Doctor's Preparation PDF

Doctor's Preparation / Fatoom Abdullah Awad Page 0 of 41  COMMUNITY HEALTH: YESTERDAY, TODAY,AND TOMORROW Objectives:- Definitions. Factors That Affect the Health of a Community. A Brief History of Community and Pu...

Doctor's Preparation / Fatoom Abdullah Awad Page 0 of 41  COMMUNITY HEALTH: YESTERDAY, TODAY,AND TOMORROW Objectives:- Definitions. Factors That Affect the Health of a Community. A Brief History of Community and Public Health. Heath “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.” Community a community has been thought of as a geographic area with specific boundaries for example, a neighborhood, city, county, or state. However, in the context of community health, a community is “a group of people who have common characteristics; communities can be defined by location, race, ethnicity, age, occupation, interest in particular problems or outcomes, or common bonds. “The following elements characterize communities: membership a sense of identity and belonging; common symbol systems similar language, rituals, and ceremonies; shared values and norms; mutual influence community members have influence and are influenced by each other; shared needs and commitment to meet them, and shared emotional connection members share a common history, experiences, and mutual support. Population Health The term population health, which is similar to community health, has emerged in recent years. The primary difference between these two terms is the degree of organization or identity of the people. Population health refers to the health status of people who are not organized and Page 1 of 41 have no identity as a group or locality and the actions and conditions to promote, protect, and preserve their health. Men under fifty, adolescents, prisoners, and white collar workers are all examples of populations. Public health refers to the health status of a defined group of people and the governmental actions and conditions to promote, protect, and preserve their health. Community Health Versus Personal Health To further clarify the definitions presented in this chapter, it is important to distinguish between the terms personal health and community health activities. Personal Health Activities Personal health activities are individual actions and decision making that affect the health of an individual or his or her immediate family members. These activities may be preventive or curative in nature but seldom directly affect the behavior of others. Choosing to eat wisely, to regularly wear a safety belt, and to visit the physician are all examples of personal health activities. Community Health Activities Community health activities are activities that are aimed at protecting or improving the health of a population or community. Factors That Affect the Health of a Community There are a great many factors that affect the health of a community. As a result, the health status of each community is different. These factors may be physical, social, and/or cultural. They also include the ability of the community to Page 2 of 41 organize and work together as a whole as well as the individual behaviors of those in the community. Physical Factors Physical factors include the influences of geography, the environment, community size, and industrial development. 1- Environment The quality of our environment is directly related to the quality of our stewardship over it. Many experts believe that if we continue to allow uncontrolled population growth and continue to deplete nonrenewable natural resources, succeeding generations will inhabit communities that are less desirable than ours. Many feel that we must accept responsibility for this stewardship and drastically reduce the rate at which we foul the soil, water, and air. 2- Community Size The larger the community, the greater its range of health problems and the greater its number of health resources. For example, larger communities have more health professionals and better health facilities than smaller communities. These resources are often needed because communicable diseases can spread more quickly and environmental problems are often more severe in densely populated areas. For example, the amount of trash generated by the approximately 8 million people in New York City is many times greater than that generated by the entire state of Wyoming, with its population of about 501,000. 