SUP 15-01 Staff Report With Attachments - Updated 6-12-2015

A Community Health Needs Assessment
Prepared for Fauquier Health and Fauquier Health Foundation

By Community Health Solutions
May 2014
Table of Contents
Section
Page
Executive Summary
Part I. Community Interview Results
Part II. Community Survey Results
1. Survey Respondents
2. Community Health Concerns
10
3. Community Service Gaps
12
4. Vulnerable/At-Risk Populations in the Community
14
5. Vulnerable/At-Risk Regions in the Community
17
6. Additional Ideas and Suggestions
18
Part III. Community Indicators
19
1. Health Demographic Trend Profile
20
2. Health Demographic Snapshot Profile
21
3. Mortality Profile
22
4. Maternal and Infant Health Profile
23
5. Preventable Hospitalization Discharge Profile
24
6. Behavioral Health Hospitalization Discharge Profile
25
7. Adult Health Risk Factor Profile
26
8. Youth Health Risk Factor Profile
27
9. Uninsured Profile
28
10. Medically Underserved Profile
29
Appendix A. Zip Code-Level Maps
30
Appendix B. Community Interview Guide and List of Participants
47
Appendix C. Community Survey: Additional Ideas and Suggestions for Improving

Community Health
49
Appendix D. Defining a Healthy Community
53
Appendix E. Data Sources
55
Executive Summary
Executive Summary
This report presents the results of a community health needs assessment commissioned by Fauquier Health and
Fauquier Health Foundation. The study is focused on the geographic region encompassed by Fauquier County and
Rappahannock County. The study results are presented in three parts, including the results of Community
Interviews with selected community leaders; a Community Survey of a broader group of community stakeholders;
and Community Indicators containing dozens of community health status indicator profiles. This Executive
Summary outlines the major findings of the study. Details are provided in the body of the report, and the data
sources and methods are described in Appendix E.
The Study Region
Part I. Community Interviews

In March of 2014, Fauquier Health and Fauquier Health Foundation hosted three group interviews with a total of 21
community leaders from diverse organizations (see participant list in Appendix B). The purpose of these interviews
was to obtain participant insights about the characteristics of a healthy community, as well as vulnerable
populations, emerging health issues, community assets, and opportunities for community collaboration. The
interview participants expressed diverse perspectives on these topics, as presented in detail in Part I of the report.
Part II. Community Survey
In an effort to expand the range of community input for the study, a Community Survey was conducted with a
broad-based group of community stakeholders identified by Fauquier Health and Fauquier Health Foundation. The
survey participants were asked to provide their viewpoints on:
Important health concerns in the community;
Significant service gaps in the community;
Vulnerable/at-risk populations in the community;
Vulnerable/at-risk geographic regions in the community; and
Additional ideas or suggestions for improving community health.
The survey was sent to a group of 172 community stakeholders. A total of 80 (47%) stakeholders submitted a
response (although not every respondent answered every question). The respondents provided rich insights about
community health in the study region, as summarized below.
Page | 1
Health Concerns. The respondents identified over 20 important health concerns including obesity, mental
health conditions, diabetes, substance abuse and other concerns.
Community Health Needs Assessment
Executive Summary
Service Gaps. The respondents identified more than two dozen specific community services in need of
strengthening. Identified services included behavioral health services, aging services, transportation and
other services.
Vulnerable or At-Risk Populations. The respondents reported a number of vulnerable/at-risk populations

in the community. Identified populations included the elderly, low income residents and persons with
behavioral health needs, and other populations with particular health concerns.
Vulnerable or At-Risk Regions. The respondents reported a number of vulnerable/at-risk neighborhoods

or geographic regions in the community, including rural areas; areas with a large population of seniors; and
areas in central, northern, and southern Fauquier County. (See Appendix A for zip-code level maps of
selected demographic and health indicators for the region).
Ideas and Suggestions. Forty-three respondents offered open-ended responses with additional ideas and
suggestions for improving community health. These responses are listed in Appendix C.

The community indicators in Part III present a wide array of quantitative community health indicators for the study
region. To produce the profiles, Community Health Solutions analyzed data from multiple sources. By design, the
analysis does not include every possible indicator of community health. The analysis is focused on a set of
indicators that provide broad insight into community health, and for which there were readily available data sources.
To summarize:
Demographic Profile. As of 2013, the study region included an estimated 74,567 people. The population is
expected to increase to 79,035 by 2018. It is projected that population growth will occur in all demographic
groups, including a 22% increase in seniors age 65+; a 21% increase in the Asian population; and a 22%
increase in the Hispanic ethnicity population. Compared to Virginia as a whole, the study region is more rural,
older, and less racially/ethnically diverse. The study region also has higher income levels than Virginia as a
whole.
Mortality Profile. In 2012, the study region had 553 total deaths. The leading causes of death were malignant
neoplasms (cancer), heart disease, and cerebrovascular disease (stroke). The age-adjusted rate for stroke
deaths in the study region was higher than the Virginia statewide rate.
Maternal and Infant Health Profile. In 2012, the study region had 925 pregnancies, 731 total live births and
four infant deaths. Compared to Virginia as a whole, the study region had a higher rate of births without early
prenatal care.
Preventable Hospitalization Discharge Profile. The Agency for Healthcare Research and Quality (AHRQ)
defines a set of conditions (called Prevention Quality Indicators, or PQIs) for which hospitalization should be
avoidable with proper outpatient health care. High rates of hospitalization for these conditions indicate potential
gaps in access to quality outpatient services for community residents. In 2011, residents of the study region
had 871 PQI hospital discharges. The leading diagnoses for these discharges were chronic obstructive
pulmonary disease (COPD) and asthma in older adults, bacterial pneumonia, and congestive heart failure. The
age-adjusted PQI discharge rates for the study region were higher than the Virginia statewide rates for most
PQI diagnoses.
Behavioral Health Hospitalization Discharge Profile. Behavioral health hospitalizations provide another
important indicator of community health status. In 2012, residents of the study region had 260 hospital
1
discharges from Virginia community hospitals for behavioral health conditions. The leading diagnoses for
these discharges were affective psychoses, alcoholic psychoses and schizophrenic disorders. The ageadjusted discharge rates for the study region were lower than the statewide rates.
Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data do not
include discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis.
Page | 2
Executive Summary
Adult Health Risk Profile. Local estimates indicate that substantial numbers of adults (age 18+) in the study
region have health risks related to nutrition, weight, physical inactivity, tobacco and alcohol. In addition,
substantial numbers of adults have chronic conditions such as high cholesterol, high blood pressure, arthritis,
diabetes and asthma.
Youth Health Risk Profile. Local estimates indicate that substantial numbers of youth (age 14-19) in the study
region have health risks related to nutrition, weight, alcohol, mental health, tobacco, and physical inactivity.
Uninsured Profile. An estimated 8,090 (13%) nonelderly residents of the study region were uninsured at a
given point in time in 2013. This included an estimated 1,188 children and 6,903 adults.
Medically Underserved Profile. Medically Underserved Areas (MUAs) and Medically Underserved
Populations (MUPs) are designated by the U.S. Health Resources and Services Administration as being at-risk
for health care access problems. The designations are based on several factors including primary care provider
supply, infant mortality, prevalence of poverty, and the prevalence of seniors age 65+. All of Rappahannock
County is designated as medically underserved. Part of Fauquier County is designated as medically
underserved. Part of Fauquier County is designated as medically underserved; two county subdivisions (minor
civil divisions or MCDs) meet the designation criteria. These MCDs are 94215 Lee District and 94511 Marshall
District.
Additional Information
Additional information on study results and methods is provided as follows.
Accompanying File of Community Indicators. A separate Microsoft Excel file contains all quantitative
indicators used in the report.
Appendix A. Zip Code-Level Maps. Appendix A provides a set of thematically colored maps displaying
variation in selected community health indicators by zip code. The underlying data for these maps are
provided in a separate Microsoft Excel file. Please read the important note about zip code-level data in
Appendix A.
Appendix B. Community Interview Guide and List of Participants. Appendix B provides a copy of the
guide used to conduct the community interviews for this study along with a list of participants.
Appendix C. Community Survey: Additional Ideas and Suggestions for Improving Community
Health. Forty-three survey respondents offered open-ended responses with additional ideas and
suggestions for improving community health. These responses are listed in Appendix C.
Appendix D. Defining a Healthy Community. On May 7, 2014, Community Health Solutions facilitated
a town hall meeting of community stakeholders on behalf of Fauquier Health and Fauquier Health
Foundation. As part of the meeting, participants were invited to share their vision of a healthy community.
Twenty-four responses were submitted. These responses are listed in Appendix D.
Appendix E. Data Sources. Appendix E provides a list of the data sources used in the analysis of this
report.
Page | 3
Part I. Community Interviews

In March of 2014, Fauquier Health and Fauquier Health Foundation hosted three group interviews with a total of 21
community leaders from diverse organizations (see participant list in Appendix B). The purpose of these interviews
was to obtain participant insights about the characteristics of a healthy community, vulnerable populations,
emerging health issues, community assets, and opportunities for community collaboration. The interview
participants expressed diverse perspectives which are summarized below and listed in detail in Exhibit I-1. (Please
note that responses are paraphrased in Exhibit I-1.)
Q1. In your own words, how would you define the idea of a healthy community?
Interview participants used a variety of descriptors to define the idea of a healthy community. Summarizing
general themes, participants described a healthy community as a place where people have an expectation
of health; are engaged in health improvement; focus on both physical and behavioral health; have access
to services; are informed about existing services; are empowered to make healthy choices; practice healthy
living; and live in a physical environment that supports health.
Q2. From your perspective, who are the population segments within the community that are especially
vulnerable/at-risk for health problems?
Interview participants identified multiple population segments that are especially vulnerable/at-risk.
Participants identified subgroups of children, adolescents, adults, and seniors with specific health
conditions as well as socioeconomic and environmental risk factors. Specific health conditions identified by
interview participants include chronic disease and disability, various mental health conditions, and
addiction. Behavioral risk factors include smoking, sedentary lifestyle, poor nutrition, and substance abuse
including abuse of prescription drugs. Socioeconomic and environmental risk factors include low income,
lack of health insurance, and geographic isolation.
Q3. Are there health issues on the horizon that few people know about, but could cause serious harm today
or in the future?
Interview participants identified multiple emerging issues of concern, including perceived increases in
populations with health challenges due to aging; chronic disease, pain, and disability; mental health needs;
substance abuse problems; human papilloma virus and risk for cervical cancer; and sexually transmitted
disease. Associated socioeconomic concerns include a growing number of working poor, and increases in
the uninsured population.
Q4. Think of health assets as people, institutions, programs, built resources (e.g. parks), or natural
resources that promote a culture of health. In your view, what are the most important health assets within
the community?
Interview participants identified a variety of community health assets, including caring and engaged
residents; good community programs and services; committed healthcare providers; an attractive physical
environment; growing support for active living and healthy eating; existing community coalitions; and
individuals willing to invest their intellectual and financial capital in the community.
Q5. Thinking of a healthy community as everyones responsibility, please share one creative way that
people could work together to promote better health in the community.
Page | 4
Interview participants identified a range of creative ways that residents could collaborate to promote better
health in the community including setting community-wide goals; developing regional strategies; sharing
information across organizations; collaborating on community information campaigns; collaborating on
fundraising and interventions; and building on current collaboration efforts.
Exhibit I-1
Community Interview Results: Detailed Responses
Q1. In your own words, how would you define the idea of a healthy community?
1.
Community efforts enforce physical and mental health.
2.
Community members are engaged in improving health.
3.
Health promotion activities are present.
4.
It's easy for people to make good and healthy choices.
5.
People are empowered to make choices to have a healthy lifestyle.
6.
People are physically active and exercise.
7.
People eat nutritionally sound diets.
8.
People have access to good care (hospitals, mental health, dental).
9.
People have access to education (e.g. schools, health information, health care services, and health resources).
10.
People have access to transportation.
11.
People have an expectation of health in the community.
12.
People receive education regarding available services.
13.
People's basic needs are met.
14.
Services are available for everyone, regardless of risk or need.
15.
The environment is healthy.
16.
There are adequate resources available across the age span.
17.
There are opportunities and access to resources and activities that help people be healthy.
18.
There is a plan for an active community.
19.
There is an awareness of resources and needs of the population.
20.
There is intellectual stimulation for both children and adults.
Q2. From your perspective, who are the population segments within the community that are especially
vulnerable or at-risk for health problems?
1.
Adolescents who will suffer from the impact of bad habits, poor health choices, social pressures and social media
2.
4.
Caregivers
Children and adolescents with increasing levels of anxiety, attention deficit hyperactivity disorder, depression,
overweight and who lack good nutrition
Children in foster care
5.
Children who lack medicines
6.
Children with undiagnosed mental health issues
7.
Employees with absenteeism issues
8.
Employees with exhaustion due to outside responsibilities or activities
9.
Geographically isolated persons
10.
Immobile persons
11.
Issues related to the role of businesses providing health insurance
12.
Lack of mental and physical breaks
13.
Long commutes lead to sedentary lifestyles and contribute to poor nutrition.
14.
Older adults with disabilities
15.
People functioning outside the mainstream of communications
16.
People in need of dental care, especially children and low-income families
17.
People with mental health issues (e.g. depression, anxiety, suicide)
18.
People with mental illness who are put in jail because it is more easily available than a mental health facility
19.
People who are non-native English speakers
20.
People who can't speak for themselves
21.
People who lack transportation to services (e.g. veterans)
22.
People with chronic diseases (e.g. diabetes, obesity)
3.
Page | 5
Exhibit I-1
23.
People with disabilities
24.
People with a family history of disease
25.
Persons with lower socio-economic status (e.g. uninsured, working poor)
26.
Prisoners who are released without a follow-up plan
27.
Seniors with economic or social barriers, lack of healthcare and local venues (e.g. food stores)
28.
Smoking and physical exhaustion in the healthcare workforce
29.
Substance users
30.
The disabled
31.
The elderly
32.
The very young
33.
There's no separation between work and home and mobile devices keep people engaged 24/7.
34.
Individuals without education
Q3. Are there health issues on the horizon that few people know about, but could cause serious harm today or in the
future?
1.
Alzheimers and Dementia
2.
Children are being left out of accessing care because few providers see Medicaid patients.
3.
Chronic disease (e.g. cancer, diabetes, hypertension and obesity in both children and adults)
4.
Dental care needs
5.
Eating disorders
6.
Effects of drug mixing
7.
Environmental health
8.
Healthcare messaging is often overwhelming and is negatively skewed.
9.
If people are not served at the free clinic, then they use the emergency room for health care.
10.
In 15-20 years, we will see the unexpected outcomes of long term prescription and over the counter drug use.
11.
In the aging population, there are changes in reactions to drugs over time and with substance abuse.
12.
Palliative care options
13.
Persons with unmanaged chronic pain
14.
Population distrust of corporate medicine will have effects on health behavior.
15.
Population growth is slowing in both counties.
16.
Quality telephone service for people without cell phones or access to cell service
17.
19.
Sexually transmitted diseases (e.g. human immunodeficiency virus, human papilloma virus)
Since the recession, there has been an increase in people needing social services. Now there is a backlog because
Virginia has changed its eligibility system.
Substance abuse (especially heroin, methamphetamine )
20.
The ability of people with disabilities or mental health issues to navigate their life and health care system
21.
The long term impact of anxiety and depression on the population
22.
The outcome of long term use of recreational drugs
23.
The population age mix will result in a gap between the young and older adults.
24.
26.
There are growing needs for people with serious disabilities. There is especially a need for infrastructure.
There is an increase in children with anxiety and mental health issues which, unless treated early, will lead to teens
and adults with these same issues.
There is an increase in the elderly.
27.
There is an increase in the working poor.
28.
There will probably be an increase in uninsured patients at the free clinic in the coming year.
29.
There's a gap between the need and the bed space available for mental health patients.
18.
25.
Page | 6
Exhibit I-1
Q4. Think of health assets as people, institutions, programs, built resources (e.g. parks), or natural resources that
promote a culture of health. In your view, what are the most important health assets within the community?
1.
2.
Some Rappahannock schools have farm to table programs.

