the Hospital's Albion site.

The American Cancer Society (ACS) in Medina offers cancer patients transportation to Rochester or Buffalo for therapy. The American Cancer Society can loan home care equipment and provide financial assistance for medication and travel expenses. The ACS provides information on prevention, detection and treatment, provides advocacy services, and is currently developing a range of educational and support groups.

Most cancer patients seek active treatment at the Roswell Park Memorial Institute in Buffalo or at the University of Rochester Cancer Programs in Rochester.

The American Lung Association, working out of Rochester, provides information and educational material. The American Diabetes Association of Western New York provides educational sessions on proper diet, insulin therapy and oral hypoglycemic agents; counseling regarding disease management and life style; visual aids: and referrals to other agencies.

The Blind Association of Western New York provides individual counseling to cope with vision loss; environmental needs assessment; assistance to community agencies helping the elderly adapt to vision loss; family conferences to teach safety techniques and use of vision aids, and referral to other agencies.

Community Priorities for 1997/1998

Chronic Disease

 

 Programs:

Human Immunodeficiency Virus - HIV

Human Immunodeficiency Virus is the name of the group of viruses believed to cause Acquired Immunodeficiency Syndrome (AIDS). AIDS is not a deadly disease in the traditionally defined sense but rather a condition that weakens the body's natural immunity to many types of diseases ranging from the common cold to cancer and pneumonia. This weakened immune system leads to death from other causes. HIV is transmitted through body fluids and is primarily transferred by sexual contact or injection in the blood stream. Although the majority of AIDS cases nationally were at first restricted to homosexuals, intravenous drug abusers, and hemophiliacs, AIDS cases are now appearing in the heterosexual population, among children and spouses of intravenous drug abusers, and among newborn and breast-fed children of HIV-positive mothers. Transmission of AIDS can be prevented by education regarding the dangers of sexual promiscuity and intravenous drug use and by the use of condoms and sterilization of needles used for intravenous injections. The treatments for AIDS are extensive and require many different components of service, the majority of which are long-term rather than acute. While recent breakthroughs in combination therapies for AIDS and early treatment of HIV hold out a good deal of hope, the course of treatment is very costly and difficult at best, and no cure has been found. Prevention still is the best answer.

Target Groups

As of March, 1998, thirty-one (31) cases of AIDS were confirmed in the general population of Orleans County. This equals a cumulative incidence rate of 80.6 cases per 100,000 people which is an intermediate rate for a county in New York State.

No cases of newborn HIV seropositivity were reported in the County in 1991-1995.

When statistics on inmates in Orleans County are included in county data, two hundred and ninety (290) cases of AIDS have been confirmed in Orleans County as of 3/31/98. This significantly higher number of cases is expected and similar to the experience of neighboring Wyoming County, 299 AIDS cases, - a county with a significant New York State prison population.

Its relatively low general population case rate for AIDS notwithstanding, Orleans County ranks very high on several key indicators of need for HIV programs--including male and female HIV discharges, low birth weight babies, and high rates of "AIDS other cases" - that is, cases of AIDS in the non-homosexual population. The high hospital admission rate for cocaine and opiate abuse, in combination with the high AIDS case rate for non-homosexual/bisexual individuals, suggests that the high HIV discharge rates for both sexes are related to substance abuse in the Orleans County population.

Existing Services

The Orleans County Human Service Council AIDS Task Force, a group of local agencies involved in HIV/AIDS prevention and treatment, includes Planned Parenthood, the American Red Cross, the County Health Department, Oak Orchard Community Health Center, and the Alternative Choices for Teens Program Coordinator.

The County Health Department provides staff education and information on HIV at Health Fairs and correctional facilities, advises people with sexually transmitted diseases of the dangers of HIV infection, and provides HIV counseling. Confidential HIV testing is available through Planned Parenthood and the Oak Orchard Community Health Center. Local physicians perform HIV testing for prison officers. Individuals who contact the Health Department to report possible exposure to HIV/AIDS through spouses or sexual partners are referred to the Partner Notification and Assistance Program.