3- Industrial Development Industrial development, like size, can have either positive or negative effects on the health status of a community. Industrial development provides a community with added resources for Page 3 of 41 community health programs, but it may bring with it environmental pollution and occupational illnesses. Communities that experience rapid industrial development must eventually regulate the way in which industries obtain raw materials, discharge by-products, dispose of wastes, treat and protect their employees, and clean up environmental accidents. Unfortunately, many of these laws are usually passed only after these communities have suffered significant reductions in the quality of their life and health. Social and Cultural Factors Social factors are those that arise from the interaction of individuals or groups within the community. for example, people who live in urban communities, where life is fast-paced, experience higher rates of stress-related illnesses than those who live in rural communities, where life is more leisurely. On the other hand, those in rural areas may not have access to the same quality or selection of health care (i.e., providers, hospitals, or medical specialists) that is available to those who live in urban communities. Cultural factors arise from guidelines (both explicit and implicit) that individuals “inherit” ‫تنشأ العوامل الثقافية من المبادئ التوجيهية (الصريحة والضمنية) التي «يرثها» األفراد‬ 1-Beliefs, Traditions, and Prejudices The beliefs, traditions, and prejudices of community members can affect the health of the community. The beliefs of those in a community about such specific health behaviors as exercise and smoking can influence policy makers on whether or not they will spend money on bike trails and no-smoking ordinances. 2-Economy Both national and local economies can affect the health of a community through reductions in health and social services. An economic downturn means lower tax revenues (fewer tax dollars) and fewer contributions to charitable groups. 3-Politics Page 4 of 41 Those who happen to be in political office, either nationally or locally, can improve or jeopardize the health of their community by the decisions they make. In the most general terms, the argument is over greater or lesser governmental participation in health issues. For example, there has been a long-standing discussion in the united States on the extent to which the government should involve itself in health care. 4-Religion A number of religions have taken a position on health care. For example, some religious communities limit the type of medical treatment their members may receive. Some do not permit immunizations; others do not permit their members to be treated by physicians. Still others prohibit certain foods. 5-Social Norms The influence of social norms can be positive or negative and can change over time. Cigarette smoking is a good example. 6-Socioeconomic Status (SES) “In both the United States and Western Europe, the gap in health status and mortality between those commanding, and those who lack, economic power and social resources continues to widen. Community Organizing The way in which a community is able to organize its resources directly influences its ability to intervene and solve problems, including health problems. Community organizing a process through which communities are helped to identify common problems or goals, mobilize resources, and in other ways develop and implement strategies for reaching their goals they have collectively set. Individual Behavior The behavior of the individual community members contributes to the health of the entire community. It takes the concerted effort of many—if not most—of the individuals in a community to make a program work. Page 5 of 41 A BRIEF HISTORY OF COMMUNITY AND PUBLIC HEALTH The history of community and public health is almost as long as the history of civilization. This brief summary provides an account of some of the accomplishments and failures in community and public health. ‫ يقدم هذا الملخص الموجز سردا ً لبعض‬.‫تاريخ المجتمع والصحة العامة يكاد يكون طويالً مثل تاريخ الحضارة‬.‫اإلنجازات واإلخفاقات في المجتمع والجمهورالصحة‬ Earliest Civilizations In all likelihood, the earliest community health practices went unrecorded. Perhaps these practices involved taboos against defecation within the tribal communal area or near the source of drinking water. ‫أقدم الحضارات‬ ‫ ربما تضمنت هذه الممارسات محرمات ضد‬.‫ لم يتم تسجيل أقدم الممارسات الصحية المجتمعية‬،‫في جميع االحتماالت‬ ‫ التغوط داخل المنطقة المجتمعية القبلية أو بالقرب من مصدر الشرب‬.‫الماء‬ Ancient Societies (Before 500 B.C.) Excavations at sites of some of the earliest known civilizations have uncovered evidence of Community health activities. )‫ قبل الميالد‬500 ‫المجتمعات القديمة (قبل‬ ‫كشفت الحفريات في مواقع بعض أقدم الحضارات المعروفة عن أدلة على األنشطة الصحية المجتمعية‬. Classical Cultures (500 B.C.– A.D. 500) Page 6 of 41  During the thirteenth and twelfth centuries B.C., the Greeks began to travel to Egypt and continued to do so over the next several centuries. Knowledge from the Babylonians, Egyptians, Hebrews, and other peoples of the eastern Mediterranean was included in the Greeks’ philosophy of health and medicine.15 During the “Golden Age” of ancient Greece (in the sixth and fifth centuries B.C.), men participated in physical games of strength and skill and swam in public facilities. )‫ م‬500 - ‫ ق م‬500( ‫الثقافات الكالسيكية‬ ‫ بدأ اليونانيون في السفر إلى مصر واستمروا في ذلك خالل‬،‫خالل القرنين الثالث عشر والثاني عشر قبل الميالد‬ ‫ المعرفة من البابليين والمصريين والعبريين‬.‫وخالل «العصر الذهبي» لليونان القديمة (في القرون العديدة التالية‬.