Prospects for Sustainable Medicine: A Status Report

Prospects for Sustainable Medicine: A Status Report

Pine Mountain Club, California

About Pine Mountain Club

Pine Mountain Club, CA, (PMC) is mountain village surrounded on four sides by the Los Padres National Forest. A small, remote community of about 2400 full-time residents we are blessed by a wealth of natural beauty, four-seasons of star-studded nights, the sound of silence, clean air and pure spring water. Located about an hour from Bakersfield on the north, the Los Angeles suburbs on the South, and Ojai on the West, we are considered to be a bucolic “nearby faraway place.”

PMC was developed in the 1970’s as a seasonal resort and quickly attracted couples who bought lots and built a second home with plans to retire here, which many did. We still have a significant contingent of retired residents, many who are living on fixed incomes. But with our lack of health services, the later years of retirement become a challenge and many move back to an urban area in time. We are now home to a diverse population that includes professional pre-retirees and young families with small and teen-aged children who have fled the city for lower housing costs and a safer, healthier way of life. An approximately 2000 additional residents are “weekenders” or “holiday-only” property owners, who come in from other areas to relax and recreate.

All well and good … idyllic almost … until one confronts the drastically changing state and national economy and the very real prospect of a future when traveling a considerable distance for jobs and nearly all basic services become a costly challenge.

Throughout our history most people who worked commute an hour or more to jobs and everyone commutes that distance to shop for food, health care and entertainment. We’re slightly less than 30 minutes from the nearest other unincorporated small town close to an Interstate I-5 exit between Los Angeles and Bakersfield, a route we’re all accustomed to traveling.

 

Our residents both earned and spend nearly all their income elsewhere. In an age of cheap, abundant oil this was never viewed as a problem. We were an idyllic nearby-far-away place. But like many small rural communities (USA Today, 7/08) and those on the far fringes of metropolitan areas that grew when home prices were soaring (Los Angeles Times, 3/30/10), we’re being hit hard by a dramatically shifting economy.

Property values have fallen 47%, energy-costs have sky-rocketed and we’re suffering a high number of foreclosures, which are projected to double over the next year. Small businesses, of which there are few, are closing. We have the highest vacant-home rate (61%) and the highest percent of people whose incomes are below the poverty level (17%) in the area, nearly double that of what are considered “poorer” nearby communities. The California Employment Development Department reports our unemployment rate as of February, 2009, to be 15.4%. This is higher than the 13.8% rate in Kern County and the 11.4% rate for California as a whole.
An out-of-sight-out-of-mind-step-child, “at the end of the line” in the far southwest corner of resource-strapped Kern County, we are underserved in terms of public services. Essentially we’re a community without a safety net, something few expected we would need, but which we must now build.

About Let’s Live Local

Let’s Live Local (LLL) is a non-profit organization with newly acquired 501(3)c status. We originally came together in August of 2005 as an informal group of volunteers concerned about the effects that climate change, peak oil, and resources depletion would have on our community and the surrounding National Forest. Given our small size and remote location we set out to identify the steps we need to be taking to develop awareness, solutions, and projects to address the issues of sustainability.
Our focus is working together to create a sustainable future where we can live, work and shop locally. Our priorities are to develop access to local food and energy and to create sustainable local services and a healthy economy while preserving the beauty and well-being of our natural environment. One of the most crucial local services we must develop is health care.
Run entirely on volunteer efforts to date, LLL has six working groups: Food, Energy, Economy, Water, Health and Regulatory Review. Our on-going projects include a Wood Pellet Coop with over 100 participants, a CSA Organic Food Coop, a Beef Coop, and an annual Clothing Exchange.