Banks
3.
County Health Fair
4.
Faith-based organizations
5.
Fire and Rescue
6.
Hospital and caring providers
7.
Infrastructure
8.
The community is getting more active.
9.
The community is a beautiful place to live.
10.
Local nonprofits
11.
Many influential people
12.
Medical professionals are responsible.
13.
New community members can be useful.
14.
Old Town Festival
15.
Park and Recreation
16.
People are generous with time and money.
17.
People are hard-working and caring.
18.
People are playing sports, walking, using trails and riding bikes.
19.
Providers use evidence-based care.
20.
Schools
21.
The community is moving towards consuming more fresh food and is willing to pay for it.
22.
The community and nature are pretty.
23.
The county is appealing to medical professionals.
24.
The food bank
25.
The free clinic is expanding to provide dental and behavioral health services.
26.
The hospital is progressive and engaged.
28.
There are a number of health and mental health-related community services such as: Community Service Board,
Adult and Child Protective Services, Home Instead, Department of Social Services, the Free Clinic, the Food pantry,
Warrenton shelters, Virginia Department of Health and the Healthy Families Program and the Red Cross.
There are lots of smart people in the community.
29.
There are many resources in the nearby Washington, D.C. metro area.
30.
There are opportunities to be active at the Warrenton Aquatic and Recreation Facility.
31.
There are retired baby boomers who want to be useful.
32.
There are three community collaboratives that focus on aging, children and community resources.
33.
There is an interest in community well-being.
34.
There is social capital and the community is helpful, compassionate, capable and committed.
35.
Wealthy people
27.
Page | 7
Exhibit I-1
Q5. Thinking of a healthy community as everyones responsibility, please share one creative way that people could
work together to promote better health in the community.
1.
3.
Assist people with needs to find resources.

Use a Care Medicine Approach and create a multi-disciplinary team (nurse, Emergency Medical Services, education,
nonprofit) to staff a mobile health care service to provide outreach services in high need communities.
Develop a five county strategy.
4.
Develop a packet of information for Emergency Medical Services to use to locate services and resources.
5.
Distribute the Department of Social Services' resource list.
6.
Emergency Medical Services could set up education tables at the town fair.
7.
9.
Every patient discharged should receive a booklet listing services and receive assistance in setting up appointments.
Free clinics have received 'bonus bucks' that can be used at farmers markets. This program could expand across the
area.
Guidance counselors from schools could share resources.
10.
Identify the gaps in services and resources.
11.
Improve health literacy.
12.
Look beyond political boundaries.
13.
Make sure everyone knows the issues and people will fill the need.
14.
Nonprofits could collaborate on fundraising and interventions.
15.
Organize a "health season" launch.
16.
Organize a health fair with stations for screenings and education on health topics.
17.
Organize a service-oriented fair for county government employees to volunteer for other organizations.
18.
Organize Mental Health First Aid trainings for community members.
19.
Other organizations can participate in Emergency Medical Services monthly meeting.
20.
People need to spend time in someone else's shoes to get out of working in silos.
21.
People need to work together even if there is no crisis.
22.
Provide educational information about resources.
23.
Provide follow-up care after discharge from hospital.
24.
Set community goals related to community health and engage the community to achieve those goals.
25.
Sometimes the government needs to get out of the way.
26.
Start early with health education for children.
27.
The collaborative on aging crosses barriers, is broad based and focuses on planning.
28.
The community needs to do something like Michelle Obama's healthy food and habits initiative.
29.
There is a request for the hospital to consider medical practice support.
2.
8.
Page | 8
Part II. Community Survey

In an effort to expand the range of community input for the study, a Community Survey was conducted with a group
of community stakeholders identified by Fauquier Health and Fauquier Health Foundation. The survey participants
were asked to provide their viewpoints on:
Important health concerns in the community;

Significant service gaps in the community;
Vulnerable/at-risk populations in the community;
Vulnerable/at-risk geographic regions in the community; and
Additional ideas and suggestions for improving community health.
The survey was sent to a group of 172 community stakeholders. A total of 80 (47%) stakeholders submitted a
response (although not every respondent answered every question). The respondents provided rich insights about
community health in the study region. The results are summarized in the remainder of this section.
1. Survey Respondents
Exhibit II-1 below lists the organizational affiliations of the survey respondents.
Exhibit II-1
2
Reported Organization Affiliation of Survey Respondents
Aging Together
Bealeton Baptist Church
Boys and Girls Club of Fauquier
Branch Banking and Trust Company
Capital Caring
Christian Science Reading Room
Chrysalis Counseling Centers, Inc.
Community Touch, Inc.
County of Rappahannock
Fauquier Bridges
Fauquier CADRE
Fauquier County Department of Social Services
Fauquier Community Child Care, Inc.
Fauquier County
Fauquier County Government
Fauquier County Government and Public Schools
Fauquier County Parks and Recreation
Fauquier County Public Schools
Fauquier County Sheriff's Office
Fauquier Domestic Violence Services
Fauquier County Fire Rescue & Emergency Management
Fauquier FISH (For Immediate Sympathetic Help)
Fauquier Free Clinic
Fauquier Health (3)
Fauquier Health Home Care Services
Fauquier Health Wellness Center
Fauquier Hospital (2)
Fauquier Sheriffs Office
Fauquier Trails Coalition, Inc.
FCAC Head Start/Bright Stars Program
Fauquier Health Physician Services (2)
Flint Hill Volunteer Fire and Rescue Company
Highland School
Hospice of the Rapidan
Hottle and Associates
Lifepoint Fauquier Hospital

Marianne Clyde, Licensed Marriage and Family Therapist
Marshall Volunteer Fire Department, Inc.
Mental Health Association of Fauquier County
Oak Springs of Warrenton
People Helping People of Fauquier County
Piedmont Dispute Resolution Center
Piedmont Family Practice
Piedmont Internal Medicine (2)
Piedmont Pediatrics
Piedmont Press and Graphics
Piedmont United Way
Advanced Practice Psychiatric Nurse
Rappahannock County Department of Social Services
Rappahannock County Public Schools (2)
Rappahannock Food Pantry
Rappahannock Historical Society
Rappahannock Office of Emergency Management
Rappahannock Rapidan Community Services (3)
Rappahannock-Rapidan Regional Commission
Saint James' Episcopal Church
School Health Advisory Board
Sperryville Volunteer Rescue Squad
The Villa at Suffield Meadows
Town of Washington
Trinity Episcopal Church
Virginia Department of Health, Rappahannock-Rapidan District
Virginia Cooperative Extension (2)
VOLTRAN
Wakefield School
Walgreens #9383
Warrenton Volunteer Fire Company
Women of Wonder (WOW)
Unknown Organization (3)
A count is provided for organizations with multiple survey respondents.
Page | 9
2. Community Health Concerns

Survey respondents were asked to review a list of common community health issues. The list of issues draws from
the topics in Healthy People 2020 with some refinements. The survey asked respondents to identify from the list
what they view as important health concerns in the community. Respondents were also invited to identify additional
issues not already defined on the list. Exhibit II-2 summarizes the results, including open-ended responses.
Exhibit II-2.
Important Community Health Concerns Identified by Survey Respondents
Answer Options
Adult Obesity
Response Percent
69%
Depression
55%
Response Count
54
43
Mental Health Conditions (other than depression)
54%
42
Diabetes
53%
41
Childhood Obesity
51%
40
Substance Abuse - Illegal Drugs
50%
39
Substance Abuse - Prescription Drugs
50%
39
High Blood Pressure
42%
33
Alcohol Use
36%
28
Heart Disease
36%
28
Alzheimer's Disease
35%
27
Cancer
30%
23
Chronic Pain
30%
23
Tobacco Use
27%
21
Domestic Violence
26%
20
Dental Care/Oral Health-Adult
22%
17
Autism
21%
16
Arthritis
18%
14
Dental Care/Oral Health-Pediatric
18%
14
Infant and Child Health
18%
14
Teen Pregnancy
17%
13
Asthma
15%
12
Physical Disabilities
15%
12
Stroke
15%
12
Orthopedic Problems
14%
11
Intellectual/Developmental Disabilities
13%
10
Respiratory Diseases (other than asthma)
13%
10
Injuries
12%
Infectious Diseases
10%
Sexually Transmitted Diseases
8%
Renal (kidney) Disease
6%
Prenatal & Pregnancy Care
5%
Environmental Quality
4%
Neurological Disorders (seizures, multiple sclerosis)
4%
HIV/AIDS
3%
Other Health Problems (see next page)
15%
12
Note: When
interpreting the
survey results,
please note
that although
the relative
number of
responses
received for
each item is
instructive, it is
not a definitive
measure of the
relative
importance of
one issue
compared to
another.
Seventy-eight (78) of the 80 survey respondents answered this question.
Page | 10
Exhibit II-2.
Important Community Health Concerns Identified by Survey Respondents (continued)
Other Important Community Health Concerns Identified by Survey Respondents
Response #
Reponses
1.
Attention deficit hyperactivity disorder

Other school difficulties
2.
Attention deficit hyperactivity disorder

Anxiety
3.
Affordable health insurance

Access to care for the elderly
Inactivity leading to other community health concerns for adults and pediatric
All of the above-mentioned community health concerns are important in our community.
Some of the least served issues would be in the area of mental health and substance abuse.
Social issues with access to health care remain due to lack of transportation in many areas of our county
and there is little access to inter-county transportation for services.
There is also very little in the way of assistance for dental treatment for the indigent in our community.
4.
5.
All of the above-listed community health concerns are concerns within our community. The items I checked
[Alzheimer's disease, mental health conditions (other than depression), substance abuse-illegal drugs and
substance abuse-prescription drugs] represent issues that I often address and have found room for
improvement as far as services available.
6.
7.
Eating disorders
8.
From the emergency response side, we are typically not aware of these issues as we handle their post effects.
However, [we] do get training and are aware of current trends so we can stay up to date on possible issues.
9.
I believe that [lack of] access to mental health and substance abuse services is a major health problem in our
area.
10.
I don't have direct experience or information on health concerns in the community.
11.
I feel that physicians over-prescribe medications to the elderly.
12.
We are dangerously deficient in mental health access.
Page | 11
Chronic diseases (multiple)

Specific to injuries - those caused by falls
3. Community Service Gaps

Survey respondents were asked to review a list of community services that are typically important for addressing
the health needs of a community. Respondents were asked to identify from the list any services they think need
strengthening in terms of availability, access, or quality. Respondents were also invited to identify additional service
gaps not already defined on the list. Exhibit II-3 summarizes the results, including open-ended responses.
Exhibit II-3.
Important Community Service Gaps Identified by Survey Respondents
Answer Options
Behavioral Health Services (including mental health, substance
use and intellectual disability)
Aging Services
Transportation
Health Care Insurance Coverage (private and government)
Health Care Services for the Uninsured and Underinsured
Health Promotion and Prevention Services
Early Intervention Services for Children
Homeless Services
Chronic Pain Management Services
Home Health Services
Job/Vocational Retraining
Long Term Care Services
Patient Self-Management Services(e.g. nutrition, exercise,
taking medications)
Social Services
Dental Care/Oral Health Services-Pediatric
Dental Care/Oral Health Services-Adult
Food Safety Net (food bank, community gardens)
Cancer Services (screening, diagnosis, treatment)
Hospice Services
Primary Health Care Services
Specialty Medical Care (e.g. cardiologists, oncologists, etc.)
Family Planning Services
Domestic Violence Services
Public Health Services
Chronic Disease Services (including screening and early
detection)
School Health Services
Pharmacy Services
Maternal, Infant & Child Health Services
Hospital Services (including emergency, inpatient and outpatient)
Physical Rehabilitation
Workplace Health and Safety Services
Environmental Health Services
Other Health Problems (see next page)
Response Percent
Response Count
71%
55
49%
44%
31%
31%
30%
27%
27%
26%
24%
24%
23%
38
23%
18
23%
21%
19%
18%
17%
17%
17%
17%
15%
14%
14%
18
16
15
14
13
13
13
13
12
11
11
13%
10
12%
8%
6%
5%
3%
3%
1%
17%
9
6
5
4
2
2
1
13
34
24
24
23
21
21
20
19
19
18
Note: When
interpreting
the survey
results,
please note
that although
the relative
number of
responses
received for
each item is
instructive, it
is not a
definitive
measure of
the relative
importance of
one issue
compared to
another.
Seventy-eight (78) of the 80 survey respondents answered this question.
Page | 12
Exhibit II-3.
Important Community Service Gaps Identified by Survey Respondents (continued)
Other Important Community Health Services Gaps Identified by Survey Respondents
Response #
1.
2.
Responses
Affordable medications and outpatient medical treatments

Affordable Herpes Zoster vaccine for adults
We need access to [a] safe haven for victims of domestic violence, such as a women's shelter.
Other communities our size have this.
The county has no urgent care clinic, no pharmacy, no hospital, little home care and no public
transportation; all of which are critical to an aging population profile.
The county is "no country for old men" (or women).
3.
Dental care is an issue for adults without insurance coverage for dental services and for children with no
coverage or with Medicaid coverage (since the health department ended its pediatric dental services).
4.
5.
Orthopedic services
6.
Palliative care
7.
[There is a need for] safe and healthful housing for very low-income and extremely low-income, including
seniors living only on Social Security. There is no source of assistance for these households to find
affordable safe housing.
8.
Teaching children and parents the value and importance of eating healthy and buying local.
9.
Integrated, all inclusive care offered in single locations

Emergency mental health care and evaluations
There are few primary care physicians who accept Medicaid and access for Medicare recipients is
becoming more limited.
We have some problems with access to certain specialties such as psychiatry and neurology.
10.
There is a huge need for a good psychiatrist.
11.
Under specialty medical care, I think we need more oncology, and neurology services.
12.
We need more endocrinology, neurology, psychiatry and urology physicians.
13.
We need more psychiatry, chronic pain [services], orthopedic [services], gastrointestinal [services] and
pharmacies.
Page | 13
4. Vulnerable/At-Risk Populations in the Community