‫ شارك الرجال في ألعاب القوة والمهارة البدنية وسبحوا في المرافق العامة‬،)‫القرنين السادس والخامس قبل الميالد‬ Middle Ages (A.D. 500–1500) The period from the end of the Roman Empire in the West to about 1500 has become known as the Middle Ages. The Eastern Roman Empire (the Byzantine Empire), with its capital in Constantinople continued until 1453. While the Greco-Roman legacy of society was largely preserved in the Eastern Roman Empire, it was lost to most of western Europe. Most of what knowledge remained was preserved only in the churches and monasteries. The medieval approach to health and disease differed greatly from that of the Roman Empire. )‫ م‬1500-500( ‫العصور الوسطى‬.‫ معروفة مثل العصور الوسطى‬1500 ‫أصبحت الفترة من نهاية اإلمبراطورية الرومانية في الغرب إلى حوالي‬.1453 ‫ استمرت حتى عام‬،‫اإلمبراطورية الرومانية الشرقية (اإلمبراطورية البيزنطية) وعاصمتها في القسطنطينية‬ ‫ فقدت لمعظم‬،‫بينما كان اإلرث اليوناني الروماني للمجتمع إلى حد كبيرمحفوظة في اإلمبراطورية الرومانية الشرقية‬ Page 7 of 41 ‫ اختلف نهج العصور الوسطى للصحة‬.‫ تم الحفاظ على معظم المعرفة المتبقية فقط في الكنائس واألديرة‬.‫أوروبا الغربية‬ ً ‫والمرض اختالفًا‬.‫كبيرا عن نهج اإلمبراطورية الرومانية‬ Renaissance and Exploration (1500–1700) The Renaissance period was characterized by a rebirth of thinking about the nature of the world and of humankind. There was an expansion of trade between cities and nations and an increase in population concentrations in large cities. This period was also characterized by exploration and discovery. The travels of Columbus, Magellan, and many other explorers eventually ushered in a period of colonialism. The effects of the Renaissance on community health were substantial. A more careful accounting of disease outbreaks during this period revealed that diseases such as the plague killed saints and sinners alike. There was a growing belief that diseases were caused by environmental, not spiritual, factors. (1500-1700)‫النهضة واالستكشاف‬ ‫ كان هناك توسع في التجارة بين المدن‬.‫تميزت فترة عصر النهضة بوالدة جديدة للتفكير في طبيعة العالم والبشرية‬ ‫ أسفرت‬.‫ضا باالستكشاف واالكتشاف‬ ً ‫ تميزت هذه الفترة أي‬.‫والدول وزيادة في التجمعات السكانية في المدن الكبيرة‬ ‫ كانت آثار‬.‫رحالت كولومبوس وماجالن والعديد من المستكشفين اآلخرين في نهاية المطاف عن فترة من االستعمار‬ ‫ضا مثل‬ ً ‫ كشف سرد أكثر دقة لتفشي األمراض خالل هذه الفترة أن أمرا‬.‫عصر النهضة على صحة المجتمع كبيرة‬ ‫ كان هناك اعتقاد متزايد بأن األمراض ناجمة عن عوامل بيئية‬.‫الطاعون قتلت القديسين والخطاة على حد سواء‬.‫وليست روحية‬ The Eighteenth Century The eighteenth century was characterized by industrial growth. In spite of the beginnings of recognition of the nature of disease, living conditions were hardly conducive to good health. Page 8 of 41  Cities were overcrowded, and water supplies were inadequate and often unsanitary. Streets were usually unpaved, filthy, and heaped with trash and garbage. Many homes had unsanitary dirt floors. ‫القرن الثامن عشر‬ ‫ ال تكاد الظروف‬،‫ على الرغم من بدايات واالعتراف بطبيعة المرض‬.‫اتسم القرن الثامن عشر بالنمو الصناعي‬.‫ وكانت إمدادات المياه غير كافية وغالبًا ما كانت غير صحية‬،‫كانت المدن مكتظة‬.‫المعيشية تفضي إلى صحة جيدة‬.‫ العديد من المنازل بها أرضيات ترابية غير صحية‬.‫كانت الشوارع عادة غير معبدة وقذرة ومليئة بالقمامة والقمامة‬ The Nineteenth Century During the first half of the nineteenth century, few remarkable advancements in public health occurred. Living conditions in Europe and England remained unsanitary, and industrialization led to an even greater concentration of the population within cities. ‫لقرن التاسع عشر‬ ‫ ظلت الظروف المعيشية‬.‫ حدث القليل من التقدم الملحوظ في الصحة العامة‬،‫خالل النصف األول من القرن التاسع عشر‬.‫ وأدى التصنيع إلى تركيز أكبر للسكان داخل المدن‬،‫في أوروبا وإنجلترا غير صحية‬ modern era of public health. Real progress in the understanding of the causes of many communicable diseases occurred during the last quarter of the nineteenth century. One of the obstacles to progress was the theory of spontaneous generation, the idea that living organisms could arise from inorganic or nonliving matter. Akin to this idea was the thought that one type of contagious microbe could change into another type of organism. ‫العصر الحديث للصحة العامة‬. Page 9 of 41  ‫وحدث تقدم حقيقي في فهم أسباب العديد من األمراض المعدية خالل الربع األخير من القرن التاسع‬ ‫ وهي فكرة أن الكائنات الحية يمكن أن‬،‫ كانت إحدى العقبات أمام التقدم هي نظرية الجيل التلقائي‬.‫عشر‬ ‫عا من‬ ً ‫ كان هناك اعتقاد بأن نو‬،‫ على غرار هذه الفكرة‬.‫تنشأ من مادة غير عضوية أو غير حية‬ ‫الميكروب المعدي يمكن أن يتغير إلى نوع آخر من الكائنات الحية‬. bacteriological period of public health. Although most scientific discoveries in the late nineteenth century were made in Europe, Significant public health achievements occurred in America as well. the first law prohibiting the adulteration of milk was passed in 1856, the first sanitary survey was carried out in New York City in 1864, and the American Public Health Association was founded in 1872..‫لفترة البكتريولوجية للصحة العامة‬ ‫ إال أن‬،‫على الرغم من أن معظم االكتشافات العلمية في أواخر القرن التاسع عشر قد تحققت في أوروبا‬ ‫ صدر أول قانون يحظر غش الحليب في‬.