With many of our residents now struggling to pay for utilities and to keep from losing their homes, we have a limited pool of available volunteers with the time and funds to continue expanding our efforts. So we are currently in the process of seeking funds through a number of grants:

– a USDA Rural Enterprise Development grant
– a capacity building grant for a biomass facility from the National Forest Foundation
– a capacity building grant for recruiting health professionals from the California Wellness Foundation
– a Teen Screen Suicide Prevention program from the Department of Health and Human
Services Substance Abuse and Mental Health Services Administration, submitted in
partnership with another local non-profit organization, the California Family Counseling
Network

About Our Health Needs

The most notable fact we can report about our health care needs is that, as far as we can determine, there has never been an assessment of the health care needs of Pine Mountain Club by any county, state, or national agency, public or private. We are simply beneath the radar of the county, state, and federal government and private health care providers. There is data on most other areas of the region, but not here.

Thus a key step in our process to develop a model for sustainable medicine in a rural area will be to fund and undertake a comprehensive Health Impact Assessment such as the one utilized the Centers for Disease Control and Prevention.

We do know that Pine Mountain Club is in a federal and state designated Medically Underserved Area (MUA) and a Health Professional Shortage Area (HPSA). There is also data on Kern County health as a whole. In addition, for purposes of this report we have done a small, unofficial preliminary survey of health needs from residents who are representative of a variety of key segments of the community.

Kern County Health Data

The Kern County Health Status Profile of 2008 reports that the age-adjusted death rate from all causes for California during the 2005 to 2007 three-year period was a third higher in Kern County than in the rest of the state. Kern County’s crude death rate from coronary heart disease is the highest in the state.  Crude death rate from cerebral vascular disease in Kern County was double the rest of California. Similarly, deaths from for chronic lower respiratory disease were more than double the rest of California, as were deaths by accident. A recitation of similar statistics, disease by disease, documents Kern Counties’ deplorable health status.
One explanation of this lays in the location of Kern County population centers. Hemmed in by mountains to both the east and the west, the San Joaquin Valley suffers from some of the United States’ worst air pollution, second only after Los Angeles in terms of short and long-term particle pollution. Kern County also suffers from an abnormally high rate of substance abuse.
Data available on child health from the Kern County Network for Children’s 2009 report card indicates that prenatal care, prematurity, low birth weight. And birth rates to young mothers are all higher in Kern County than across California. The birthrate for adolescents aged 15 to 19 in Kern County was also considerably higher. Across the spectrum of measures for children’s health, including rates for childhood obesity and fitness, Kern County does poorly in comparison to the rest of the state.

Asthma is prevalent throughout our area and often linked to agriculture-generated dust, heavy trucking corridors, and the geography of the Southern Valley.

As bleak as the nationwide statistics on chronic diseases are, when you narrow the focus to Kern County, it only gets worse. Annually, the state releases information about health status indicators within each county. Of the eight health indicators related to causes of death, Kern County ranks in the bottom 25 percent of all counties in six out of the eight indicators. To highlight the gravity of our situation, when it comes to heart disease as a cause of death, when ranked in comparison with the other 57 California counties, Kern was the worst – 58 out of 58.

Pine Mountain Club Health Information

For purposes of this report Let’s Live Local developed an informal preliminary survey of health needs and services based on our review of a wide variety of community health surveys. Then over a two-week period volunteers reached out to solicit input from key segments of the community in terms of physical resources, organizational resources, and individual resources in the areas of social and family life, disease, lifestyles, environment, education, community service, commerce and safety.
The survey was voluntary and anonymous. A little over half were women. Ages ranged from early 20’s to over 65, with the majority 35 years of age and older. Very few of our families with children responded, but among those who did children in the household ranged from two months to 17 years of age.

Others characteristics of the survey sample included:

• 48% were married; 21% divorced; 15% single; 15% widowed, separated or other.
• 39% are self-employed; 30% work full-time.
• 15% part-time; 33% had on social or pension income (multiple choices provided).
Less than 1% was unemployed.
• 91% have health insurance; 60% through private insurance companies; 85% of which were in an HMO and 50% of those being with Permanente.