Survey respondents were asked if there are particular populations within the community who are vulnerable/at-risk
for health concerns or difficulties obtaining health services. Exhibit II-4 summarizes the results, including
5
representative comments.
Exhibit II-4.
Vulnerable/At-Risk Populations Identified by Survey Respondents
Vulnerable/At-Risk
Population Category
Elderly
Representative Comments
1.
An aging population demographic in need of services now delivered in Culpeper, Warrenton and
Front Royal
2.
Elderly and low income
3.
If [an individual is] fortunate to have Medicaid, not all health care providers are willing to accept
it. This can result in clients having to travel some distance to receive medical services. The
problem is then compounded by inadequate transportation.
4.
Elderly eligible for Medicare but unable to afford medicines or recommended vaccines
5.
Elderly living in rural areas
6.
Elderly patients with underserved needs such as caregiver assistance and transportation needs
7.
Older adults who are isolated and don't have family support
8.
Rappahannock is aging and graying. It has relatively few children, relatively few young families
with growing children, and an enlarging population of senior citizens. [These are] trends that are
projected to continue for the next couple of decades. Seniors with chronic health conditions have
little choice but to move away, as we did last year, to be convenient to medical care, senior
services, appropriate housing, transportation and services.
9.
Resources for seniors with behavioral health issues
10. The elderly need constant supervision. If they want to maintain their independence, they need
help in doing so.
11. The elderly, especially CTC residents [are vulnerable or at-risk]. It is hard to find services for
residents already in CTC setting, especially with Medicaid.
12. We often see frail elderly and disabled trying to continue living in their homes without adequate
care resources. We coordinate with Social Services [staff] who provide what help they can, but
their resources are very limited.
Low Income
1.
Fixed income adults, age range 25-59, who have medical issues and can't afford all their
medications and living expenses [are vulnerable or at-risk].
2.
I feel that all low income residents, and even middle class families of the community, are at-risk
for health problems due to poor preventative care (due to the inability to afford the same
[prevention care]). That same group has difficulties obtaining health services, preventative and
affordable services for economic reasons.
3.
In my short experience, the working poor struggle mightily in this county due to the limited
affordable housing and basic high cost of living.
4.
Lack of adequate housing and basic needs like food, clean water, and indoor plumbing
5.
Low income families and those on Medicaid would be included in this group.
6.
Low income or indigent persons who do not have a category for Medicaid.
7.
Persons who are working but do not earn enough to pay for insurance.
Sixty-four (64) of the 80 survey respondents answered this question. Most responses included multiple at-risk populations.
Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed in the
Exhibit represent the range of populations identified.
6
Page | 14
Exhibit II-4.
Vulnerable/At-Risk Populations Identified by Survey Respondents (continued)
Vulnerable/At-Risk Population
7
Category
1.
Availability of inpatient behavioral health services
2.
Children, adolescents and adults who have symptoms of mental illness but who can't
access services because of stigma, wait times to get into care or lack of resources.
3.
[There is] difficulty obtaining mental health and substance abuse intervention for
those with limited financial resources.
Doctors familiar or experienced with individuals with cognitive and physical
disabilities
4.
Behavioral Health
5.
6.
Community Services Board is unable to keep up with the needs of dual diagnosed
mental health and substance abusers.
The elderly population will not seek medical attention due to not having medical
insurance. Most of our elderly population has an extensive medical history.
7.
Individuals with developmental and intellectual disabilities
8.
The mentally ill have problems accessing mental health and physical health services.
The mental health population is much more [at-risk for] chronic diseases due to their
lack of access to health care.
9.
There is a lack of dependable, holistic psychiatry.
10. Those [individuals] needing behavioral medicine have few choices.

11. Those [individuals] with mental health issues, including substance abuse, have few
services available to them; especially on an immediate need basis.
Uninsured
Residents without
Transportation
1.
The uninsured who fall into [the] gap due to Virginia not expanding Medicaid.
2.
3.
Women age 50+who have separated or become divorced and do not have any type
of health insurance
Yes, children who don't qualify for Medicaid [are vulnerable or at-risk] because their
parent, or parents, work and are over the guidelines but no insurance is offered on
the job.
1.
Anyone dependent on public transportation not living in Warrenton City proper
2.
Older adults without transportation
3.
We have a large aging population and our area is very rural with no public
transportation.
If we lose dental service from the county or state health services many of our
children will be without dental care.
Our rural students, without access to local food banks, may not have access to
sufficient food and nutritional services when school is not in session.
1.
Children
Immigrant Community
2.
3.
We have children in the schools who do not have access to healthy and regular food
choices.
4.
Young children from single parent homes
1.
Folks coming from outside the U.S.
2.
People who speak a language other than English
3.
The Latino community [is vulnerable or at-risk] because they may not be aware of
existing services or because of language, cultural barriers or legal implications, they
do not or cannot seek services.
4.
Undocumented migrant workers
5.
Undocumented workers
Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed in the
Exhibit represent the range of populations identified.
8
Page | 15
Exhibit II-4.
Vulnerable/At-Risk Populations Identified by Survey Respondents (continued)
Vulnerable/At-Risk Population
9
Category
10
1.
Dental
2.
Caregivers
3.
Families in crisis
4.
Homeless
5.
No internet access or understanding
6.
People who are nonwhite
7.
People who have religious traditions other than Christian
8.
Persons re-entering the community after incarceration
9.
Prescription drug abuse is a substantial, but largely hidden, health problem in our
community.
10. Rappahannock County is underserved by health professionals. [There are] two
doctors, one of whom is retiring.
Other
11. Single mothers with children

12. Single males
13. Those families who are geographically isolated.
14. Those with "pre-diabetes" are often in need of "healthy living" information; such as
what is provided in our diabetes services. However, most commercial insurances and
Medicare do not cover any sort of health or nutrition counseling for those with a
diagnosis of pre-diabetes. Those services, unfortunately, are only paid for once
someone has diabetes. Some people referred here will pay out of pocket for a one on
one visit with our Registered Dietician, but some won't do it if their insurance doesn't
cover. Often, one visit isn't enough to learn about an entire lifestyle change over time.
15. Those with advanced stage diseases
16. Victims of domestic violence
17. Victims of sexual violence
18. We need primary care services.
19. Working with Fauquier Social Services and the Virginia Health Department will also
provide us this information.
Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed in
the Exhibit represent the range of populations identified.
10
Page | 16
5. Vulnerable/At-Risk Geographic Regions

Survey respondents were asked if there are particular neighborhoods or geographic regions within the community
where residents may be vulnerable/at-risk for health problems or difficulties obtaining health services. Exhibit II-5
11
summarizes the results, including representative comments.
Exhibit II-5.
Vulnerable/At-Risk Neighborhoods or Geographic Regions Identified by Survey Respondents
Vulnerable/At-Risk
Neighborhood/Geographic
Region
12
1.
Rural/Remote Areas In General
2.
Outlying areas of the county [are at-risk] because transportation to health care
services may be a significant problem.
Remote mountain areas and hollows
3.
Rural uninsured or underinsured with rabies exposure
4.
5.
Rural, low income areas

Those [individuals] whose geographic location (rural, isolated) makes it difficult to
access health care.
The southern end of Fauquier County including Bealeton, Midland, Goldvein, etc.
The central and southern regions of our county have a higher population and,
therefore, require more services.
Bealeton area and Northern area
1.
2.
Central, Northern, and Southern
Fauquier County
3.
4.
5.
6.
Central and southern areas of the county [have] poor access and transportation.
Southern and Northern Fauquier do not have adequate transportation for patients to
obtain needed services in Warrenton.
It is more difficult for residents of Marshall to access health care resources.
7.
Marsh Run Mobile Home Community
1.
In outlying areas, seniors have particularly difficult times getting to medical services.
2.
One of our areas that we see an issue with is the local nursing homes. There seems
to be a lack of education on when and when not to call 911. We have had incidences
where we have [been] called to a nursing home at 2 am and transported them
[nursing home residents] to the emergency room because the blood labs came back
abnormal. The Medic unit had to wake the resident up from a comfortable sleep to
take them to the emergency department.
3.
Housing designed for aging seniors with mobility problems is also badly needed.
4.
Our community is a retirement community.
1.
Homeless people who do not meet the Family Shelter's rigid requirements
2.
People who are in treatment
3.
None I am aware of. Geography is not the issue, economics is, I believe.
4.
The whole county is one under-served community bypassed by modern medical

care. We desperately need an urgent care clinic and pharmacy at a minimum.
I am only familiar with the health problems in Rappahannock County. The problems
appear to be county wide.
Areas with a large Senior

Population
Other
5.
11
Thirty-nine (39) of the 80 survey respondents answered this question. Most responses included multiple at-risk populations.
Many respondents identified the same types of geographic regions (e.g. southern Fauquier), although with slightly different language. The
populations listed in the Exhibit represent the range of populations identified.
12
Page | 17
6. Additional Ideas and Suggestions

Forty-three respondents offered open-ended responses with additional ideas and suggestions for improving
community health. These responses are listed in Appendix C.
Page | 18

This section of the report provides a quantitative analysis on a wide array of community health indicators. To
produce the profiles, Community Health Solutions analyzed data from multiple sources. By design, the analysis
does not include every possible indicator of community health. The analysis is focused on a set of indicators that
provide broad insight into community health, and for which there were readily available data sources.
The results of this profile can be used to evaluate community health status compared to Virginia overall. The results
can also be helpful for determining the number of people affected by specific health concerns. In addition, the
results can be used alongside the Community Interview and Community Survey results, as well as the zip codelevel maps in Appendix A to help inform action plans for community health improvement. This section includes ten
profiles as follows:
Page | 19

Trends in health-related demographics are instructive for anticipating changes in community health status.
Changes in the size, age and racial/ethnic mix of the population can have a significant impact on overall health
status, health needs and demand for local services.
As shown in Exhibit III-1, as of 2013, the study region included an estimated 74,567 people. The population is
expected to increase to 79,035 by 2018. It is projected that population growth will occur in all age groups, including
a 22% increase in seniors age 65+. Focusing on racial background, growth is projected for all populations, including
a 21% increase in the Asian population. The Hispanic ethnicity population is also expected to grow by 22%.
Exhibit III-1.
Health Demographic Trend Profile for the Study Region, 2010-2018
2010 Census
2013
Estimate
2018
Projection
% Change
2013-2018
72,576
74,567
79,035
6%
79.0
81.2
86.1
6%
25,909
27,544
29,440
7%
Children Age 0-17
17,512
17,977
18,311
2%
Adults Age 18-29
8,853
9,021
9,876
9%
Adults Age 30-44
13,463
13,414
13,516
1%
Adults Age 45-64
23,051
23,833
24,734
4%
Seniors Age 65+
9,697
10,322
12,598
22%
875
1,015
1,226
21%
Black/African American
5,642
6,400
7,232
13%
White
62,441
63,299
66,102
4%
Other or Multi-Race
3,618
3,853
4,475
16%
13
4,406
4,685
5,698
22%
Indicator
Total Population
Population Density (per Sq. Mile)
Total Households
Population by Age
Population by Race/Ethnicity
Asian
Hispanic Ethnicity
Source: Community Health Solutions analysis of US Census data and estimates from Alteryx, Inc. See Appendix E.
Data Sources for details.
13
Classification of ethnicity; therefore, Hispanic individuals are also included in the race categories.
Page | 20

Community health is driven in part by community demographics. The age, sex, race, ethnicity, income and
education status of a population are strong predictors of community health status and community health needs.
Exhibit III-2 presents a snapshot of key health-related demographics of the study region. As of 2013, the study
region included an estimated 74,567 people. Focusing on population rates in the lower part of the Exhibit,
compared to Virginia as a whole, the study region is more rural, older, and less racially/ethnically diverse. The study
region also has higher income levels than Virginia as a whole. Note: Maps 1-13 in Appendix A show the geographic
distribution of the population by zip code.
Exhibit III-2.
Health Demographic Snapshot Profile, 2013
Study
Region
Fauquier
County
Rappahannock
County
Virginia
Population
74,567
67,137
7,430
8,246,990
Children Age 0-17
17,977
16,525
1,452
1,889,997
Indicator
Population Counts
Total
Population
Adults Age 18-29
9,021
8,214
807
1,411,537
Adults Age 30-44
13,414
12,281
1,133
1,673,982
Adults Age 45-64
23,833
21,252
2,581
2,244,242
Seniors Age 65+
10,322
8,865
1,457
1,027,232
Ethnicity
Female
Male
Asian
Black/African American
White
Other or Multi-Race
Hispanic Ethnicity14
37,741
36,826
1,015
6,400
63,299
3,853
4,685
34,025
33,112
970
6,015
56,519
3,633
4,429
3,716
3,714
45
385
6,780
220
256
4,197,377
4,049,613
478,144
1,607,903
5,606,007
554,936
696,403
Income
Low Income Households (Households with Income < $25,000)
3,160
2,605
555
581,266
5,376
4,317
1,059
668,407
Population Density (pop. per sq. mile)
81.2
103.1
27.8
204.5
Children Age 0-17 pct. of Total Pop.
24%
25%
20%
23%
Adults Age 18-29 pct. of Total Pop.
12%
12%
11%
17%
18%
18%
15%
20%
32%
32%
35%
27%
Seniors Age 65+ pct. of Total Pop.
14%
13%
20%
12%
Female pct. of Total Pop.
51%
51%
50%
51%
Male pct. of Total Pop.
49%
49%
50%
49%
Asian pct. of Total Pop.
1%
1%
1%
6%
Black/African American pct. of Total Pop.
9%
9%
5%
19%
White pct. of Total Pop.
85%
84%
91%
68%
Other or Multi-Race pct. of Total Pop.
5%
5%
3%
7%
Hispanic Ethnicity pct. of Total Pop.
6%
7%
3%
8%
Per Capita Income
$42,467
$43,103
$36,716
$34,707
Median Household Income
$85,784
$89,397
$60,802
$63,146
Low Income Households (Households with Income <$25,000)

pct. of Total Households
11%
11%
18%
18%
Pop. Age 25+ Without a High School Diploma pct. of Total

Pop. Age 25+
11%
9%
19%
12%
Age
Sex
Race
Education
Population Age 25+ Without a High School Diploma
Population Rates
Total
Population
Age
Sex
Race
Ethnicity
Income
Education
Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix E. Data Sources for details.
14
Classification of ethnicity; therefore, Hispanic individuals are also included in the race categories.
Page | 21
Mortality is one of the most commonly cited community health indicators. As shown in Exhibit III-3, in 2012, the
study region had 553 total deaths in 2012. The leading causes of death were malignant neoplasms (cancer) (125),
heart disease (117), and cerebrovascular disease (stroke) (36). The age-adjusted rate for stroke deaths in the study
region was higher than the Virginia statewide rate. Note: Maps 14-17 in Appendix A show the geographic
distribution of deaths by zip code.
Exhibit III-3.
Mortality Profile, 2012
Study Region
Fauquier
County
Rappahannock
County
Virginia
553
469
84
61,101
Malignant Neoplasms Deaths
125
106
19
14,209
Heart Disease Deaths
117
92
25
13,289
Cerebrovascular Diseases Deaths
36
28
3,390
Unintentional Injury Deaths
28
24
2,779
Chronic Lower Respiratory Diseases Deaths
27
23
3,046
Nephritis and Nephrosis Deaths
18
17
1,518
Septicemia Deaths
18
18
1,308
Suicide Deaths
14
11
1,056
Alzheimer's Disease Deaths
12
1,708
Influenza and Pneumonia Deaths
11
10
1,302
Chronic Liver Disease Deaths
10
809
Diabetes Mellitus Deaths
1,589
Parkinsons Disease Deaths
561
Primary Hypertension and Renal Disease Deaths