‫ضا‬ ً ‫إنجازات كبيرة في مجال الصحة العامة حدثت في أمريكا أي‬ ‫ وتأسست جمعية الصحة‬،1864 ‫ وتم إجراء أول مسح صحي في مدينة نيويورك في عام‬،1856 ‫عام‬.1872 ‫العامة األمريكية في عام‬ The Twentieth Century As the twentieth century began, life expectancy was still less than 50 years. The leading causes of death were communicable diseases influenza, pneumonia, tuberculosis, and the modern era of public health that began in 1850 and continues today a bacteriological period of public health the period of 1875-1900, during which the causes of many bacterial diseases were Discovered in London, England, in 1849, John Snow interrupted a cholera epidemic by removing the handle from this pump, located on Broad Page 10 of 41  Street. infections of the gastrointestinal tract. Other communicable diseases, such as typhoid fever, malaria, and diphtheria, also killed many people. ‫القرن العشرين‬ ‫ كانت األسباب الرئيسية للوفاة‬.‫ عاما‬50 ‫ كان العمر المتوقع ال يزال أقل من‬،‫ومع بداية القرن العشرين‬ ‫ والعصر الحديث للصحة العامة‬.‫ اإلنفلونزا وااللتهاب الرئوي والسل والدرن‬- ‫هي األمراض المعدية‬ ‫ تم‬،1900-1875 ‫ وال يزال اليوم فترة بكتريولوجية للصحة العامة في الفترة‬1850 ‫الذي بدأ في عام‬ ‫ قاطع جون‬،1849 ‫ في عام‬،‫ إنجلترا‬،‫خاللها اكتشاف أسباب العديد من األمراض البكتيرية في لندن‬.‫ التهابات الجهاز الهضمي‬.‫سنو وباء الكوليرا بإزالة المقبض من هذه المضخة الواقعة في شارع برود‬ ‫ في مقتل العديد من‬،‫ مثل حمى التيفود والمالريا والدفتيريا‬،‫كما تسببت أمراض معدية أخرى‬.‫األشخاص‬ Health Resources Development Period (1900–1960) Much growth and development took place during the 60-year period from 1900 to 1960. Because of the growth of healthcare facilities and providers, this period of time is referred to as the health resources development period. (1900-1960)‫فترة تنمية الموارد الصحية‬ ‫ ألن نمو‬.1960 ‫ إلى‬1900 ‫وحدث قدر كبير من النمو والتطور خالل فترة الستين عاما الممتدة من‬.‫ يشار إلى هذه الفترة الزمنية باسم فترة تنمية الموارد الصحية‬،‫مرافق ومقدمي الرعاية الصحية‬ The Reform Phase (1900–1920) By the beginning of the twentieth century, there was a growing concern about the many social problems in America. the remarkable discoveries in microbiology made in the previous years had not dramatically improved the health of the average citizen. By 1910, the urban population had grown to 45% of the total population (up from 19% in 1860). Much of the growth was Page 11 of 41  the result of immigrants who came to America for the jobs created by new industries. Northern cities were also swelling from the northward migration of black Americans from the southern states. Many of these workers had to accept poorly paying jobs involving hard labor and low wages. There was also a deepening chasm between the upper and lower classes and social critics began to clamor for reform. (1900-1920)‫مرحلة اإلصالح‬.‫ كان هناك قلق متزايد بشأن العديد من المشاكل االجتماعية في أمريكا‬،‫بحلول بداية القرن العشرين‬ ‫االكتشافات الرائعة في علم األحياء الدقيقة التي تحققت في السنوات السابقة لم تحسن صحة المواطن‬ ‫عا‬ ً ‫ من إجمالي السكان (ارتفا‬٪45 ‫ نما عدد سكان الحضر إلى‬،1910 ‫ بحلول عام‬.‫العادي بشكل كبير‬ ‫ كان الكثير من النمو نتيجة للمهاجرين الذين جاءوا إلى أمريكا من أجل‬.)1860 ‫ في عام‬٪19 ‫من‬ ‫ضا من الهجرة الشمالية‬ ً ‫ كانت المدن الشمالية تتضخم أي‬.‫الوظائف التي خلقتها الصناعات الجديدة‬ ‫ كان على العديد من هؤالء العمال قبول وظائف ضعيفة األجر‬.‫لألمريكيين السود من الواليات الجنوبية‬ ‫ضا هوة عميقة بين الجزء العلوي‬ ً ‫ كان هناك أي‬.‫تشمل األشغال الشاقة واألجور المنخفضة‬.‫وبدأت الطبقات الدنيا والنقاد االجتماعيون يطالبون باإلصالح‬ Period of Social Engineering (1960–1973) The 1960s marked the beginning of a period when the federal government once again became active in health matters. The primary reason for this involvement was the growing realization that many Americans were still not reaping any of the benefits of 60 years of medical advances. These Americans, most of whom were poor or elderly, either lived in underserved areas or simply could not afford to purchase medical services. (1960-1973)‫فترة الهندسة االجتماعية‬ Page 12 of 41 ‫ كان‬.‫كانت الستينيات بداية فترة أصبحت فيها الحكومة الفيدرالية نشطة مرة أخرى في الشؤون الصحية‬ ‫السبب الرئيسي لهذه المشاركة هو اإلدراك المتزايد بأن العديد من األمريكيين ما زالوا ال يجنون أيًا من‬ ‫ إما يعيشون‬،‫ ومعظمهم من الفقراء أو كبار السن‬،‫ هؤالء األمريكيون‬.‫ عا ًما من التقدم الطبي‬60 ‫فوائد‬.‫في مناطق تعاني من نقص الخدمات أو ببساطة ال يستطيعون شراء الخدمات الطبية‬ Period of Health Promotion (1974– present) By the mid-1970s, it had become apparent that the greatest potential for saving lives and reducing health care costs in America was to be achieved through means other than healthcare. )‫ حتى اآلن‬1974( ‫فترة تعزيز الصحة‬ ‫ أصبح من الواضح أن أكبر إمكانات إنقاذ األرواح و‬،‫بحلول منتصف السبعينيات‬ ‫كان من المقرر تحقيق خفض تكاليف الرعاية الصحية في أمريكا من خالل وسائل أخرى غير الرعاية‬ ‫الصحية‬. Community Health in the Early 2000s Early in the new millennium, it is widely agreed that while decisions about health are an individual’s responsibility to a significant degree, society has an obligation to provide an environment in which the achievement of good health is possible and encouraged. Furthermore ,many recognize that certain segments of our population whose disease and death rates exceed the general population may require additional resources, including education, in order to achieve good health. ‫صحة المجتمع في أوائل العقد األول من القرن الحادي والعشرين‬ Page 13 of 41  ‫ من المتفق عليه على نطاق واسع أنه في حين أن القرارات المتعلقة بالصحة‬،‫وفي أوائل األلفية الجديدة‬ ‫ فإن المجتمع ملزم بتوفير بيئة يمكن فيها تحقيق الصحة الجيدة‬،‫هي مسؤولية الفرد إلى حد كبير‬ ‫ يعترف الكثيرون بأن شرائح معينة من سكاننا تدرك معدالت مرضهم‬،‫ عالوة على ذلك‬.