By G. Jeffrey MacDonald
Like rural counties across the United States, Carroll County, Maryland, has no easy solutions to the challenge of access to healthcare. Obstacles from unreliable transportation to social isolation contribute to untreated conditions and relapses in people managing health issues.
But Carroll County congregations are putting a big dent in the age-old problem of caring for people in sparsely populated areas. They have significantly reduced hospitalization rates by making sure at-risk congregants are well-tracked when they need care and do not fall through the cracks of a labyrinthine system.
They have done it by partnering with Carroll Hospital Center through a pilot program that includes hospitals and congregations in two other regions, one urban and one suburban. When churchgoers opt in to the Maryland Faith Health Network (MFHN), they become part of a system that alerts church contacts when someone is hospitalized, moved to rehabilitation, or sent home with a crucial list of do’s and don’ts.
Results from the 21-month pilot, delivered in MFHN’s February report, show fewer patients returning to hospital after discharge. When compared to individuals who did not enroll in the network, congregants who had been treated at the hospitals were 75 percent less likely to return within a month and 17 percent less likely to return within a year. Among participating hospitals, Carroll Hospital Center had the most patients involved, in part by asking upon admission: do you belong to a congregation? Would you like us to let the church know you are in the hospital?
“We were putting another layer of keeping track of post-hospitalization to make sure they didn’t end up back in the hospital because they didn’t have meals or medication or they weren’t following up with doctor visits,” said the Rev. Shari McCourt, pastor of St. Paul United Methodist Church in rural New Windsor, Maryland. “I saw a lot more hospitalizations in the first six months than I did after we launched the Maryland Faith Health Network.”
The partnership helped reconnect isolated former churchgoers in declining health with their congregations, said Suzanne Schlattman, deputy director of development for the Maryland Citizens Health Initiative, which coordinates the MFHN project.
“Through that connection, they were able to start getting regular visitors,” Schlattman said. “Their health dramatically improved. And they’re now kind of back into the life of the congregation, which has addressed their loneliness and their depression. These are things that are difficult to quantify, perhaps, but lead to significant improvements in health.”
Based on a model pioneered in urban Memphis, the MFHN program is showing how congregations can have a strong effect on healthcare in rural areas. Where populations are spread out geographically, budgets are tight, and resources are limited, churches help communities identify assets at their disposal. Simple partnerships in Maryland and other states are opening doors to better health where needs are urgent.
The work comes none too soon. Data gathered by the Rural Policy Research Institute (RUPRI) show America’s most rural areas have the highest poverty rates, especially among children (25.5%) and the elderly (11%). Environmental factors, including aging water systems and pollutants from mining and agriculture, can add to the risks, according to RUPRI. Data from the Centers for Disease Control and Prevention show rural areas experience substantially higher rates of death from cancer, heart disease, stroke, and unintentional injuries than more populated areas do.
“These issues in the rural communities have been going on for a long time — dealing with lack of transportation, lack of providers, and things like that,” said Shao-Chee Sim, vice president for applied research at the Episcopal Health Foundation, which aims to improve health in the 57 counties served by the Diocese of Texas. “In East Texas, we’re really taking a partnership approach and trying to support community coalitions.”
Faced with nagging challenges, rural congregations are showing creativity.
Episcopalians are taking action, for example, in rural Hearne, a hardscrabble town of 4,400 located 90 miles northeast of Austin. Vacant storefronts testify to what has been a bumpy commercial history, including how a Walmart came to town, drove family retailers out of business, and then closed in 1990.
Like the local retail sector, churches in Hearne have struggled. By 2014, St. Philip’s Church had only one remaining parishioner: a 95-year-old woman. But the congregation did not close.
“One of the things the bishop said was, ‘We would never think to close down a church that was trying to help, do outreach, reach out to the community,’” said Kathleen Phillips, a member of St. Andrew’s, a larger congregation 20 miles away in Bryan. “That kind of was the kernel.”
With involvement from St. Andrew’s volunteers who helped maintain the building and offer a Vacation Bible School, St. Philip’s has clawed its way back. Volunteers from St. Andrew’s are writing personal notes to all 6,000 residents in the area, inviting them to worship at St. Philip’s. The worshiping congregation climbed back to about 12 on an average Sunday. Mission is now solidly on the church’s radar.
“Everybody in town thought St. Philip’s had closed,” said the Rev. Nandra Perry, priest in charge of St. Philip’s since last year. “We thought: what can we do to reintroduce ourselves to this community?”
Improving morale and health in Hearne emerged quickly as priorities. With grant support from the Episcopal Health Foundation, the congregation put on a festival that attracted 3,000 visitors this spring and gave the town a confidence boost, Phillips said. For a second project, St. Philip’s now hosts regular meetings of seven local residents who are drawing up plans for a health resource center.
“Their vision is for all the health agencies that are around in other counties would have a location where their representatives could come and have an office maybe once or twice a week and provide services for people in the county,” said Phillips, one of the planners.
Like in Carroll County, the approach in Hearne involves building on existing infrastructure, tested models, and new partnerships. Other counties in east Texas have similar facilities that came together with assistance from Texas A&M University’s Southwest Rural Health Research Center, located 26 miles from Hearne in College Station. The hope for Hearne is to accommodate nonprofit agencies working in such areas as nutrition, elder services, and child welfare.
Despite scant resources, St. Philip’s plays an essential role in making the center a reality. It provides both meeting space and facilitators trained by the Texas Rural Leadership Project. They have learned what to do if tempers flare, and how to help participants recognize long-overlooked assets.
The work in Hearne could be replicated elsewhere, observers say, especially if hospitals, community foundations, or other benefactors help cover training costs. Training for congregational volunteers is also a key piece in Carroll County, as volunteers learn to protect patient privacy by keeping key information confidential.
“If all these [training protocols] were not in place, I would have never wanted to sign off on it because the last thing you want is people being gossiped about when they’re ill and trying to recover from something,” McCourt said.
As it turns out, much of what congregations are doing to improve rural health draws on what they already know how to do. Helping the infirm travel to appointments makes a big difference in their overall health, Sim said. One key to unleashing a congregation’s potential lies in identifying those who need help and connecting them with helpers.
In Maryland, congregations have been learning what makes a partnership work. When churches and hospitals invite people to join the network, both types of institutions raise awareness of the opportunity and importance of keeping churches informed of a person’s health status. After joining, they still have a choice whether to notify their home churches about their hospitalization. But having the network in place shifted the status quo.
“It raised awareness with the hospital staff,” McCourt said. “They asked most folks that came in if they were affiliated with a faith community. … That gave them all the contact info for the local pastors.”
Those who opt to keep their churches informed are linked with a nurse navigator, who makes sure the church knows where to find a person who has been transferred to a rehabilitation facility. That has allowed congregations to keep tabs despite privacy laws that otherwise make it difficult to obtain information about parishioners.
Before the network launched, “I was just losing countless hours trying to figure out where people went when they were discharged,” McCourt said.
Now when a person returns home, a nurse navigator can coordinate with a congregational liaison to make sure the right level of support is provided — if not a family member then by someone else in the church or neighborhood.
As rural congregations tap the power of partnership with hospitals, foundations, and universities, they are learning to recognize and maximize their assets. Leveraging what they have is turning out to be enough to boost health and well-being where their people live.