Age Adjusted Death Rates per 100,000
15
Population
Total Deaths
639
686.0
676.0
778.1
724.9
Malignant Neoplasms Deaths
143.2
142.5
--
164.1
Heart Disease Deaths
143.9
131.6
--
157.4
Cerebrovascular Diseases Deaths
46.4
--
--
40.7
Unintentional Injury Deaths
--
--
--
33.3
Chronic Lower Respiratory Diseases Deaths
--
--
--
36.6
Nephritis and Nephrosis Deaths
--
--
--
18.2
Septicemia Deaths
--
--
--
15.6
Suicide Deaths
--
--
--
12.5
Alzheimer's Disease Deaths
--
--
--
21.1
Influenza and Pneumonia Deaths
--
--
--
15.8
Chronic Liver Disease Deaths
--
--
--
8.8
Diabetes Mellitus Deaths
--
--
--
18.5
Parkinsons Disease Deaths
--
--
--
7.1
Indicator
Total Deaths
Deaths by All Causes
Deaths by Top 14 Causes
Primary Hypertension and Renal Disease Deaths

---7.6
Source: Community Health Solutions analysis of mortality data from the Virginia Department of Health. See Appendix E. Data
Sources for details.
15
-- Age adjusted rates are not calculated where the number of deaths is less than 30.
Page | 22

Maternal and infant health indicators are another widely cited category of community health. As shown in Exhibit III4, the study region had 925 pregnancies, 731 total live births and four infant deaths in 2012. Compared to Virginia
as a whole, the study region had a higher rate of births without early prenatal care. Note: Maps 18-21 in Appendix A
show the geographic distribution of births by zip code.
Exhibit III-4
Maternal and Infant Health Profile, 2012
Indicator
Study
Region
Fauquier
County
Rappahannock
County
Virginia
Total Pregnancies
925
844
81
129,787
Induced Terminations of Pregnancy
118
106
12
21,438
Natural Fetal Deaths
76
63
13
5,538
Total Live Births
731
675
56
102,811
Low Weight Births (under 2,500 grams / 5 lb. 8 oz.)
51
48
8,391
Births Without Early Prenatal Care (No Prenatal

Care in First 13 Weeks)
152
138
14
13,368
Non-Marital Births
225
208
17
36,271
Total Teenage (age 10-19) Pregnancies
65
59
8,651
Live Births to Teens Age 10-19
45
41
6,134
34
31
4,504
11
10
1,559
Live Births to Teens Age <15
71
650
Live Birth Rate per 1,000 Population
9.9
10.1
7.5
12.6
Low Weight Births pct. of Total Live Births
7%
7%
5%
8%
Births Without Early Prenatal Care (No Prenatal Care in

First 13 Weeks) pct. of Total Live Births
21%
20%
25%
13%
Non-Marital Births pct. of Total Live Births
31%
31%
30%
35%
Counts
Total Infant Deaths

Rates
Teenage (age 10-19) Pregnancy Rate per 1,000 Teenage

12.6
12.5
14.3
16.7
Female Population
Five-Year Average Infant Mortality Rate per 1,000 Live
5.1
5.5
0.0
6.7
Births) 2008-2012
Source: Community Health Solutions analysis of data from the Virginia Department of Health. See Appendix E. Data Sources for
details.
Page | 23

The Agency for Healthcare Research and Quality (AHRQ) identifies a defined set of conditions (called Prevention
16
Quality Indicators, or PQIs) for which hospitalization should be avoidable with proper outpatient health care. High
rates of hospitalization for these conditions indicate potential gaps in access to quality outpatient services for
community residents.
17
As shown in Exhibit III-5, residents of the study region had 871 PQI hospital discharges in 2011. The leading
diagnoses for these discharges were chronic obstructive pulmonary disease (COPD) and asthma in older adults
(213), bacterial pneumonia (183), and congestive heart failure (156). The age-adjusted PQI discharge rates for the
study region were generally higher than the Virginia statewide rates for most PQI diagnoses. Note: Map 22 in
Appendix A shows the geographic distribution of PQI discharges by zip code.
Exhibit III-5.
Prevention Quality Indicator (PQI) Hospital Discharge Profile, 2011
Indicator
Study
Region
Fauquier
County
Rappahannock
County
Virginia
Total PQI Discharges by All Diagnoses
871
793
78
88,544
PQI Discharges by Diagnosis

Chronic Obstructive Pulmonary Disease (COPD) and Asthma in
Older Adults PQI Discharges
Bacterial Pneumonia PQI Discharges
213
197
16
16,007
183
170
13
15,720
Congestive Heart Failure PQI Discharges
156
138
18
20,006
Urinary Tract Infection PQI Discharges
108
97
11
10,826
Diabetes PQI Discharges
76
64
12
12,200
Dehydration PQI Discharges
58
54
7,422
Hypertension PQI Discharges
42
40
3,299
Perforated Appendix PQI Discharges
15
14
1,282
Asthma in Younger Adults PQI Discharges
14
13
1,121
661
All Diagnoses
Chronic Obstructive Pulmonary Disease (COPD) and Asthma in
Older Adults
Bacterial Pneumonia
947.5
967.7
828.1
1,068.1
238.2
187.8
--
134.2
236.4
281.3
--
197.4
Congestive Heart Failure
193.8
275.5
--
233.0
Urinary Tract Infection
140.6
150.5
--
131.0
Diabetes
85.1
79.7
--
133.2
Dehydration
70.4
35.7
--
41.4
Hypertension
Total PQI Discharges
Angina PQI Discharges

Age Adjusted PQI Discharge Rates per 100,000 Population
18
47.4
57.7
--
34.8
Perforated Appendix
--
--
--
18.1
Asthma in Younger Adults
--
--
--
75.3
Angina
---8.3
Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information, Inc. and local
demographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.
16
The PQI definitions are detailed in their specification of ICD-9 diagnosis codes and procedure codes. Not every hospital admission for
congestive heart failure, bacterial pneumonia, etc. is included in the PQI definition; only those meeting the detailed specifications. Low birth
weight is one of the PQI indicators, but for the purpose of this report, low birth weight is included in the Maternal and Infant Health Profile. Also,
there are four diabetes-related PQI indicators which have been combined into one for the report. For more information, visit the AHRQ website
at www.qualityindicators.ahrq.gov/pqi_overview.htm
17
Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data do
not include discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis.
18
-- Age adjusted rates are not calculated where the number of PQI discharges is less than 30.
Page | 24

Behavioral health (BH) hospitalizations provide another important indicator of community health status. As shown
in Exhibit III-6, residents of the study region had 260 hospital discharges from Virginia community hospitals for
19
behavioral health conditions in 2012. The leading diagnoses for these discharges were affective psychoses (133),
alcoholic psychoses (21) and schizophrenic disorders (20). The age-adjusted BH discharge rates for the study
region were lower than the statewide rates. Note: Map 23 in Appendix A shows the geographic distribution of BH
discharges by zip code.
Exhibit III-6.
Behavioral Health Hospital Discharge Profile, 2012
Study Region
Fauquier
County
Rappahannock
County
Virginia
260
232
28
55,372
133
123
10
27,038
Alcoholic Psychoses Discharges
21
19
3,623
Schizophrenic Disorders
20
19
8,142
Depressive Disorder, Not Elsewhere Classified
16
14
3,410
Drug Psychoses
15
12
1,532
Adjustment Reaction Discharges
2,346
Neurotic Disorders
1,374
Other Nonorganic Psychoses
2,147
Alcohol Dependence Syndrome Discharges
2,162
Drug Dependence
649
Other Organic Psychotic Conditions-Chronic
773
Non Dependent Abuse of Drugs

Age Adjusted BH Discharge Rates per 100,000
21
Population
626
All Diagnoses
384.8
378.5
--
674.0
Affective Psychoses Discharges
199.4
201.3
--
332.3
Alcoholic Psychoses Discharges
--
--
--
42.2
Schizophrenic Disorders
--
--
--
96.4
Depressive Disorder, Not Elsewhere Classified
--
--
--
42.3
Drug Psychoses
--
--
--
18.5
Adjustment Reaction Discharges
--
--
--
29.0
Neurotic Disorders
--
--
--
16.9
Other Nonorganic Psychoses
--
--
--
26.0
Alcohol Dependence Syndrome Discharges
--
--
--
25.5
Drug Dependence
--
--
--
8.0
Other Organic Psychotic Conditions-Chronic
--
--
--
9.1
Indicator
BH Discharges
Total BH Discharges by All Diagnoses
BH Discharges by Diagnosis
Affective Psychoses Discharges
20
Non Dependent Abuse of Drugs

---7.6
Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information, Inc. and local
demographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.
19
Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data do
not include discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis.
20
Includes major depressive, bipolar affective and manic depressive disorders.
21
-- -- Age adjusted rates are not calculated where the number of discharges is less than 30.
Page | 25

This section examines health risks for adults age 18+. Prevalence estimates of health risks, chronic disease and
health status can be useful in developing prevention and improvement efforts. Exhibit III-7 shows estimates
indicating that substantial numbers of adults in the study region have health risks related to nutrition, weight,
physical inactivity, tobacco and alcohol. In addition, substantial numbers of adults have chronic conditions such as
high cholesterol, high blood pressure, arthritis, diabetes and asthma. Note: Maps 24-27 in Appendix A show the
geographic distribution of selected adult health risks by zip code.
Exhibit III-7.
Adult Health Risk Factor Profile (Estimates), 2013
Study
Region
Fauquier
County
Rappahannock
County
56,590
45,152
33,747
26,597
50,612
40,490
29,861
23,788
5,978
4,663
3,886
2,810
11,645
11,079
10,629
10,122
1,016
956
19,866
17,714
2,152
16,471
13,195
6,165
14,677
11,641
5,567
1,793
1,554
598
10,306
9,110
1,196
9,620
8,604
1,016
Less than Five Servings of Fruits and Vegetables Per Day

Overweight or Obese
Not Meeting Recommendations for Physical Activity in the Past 30
Days
Smoker
At-risk for Binge Drinking (males having five or more drinks on one
occasion, females having four or more drinks on one occasion)
High Cholesterol (was checked, and told by a doctor or other health
professional it was high)
High Blood Pressure (told by a doctor or other health professional)
80%
80%
78%
60%
47%
59%
47%
65%
47%
21%
21%
17%
20%
20%
16%
35%
35%
36%
29%
29%
30%
Arthritis (told by a doctor or other health professional)
23%
23%
26%
Indicator
Estimates-Counts
Estimated Adults age 18+
Less than Five Servings of Fruits and Vegetables Per Day
22
Overweight or Obese
Not Meeting Recommendations for Physical Activity in the Past 30
Risk
Days
Factors
Smoker
At-risk for Binge Drinking (males having five or more drinks on one
occasion, females having four or more drinks on one occasion)
High Cholesterol (was checked, and told by a doctor or other health
professional it was high)
Chronic
High Blood Pressure (told by a doctor or other health professional)
Conditions
Arthritis (told by a doctor or other health professional)
Diabetes (told by a doctor or other health professional)
Limited in any Activities because of Physical, Mental or Emotional
General
Problems
Health
Status
Fair or Poor Health Status
Estimates-Percent of Adults Age 18+
Risk
Factors
Chronic
Conditions
11%
11%
10%
Diabetes (told by a doctor or other health professional)
Limited in any Activities because of Physical, Mental or Emotional
18%
18%
20%
General
Problems
Health
17%
17%
17%
Status
Fair or Poor Health Status
Source: Estimates produced by Community Health Solutions using Virginia Behavioral Risk Factor Surveillance System data
and local demographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.
22
According to the CDC, for adults 20 years old and older, BMI is interpreted using standard weight status categories that are the same for all
ages and for both men and women. Overweight is defined as a BMI between 25.0 and 29.9. Obesity is defined as a BMI 30.0 and above. For
more information: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Interpreted
Page | 26

This section examines selected health risks for youth age 14-19. These risks have received increasing attention as
the population of American children have become more sedentary, more prone to unhealthy eating and more likely
to develop unhealthy body weight. The long-term implications of these trends are serious, as these factors place
children at higher risk for chronic disease both now and in adulthood.
Exhibit III-8 shows estimates indicating that substantial numbers of youth in the study region have health risks
related to nutrition, weight, alcohol, mental health, tobacco, and physical activity. Note: Maps 28-29 in Appendix A
shows the geographic distribution of selected youth health risks by zip code.
Exhibit III-8.
Youth Health Risk Factor Profile (Estimates), 2013
Study Region
Fauquier
County
Rappahannock
County
6,150
5,617
533
Less than the Recommended Intake of Vegetables
5,414
4,944
470
Less than the Recommended Intake of Fruit
5,356
4,891
465
23
1,585
1,455
131
883
810
74
1,382
1,258
124
2,008
1,829
179
1,537
1,407
130
Less than the Recommended Intake of Vegetables
88%
88%
88%
Less than the Recommended Intake of Fruit
87%
87%
87%
Indicator
Estimates-Counts
Estimated Youth Age 14-19
Overweight or Obese
Risk
Not Meeting Recommendations for Physical Activity in
Factors
the Past Week
Used Tobacco in the Past 30 Days
Have at least One Drink of Alcohol at least One Day in
the Past 30 Days
General
Feel Sad or Hopeless (almost every day for two or more
Health
weeks in a row so that they stopped doing some usual
Status
activities)
Estimates-Percent of Youth Age 14-19
Overweight or Obese
26%
26%
25%
Not Meeting Recommendations for Physical Activity in
14%
14%
14%
the Past Week
Used Tobacco in the Past 30 Days
22%
22%
23%
Have at least One Drink of Alcohol at least One Day in
33%
33%
34%
the Past 30 Days
General
Feel Sad or Hopeless (almost every day for two or more
Health
weeks in a row so that they stopped doing some usual
25%
25%
24%
Status
activities)
Source: Estimates produced by Community Health Solutions using Virginia Youth Risk Behavioral Surveillance System data and
local demographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.
Risk
Factors
23
For children and adolescents (aged 219 years), the BMI value is plotted on the CDC growth charts to determine the corresponding BMI-forage percentile. Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile. Obesity is defined as a BMI
at or above the 95th percentile for children of the same age and sex. For more information:
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_BMI/about_childrens_BMI.html
Page | 27
Decades of research show that health coverage matters when it comes to overall health status, access to health
care, quality of life, school and work productivity, and even mortality. Exhibit III-9 shows the estimated number of
24
uninsured individuals, by income as a percent of the federal poverty level (FPL), in the study region as of 2013.
An estimated 8,090 (13%) nonelderly residents of the study region were uninsured at a given point in time in 2013.
This included an estimated 1,188 children and 6,903 adults. Note: Maps 30-31 in Appendix A show the geographic
distribution of the uninsured population by zip code.
Exhibit III-9.
Uninsured Profile (Estimates), 2013
Study
Region
Fauquier
County
Rappahannock
County
Uninsured Nonelderly Age 0-64
8,090
7,094
996
Uninsured Children Age 0-18
1,188
1,044
144
Uninsured Children Age 0-18 <=138% FPL
345
300
45
578
508
70
711
624
87
995
870
125
Uninsured Children Age 0-18 138-400% FPL
649
569
81
6,903
6,050
852
Uninsured Adults Age 19-64 <=138% FPL
2,095
1,801
294
3,333
2,899
434
4,073
3,544
529
5,511
4,802
709
Uninsured Adults Age 19-64 138-400% FPL
3,415
3,001
415
13%
12%
17%
6%
6%
9%
15%
15%
19%
Indicator
Estimated Uninsured Counts*
Uninsured Adults Age 19-64
Estimated Uninsured Percent