Based on common knowledge and this preliminary survey, health services here are severely limited. Here is a summary of what we have, how well it is meeting our needs, what we perceive as our most important medical services now and the future.
Overall Satisfaction with Health Services within the Community

Physical:      Well served – 10%                 Adequately served – less than 10%; Poorly served – 10%             Not Served at All – 81%

Mental:         Well served – 35%                 Adequately served – less than 12%;  Poorly served – 12%             Not Served at All – 46%

Emotional:    Well served – 35%                 Adequately served – less than 15%;  Poorly served – 12%             Not Served at All – 42%

Spiritual:       Well served – 35%                Adequately served – less than 10%;  Poorly served – 0%              Not Served at All – 35%

Basic Care

There are no practicing MD’s or nurses in the community and no public health services. There are two small satellite clinics 30 minutes from here, one in Lebec and one in Frazier Park. The Lebec facility has a MD family practitioner, a practitioner nurse and two pediatricians who take appointments once a month. These clinics focus on serving low-income individuals. They are not highly patronized, however, by Pine Mountain residents (i.e. only 1% of those surveyed used one of these facilities for basic medical care.)

Nearly all our residents currently get their health care outside the mountain area. The majority find their needs to be well or adequately met elsewhere. But, based on the survey, over two thirds would prefer to get their basic care here

Emergency Care

Pine Mountain Club has a three-man fire station with an FAA approved heliport. We also have one paramedic based in PMC 24-hours a day because last November Pine Mountain Club residents voted to tax themselves $70 a year to obtain paramedic services from the county fire department.

A private ambulance service covers this area under an exclusive contract with Kern County. Their ambulances are based 13 miles away in Frazier Park and are available if their services are not already deployed to other communities in the area and if the mountain roads are passable. A number of deaths have been attributed to delayed arrival of an ambulance.
Nearly half of survey respondents indicated that they use emergency care, but only 15% of them indicated they use emergency services in PMC, referring we assume to the fact that ultimately the comprehensive emergency care is provided elsewhere. Local emergency care was one of the top three health priorities among the most respondents both for now and in the future.

Dental

The one dentist we had here three days a week has just closed his practice. He had a hygienist who came in periodically from outside the community. Only two responders to our survey utilized his services. Those that did felt adequately served. There is a dentist in Lebec, which is an hour’s drive roundtrip. Those using that service are satisfied. Half of those surveyed would prefer to have dental care here.

Chiropractic

There are no chiropractors in Pine Mountain but three within 30 minutes of here. About half of those surveyed who use chiropractic service do so in the area. All but one person using chiropractic reported said they are well served by their provider, but with one exception those getting this service would rather have it here.

Alternative Health and Fitness

 A variety of alternative health practitioners are available in Pine Mountain and others in Frazier Park, 30 minutes from here, where there is also a small health food store. The survey respondents reported using one or more of seven different kinds of alternative health care services: homeopathic, herbal treatments, nutrition, intuitive, acupuncture, massage and bioenergetics. Nearly all were satisfied with their services, but only 9% were obtaining any of these services in PMC. Most of those using these treatments elsewhere would prefer to have them here.

A third of those responding to the survey would like to have homeopathic services; nearly a third would like to have a nutritionist here.
Massage therapy and a variety of fitness programs are available here: i.e. aerobics, yoga, Pilates. About a third of individuals surveyed participate in a local fitness program, only one elsewhere. All but one reported their needs are well or adequately met.
 

Mental Health

There are three part-time mental health professionals in private practice in Pine Mountain. They have formed a referral network and work collaboratively. They have created and compose a Red Cross Mental Health Emergency Response Team and two are Victims of Crime providers. Thirty minutes from here is a Family Resource Center that provides mental health services for children who are on MediCal.

83% of those responding to the survey who indicated using this form of health care obtain it PMC. One problem here though is that Kaiser does not reimburse outside mental health professionals; nor does Kern County Mental Health. Other private insurers have been resistant to adding our professionals to their panels, requiring policy holders drive into the city to use practitioners on panels instead. Unlike for MD’s panels, which remain open, many mental health panels are closed regardless of need or proximity of service.
Other Medical Services

Many medical services available elsewhere are simply not available locally: elder care, emergency or urgent care, eye care, handicapped/disabled care, hospital care, hospice, lab work, long term care, pediatric care, podiatry, maternity care, and urgent care.
While at least one respondent indicated a desire to have each of these services locally, over a third want emergency or urgent care here; over a half want eye care; and a third want hospital care.