‫وتشجيعها‬ ‫ من أجل لتحقيق صحة‬،‫ بما في ذلك التعليم‬،‫ووفاتهم أكثر من عامة السكان قد تحتاج إلى موارد إضافية‬.‫جيدة‬ Health Care Delivery Arguably, healthcare delivery continues to be the single greatest community health challenge in the United States. The exorbitant cost of health care is impacting the entire economy in America. Even though the annual growth rate in national health expenditure slowed during the late 1990s due primarily to the advent of managed care, the United States continues to spend more money on health care than any other industrialized country. In 2002, healthcare expenditures made up about 14.9% of America’s gross domestic product, up from 10.2% in 1985. Also in 2002, national healthcare expenditures totaled $1.553 trillion, an average of more than $5,540 per person.28 If left unchecked, it is estimated that the cost of health care will continue to rise faster than the rate of inflation. It was estimated that total healthcare expenditures would reach $1.9 trillion in 2005 and $2.7 trillion by 2010. ‫قديم الرعاية الصحية‬ ‫ تؤثر‬.‫يمكن القول إن تقديم الرعاية الصحية ال يزال يمثل أكبر تحد صحي للمجتمع في الواليات المتحدة‬ ‫ على الرغم من تباطؤ معدل النمو‬.‫التكلفة الباهظة للرعاية الصحية على االقتصاد بأكمله في أمريكا‬ ‫السنوي في اإلنفاق الصحي الوطني خالل في أواخر التسعينيات بسبب ظهور الرعاية المدارة في المقام‬ ‫ في‬.‫ تواصل الواليات المتحدة إنفاق أموال على الرعاية الصحية أكثر من أي بلد صناعي آخر‬،‫األول‬ Page 14 of 41  ‫عام ‪ ،2002‬الرعاية الصحية شكلت النفقات حوالي ‪ ٪14.9‬من الناتج المحلي اإلجمالي ألمريكا‪،‬‬ ‫ضا‪ ،‬بلغ إجمالي نفقات الرعاية الصحية الوطنية‬ ‫عا من ‪ ٪10.2‬في ‪ 1985.‬في عام ‪ 2002‬أي ً‬ ‫ارتفا ً‬ ‫‪ 1.553‬تريليون دوالر‪ ،‬بمتوسط قدره‬ ‫‪Environmental Problems‬‬ ‫‪Millions of Americans live in communities where the air is unsafe to breathe,‬‬ ‫‪the water is unsafe to drink, or solid waste is disposed of improperly. With a‬‬ ‫‪few minor exceptions, the rate at which we pollute our environment continues‬‬ ‫‪to increase.‬‬ ‫أكثر من ‪ 5 540‬دوالرا للشخص الواحد‪(28).‬‬ ‫سيستمر في االرتفاع بوتيرة أسرع من معدل التضخم‪.‬تشير التقديرات إلى أن إجمالي الرعاية الصحية‬ ‫وستصل النفقات إلى ‪ 1.9‬تريليون دوالر في عام ‪ 2005‬و ‪ 2.7‬تريليون دوالر بحلول عام ‪.2010‬‬ ‫‪Lifestyle Diseases‬‬ ‫‪The leading causes of death in the United States today are not the‬‬ ‫‪communicable diseases that were so feared 100 years ago but chronic illnesses‬‬ ‫‪resulting from unwise lifestyle choices. “The prevalence of obesity and‬‬ ‫"‪diseases like diabetes are increasing.‬‬ ‫لمشاكل البيئية‬ ‫يعيش ماليين األمريكيين في مجتمعات يكون فيها الهواء غير آمن للتنفس‪ ،‬والماء هوغير آمن للشرب‪،‬‬ ‫أو يتم التخلص من النفايات الصلبة بشكل غير صحيح‪.‬مع بعض االستثناءات الطفيفة‪ ،‬المعدل حيث‬ ‫نستمر في تلويث بيئتنا‪.‬‬ ‫‪Page 15 of 41‬‬  Communicable Diseases While communicable (infectious) diseases no longer constitute the leading causes of death in the United States, they remain a concern for several reasons. First, they are the primary reason for days missed at school or at work. The success in reducing the life- threatening nature of these diseases has made many Americans complacent about obtaining vaccinations or taking other precautions against contracting these diseases. Except for smallpox, none of these diseases has been eradicated when several should have been, such as measles. Second, as new communicable diseases continue to appear, old ones re-emerge, sometimes in drug-resistant forms like tuberculosis, demonstrating that communicable diseases still represent a serious community health problem in America. Legionnaires’ disease, toxic shock syndrome, Lyme disease, acquired immunodeficiency syndrome (AIDS), and severe acute respiratory syndrome (SARS) are diseases that were unknown only 30 years ago. Page 16 of 41 promoting health infrastructure as a front-line defense against bioterrorism..‫تعزيز البنية التحتية الصحية كخط دفاع أمامي ضد اإلرهاب البيولوجي‬ public health infrastructure was not where it should be to handle large-scale emergencies, as well as several more common public health concerns. The public health infrastructure has suffered from political neglect and the pressure of political agendas and public opinion that frequently override empirical evidence. Under the glare of a national crisis, policymakers and the public became aware of vulnerable and outdated health information systems and technologies, an insufficient and inadequately trained public health workforce, antiquated laboratory capacity, a lack of real-time surveillance and epidemiological systems, ineffective and fragmented communications networks, incomplete domestic preparedness and emergency response capabilities, and communities without access to essential public health services. Many efforts, including the creation of the Department of Homeland Security and special. World Planning for the Twenty-First Century World health leaders recognized the need to plan for the twenty-first