Uninsured Nonelderly Percent
Uninsured Children Percent
Uninsured Adults Percent
*FPL Categories are cumulative
Source: Estimates of uninsured are based on Community Health Solutions analysis of U.S. Census Bureau Small Area Health
Insurance Estimates (2012) and demographic data from Alteryx, Inc. (2012).See Appendix E. Data Sources for details.
24
For more information, please see: http://aspe.hhs.gov/poverty/12poverty.shtml
Page | 28

Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) are designated by the U.S.
Health Resources and Services Administration as being at-risk for health care access problems. The designations
are based on several factors including primary care provider supply, infant mortality, prevalence of poverty and the
prevalence of seniors age 65+.
As shown in Exhibit III-10, All of Rappahannock County is designated as medically underserved. Part of Fauquier
County is designated as medically underserved; two county subdivisions (minor civil divisions or MCDs) meet the
designation criteria:
94215 Lee district

94511 Marshall district
For a more detailed description, visit the U.S. Health Resources and Service Administration designation webpage
at http://muafind.hrsa.gov/.
Exhibit III-10.
Medically Underserved Area/Populations Profile
Locality
Fauquier County
Rappahannock County
MUA/MUP Designation
Partial
Census Tracts
2 MCDs of 17 Census Tracts
Full
2 of 2 Census Tracts
Source: Community Health Solutions analysis of U.S. Health Resources and Services Administration data.
Page | 29
Appendix A
APPENDIX A. Zip Code-Level Maps for the Study Region

The maps in this section illustrate the geographic distribution of the zip code-level study region population on key
demographic and health indicators. The results can also be used alongside the Community Interview Results,
Community Survey Results and the Community Indicators to help inform plans for community health initiatives. The
underlying data for these maps are provided in a separate Microsoft Excel file. The maps in this section include the
following:
1. Total Population, 2013
17. Cerebrovascular Disease (Stroke) Deaths, 2012
2. Population Density, 2013
18. Total Live Births, 2012
3. Child Population Age 0-17, 2013
19. Low Weight Births, 2012

20. Births Without Early Prenatal Care (No Prenatal Care
in the First 13 Weeks), 2012
21. Births to Teen Mothers Under Age 18, 2012
22. Prevention Quality Indicator (PQI) Hospital
Discharges, 2011
23. Behavioral Health (BH) Hospital Discharges, 2012
24. Estimated Adults Age 18+ Overweight or Obese,
2013
25. Estimated Adult Age 18+ Smokers, 2013
4. Senior Population Age 65+, 2013

5. Asian Population, 2013
6. Black/African American Population, 2013
7. White Population, 2013
8. Other or Multi-Race Population, 2013
9. Hispanic Ethnicity Population, 2013
10. Per Capita Income, 2013
14. Total Deaths, 2012
26. Estimated Adults Age 18+ with Diabetes, 2013

27. Estimated Adults Age 18+ with High Blood Pressure,
2013
28. Estimated Youth Age 14-19 Overweight or Obese,
2013
29. Estimated Youth Age 14-19 who had No Physical
Activity in the Past Week, 2013
30. Estimated Uninsured Children Age 0-18, 2013
15. Malignant Neoplasm (Cancer) Deaths, 2012
31. Estimated Uninsured Adults Age 19-64, 2013
11. Median Household Income, 2013

12. Low Income Households (Households with Income
<$25,000), 2013
13. Population Age 25+ Without a High School Diploma, 2013
16. Heart Disease Deaths, 2012
**Technical Notes**
1. The maps and data include 26 zip codes, as identified by Fauquier Health and Fauquier Health Foundation,
most of which fall within Fauquier and Rappahannock counties. Because zip code boundaries do not
automatically align with city/county boundaries, there are some zip codes that extend beyond the county
boundaries. Additionally, not all zip codes in each of the two localities were identified by Fauquier Health
and Fauquier Health Foundation as part of the study region. Consequently, the combined zip code-level
totals for population, deaths, births, hospital discharges, etc. differ from the city/county-level study region
totals listed throughout the body of the report.
2. With the exception of population density, per capita income and median household income, the maps show
counts rather than rates. Rates are not mapped at the zip code-level because in some zip codes the
population is too small to support rate-based comparisons.
3. Data are presented in quintiles (categorized in groups of five) where feasible.
4. Gray shading indicates either zip codes not included in the study region, or zero values for zip codes that
are included in the study region. Study region zip codes with zero values are noted.
Page | 30
Appendix A
Map 1: Total Population, 2013
Map 2: Population Density (population per square mile), 2013
Page | 31
Appendix A
Map 3: Child Population Age 0-17, 2013
Map 4: Senior Population Age 65+, 2013
Page | 32
Appendix A
Map 5: Asian Population, 2013
Map 6: Black/African American Population, 2013
Page | 33
Appendix A
Map 7: White Population, 2013
Map 8: Other or Multi-Race Population, 2013
Page | 34
Appendix A
Map 9: Hispanic Ethnicity Population, 2013
Page | 35
Appendix A
Map 10: Per Capita Income, 2013
Map 11: Median Household Income, 2013
Page | 36
Appendix A
Map 12: Low Income Households (Households with Income<$25,000), 2013
Map 13: Population Age 25+ Without a High School Diploma, 2013
Page | 37
Appendix A
Map 14: Total Deaths, 2012
Map 15: Malignant Neoplasm (Cancer) Deaths, 2012*
* There were no reported cancer deaths for zip codes 22639 and 22643.
details.
Page | 38
Appendix A
Map 16: Heart Disease Deaths, 2012*
Map 17: Cerebrovascular Disease (Stroke) Deaths, 2012*
*There were no reported heart disease deaths for zip codes 20184, 22643, and 22747. There were no reported stroke deaths for
zip codes 22643, 22742, 22639, 22718, 20144, 22713, 22716, 22642, 20137, and 22734.
details.
Page | 39
Appendix A
Map 18: Total Live Births, 2012*
Map 19: Low Weight Births, 2012*
*There were no reported live births for zip code 22643. There were no reported low weight births for zip codes 22643, 22640,
20184, 20144, 22639, 22749, 22627, 22718, 22742, and 22740.
details.
Page | 40
Appendix A
Map 20: Births Without Early Prenatal Care (No Prenatal Care in the First 13 Weeks), 2012*
Map 21: Births to Teen Mothers Under Age 18, 2012*
*There were no reported births without early prenatal care for zip codes 22643, 20144, and 22740.There were no reported births
to teen mothers under age 18 for zip codes 22643, 20144, 22740, 22640, 20184, 22627, 20117, 20137, 22639, 22718, 22713,
22749, 22716, 22720, 22742, 22747, 22642, and 20115.
details.
Page | 41
Appendix A
Map 22: Prevention Quality Indicator (PQI) Hospital Discharges, 2011
Map 23: Behavioral Health Hospital Discharges, 2012*
*There were no reported behavioral health discharges for zip codes 22643, 22640, and 22749.
Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information, Inc.
See Appendix E. Data Sources for details.
Page | 42
Appendix A
Map 24: Estimated Adults Age 18+ Overweight or Obese, 2013
Map 25: Estimated Adult Age 18+ Smokers, 2013
Source: Estimates based on Community Health Solutions analysis of Virginia Behavioral Risk Factor Surveillance System data
and estimates from Alteryx, Inc. See Appendix E. Data Sources for details.
Page | 43
Appendix A
Map 26: Estimated Adults Age 18+ with Diabetes, 2013
Map 27: Estimated Adults Age 18+ with High Blood Pressure, 2013
Source: Estimates based on Community Health Solutions analysis of Virginia Behavioral Risk Factor Surveillance System data
Page | 44
Appendix A
Map 28: Estimated Youth Age 14-19 Overweight or Obese, 2013
Map 29: Estimated Youth Age 14-19 Not Meeting Recommendations for Physical Activity in the Past Week,
2013
Source: Estimates based on Community Health Solutions analysis of Virginia Youth Risk Behavioral Surveillance System data
Page | 45
Appendix A
Map 30: Estimated Uninsured Children Age 0-18, 2013
Map 31: Estimated Uninsured Adults Age 19-64, 2013
Source: Estimates of uninsured are based on Community Health Solutions analysis of U.S. Census Bureau Small Area Health
Insurance Estimates (2012) and demographic data from Alteryx, Inc. (2012).See Appendix E. Data Sources for details.
Page | 46
Appendix B
Appendix B. Community Interview Guide and List of Participants

Appendix B-1.
Community Interview Guide
Introduction
Thank you for agreeing to participate in a Community Interview as part of the community
health needs assessment (CHNA) being conducted by Fauquier Health and Fauquier
Health Foundation. This Interview Guide is intended to help you prepare for the interview.
We invite you to review this Interview Guide prior to the interview, so that you can be fully
prepared to share your insights.
The Purpose of the

Interview
The purpose of this interview is to obtain your insights about community health in our
region. Your insights are important because you have a distinctive perspective on the
health of the community and the opportunities and challenges faced by community
residents and service providers. By participating in this interview, you are helping to inform
the work of many community organizations in the coming days.
The Interview
Process and
Product
The process for the interview follows:
The Interview
Questions
The interview will take place at the time and place designated in your invitation letter.
The interview will take place over a two-hour period with short breaks as appropriate.
The interview will be facilitated by staff from Community Health Solutions, our
contractor for the CHNA.
The interview will include between eight and twelve participants who have been invited
to participate by Fauquier Health and Fauquier Health Foundation.
The interview will cover five questions about community health as outlined in the
following section.
During the interview, the facilitator will ask each question and then invite each
participant to share their insights. You will have the option of responding or declining
as you so decide.
During the interview, staff from Community Health Solutions will be manually recording
the responses provided by participants. The objective is to capture the main point of
each response, and some paraphrasing may be used.
After the interview, staff from Community Health Solutions will produce an interview
report outlining the interview participants, the questions asked, the actual or
paraphrased responses to each question, and the source of the response.
A summary of the interview results may be included in the published CHNA report. If
they are included, they will be in summary form and no names will be reported in
association with specific responses.
The interview will include the following questions. Please be assured that there are no
right or wrong answers to these questions. The purpose of the interview is not to judge
or debate peoples responses. We are simply interested in your distinctive perspective on
each question.
1.
2.
3.
4.
5.
Page | 47
In your own words, how would you define the idea of a healthy community?
From your perspective, who are the population segments within the community
that are especially vulnerable or at-risk for health problems?
Still thinking about health problems, are there health issues on the horizon that
few people know about, but could cause serious harm today or in the future?
Think of health assets as people, institutions, programs, built resources (e.g.
parks), or natural resources that promote a culture of health. In your view, what
are the most important health assets within the community?
Thinking of a healthy community as everyones responsibility, please share one
creative way that people could work together to promote better health in the
community.
Appendix B
Appendix B-2.
Community Interview Participants
First Name
Chris
Ray
Tyronne
Jessica
Sam
Shawna
Kathy
Janelle
Andy
Darren
Sandi
Jerry
Rebecca
Sallie
Dennis
John
Donna
Bev
Brian
Cee Ann
Barbara
Page | 48
Last Name
Miller
Knott
Champion
(last name unknown)
Myers
(last name unknown)
Hatter
Downes
Marshall
Stevens
Kelly
Hoke
Wolfrey
Morgan
Rustom
McCarthy
Matthews
Dunford
Duncan
Davis
Downes
Organization
Aging Together
BB&T Bank
Community Touch
Company 1, Warrenton Volunteer Fire and Rescue
Department of Health
Fauquier County Government and Public Schools
Fauquier County Sheriff
Fauquier Fire and Emergency Services
Fauquier Free Clinic
Fauquier Health
Fauquier Health
Mental Health Association of Fauquier County
Piedmont Pediatrics
Rappahannock County Administrator
Rappahannock County Public Schools
Rappahannock Department of Social Services
Rappahannock Rapidan CSB
Rappahannock Rapidan Department of Health
Rappahannock Rapidan Health District
Appendix C
APPENDIX C. Community Survey:

Additional Ideas and Suggestions for Improving Community Health
Survey respondents were given the option to submit additional ideas and suggestions for improving community
health. The open-ended responses are listed below.
Response
#
Responses
A provision of ambulance transport for bedbound patients to access physicians, for routine follow up
appointments, would result in a decrease of costs for emergency services and likely prevent unavoidable
hospitalizations.
Areas that we need to improve, in order to better treat the behavioral health population, are the following:
More psychiatrists in our area
Rapid access for people in need of behavioral health services
There should be no wait time for needed services.
More physicians willing to take Medicaid clients
Consider establishing a Medicaid clinic
Combine Rappahannock-Rapidan Community Services Behavioral Health Clinic with a Health Care Clinic
to ensure comprehensive treatment.
A small inpatient unit at Fauquier hospital to keep residents local and move people out of the Emergency
Room quickly
A holding area for people being assessed for admission to psychiatrist hospitals would save valuable
resources for both the hospital and community law enforcement.
Eldercare services (a coordinator to help families find services)
Health fairs are always a good venue with free screenings and information.
Health self-care information that is engaging enough to get people's attention
Healthy programs and nutrition for youth to make them active and to fight childhood obesity
I appreciate Fauquier Health for their willingness to hear from local stakeholders. The challenge I believe
is to find innovative ways to restore, promote and maintain the health of our community.
A few of the at-risk populations may not fit into the current assistance programs that are available in
Fauquier County but [they] still need assistance. If resource outlets in Fauquier County, who distribute
financial assistance, are stringent and only address a certain section of the community some people may
fall through the cracks. Thank you for listening and I look forward to working with you.
I feel that if Fauquier Health could establish an ambulance transport section of the hospital, in conjunction with
County Fire and Rescue, [then] a long standing partnership along with another source of revenue could be the
outcome. Right now, the nursing home residents and our elderly population are waiting for these outside
transportation services to arrive. [They] sometimes have an hour or longer wait time. If this idea were to be
investigated a few of the outcomes could be:
Ambulances at the hospital for transports to and from the nursing homes (revenue both ways),
In the advent [that] inter-hospital transport and helicopters are grounded due to weather, this unit could
transport them to nearest appropriate facility,
The crew could be used as Emergency Room technicians in the Emergency Room when they are on a
transport. A partnership between the county Fire and Rescue and the hospital could be started and we
could place new Emergency Medical Technicians and Paramedics on this unit in order to gain experience
all the while working with and getting to know the hospital staff.
I wish you would work more collaboratively with outside organizations. I realize you have a full continuum of
services within Fauquier Health but there is still room for working more with healthcare and community
services outside the system. Building partnerships and community capacity would improve your work as well.
Page | 49
APPENDIX C. Community Survey: Additional Ideas and Suggestions for Improving