Respondents mentioned several medical specialties they use, i.e. neurologist, dermatologist, cardiologist, allergist, pediatrician, and obstetrician/gynecologist. None of these specialties were mentioned with enough frequency to make having such a service available here, suggesting telemedicine as the best possible option for having such services short of driving over two hours roundtrip into the city.

 Chronic or Routine Medical Needs

Respondents identified twenty-six chronic or routine health issues not provided here. Those mentioned most often included: arthritis (1/5), allergies (1/3),  hearing loss (1/3), high blood pressure (1/4), high cholesterol (1/3) oral health (nearly ½), thyroid conditions (1/20), and vision care (nearly ½).
One fourth of the families with children who responded to the survey identified school/academic/behavioral problems as an on-going health issue. Other problems names included alcohol addiction, asthma, autoimmune disease, cancer, chronic pain, diabetes, drug abuse, smoking, obesity, orthopedic issues, and sleep problems.

Pharmaceuticals

Prescription: Of those surveyed two thirds routinely used prescription medication. Forty-four different kinds were mentioned, of which only Synthroid and Lisinopril were mentioned more than once.
There is a pharmacy in Frazier Park, which is slightly less than a half hour from here depending on road conditions and delays due to slow vehicles on the two lane road, most of which does not allow passing. About a third of respondents used this pharmacy for their medication. The rest ordered by mail or got their medications from a pharmacy in Bakersfield or the LA metro area.
Over the Counter: Fifty-six percent of those surveyed take multi-vitamins. Others listed one or more of 20 various individual vitamins, minerals and herbs. Twelve commonly used over-the-counter medications for ailments such as pain, cold and flu symptoms, allergies, heartburn and indigestion were listed.

Most Important Priorities for Local Health Care Now

Survey participants listed 11 different services as one of the three top health priorities to have available in PMC now. By far the three listed as most important to the most people are –

1. Basic Medical Care: 69%.
2. Emergency/Urgent Care/Hospital: 38%.
3. Dentistry was listed as one of their top three current priorities by 28%.

Other priorities listed more than once include: RN, lab work, vision, ob/gyn, and pediatric care.

Most Important Priorities for Local Health Care in a Future Where One Is Unable to Travel Elsewhere for Health Care
Survey participants listed 20 different services as one of the three top local health priorities to have available in PMC in such a future. Once again the top three are –

1. Basic Medical Care: 75%.
2. Emergency/Urgent Care/Hospital: 50%.
3. Dentistry: 28%.

Two survey respondents indicated that they would move from Pine Mountain if going elsewhere were no longer possible. Other services listed as priorities for such a future that were not mentioned as current priorities included: assisted living, elder care, house calls, home care, long term care, hospice, pharmacy, disability, cardiac care, and chiropractic.

SWOT
The Let’s Live Local Heath Working Group conducted a workshop to develop an overview of what we consider to be PMC’s strengths, weaknesses, opportunities and threats (SWOT) in becoming a rural site for a national pilot project to develop a model for sustainable health care.