A full range of services is offered in Orleans County to meet the health, mental health and social service needs of AIDS patients. Patients or their families should contact the Orleans County Health Department, the Department of Social Services, or the Mental Health Clinic.

Community Priorities for 1997/1998

HIV

   Health Care Services

Service Providers

Medina Memorial Hospital maintains operation as a full service community hospital located in Medina for Orleans County. Residents of the central and eastern portion of the County also utilize Lakeside Hospital in neighboring Brockport, NY, for acute care and hospital related services. Access to hospital care has not been reduced for residents of this area of the County even after Albion Hospital closed in 1989. Admission rates for the Albion community are higher than for other parts of the County.

There are three nursing homes in the County - Medina Memorial Hospital Skilled Nursing Facility in Medina, Orchard Manor Nursing Home and HRF, Inc. in Medina, and the Orleans County Home and Infirmary in Albion. The Orleans County Health Department provides health services in Albion and the Oak Orchard Health Center and Medina Memorial Hospital operate outpatient clinics in Albion. Medina has also recently opened a part time outpatient clinic in Lyndonville, NY. Community based home health care programs are operated by the Orleans County Health Department (CHHA) and Medina Memorial Hospital (LTHHCP). Hospice of Orleans County offers provides social work services, home-health aides, bereavement counseling, spiritual and medical care to County residents either in their homes or at local hospitals.

 

The Orleans County Health Department is the lead agency of Rural Health Network, supported by the New York State Department of Health Office of Rural Health. The Lake Ontario Rural Health Network - LORHN - is composed of six charter members which include:

LORHN's service area includes the County of Orleans and neighboring portions of Niagara, Genesee, and Monroe Counties. During 1995, it conducted an extensive examination of community health needs and perceptions. Many of the findings of that review, which involved over 50 individuals from various aspects of the community, are included as appropriate in this assessment.

Medicaid Managed Care

The County is scheduled to begin enrolling Medicaid recipients in managed care in 1997. Six plans have proposed to offer managed care programs within a county elected mandated environment:

Better Health Plan (Buffalo)

Currently 16% of the population residing in Orleans County participates in a managed care plan known as an HMO. This membership is comprised of workers and/or their dependents associated with firms offering HMO coverage. No Medicaid recipients participate in managed care plans as of February, 1996.

The Year One enrollment target is approximately 1,928 people, which represents about 45% of the County's total Medicaid eligible population. Target enrollment for 1997 is 3,566, and "full" enrollment - 3,735 Medicaid eligible individuals- is projected for 1998. "Full" enrollment does not include special care populations or individuals with SSI or HIV infection.

Depending upon State of New York funding mechanisms, several opportunities exist for counties to secure quality health care for this population. The spectrum of county and local private player involvement ranges from total, unified local control over premium dollar and health care delivery system to market involvement by non-county managed care plans who contract with various local providers to build a health care network controlled by the HMO's remote administration. Premium ownership usually denotes ownership of the decision-making process for payment levels and method of compensation, utilization and quality guidelines, and provider membership composition. Therefore, a large factor in the County's ability to serve the Medicaid population locally through its programs may be its control or receipt of premium or other health-care services funding. LORHN has begun an employer survey to assess the potential for commercial local products.

A large factor for urban-based HMOs seeking to expand membership for Medicaid and commercial products into rural areas like Orleans County is the development of a strong and qualified primary and secondary care network at an optimal price. An issue for rural counties and rural hospitals is the extent to which the membership of the community leaves the area to seek secondary and tertiary care not offered in the home county. Orleans County is designated as a Shortage Area (1990) by New York State for the following specialties:

Changes in the age makeup of the County will place additional demands upon local primary care capacity. The County is "losing" the population group which has the lowest use rate of outpatient services, the young adult. Conversely, it is forecasted that significant gains will occur in the 45 to 55 years of age group. This age group is at the base of the incline of service utilization. Hence, more outpatient capacity is the norm for the foreseeable future for the County. Extensive statistics on outpatient needs are contained in the Data Section of this report.

The Data and Analyses section is not included on this web site. To obtain a complete copy, please contact the Orleans County Health Department.

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