Community Health (continued)
Appendix C
10
I would like to see more community activities and outreach programs such as diabetes clinics, cholesterol
screening and mobile flu shot clinics. I also believe more community activities such as a 5K, bike rides and
"lets get active" events would put Fauquier on the map as a healthy community. The Richmond area has
done a great job of this with their partners Anthem and HCA.
11
I would like to see us work on bringing more physicians and services to this area such as: cardiac catheter
labs, vascular labs, neurology on-site, cancer service line, open MRI and other state of [the] art technologies
as well as expert physicians.
12
I would love to see some sort of community service where a nutritionist comes in and talks to the kids about
nutrition [with] one for each level: lower, middle, and upper. Also possibly a trainer who can talk to them about
safe exercise for their ages.
13
I would strongly encourage a satellite operation within or near the town of Washington to serve county needs.
14
[There is a need for] increased health awareness, health screening and physical activity improvement for
children and teens. I have seen a large rise of children and teens living sedentary lifestyles, with limited
physical activity, resulting in a rise of child and teen obesity.
15
Like I mentioned at the round table discussion 3 days ago, I think a health fair would be a great idea! This
could be done, with different stations representing the different health needs (cardiovascular, mental, etc.). If
successful, this could be an annual or (as [fellow community member] suggested) a seasonal event.
16
[There is a need for] more community follow-up by health care professionals (e.g., regular home visits by
doctors and community nurses). Studies indicate that taking responsibility for one's health and taking
appropriate steps to manage chronic conditions does not occur on a level the health care industry would like
[to see]. And it is frequently those in most need who have the least resources.
17
My experience with Fauquier Health, which I assume owns Fauquier Hospital, is that they have been very
quick to pull the trigger regarding sending due bills to collections. I have had at least two experiences where
my insurance has paid the bulk of my bill and I have made partial payments and communicated only to find a
collections letter in my mailbox. If this happens to me, someone who has a good health insurance plan and
who has an upper middle class income, I cannot imagine what happens to those who have no insurance and
little income. I feel, strongly, that Fauquier Health should re-examine its policies regarding turning accounts
over to collections agencies. I realize that the hospital must maintain some cash flow and make a profit per se,
but I do not think their bottom line would be hurt if this policy were changed. Given that a collections agency
probably takes 30% or more as its fee, I would expect that in the long run the hospital may find they bring in
more money if they turned fewer accounts over to collections. And I assure you they would have far more
satisfied customers.
18
My interactions with the staff at the hospital and foundation exemplify the mission.
19
[There is a] need to promote healthy eating and exercise in the schools.
20
Offer partnerships with other nonprofit organizations in your area [that are] established to assist and meet the
needs of the elderly, however, with additional funding [they] could expand their service lines to include and
serve more people in the Fauquier area.
21
Page | 50
Our community could really use a federally qualified health center to provide maternity, mental health
services and elder care.
Our community needs good access to psychiatric hospitalization for adults and children and rapidly
available outpatient assessment and support.
We need counselling and shelter support for victims of domestic violence or good coordination with
another nearby community that has these services and [we need] to involve emergency room, women's
services, and police in assuring safe access to these havens.
We need financial support for services that provide reliable long-acting contraceptives to patients,
regardless of income, as the health department has to bear the cost of these expensive units for indigent
patients without the old levels of state funding.
Appendix C
APPENDIX C. Community Survey: Additional Ideas and Suggestions for Improving

Community Health (continued)
22
Our CTC community needs mental health options and transportation services. Logisticare does not have
enough drivers to work reliably and Lifecare only provides stretchers.
23
Palliative Care services open the door to partnership and extend the reach of the care provider.
24
Participation by Fauquier Health in helping to either expand existing physician services or start its own
physician office would dramatically improve access to health care.
25
Partnering with the schools and after-school programs, such as FCCC and Boys and Girls Clubs, we could
begin to develop healthy lifestyles through promotion of exercise, food choices and mental and social wellness.
Starting in the schools will continue to benefit the entire community by providing services for the children that
will carry lessons forward.
26
27
Promote healthy eating and exercise options in the schools.
28
Promoting integrated all inclusive care
29
Recognizing that mental health is fundamental to overall health, promote services that address mental health
needs and integrate mental health with physical health care. [A need for] increased support for mental health
emergencies coming through the emergency department is a particular concern.
30
Please continue to actively support the free clinic.

Enhance offerings to those in need of mental health professionals or substance abuse counselors.
Strengthen transportation services to medical and rehabilitation appointments

If possible, require those with diabetes, using free clinic services, to attend diabetes education services
offered to this population (for free) at the Fauquier Health Wellness Center.
Offer, at least yearly, a health fair for the community.
31
Suggest a grant program encouraging front line health organizations to work together to help alleviate the types
of health problems identified above [in the stakeholder survey]. The types of organizations are Social Services,
Emergency Medical Services, Fauquier Free Clinic, etc.
32
Support for the Fauquier Free Clinic
33
Support walking, jogging, biking and community connectivity

I think mental health services are the most desperate need we have. We are far too short of experts to
help folks with depression; especially young people.
34
Tap into the richness of the local nonprofits. We have our pulse on all facets of the community. Partnerships
with the nonprofits will greatly enhance both the mission of Fauquier Health and the residents of this
extraordinary county.
35
Thank you for allowing me to participate. I am sure you will agree that there is more to health than just the
physical absence of disease.
36
There are many services available to our community. More linkage to these services could be beneficial.
37
This would turn into a dissertation. Start with cultural competency and work from here.
38
To possibly form a partnership with additional mental health facilities for a less time consuming process
39
Page | 51
To restore, we must target the uninsured and keep the insured healthy.
Education is so vital.
Go back to go bedside manners when seeing patients is good but not when they're in the hospital thinking
about what is going on with them that someone comes to their room [to] talk about a bill. This becomes
discouraging to the mental wellness of people.
Appendix C
APPENDIX C. Community Survey: Additional Ideas and Suggestions for

Improving Community Health (continued)
40
We are your local fire, rescue, and Emergency Medical Service organization that protects the Fauquier Hospital
and most of Fauquier Health's facilities. We serve the largest population in the county along with providing
service to the Town of Warrenton and County of Fauquier for over 4,600 incidents annually on average. We do
have current equipment and apparatus needs to keep our mission surviving so we can ensure the highest level
of capability to the residents and visitors in our community. Our current lifesaving equipment is aging and
needs to be replaced, along with upgrades to several other items. Our link in the chain of survival is critical and
without the proper tools, equipment and training, the post portion of an incident (getting the patient to definitive
care) will be hampered. I would like to meet with the foundation and discuss and review some of our current
needs and thoughts on ways to enhance our capacity.
41
We need social services to help people navigate available resources and set them up with elder care help,
psychiatric help, substance abuse help, and establishing a medical home instead of using the emergency room
services or urgent care.
42
You could do a great service by establishing a satellite primary care clinic and pharmacy in the central area of
Rappahannock County, somewhere along Route 211.
43
You have been a wonderful partner with the schools aiding us in promoting the health and welfare of our
students. We especially appreciated the help with the IMPACT program.
Page | 52
Appendix D
Appendix D. Defining a Healthy Community

On May 7, 2014, Community Health Solutions (CHS) facilitated a town hall meeting of community stakeholders on
behalf of Fauquier Health and Fauquier Health Foundation. As part of the meeting, participants were invited to
share their vision of a healthy community. Twenty-four responses were submitted. These responses are listed
below.
Response #
1.
Every person, family, organization, business and government values wellness and actively
pursues it.
2.
Children have safe places to grow and play, community resources for physical fitness, facilities
that support safe travel, up-to-date schools that grow the mind and body, and schools that offer
clean air, regulated heat, nutritious foods, and foster community learning spaces.
3.
All citizens' needs are valued, and if possible, addressed.
4.
Everyone has access to affordable healthcare.
5.
[Everyone has] time for an afternoon walk; [this] requires jobs close to (or at) home.
6.
Comprehensive health services available to all; including health promotion, healthy environments
healthy food.
7.
Members are encouraged, supported and model good health. Health needs to be broad and
include mental health, physical health, and education regarding health.
8.
A well-educated, healthy, mentally fit, [and] emotionally well-balanced population are allowed [to]
and capable of working out a world view; a life plan. This would be a place where each citizen is
satisfied with his or her situation, and there is help available for those who are under physical,
emotional, financial, spiritual, or mental stress or threat.
9.
Every faith community has an active, engaged health ministry to provide health information and
direct access to services.
10.
There is an awareness at all age levels to improve health status, and one that focuses on the
family unit as a way to engage all age levels. I envision schools and community centers being an
active change agent in this awareness.
11.
Community supports the individual, to achieve his or her personal goal, by a support structure in
place to assist each objective for an overall goal of physical and mental health.
12.
13.
14.
15.
16.
17.
Page | 53
Responses
People in the community are educated on health related topics that are important to the
individual's family. Community folks should know where to go for information and resources that
are available to them in regards to their personal needs. Service providers should be well-versed
in the services they offer, as well as be willing to offer referrals to other agencies for help. If we
create an educated community based around the cooperation of service providers, we would be
able to tackle anything that comes our way!
Citizens feel connected one to another and all citizens are acknowledged as important to the
community. This includes positive behavioral interventions and supports for those populations
who might otherwise be marginalized, such as returning offenders (from prison), minority
populations, and victims of crime. [A healthy community is a place where] providers dialogue to
address and resolve community issues, before they reach a crisis.
The community provides services which meet the residents needs; physical and emotional,
educational and social.
The ethic of the community is that health is permanent, and an asset to be engaged defensively
and prophylactically, and that pathology and infirmity [are] prevented/avoided, to the extent
practical, is the real hallmark of health.
There is physical, emotional/mental and spiritual balance; [an] emphasis on the prevention, acute
and post-acute care; and an environment [that] supports a healthy culture which starts [with] the
youth through the end of life.
All resources are utilized to create a culture that is promoting and expecting good health, and the
practices to accomplish good health.
Appendix D
Response #
Responses
18.
[The] community gives access to all citizens. It also incorporates preventive care by advocating,
through medical facilities and schools, choices that will help them on a daily basis.
19.
People have access to great services and opportunities regardless of economic status. Health
care and dental care services, in particular.
20.
21.
Available health and mental health services, as well as services for those with developmental
disabilities and intellectual disability are transparent. Parents and caregivers have enough on
their plates without having to also search for [a] 'needle in the haystack' to find out where/how to
access transition services; get assistance with applying for Medicaid, DD/ID waivers; find
housing; get rent assistance; etc.
The community encourages a collaborative approach to addressing issues; input from all
perspectives, focus on physical and mental health, shift from curing disease to maintaining and
improving heath, celebration of differences, recognition that people of all abilities are equal
members, open forums encourage input with program development or improvements. Supports
that allow all members of community to stay actively engaged and meaningfully connected
regardless of abilities. Stagnation, isolation, lack of meaningful connection all lead quickly to
impaired mental and physical health.
22.
[The community is] informative with ease of access, supported by adequate personnel and
resources.
23.
People are able to live lives secure in the knowledge that if they have a need for services to help
them thrive, those services are available and easily accessed.
An entire community is focused on health. Highway posters, schools, and businesses that have a
constant thrust towards health; a true interest in the health of its' community. Primary focus is
health then the business of service they provide is next to this. [This includes:]
24.
People in the community who care and assist others to meet needs
Removal of items - sale of items such as cigarettes, alcohol, etc.
Physicians who aren't over burdened with patients
Daily community activities that are promoted as a community activity physical, mental, social
Transportation to and from needed services
Education - free, on healthy living in rotated areas in the community
Healthy foods and community gardens.
Places to help parents get together to share ideas, connections and go out
to understand under-privileged families and join with them
Too big a scope to really say it all.
Page | 54
Appendix E
Appendix E: Data Sources

Section
Source
Qualitative Data

1)
Community Interview Results
Community Health Solutions analysis of three community interviews

conducted with a total of 21 community stakeholders in March 2014.
Part I. Community Insight Profile

2)
3)
4)
5)
Survey Respondents
Community Health Concerns
Community Service Gaps
Vulnerable/At-Risk Populations
in the Community
Community Health Solutions analysis of Community Insight survey
6) Vulnerable/At-Risk Regions in
responses submitted by community stakeholders.
the Community
7) APPENDIX D. Community
Insight Profile-Additional Ideas
and Suggestions for Improving
Community Health
Appendix D: Defining a Healthy Community
1) Defining a Healthy Community Community Health Solutions analysis of each town hall meeting
participants definition of a healthy community.
Quantitative Data
Part II. Community Indicator Profile
1) Health Demographic Trend
Profile
2) Health Demographic Snapshot
(also Appendix A. Maps 1-13)
Page | 55
3)
Mortality Profile
4)
Maternal and Infant Health

Profile (also Appendix A. Maps
18-21)
Community Health Solutions analysis of U.S. Census data and local

demographic estimates from Alteryx, Inc. (2013 and 2018). Alteryx,
Inc., is a commercial vendor of demographic data. Note that
demographic estimates may vary from other sources of local
demographic indicators.
Community Health Solutions analysis of Virginia Department of Health
death record data (2012). Locality level counts and rates were obtained
from the Virginia Department of Health. The combined study region
counts and rates, plus zip code-level counts were produced by
Community Health Solutions.
Community Health Solutions analysis of Virginia Department of Health
death record data (2012). Locality level counts and rates were obtained
from the Virginia Department of Health. The combined study region
counts and rates, plus zip code-level counts were produced by
Community Health Solutions.
Appendix E
5)
Preventable Hospitalization
Profile (also Appendix A. Map
22)
6)
Behavioral Health
Hospitalization Profile (also
Appendix A. Map 23)
Community Health Solutions analysis of hospital discharge data from

the Virginia Health Information (VHI) 2011 and 2012 datasets and
demographic estimates from Alteryx, Inc. (2011 and 2012). Data
include discharges for Virginia residents from Virginia hospitals
reporting to Virginia Health Information, Inc. These data do not include
discharges from state behavioral health facilities or federal (military)
facilities. Data reported are based on the patients primary diagnosis.
NOTE: Virginia Health Information (VHI) requires the following
statement to be included in all reports utilizing its data: VHI has
provided non-confidential patient level information used in this report
which was compiled in accordance with Virginia law. VHI has no
authority to independently verify this data. By accepting this report the
requester agrees to assume all risks that may be associated with or
arise from the use of inaccurately submitted data. VHI edits data
received and is responsible for the accuracy of assembling this
information, but does not represent that the subsequent use of this data
was appropriate or endorse or support any conclusions or inferences
that may be drawn from the use of this data.
Estimates of chronic disease and risk behaviors for adults 18+ were
produced by Community Health Solutions using:
7)
Adult Health Risk Factor

Profile
A multi-year dataset (2006-2010)from the Virginia Behavioral

Risk Factor Surveillance System (BRFSS).For more
information on BRFSS visit:
http://www.cdc.gov/brfss/about/index.htm
Local demographic estimates from Alteryx, Inc. (2013)
Estimates are used when there are no primary sources of data

available at the local level. The statistical model to produce the
estimates was developed by Community Health Solutions. The
estimates are for planning purposes only and are not guaranteed for
accuracy. The table does not include a comparison to Virginia statewide
rates because the local estimates were derived from state-level data.
Differences between local rates and state rates may reflect estimation
error rather than valid differences.
Estimates of risk behaviors for children age 14-19 were produced by
Community Health Solutions using:
8)
Page | 56
Youth Health Risk Factor

Profile (also Appendix A. Maps
28)
Data from the Virginia Youth Risk Behavioral Surveillance

System from the Centers for Disease Control (2011). For more
information on YRBSS visit:
http://www.cdc.gov/HealthyYouth/yrbs/index.htm
Local demographic estimates from Alteryx, Inc. (2013).