century at the thirtieth World Health Assembly of the World Health Organization (WHO), held in 1977. At that assembly, delegations from governments around the world set as a target “that the level of health to be attained by the turn of the century should be that which will permit all people to lead a socially and economically productive life. Page 17 of 41 The challenges46 of the twenty-first century that need to be addressed in order to improve the world’s health include: 1. Greatly reducing the burden of excess mortality and morbidity suffered by the poor. 2. Countering the potential threats to health resulting from economic crises, unhealthy environments, or risky behaviors. Stable economic growth throughout the world,environments with clean air and water, adequate sanitation, healthy diets, safer transportation, and reductions in risky behaviors, such as tobacco use. 3. Developing more effective health systems. The goals of these systems should be to improve health status, reduce health inequalities, enhance responsiveness to legitimate expectations, increase efficiency, protect people from financial loss, and enhance fairness in the financing and delivery of health care. 4. Investing in the expanding knowledge base. The increased knowledge base of the twentieth century did much to improve health. Page 18 of 41 Nutrition for Public Health Professionals How does improved nutrition result in better health outcomes? Nutrition is essential for health throughout a person’s life. According to the CDC, consuming a healthy diet that includes proper portions of fruits, vegetables, whole grains, fat-free/low-fat dairy products, protein sources, and some oils allows children to grow and develop properly. Adequate nutrition beginning in infancy and continuing through all stages of life also reduces the risk of chronic diseases, including heart disease, type diabetes, and cancer, throughout the lifespan. These chronic illnesses are also all impacted by physical activity, a significant partner to nutrition in health science and, thus, in messaging surrounding health promotion. What are public health interventions to help people improve their nutrition? Poor nutrition and food insecurity, a phenomenon in which people lack access to an adequate amount of food, resulting in nutritional deficiencies, are considered major public health issues; public health practitioners understand that the resolution of these problems will result in better community nutrition and, thus, health outcomes for the population at large. Such phenomena often occur in communities due to greater societal factors, such as socioeconomic status, that impact food systems, demonstrating that this issue needs to employ a population health sciences perspective rather than an individualistic one. Knowledge of the distribution of nutritional deficiencies and their associated disease risks falls under the study of nutritional epidemiology. Many public health professionals work to support causes such as public health nutrition by trying to influence policy decisions. Page 19 of 41 Assessing, Promoting, and Improving Community Health Community Health Assessment and Improvement Planning Three core functions define the fundamental purpose of public health:- Assessment. policy development assurance. Community health assessments (CHAs) provide information for problem and asset identification and policy formulation, implementation, and evaluation. CHAs also help measure how well a public health system fulfills its assurance function. A CHA should be part of an ongoing broader community health improvement process. ▪ A community health improvement process uses CHA data to identify priority issues, develop and implement strategies for action, and establish accountability to ensure measurable health improvement, which are often outlined in the form of a community health improvement plan (CHIP). ▪ A community health improvement process looks outside of the performance of an individual organization serving a specific segment of a community to the way in which the activities of many organizations contribute to community health improvement. A variety of tools and processes may be used to conduct a community health improvement process; the essential ingredients are community engagement and collaborative participation. Below you will find a description of the steps in a CHA/CHIP, and links to additional resources for each of the six steps interested residents about health priorities and concerns. This information forms the basis for improving the health status of the community through a strategic plan. Page 20 of 41 CHA/CHIP components Organizing and Engaging Partners The first steps of a CHA/CHIP process involve two critical and interrelated activities: organizing the planning process and developing the planning partnership. The purpose of this phase is to structure a planning process that builds commitment, engages participants as active partners, uses participants' time well, and results in a plan that can be realistically implemented. This is the first phase of the MAPP process. Visioning Visioning guides the community through a collaborative process