STRENGTHS
• Established in the early 1970’s, most residents have chosen to move from an urban area to live in the Pine Mountain community, making the upper Los Padres mountain valley their permanent home.
• Strong motivation and need for local services  exemplified by volunteer-driven efforts, i.e. the task force responsible for this SWOT
• “Can do” attitude has resulted in the creation of parks, a helipad,  and the first Emergency Mental Health Team in Kern County
• High quality of life – clean air and water. Water supply totally local and requires minimal energy.
• Lack of conflicts or jurisdictional claims by vested health interests
• A culturally diverse population
• Self-contained and self-governing community though limited in jurisdiction as a common interest development
• Surrounded by the Los Padres National Forest, the community cannot grow beyond existing boundaries
• Track record of the community voting to tax itself (paramedic services, guard rails)
• Ready labor pool willing to work for competitive wages
• Community-owned water supply solely derived from watershed
• Abundance of native medicinal plants, i.e. stinging nettle, milk thistle, elderberry, willows from which aspirin is made. Food plants native to this locale, such as minor’s lettuce, pine nuts and acorns.
• Strong CERT and Red Cross Teams WEAKNESSES
• Unincorporated remote area “the end of the line” for county services
• Most emergency and all health services are 25-65 minutes away
• Lack of jobs within an hour’s drive
• Lack of broadband service capable of supporting telemedicine and mobile technology
• Lack of a public or non-profit entity capable of receiving funds for operation of a health facility
• Unstable governing body of common interest development
• Existing businesses that depend on cultural tourism have been badly affected by the economic downturn
• No year-round public transportation
• Few commercial and institutional amenities to attract younger health professionals
• Omitted from all data collection efforts on health matters, in part due to distant county government
• No doctors living or practicing in the community
• Community efforts are volunteer-driven versus professionally staffed
• Most residents living in the community for ten or more years ever expected to have health services
• In the past, aging residents often move away from the community due to lack of health resources, but because of the sharp decline of housing prices, they find themselves unable to sell their homes and move to locations with needed medical services.
• Propane dependence a vulnerability
 

OPPORTUNITIES

• Community certified as a Medically Underserved Area (MUA) with a high number of children and elderly in high need of service
• Community certified as a Health Professional Service Area (HPSA)
• Opportunity to create new structures from a “clean slate”
• Fertile environment for demonstrating rural health solutions
• Track record of community problem-solving voting in taxes (i.e. paramedic services) being replicated in other rural communities
• Recreational appeal suitable for the Health 2010 program
• Health services will enable this community to play a role in Homeland Security contingency planning
• Marketability of cultural and ecotourism will be enhanced with availability of needed health services
• Potential to brand ourselves as a sustainable rural community  THREATS
• Forest fires and earthquakes can isolate the community, make it inaccessible, and overwhelm the single paramedic in the community
• Travel time for emergency and health services tripled during snowstorms and following snows resulted in traffic congestion caused by “snow bunny” tourists, road closures and other dangers, such as black ice.`
• Planned new communities in the mountain and valley corridor region  will increasingly worsen access to health appointments and care
• Compassion exhaustion and demands of work lessen volunteer leadership
• Lack of start-up capital or seed money for medical or other related services.
• Risk of sharp decline of the community due to the economic downturn as is happening in numerous other fringe exurban communities
• Uncertainty of any funding from State of California because of severe budget crisis

WEAKNESSES

• Unincorporated remote area “the end of the line” for county services
• Most emergency and all health services are 25-65 minutes away
• Lack of jobs within an hour’s drive
• Lack of broadband service capable of supporting telemedicine and mobile technology
• Lack of a public or non-profit entity capable of receiving funds for operation of a health facility
• Unstable governing body of common interest development
• Existing businesses that depend on cultural tourism have been badly affected by the economic downturn
• No year-round public transportation
• Few commercial and institutional amenities to attract younger health professionals
• Omitted from all data collection efforts on health matters, in part due to distant county government
• No doctors living or practicing in the community
• Community efforts are volunteer-driven versus professionally staffed
• Most residents living in the community for ten or more years ever expected to have health services
• In the past, aging residents often move away from the community due to lack of health resources, but because of the sharp decline of housing prices, they find themselves unable to sell their homes and move to locations with needed medical services.
• Propane dependence a vulnerability

THREATS

• Forest fires and earthquakes can isolate the community, make it inaccessible, and overwhelm the single paramedic in the community
• Travel time for emergency and health services tripled during snowstorms and following snows resulted in traffic congestion caused by “snow bunny” tourists, road closures and other dangers, such as black ice.`
• Planned new communities in the mountain and valley corridor region  will increasingly worsen access to health appointments and care
• Compassion exhaustion and demands of work lessen volunteer leadership
• Lack of start-up capital or seed money for medical or other related services.
• Risk of sharp decline of the community due to the economic downturn as is happening in numerous other fringe exurban communities
• Uncertainty of any funding from State of California because of severe budget crisis

A Vision Statement for Sustainable Health Care in PMC

After reviewing our strengths, weaknesses, opportunities and threats, our Health Group focused in on the implications of the very real possibility that in the future the cost of a trip to the doctor, already at $56 a round trip into the city, will grow to many multiples of our current co-pays due to the rising cost of gasoline. As we discussed these implications, a vision for what sustainable health care might look like here began to coalesce.