Appendix E
Estimates of uninsured nonelderly age 0-64 were produced by

Community Health Solutions using:
9)
Uninsured Profile
10) Medically Underserved Profile
Page | 57
U.S. Census Bureau Small Area Health Insurance Estimates

(2012). For more information visit:
http://www.census.gov/did/www/sahie/data/index.html
Local demographic estimates from Alteryx, Inc. (2013)

Community Health Solutions analysis of U.S. Health Resources and
Services Administration data. For more information visit:
http://muafind.hrsa.gov/.
10461 Mill Run Circle - Suite 215

Owings Mills, MD 21117
410 998 9310 fax 410 998 9320
www.thevincagroup.com
Cost Effective Strategies for Quality Health Care
June 11, 2015
Mr. Neal Gumbin

Beckham Gumbin Ventures, LLC
10611 N. Hayden Road
Suite D-105
Scottsdale, AZ 85260
Dear Mr. Gumbin,
The Vinca Group L.L.C. is pleased to present the demand estimate for a routine assisted living and
Alzheimers disease/dementia assisted living facility to be located on Legion Drive in Warrenton,
VA. The demand calculations indicate that the market could support up to 48 routine assisted
living beds and 24 dementia assisted living beds for Phase I of the project. A possible Phase II
could include an additional 46 dementia assisted living beds.
We defined the primary market area based on resident origin data from The Villa at Suffield
Meadows, which is an assisted living facility located in Warrenton, VA. The data showed that
46% of the facilitys residents came from the following zip codes:
20137 Broad Run
20169 Haymarket
20187 Warrenton
20155 Gainesville
20186 Warrenton
We tested the market demand using $4,450 monthly rent for routine assisted living and $6,640
monthly rent for dementia assisted living based on another facility in the market area.
Mr. Neil Gumbin

June 11, 2015
Page 2
We use two projections to evaluate the market areas ability to support the project at stabilized
occupancy. The Market Penetration Rate helps to determine a markets depth and assess the degree
of difficulty for a single facility to achieve and maintain occupancy. We use 5% as the threshold
for Market Penetration Rates. Saturation occurs when the markets total capacity of units exceed
market demand. The Saturation Rate compares the markets total inventory of units to the qualified
market. We use Saturation Rates that are less than 25% for assisted living.
We use the following assumptions when projecting demand:
We assumed 93% stabilized occupancy for the project.
We assumed that 75% of the projects residents will come from the market area.
The market for people entering routine assisted living is limited to people ages 75 and
older.
The market for people entering Alzheimers disease/dementia assisted living is limited to
people ages 65 and older.
Income qualifications assume routine assisted living and Alzheimers disease/dementia
assisted living residents use 92% of available income and $20,000 of their assets annually
to help to pay for assisted living care.
The demand for routine assisted living uses age specific rates for people who require
assistance with activities of daily living reported in U.S. Census, Americans with
Disabilities, Household Economic Studies, July 2012.
Age
75-79
80 and Older
Routine AL Utilization
15.40%
30.20%
The incidence rate for dementia is from Alzheimer Disease in the United States using
2010 Census, published February 2013 by the American Academy of Neurology.
Age
65-74
75-84
85 and Older
Dementia AL Utilization
2.90%
17.30%
32.10%
Mr. Neil Gumbin

June 11, 2015
Page 3
The Market Penetration Rate for the projects 40 routine assisted living units calculates to 7.7% in
2015 and 5.2% in 2020. The Saturation Rate for the market area calculates to 27.0% in 2015 and
20.0% in 2020.
The Market Penetration Rate for the projects 24 dementia assisted living beds calculates to 3.0%
in 2015 and 2.2%. We project one property could support up to 56 dementia assisted living beds
using 2020 demographic data.
Following this letter are the following documents:
A map of the market area showing the locations of retirement facilities
A list of the retirement facilities in the market area with addresses and bed complements
Exhibits 1 through 8 showing the demand calculations
A Claritas Senior Life Report presenting 2015 and 2020 demographic projections for the
market area.
This report is intended for use in the planning of this project. Conclusions are based on a desk
review of published data. Site visits were not conducted. The report is based on estimates,
assumptions and other information available to us when we conducted the study or developed in
connection to the study. Sources of the information and the basis of the estimates and assumptions
are stated in the appropriate places within this report. However, some assumptions may not
materialize and unanticipated events and circumstances may occur. Therefore, actual results
achieved may vary from those reported. We have not evaluated the effectiveness of the projects
management and we are not responsible for future marketing efforts and other management actions
upon which results will depend.
If we can answer any questions, or if you require additional information please do not hesitate to
contact us at 410-998-9310. Thank you for this engagement.
Very truly yours,
Alice Katz
President
Produced by: The Vinca Group L.L.C.
Blue Circle-Independent Living
RETIREMENT FACILITIES
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
Purple Triangle-Assisted Living
6/9/2015
NAME
239 ALEXANDRIA PK
305 OAK SPRINGS DR
6735 SUFFIELD LN
13650 HEATHCOTE BLVD
ADDRESS
WARRENTON
WARRENTON
WARRENTON
GAINSVILLE
CITY
VA
VA
VA
VA
ST
20186
20186
20187
20155
ZIP
540-347-6000
540-349-9725
540-316-3800
703-468-1895
PHONE
FACILITY LIST
RETIREMENT FACILITIES
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
AMERISIST OF WARRENTON
THE OAKS
THE VILLA AT SUFFIELD MEADOWS
THE TRIBUTE AT HERRITAGE VILLAGE (Planned)
TOTAL
Source: The Vinca Group L.L.C. Analysis
BEDS
IL
AL ALZ SNF
0
41
0
0
111
0
0
0
0
60
12
0
0
60
30
0
111 161
42
0
Page 1 of 1
6/11/2015 - 12:07 PM
EXHIBIT 1
ROUTINE ASSISTED LIVING AND DEMENTIA ASSISTED LIVING
REQUIRED INCOME
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
2015 AND 2020 PROJECTED
$434,191
$334,327
$26,746
$307,581
$15,379
17.53%
$4,450
$53,400
$58,043
$10,175
$434,191
$334,327
$26,746
$307,581
$15,379
87.27%
$6,640
$79,680
$86,609
$15,379
$71,230
$62,162
12.73%
$6,640
$79,680
$86,609
$11,025
$434,191
$334,327
$26,746
$307,581
$15,379
2015
$73,187
$20,000
87.27%
$6,640
$79,680
$86,609
$15,379
$71,230
$62,162
12.73%
$6,640
$79,680
$86,609
$11,025
$434,191
$334,327
$26,746
$307,581
$15,379
2020
Dementia Assisted Living
17.53%
$4,450
$53,400
$58,043
$10,175
82.47%
$4,450
$53,400
$58,043
$15,379
$42,664
$35,185
$73,187
$20,000
$53,187
2020
REQUIRED INCOME
Renter Occupied Units:
Market area rent
Annualized
Available income used per year - 92% AL; 92% ALZ
Weighted average renter income
82.47%
$4,450
$53,400
$58,043
$15,379
$42,664
$35,185
$45,360
$20,000
$53,187
2015
Owner Occupied Units:

Market area base rent
Annualized
Available income used per year - 92% AL; 92% ALZ
Less: income from home sale
Net income qualification for owners
Weighted average owner income
$45,360
$20,000
$25,360
Routine Assisted Living
Weighted average required income

Less: Asset spend down
$25,360
HOUSING VALUE CALCULATION

Median housing value
Elderly Housing Valued at 77% of Median
Less: 8% transaction costs
Net Proceeds
Income invested at 5% per year
Net Income Qualification
6/11/2015 12:07 PM
EXHIBIT 2
ROUTINE ASSISTED LIVING
INCOME QUALIFIED MARKET
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
MONTHLY RENT
$4,450
2015
Age Cohorts
2020
75 - 84
85 +
75 - 84
85 +
Population
3,562
1,108
4,765
1,300
Total Households
2,049
547
2,628
633
Income Qualified Households
1,675
380
2,229
463
81.75%
69.47%
84.82%
73.14%
2,912
770
4,042
951
2,912
770
4,042
951
50.22%
50.22%
50.22%
50.22%
1,462
387
2,030
478
21.91%
30.20%
21.91%
30.20%
320
117
445
144
Percent Income Qualified Households

Income Qualified People
Less: CCRC IL Households
Net Income Qualified People
Single %
Income Qualified Singles
Needing Assistance %
Income Qualified Singles Needing Assistance
Total Assisted Living Income Qualified Singles
Adjustment for married/significant other
Total Assisted Living Income Qualified PMA Residents
437
589
72
97
509
686
Assumptions:
1. Monthly rent is
.
2. Potential assisted living residents are aged 75 years and older.
3. ASHA reports 16.5% of assisted living residents are married or have a significant other.
4. Utilization percentages are taken from the U.S. Census Bureau, Americans with Disabilities, Household Economic
Studies, July 2012. Ages 75-84 incidence rate is calculated weighted average using 2010 U.S. Census population.
6/11/2015 12:07 PM
EXHIBIT 3
MARKET PENETRATION RATE
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
MONTHLY RENT
$4,450
2015
Assisted Living Qualified PMA Residents

Competitor Licensed Beds PMA (Existing and Planned)
Occupancy @ 93%
Net Available AL Qualified PMA Residents
Subject Facility Licensed Beds
Subject Facility Licensed Beds @ 93% Occupancy
PMA Origin @ 75%
Market Penetration Rate Licensed Beds
Assisted Living Qualified PMA Residents
Competitor Operating Units PMA (Existing and Planned)
Occupancy @ 93%
Net Available PMA Residents
Subject Facility Operating Units
Subject Facility Operating Units @ 93% Occupancy
PMA Origin @ 75%
Market Penetration Rate Operating Units
2020
509
161
150
360
686
161
150
536
48
45
33
9.3%
48
45
33
6.2%
509
157
146
363
686
157
146
540
40
37
28
7.7%
40
37
28
5.2%
Assumptions:
1. The Market Penetration Rate is used to measure a market's depth and assess the difficulty in achieving
and maintaining stabilized occupancy. Penetration Rates under 5% are viewed favorably for assisted living.
The higher the Penetration Rate, the greater the potential level of risk.
2. Please refer to Exhibit 8 for a schedule of units in the market area.
6/11/2015 12:07 PM
EXHIBIT 4
SATURATION RATE
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
MONTHLY RENT
$4,450
2015
Total Assisted Living Qualified PMA Residents

Saturation Rate @ 25%
Market Area PMA Residents Seeking Assisted Living
2020
509
686
25%
25%
127
172
Total Licensed Assisted Living Beds Including Subject Facility
209
209
Assumed Occupancy @ 93%
93%
93%
Occupancy Adjusted Beds

PMA Origin @ 75%
Occupancy and PMA Adjusted Licensed Beds
194
194
75%
75%
146
146
Market Area Residents Using AL
127
172
Less: Occupancy and PMA Adjusted Licensed Beds
146
146
Net Need
-18
26
28.6%
21.2%
Saturation Rate Licensed Beds

2015 = 146 beds /
509
AL qualified PMA residents
2020 = 146 beds /
686
Total Operating Assisted Living Units Including Subject Facility
197
197
93%
93%
Occupancy Adjusted Units
183
183
PMA Origin @ 75%
75%
75%
Occupancy and PMA Origin Adjusted Operating Units
137
137
Market Area Residents Using AL
127
172
Less: Occupancy and PMA Origin Adjusted Operating Units
137
137
Net Need
-10
34
27.0%
20.0%
Saturation Rate Operating Units

2015 = 137 beds /
509
2020 = 137 beds /
686
Assumptions:
1. The Saturation Rate is used to compare the inventory of units (or capacity) in the market to the qualified market.
The Saturation Rate equals the total occupancy and PMA adjusted units including the proposed project divided by the
AL qualified market. Saturation Rates under 25% are viewed favorably for assisted living.
6/11/2015 12:07 PM
EXHIBIT 5
DEMENTIA ASSISTED LIVING
INCOME QUALIFIED MARKET
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
MONTHLY RENT
$6,640
2015
2020
Age 65-74
Income Qualified Households 65-74
3,557
4,665
68.04%
68.04%
Married Couples
2,420
3,174
Married Individuals
4,840
6,348
Single Individuals
1,137
1,491
Income Qualified Residents
5,977
7,839
2.90%
2.90%
173
227
1,206
1,660
Married Couples %
Incidence Factor
Dementia AL Income Qualified Ages 65-74
Age 75-84
Income Qualified Households 75-84
Less CCRC Households
Available Income Qualified Households
Married Couples %
Married Couples
Married Individuals
Single Individuals
Incidence Factor
Dementia AL Income Qualified Ages 75-84
1,206
1,660
49.78%
49.78%
600
826
1,201
1,653
606
834
1,806
2,486
17.30%
312
17.30%
430
243
301
Age 85+
Income Qualified Households 85+
Less CCRC Households
Available Income Qualified Households
Married Couples %
243
301
49.78%
49.78%
Married Couples
121
150
Married Individuals
242
300
Single Individuals
122
151
364
451
32.10%
32.10%
117
145
603
802
Incidence Factor
Dementia AL Income Qualified Ages 85+
Total Dementia Assisted Living
Income Qualified PMA Residents
Assumption:
1. The incidence rates are from Alzheimer Disease in the United States using 2010 Census,
published February 2013 by the American Academy of Neurology.
6/11/2015 12:07 PM
EXHIBIT 6
MARKET PENETRATION RATE
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
MONTHLY RENT
$6,640
2015
Dementia Assisted Living Qualified PMA Residents
2020
603
802
Competitor Licensed Beds PMA
42
42
Occupancy @ 93%
39
39
564
763
24
24
22
22
17
17
3.0%
2.2%
Net Available Dementia AL Qualified PMA Residents

Subject Facility Licensed Beds
Subject Facility Licensed Beds @ 93%
Occupancy
PMA Origin @ 75%

Market Penetration Rate Licensed Beds
Assumptions:
1. The Market Penetration Rate is used to measure a market's depth and assess the difficulty in achieving and
maintaining stabilized occupancy. Penetration Rates under 5% are viewed favorably for assisted living. The
higher the Penetration Rate, the greater the potential level of risk.
2. Please refer to Exhibit 8 for a schedule of units in the market area.
6/11/2015 12:07 PM
EXHIBIT 7
SATURATION RATE
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
MONTHLY RENT
$6,640
2015
2020
Total AL Dementia Qualified PMA Residents
603
802
Saturation Rate @ 25%
25%
25%
Market Area Residents Seeking AL Dementia Care
151
201
Licensed AL Dementia Beds Including Subject Facility

Occupancy Adjusted Beds
PMA Origin @75%
Occupancy and PMA Origin Adjusted Licensed Beds
Market Area Residents Seeking AL Dementia Care
Less: Occupancy and PMA Origin Adjusted Licensed Beds
Net Need
Saturation Rate Licensed Beds
2015 = 46
beds / 603 AL qualified PMA residents
2020 = 46
beds / 802 AL qualified PMA residents
66
66
93%
93%
61
61
75%
75%
46
46
151
201
46
46
105
155
7.6%
5.7%
Assumptions:
1. The Saturation Rate is used to compare the inventory of units (or capacity) in the market to the qualified market.
The Saturation Rate equals the total occupancy and PMA adjusted units including the proposed project divided by the
dementia AL qualified market. Saturation Rates under 25% are viewed favorably for dementia assisted living.
6/11/2015 12:07 PM
EXHIBIT 8
SCHEDULE OF UNITS
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
JUNE 2015
FACILITY
Existing
Ameristist of Warrenton
The Villa at Suffield Meadows
Existing Beds Subtotal
Proposed Facilities
The Tribute at Heritage Village
Proposed Facilities Subtotal
TOTAL LICENSED TOTAL OPERATING