that leads to a shared community vision and common values. Vision and values statements provide focus, purpose, and direction to a CHA/CHIP process so that participants collectively achieve a shared vision for the future. A shared community vision provides an overarching goal for the community—a statement of what the ideal future looks like. Values are the fundamental principles and beliefs that guide a community-driven planning process. Visioning is ideally conducted at the beginning of the CHA/CHIP process, as it offers a useful mechanism for convening the community and building enthusiasm for the process, setting the stage for planning, and providing a common framework throughout subsequent phases. This is the second phase of the MAPP process. Collecting and analyzing data Collecting comprehensive data about a community is essential to understanding the health status and contributing and root causes that affect the local public health system and the community. This is the third phase of the MAPP process. Phase 3 contains four distinct assessments: the Community Themes and Strengths, Local Public Health System, Forces of Change, and Page 21 of 41 Community Health Status Assessments. Each assessment yields important information for improving community health, but the value of the four MAPP Assessments is multiplied by considering the findings as a whole. Disregarding any of the assessments will leave participants with an incomplete understanding of the factors that affect the local public health system and the health of the community. Identifying and prioritizing strategic issues During this step, participants use data to develop and prioritize a list of issues facing the community. Strategic issues are identified by exploring the convergence of the results of the data collection efforts, such as through the four MAPP Assessments, and determining how those issues affect the achievement of the shared vision. This is the fourth phase of the MAPP process. Developing Goals, Strategies, and an Action Plan During this step, participants take the strategic issues identified and formulate goals, strategies and an action plan related to those issues. The result is the development and adoption of an interrelated set of strategy statements and a plan of action including activities, timeframes, responsibility parties, and performance measures. This is the fifth phase of the MAPP Process. Taking and Sustaining Action The Action Cycle links three activities—Planning, Implementation, and Evaluation. Each of these activities builds upon the others in a continuous and interactive manner. This is the sixth phase of the MAPP process - While the Action Cycle is the final phase of MAPP, it is by no means the "end" of the process.During this phase, the efforts of the previous phases begin to produce results, as the local public health system develops and implements an action plan for Page 22 of 41 addressing priority goals and objectives. This is also one of the most challenging phases, as it may be difficult to sustain the process and continue implementation over time. Evidence-Informed Community Health Interventions. Evidence-Informed Public Health Evidence-informed public health is “the process of distilling and disseminating the best available evidence from research, practice, and experience and using that evidence to inform and improve public health policy and practice. But, it means finding, using, and sharing what works in public health.” The model outlines an evidence-based approach in seven steps: :‫ويحدد النموذج نهجا قائما على األدلة في سبع خطوات‬ ‫ تحديد المشكلة وصياغة سؤال جيد استجابة للحاجة إلى المعلومات‬.1 ‫ ابحث في األدبيات عن أفضل األدلة المتاحة‬.2 ‫ تقييم نقدي لألدبيات ذات الصلة الموجودة‬.3 ‫ تجميع األدلة وتفسيرها لوضع توصيات تعالج هذه المسألة‬.4 ‫ والموارد‬،‫ واإلرادة السياسية‬،‫ تكييف األدلة والتوصيات مع السياق المحلي على أساس احتياجات المجتمع المحلي‬.5 ‫المجتمعية‬/‫ واألفضليات المهنية‬،‫موارد الموظفين‬/‫االقتصادية‬ ‫ تنفيذ األدلة والتوصيات المكيفة‬.6 ‫ تقييم آثار القرارات واإلجراءات المتخذة‬.7 Many published resources detail the implementation of an evidence-informed approach to public health practice. The National Collaborating Centre for Methods and Tools at McMaster University provides a Model for Evidence-Informed Decision-Making in Public Health that is widely accepted by public health professionals. The model outlines an evidence-based approach in seven steps: Page 23 of 41 1. Define the problem and formulate a good question in response to the information need. Define: Clearly define the question or problem “Who is my target group? What is the issue we are dealing with? What specifically are we trying to change?” Use four elements to frame a question about the effectiveness of a public health intervention: Population Intervention Comparison Outcome 2. Search the literature for the best available evidence. A clearly defined question or problem is the starting point for an effective literature search. This step of the Evidence-Informed Decision Making in the Public Health process helps you answer the question: “Where should I look to find the best available research evidence to address the issue?” Your search strategy should aim to locate the strongest quality and most relevant evidence first. 