Some of us were focused on the realities of what this meant for our needs right now; others considered scenarios of the quite different future that lies ahead; all of us considered how to get from here to there.

What emerged was a plan that begins with small seeds that flower into a sustainable community-wide health program. One would begin with the recruitment and funding for in-home elder care to be staffed desirably by a resident public health nurse, active or retired nurses, our mental health crisis support team, and other local volunteers.

The goal of this service would be similar to the naturally occurring retirement communities, sometimes called Aging in Place programs that are being adopted in various places across the country. It would serve as an umbrella for a constellation of services as Meals on Wheels; assistance with household tasks; transportation to essential medical care in the city; pick up and delivery of medications, groceries and mail; basic health and nutrition education; home-based hospice; and assisted-living.

In-home telemedicine hook-ups using products currently available for home-assisted medical monitoring could play an important role in our “aging in place” communities.  Many of these products utilize existing telephone lines.
As quickly as possible, this particular seed would expand to provide these same basic services to young mothers, injured, disabled, and ill and chronically ill residents of all ages.

Another seed to be pollinated as quickly as possible would be identifying and shining a bright spotlight on the various professional licensed alternative health care practitioners living here in PMC and a process of educating the residents about their role in preventative health. This approach could utilize the guidelines of the present Healthy People 2010 Federal program.  Healthy People 2010 that challenges individuals, communities and professionals, indeed all of us, to take specific steps to ensure that good health, as well as long life, are enjoyed by all.

Then yet another seed in our vision is the recruitment of a family practitioner who would be willing to work with us to create a small rural health clinic, probably located in a comfortable and inviting converted home that is situated in a natural setting. Initially the clinic would feature treatment rooms for office visits for routine medical care and space for educationally-oriented preventive health group programs.

As soon as funding was available the clinic would also have access to telemedicine so the doctor and ancillary personnel could easily consult and be advised by health specialists in urban centers. Eventually a wing would be include a small number of extended care and recovery beds, possibly including the use of a “DocBotTM” through telemedicine’s capabilities.
Depending on funding availability and the priorities of the community, alternatively the converted home facility could begin as an extended care or hospice that would then be expanded to include clinic space for well-patient treatment and walk-in care.
While we currently have a pharmacy 30-minutes away that has easy access to the freeway, few if any available medications come from a local source. So desirably another seed would be to recruit an herbal pharmacologist who could use our abundant naturally- growing medicinal herbs such as willow, milk thistle, and elderberry to foster health, treat wounds and reduce the pain and discomfort of chronic conditions associated with aging.

Of course, our plans for sustainable medicine must also address the health needs of pets and the work animals of the future. Our nearest vet now is 30 minutes away, so again recruitment will be needed for these services to be woven into the care provided here.
Because our mountain forest village is a natural healing place tracing back to time of the Chumash Natives who first populated this area, our small clinic could potentially expand into a larger residential healing center incorporating traditional and alternative treatment to serve the needs not only of our immediate community, but also those for others from outside the community who could come for long-term healing.

Finally as we reflected on this vision, it was clear we need to obtain three resources as quickly as possible to make the transition from our current reality into the future:  some form of public transportation, high-speed internet service that will support telemedicine, and access to cell service. Cell service is particularly vital for providing comprehensive emergency services in case of catastrophic fire and earthquake.

A Time Line

When and in what order the elements of this vision might materialize will be dependent upon at several variables.

1. Expanded the interest and commitment of Pine Mountain Club residents to put a sustainable health care system in place. Residents are for the most part satisfied with their health care. Most never expected to obtain health care here. They do not fully grasp the existence or implications the triple threat of resource depletion, climate chance/ environmental catastrophes, and global economic instability will have for their access to health care.
Even among those who understand the challenges we face, there is no clear agreement on how dramatic the changes we face will be and to what extent we need to begin taking steps now. Will we have access to Internet services? Will group travel to health care to metro areas be feasible? Many still see such questions as too far away to begin addressing now.