UNITS
BEDS
Routine Dementia Routine Dementia
Assisted Assisted
Assisted Assisted
41
60
101
0
12
12
41
56
97
0
12
12
60
60
30
30
60
60
30
30
Subject Facility Beds Total
161
48
42
24
157
40
42
20
TOTAL
209
66
197
62
Existing and Proposed Total
6/11/2015 12:07 PM
Prepared on: Wed Jun 10, 2015

Project Code: #417 - Warrenton, VA
Prepared For: #417 - Warrenton, VA
Page 1 of
Area Map
Nielsen Solution Center 1 800 866 6511
Zip Code
See Appendix for Geographies
2015 The Nielsen Company. All rights reserved. 2006-2014 TomTom

Prepared By:
Senior Life 2015

Warrenton, VA - defined market area
Area ZIP Codes (see appendix for geographies), Total
Totals
Population
2020 Projection
2015 Estimate
2010 Census
2000 Census
102,609
92,925
81,019
40,072
Growth 2000 - 2010

Growth 2010 - 2015
Growth 2015 - 2020
102.18%
14.70%
10.42%
2010
Census
Population by Age
2015
Estimate
2020
Projection
Total Population
Age 45 - 54
Age 55 - 64
Age 65 - 74
Age 75 - 84
Age 85 and over
81,019
13,117
9,309
5,934
2,722
835
16.19%
11.49%
7.32%
3.36%
1.03%
92,925
15,000
11,421
8,394
3,562
1,108
16.14%
12.29%
9.03%
3.83%
1.19%
102,609
15,332
14,287
10,863
4,765
1,300
14.94%
13.92%
10.59%
4.64%
1.27%
Age 65 and over
9,491
11.71%
13,064
14.06%
16,928
16.50%
39,845
6,604
4,475
2,789
1,220
264
16.57%
11.23%
7.00%
3.06%
0.66%
45,686
7,452
5,502
3,966
1,603
390
16.31%
12.04%
8.68%
3.51%
0.85%
50,380
7,464
6,938
5,141
2,126
459
14.82%
13.77%
10.20%
4.22%
0.91%
Age 65 and over
4,273
10.72%
5,959
13.04%
7,726
15.34%
Total Population, Female

Age 45 - 54
Age 55 - 64
Age 65 - 74
Age 75 - 84
Age 85 and over
41,174
6,513
4,834
3,145
1,502
571
15.82%
11.74%
7.64%
3.65%
1.39%
47,239
7,548
5,919
4,428
1,959
718
15.98%
12.53%
9.37%
4.15%
1.52%
52,229
7,868
7,349
5,722
2,639
841
15.06%
14.07%
10.96%
5.05%
1.61%
Age 65 and over
5,218
12.67%
7,105
15.04%
9,202
17.62%
Total Population, Male

Age 45 - 54
Age 55 - 64
Age 65 - 74
Age 75 - 84
Age 85 and over
Prepared On: Wed Jun 10, 2015
Page
Of 7
Prepared By:
2015 The Nielsen Company. All rights reserved.
Senior Life 2015

2010
Census
Population by Single-Classification Race

White Alone
Age 65 and over
Black or African American Alone
Age 65 and over
American Indian and Alaska Native Alone
Age 65 and over
Asian Alone
Age 65 and over
Native Hawaiian and Other Pacific Islander Alone
Age 65 and over
Some Other Race Alone
Age 65 and over
Two or More Races
Age 65 and over
63,277
8,215
7,052
642
241
18
6,103
496
63
7
1,614
40
2,669
69
2010
Census
Population by Hispanic or Latino

Hispanic or Latino
Age 65 and over
Not Hispanic or Latino
5,862
217
75,157
2000
Census
Households by HH Income by Age of Householder

Householder Age 45 - 54
Income less than $15,000
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
Income $200,000 or more
3,577
104
109
159
280
761
721
607
373
286
177
$88,020
Page
Of 7
%
12.98%
9.10%
7.47%
8.13%
11.11%
2.48%
2.59%
%
3.70%
%
2.91%
3.05%
4.45%
7.83%
21.27%
20.16%
16.97%
10.43%
8.00%
4.95%
2015
Estimate
69,539
11,080
8,739
877
279
17
8,619
879
73
8
1,985
57
3,691
132
%
15.93%
10.04%
6.09%
10.20%
10.96%
2.87%
3.58%
2015
Estimate
7,505
343
85,420
4.57%
2015
Estimate
7,870
144
133
170
310
587
1,059
1,054
898
1,675
1,840
$138,307
%
1.83%
1.69%
2.16%
3.94%
7.46%
13.46%
13.39%
11.41%
21.28%
23.38%
Prepared By:
2020
Projection
73,606
13,997
10,413
1,189
304
29
11,110
1,351
87
14
2,345
118
4,744
215
2020
Projection
9,088
567
93,521
2020
Projection
7,963
112
98
123
253
465
900
980
831
1,715
2,486
$156,399
%
19.02%
11.42%
9.54%
12.16%
16.09%
5.03%
4.53%
%
6.24%
%
1.41%
1.23%
1.54%
3.18%
5.84%
11.30%
12.31%
10.44%
21.54%
31.22%
Senior Life 2015

2000
Census

Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
2,308
87
91
164
226
431
498
232
185
222
172
$82,781
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
Page
Of 7
2015
Estimate
3.77%
3.94%
7.11%
9.79%
18.67%
21.58%
10.05%
8.02%
9.62%
7.45%
6,138
181
165
177
293
501
860
762
649
1,201
1,349
$130,008
1,304
114
145
135
210
286
164
122
41
53
34
$54,196
8.74%
11.12%
10.35%
16.10%
21.93%
12.58%
9.36%
3.14%
4.06%
2.61%
681
135
90
87
116
108
69
23
14
28
11
$38,685
19.82%
13.22%
12.78%
17.03%
15.86%
10.13%
3.38%
2.06%
4.11%
1.62%
2020
Projection
2.95%
2.69%
2.88%
4.77%
8.16%
14.01%
12.41%
10.57%
19.57%
21.98%
7,512
173
155
159
295
507
907
870
759
1,501
2,186
$147,727
2.30%
2.06%
2.12%
3.93%
6.75%
12.07%
11.58%
10.10%
19.98%
29.10%
4,632
157
198
192
413
905
618
563
434
616
536
$93,244
3.39%
4.27%
4.15%
8.92%
19.54%
13.34%
12.15%
9.37%
13.30%
11.57%
5,838
170
196
215
466
992
717
710
564
852
956
$105,739
2.91%
3.36%
3.68%
7.98%
16.99%
12.28%
12.16%
9.66%
14.59%
16.38%
2,049
157
212
150
272
406
225
160
132
178
157
$64,378
7.66%
10.35%
7.32%
13.27%
19.81%
10.98%
7.81%
6.44%
8.69%
7.66%
2,628
169
223
191
324
482
284
220
182
258
295
$71,110
6.43%
8.49%
7.27%
12.33%
18.34%
10.81%
8.37%
6.93%
9.82%
11.23%
Prepared By:
Senior Life 2015

2000
Census

Householder Age 85 and over
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
171
47
27
23
23
22
13
4
3
8
1
$30,000
2000
Census
Households by Household Income

Total Households
Income Less than $15,000
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
Income $200,000 - $249,999
Income $250,000 - $499,999
14,266
705
704
943
1,610
3,329
2,649
1,838
942
943
313
216
74
%
27.49%
15.79%
13.45%
13.45%
12.87%
7.60%
2.34%
1.75%
4.68%
0.58%
%
4.94%
4.93%
6.61%
11.29%
23.34%
18.57%
12.88%
6.60%
6.61%
2.19%
1.51%
0.52%
2015
Estimate
547
87
78
47
81
90
48
44
31
23
18
$46,389
%
15.90%
14.26%
8.59%
14.81%
16.45%
8.78%
8.04%
5.67%
4.20%
3.29%
2015
Estimate
31,167
997
984
1,117
1,944
3,679
4,132
3,917
3,524
5,297
2,148
2,410
1,018
%
3.20%
3.16%
3.58%
6.24%
11.80%
13.26%
12.57%
11.31%
17.00%
6.89%
7.73%
3.27%
2020
Projection
633
88
80
58
93
100
60
59
35
31
29
$49,597
2020
Projection
34,140
953
921
1,063
1,966
3,573
4,012
4,045
3,680
5,878
3,304
3,186
1,559
Average Household Income
$87,474
$140,853
$155,377
$73,813
$117,427
$128,648
Page
Of 7
Prepared By:
%
13.90%
12.64%
9.16%
14.69%
15.80%
9.48%
9.32%
5.53%
4.90%
4.58%
%
2.79%
2.70%
3.11%
5.76%
10.47%
11.75%
11.85%
10.78%
17.22%
9.68%
9.33%
4.57%
Senior Life 2015

2000
Census
Owner-Occupied Housing Units by Value

Total Owner-Occupied Housing Units
Value Less than $20,000
Value $20,000 - $39,999
Value $40,000 - $59,999
Value $60,000 - $79,999
Value $80,000 - $99,999
Value $100,000 - $149,999
Value $150,000 - $199,999
Value $200,000 - $299,999
Value $300,000 - $399,999
Value $400,000 - $499,999
Value $500,000 - $749,999
Value $750,000 - $999,999
Value $1,000,000 or more
11,840
150
35
56
197
552
2,108
3,309
3,262
1,095
673
280
78
45
Median All Owner-Occupied Housing Unit Value
%
1.27%
0.30%
0.47%
1.66%
4.66%
17.80%
27.95%
27.55%
9.25%
5.68%
2.36%
0.66%
0.38%
$192,641
2010
Census
Group Quarters by Population Type

Group Quarters Population
Correctional Institutions
Nursing Homes
Other Institutions
College Dormitories
Military Quarters
Other Noninstitutional Quarters
464
96
337
0
0
0
31
Owner-Occupied
Renter-Occupied
%
20.69%
72.63%
0.00%
0.00%
0.00%
6.68%
23,437
4,483
Page
Of 7
26,264
79
129
73
45
14
243
752
3,926
5,984
5,519
6,382
2,414
704
%
0.30%
0.49%
0.28%
0.17%
0.05%
0.93%
2.86%
14.95%
22.78%
21.01%
24.30%
9.19%
2.68%
$434,191
2010
Census
Occupied Housing Units by Tenure
2015
Estimate
28,830
72
119
96
31
16
197
593
3,402
5,643
5,597
7,833
3,792
1,439
%
0.25%
0.41%
0.33%
0.11%
0.06%
0.68%
2.06%
11.80%
19.57%
19.41%
27.17%
13.15%
4.99%
$475,862
2015
Estimate
466
96
339
0
0
0
31
2020
Projection
%
20.60%
72.75%
0.00%
0.00%
0.00%
6.65%
2015
Estimate
26,264
4,903
Prepared By:
2020
Projection
470
96
342
0
0
0
32
2020
Projection
28,830
5,310
%
20.43%
72.77%
0.00%
0.00%
0.00%
6.81%
Senior Life 2015

Totals
Households by Tenure by Age of Householder

Total Households
Owner-Occupied
Householder 55 to 64 Years
Householder 85 and over
27,920
23,437
4,612
3,089
1,406
302
Renter-Occupied
Householder 85 and over
4,483
559
338
239
109
19.68%
13.18%
6.00%
1.29%
31,167
26,264
5,481
4,167
1,759
382
12.47%
7.54%
5.33%
2.43%
4,903
657
465
290
165
20.87%
15.87%
6.70%
1.45%
34,140
28,830
6,711
5,258
2,273
452
23.28%
18.24%
7.88%
1.57%
13.40%
9.48%
5.91%
3.37%
5,310
801
580
355
181
15.08%
10.92%
6.69%
3.41%
Some median values are assigned pre-determined amounts rather than calculated amounts. Med HH Inc by Age values more than
$200,000 are displayed as $200,001. Med HH Inc values less than $15,000 are displayed as $14,999. Med HH Inc values more than
$500,000 are displayed as $500,001. Med Housing Values more than $1,000,000 are displayed as $1,000,001.
Page
Of 7
Prepared By:
Senior Life 2015

Appendix: Area Listing

Area Name:
Type: List - Area ZIP Codes
Reporting Detail: Aggregate
Reporting Level: Area ZIP Codes
Geography Code
Geography Name
Geography Code
Geography Name
20137
Broad Run
20155
Gainesville
20169
Haymarket
20186
Warrenton
20187
Warrenton
Project Information:
Site:
Order Number: 975036043
Page
Of 7
Prepared By:

SUP 15-01 Staff Report With Attachments - Updated 6-12-2015

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

SUP 15-01 Staff Report With Attachments - Updated 6-12-2015

Uploaded by

Copyright:

Available Formats

A Community Health Needs Assessment

Prepared for Fauquier Health and Fauquier Health Foundation

Part I. Community Interview Results

Part II. Community Survey Results

2. Community Health Concerns

3. Community Service Gaps

4. Vulnerable/At-Risk Populations in the Community

5. Vulnerable/At-Risk Regions in the Community

6. Additional Ideas and Suggestions

Part III. Community Indicators

1. Health Demographic Trend Profile

2. Health Demographic Snapshot Profile

4. Maternal and Infant Health Profile

5. Preventable Hospitalization Discharge Profile

6. Behavioral Health Hospitalization Discharge Profile

7. Adult Health Risk Factor Profile

8. Youth Health Risk Factor Profile

10. Medically Underserved Profile

Appendix A. Zip Code-Level Maps

Appendix B. Community Interview Guide and List of Participants

Appendix C. Community Survey: Additional Ideas and Suggestions for Improving

Appendix D. Defining a Healthy Community

Appendix E. Data Sources

Part I. Community Interviews

Vulnerable or At-Risk Populations. The respondents reported a number of vulnerable/at-risk populations

Vulnerable or At-Risk Regions. The respondents reported a number of vulnerable/at-risk neighborhoods

Part III. Community Indicators

Community Health Needs Assessment

Community Health Needs Assessment

Part I. Community Interview Results

Part I. Community Interviews

Community Health Needs Assessment

Part I. Community Interview Results

Community efforts enforce physical and mental health.

Community members are engaged in improving health.

Health promotion activities are present.

It's easy for people to make good and healthy choices.

People are empowered to make choices to have a healthy lifestyle.

People are physically active and exercise.

People eat nutritionally sound diets.

People have access to good care (hospitals, mental health, dental).

People have access to transportation.

People have an expectation of health in the community.

People receive education regarding available services.

People's basic needs are met.

Services are available for everyone, regardless of risk or need.

The environment is healthy.

There are adequate resources available across the age span.

There is a plan for an active community.

There is an awareness of resources and needs of the population.

There is intellectual stimulation for both children and adults.

Children who lack medicines

Children with undiagnosed mental health issues

Employees with absenteeism issues

Employees with exhaustion due to outside responsibilities or activities

Geographically isolated persons

Issues related to the role of businesses providing health insurance

Lack of mental and physical breaks

Long commutes lead to sedentary lifestyles and contribute to poor nutrition.

Older adults with disabilities

People functioning outside the mainstream of communications

People in need of dental care, especially children and low-income families

People with mental health issues (e.g. depression, anxiety, suicide)

People who are non-native English speakers