So community education, discussion, consensus-building will need to be a first and immediate step. In this vein we have submitted a letter of intent (See Appendix 1) to California Wellness Foundation for a capacity building grant for recruitment of health care professionals.

2. Available funding and resources. Currently there is an emphasis on rural health especially in underserved rural areas. Hopefully this means there will be funding for our efforts here. But there will also be a lot of competition so we will need to be persistent and maintain a determined volunteer base until we can obtain funding to devote full-time efforts to our goals for sustainable health care.

3. The degree to and speed at which the area, country, and world economy reaches a state of crisis. On the one hand, the more rapidly and severely the effects of the triple threat, the more motivated our community will become to take protective steps to preserve the community. On the other hand the more costly it will become to live here, the more people will leave or lose their homes at the same time the more competition there will be for dwindling public and private resources with which to fund our projects.
With these factors in mind we project the following possible timeline:
Phase One: 2010-2012 or as possible
1. Seeking funding for capacity building through to do community education, health scenario planning and consensus building.
2. Locate affiliates and build alliance with agencies and resources we can build funding partnerships with such as Kern County Public Health and health education programs at colleges and universities in the region.
3. Expertise gathering by becoming part of this pilot project so we can obtain the guidance and assistance of Dr. Dan Bednarz and other sustainable medicine resources he can put us in touch with to finalize and implement a comprehensive plan for our community.
4. Obtain funding and carry out a comprehensive Health Impact Assessment such as the one utilized the Centers of Disease Control and Prevention.
5. Obtaining funding for cellular service for emergency access and high speed internet services that will support telemedicine.
6. Arrange for funding and resources for short- and longer-term projects below including recruitment of needed health service professionals.

Phase Two: 2011-2014 or as possible

Once there is community support, funding and management capability  for such projects:
1. Obtain a dedicated Public Health Nurse as other communities in our region have done.
2. Establish a comprehensive wellness education program with special emphasis on parents, teens, the elderly and caregivers
3. In conjunction with the local business association and local Small Business Development Center representatives, identify and draw our local alternative health providers into a network to obtain funds and work to market and increase community awareness and understanding of their services.
4. Provide information about accessible professional training available to gain, boost or extend the health skills and expertise of local residents.
5.  Set up a Meals on Wheels program and other Aging in Place services to be expanded to
include pre-and-post maternity care, and home assistance services for the disabled, as
well as transportation to needed medical care in the city until services are available
locally.
6. Find, and build or convert a facility, recruit staff for, and open an independent or affiliated small basic health care clinic that can provide:

–    health and wellness education, basic health services such as routine exams and lab
tests, well as routine dental and vision care.
–    an emergency care response in conjunction with our l paramedic
–    access to various needed specialties via telemedicine.

Phase Three: 2013-2014 or as possible
1. Health services at the clinic expanded to a small number of inpatient recovery beds.
2. Research and develop potential for a nursing or an assisted living home.
3. Develop a hospice facility.

Appendix A

P.O. Box 6775     2624 Teakwood Court  Pine Mountain Club, CA 93222 (661) 242-2624   email:  sedwards@frazmtn.com  www.letslivelocal.org

Director of Grants Management
The California Wellness Foundation
6320 Canoga Avenue, Suite 1700
Woodland Hills, CA 91367
Letter of Intent

Information about the Organization’s Mission and Activities
Let’s Live Local (LLL) is a newly formed non-profit organization, with recent 501(3)c status. We originally came together in August of 2005 as an informal group of volunteers concerned about the effects that climate change, peak oil, and resources depletion were having and would have on our community and the surrounding National Forest. Given our small size and remote location we wanted to identify the steps we need to be taking to develop awareness, solutions, and projects to address sustainability issues.
As a newly formed non-profit, Let’s Live Local has relied on the efforts of a dedicated cadre of volunteers.  Our population is small while the threats to our community are large. Existing local and state government services, long focused primarily on urban areas, are being reduced, not expanded. With many local residents now struggling to pay for utilities and to keep from losing their homes, we don’t have the depth of affluent volunteers who can donate the time and funding needed to accomplish our goals to create sustainable local health services in our remote area.

The Region and Population(s) Served: An Explanation of How the Funds Will Be Used

LLL is located in Pine Mountain Club (PMC), CA, a small village surrounded on four sides by the Los Padres National. As a small, remote community of about 2400 full-time residents in resource-strapped Kern County, we are underserved and suffer from severe economic challenges due to lack of local jobs, falling property values (35-50%), sky-rocketing energy costs, and a high number of foreclosures. Small businesses, of which there are few, are closing. We have the highest vacant-home rate (61%) and the highest percent of people whose incomes are below the poverty level (17%) in the area.

PMC residents range from families with young children to seniors on fixed income and represent a wide diversity of interests. We have governmental diversity as well, being in or adjacent to three different counties (Kern, Ventura, and Los Angeles). Each county has a different impact on plans for local sustainability and together can create three times the compliance tasks as required of most communities.
Our goal is to engage wide segments of the PMC community in a collaborative process to explore possible establishment of a Rural Health Clinic and to utilize the NHSC Loan Repayment Program as a vehicle for recruiting the medical staff required for operation of a Rural Health Clinic.

According to government websites regarding Rural Health Clinics, approximately 43 percent of RHCs are located in
Health Professional Shortage Areas (HPSA) and 40 percent are located in Medically Underserved Areas (MUA).  69 percent of all RHCs are located in ZIP codes classified by the Department of Agriculture as small towns or isolated areas. A small town or isolated area is a community with fewer than 2,500 people.  PMC has Federal rating as being both a HPSA and a MUA.  PMC also qualifies as a rural isolated area.

With these demographic features, PMC then qualifies for the NHSC-approved loan repayment program as a vehicle for recruitment and retention of medical providers.

This Administrative Grant will provide funds for basic capacity building activities, i.e. non-profit insurance, general liability, D&O and volunteer coverage; legal and accounting fees, collaterals, website development, operating funds for basic research and information gathering, engagement of stakeholders, conduct of meetings, seminars, workshops and community events, identification of community medical and health needs, researching and writing proposals for governmental and foundation grants, and oversight of a collaborative process for establishment of a Rural Health Clinic.

Two- Year Funding Requested
Consultants and Contractors @$200/day    $    30,000.00
Travel and Mileage                                             $       3273.00
Supplies & Materials                                          $       3000.00
Operational Expenses of Organization          $       6000.00
Training & Retreat Costs                                  $       7500.00
TOTAL AMOUNT REQUESTED                    $    49,773.00

Funding Priority for Which You Want Your Request Considered

We submit that our request fits under the “Diversity in the Health Professions” category, specifically to address the “outreach and retention programs” and “loan repayment programs” for communities which are underrepresented in the health professions.
Project Goals, Leadership and Duration (For Project Funding Only)

Our objectives are to work with our local organizations and business leaders and draw upon proven collaboration, strategic planning, and social marketing methodologies in public meetings, workshops, seminars, public information, and publicity targeted to:
*  Provide a context for exploring the Rural Health Clinic by generating interest in and providing information  about the
value, characteristics, and benefits of having a local Rural Health Clinic and by raising awareness of the  value and
need for having local medical resources.
*  Educate the community as to what a Rural Health Clinic is, its value as a community resource and its possible uses.
*  Engage community members in a creative dialogue to generate ideas, possibilities, and pathways for local uses of a Rural Health Clinic here in Pine Mountain.
*  Obtain community consensus on the diversity of desired medical service and projects to pursue.
*  Develop plans and seek funding for projects that have gained wide and enthusiastic public support.
* Generate and prepare proposals and a final set of recommendations for development of a Rural Health Clinic  that will enable more residents to get their medical and health needs met within the within the local community.

Sarah Edwards, Director