3. Critically appraise the relevant literature found. Appraise: Critically and efficiently appraise the research sources Critical appraisal is the process of assessing the quality of study methods in order to determine if findings are trustworthy, meaningful, and relevant to your situation. Critical appraisal helps you answer the question: “Were the methods used in this study good enough that I can be confident in the findings?” 4. Synthesize and interpret the evidence to create recommendations that address the question. Page 24 of 41  Synthesize: Interpret/form recommendations for practice based on the literature found The fourth step of the Evidence-Informed Decision Making in Public Health process focuses on deciphering the ‘actionable message(s)’ from the research evidence that you have reviewed. Recommendations should be formed from the highest quality and most synthesized research evidence available. This step helps you answer the question: “What does the research evidence tell me about the issue?” 5. Adapt the evidence and recommendations to the local context based on community needs, political will, economic/ staff resources, and professional/community preferences. Adapt: Adapt the information to a local context The fifth step in the Evidence-Informed Decision Making in the Public Health process is adapting research evidence to the local context. This step helps you answer the question: “Can I use this research with my client, community, or population?” 6. Implement the adapted evidence and recommendations. Implement: Decide whether (and plan how) to implement the adapted evidence into practice or policy Implementation, also known as application, involves acting on the evidence to bring about a change in practice. Deciding whether and planning how to implement the adapted evidence in the local context involves developing an implementation plan. This step of the Evidence-Informed Decision Making in Public Health process helps you answer the question: “How will I use the research evidence in my practice?” Creating an implementation plan consists of these three critical steps: 1. Conducting a situational assessment 2. Planning a program Page 25 of 41  3. Disseminating the intervention 7. Evaluate the effects of the decisions and actions taken Evaluate: Evaluate the effectiveness of implementation efforts The final step in the Evidence-Informed Decision Making in Public Health process involves evaluating the effectiveness of implementation efforts. This step helps you answer these two questions: “Did we do what we planned to do?” “Did we achieve what we expected?” Evaluating implementation efforts involves evaluating the intervention (program evaluation) and the implementation strategies (evaluation of the knowledge translation strategy). Both evaluations involve these steps: 1. Identify outcomes of interest. 2. Select indicators to measure these outcomes. 3. Collect baseline data about outcomes of interest. 4. Measure outcomes post-intervention to determine the effectiveness of the program or implementation plan. Page 26 of 41  Public Health Policy and Advocacy Public Health Advocacy WHAT IS ADVOCACY? Advocacy is participating in the democratic process by taking action in support of a particular issue or cause. Advocacy is the active support for policies and programs that can improve health in families and communities Advocacy is also a strategy to influence decision-makers when drafting laws and regulations, distributing resources, and making other decisions that affect public health issues, infrastructure, and the workforce. The purpose of utilizing advocacy as a strategy is essentially about three things: 1. Creating needed policies when none exist. 2. Reforming harmful or ineffective policies. 3. Ensuring good policies are implemented and enforced. The goal of advocacy is policy change. ADVOCACY VS. LOBBYING One important question is, “How is advocacy different from lobbying?” Although most people use the two terms interchangeably, it is important to understand the difference between advocacy and lobbying. Page 27 of 41 Public Health Policy Public health policy plays a vital role in the general wellness and safety of a population. Based on the given needs of a community, public health policy establishes clear goals and solutions towards total health. What is Public Health Policy? Public health policy is defined as the laws, regulations, actions, and decisions implemented within society in order to promote wellness and ensure that specific health goals are met. Public health policies) can range from formal legislation to community outreach efforts. Public health policy plays a role in multiple sectors, including: 1. Health care 2. Insurance 3. Education 4. Agriculture 5. Business 6. And more. A clear public health policy definition can be hard to pin down due to its multidisciplinary nature. However, at the core of all public health policy is a singular mission towards health. Organizations such as the World Health Organization Centers for Disease Control and Prevention Food and Drug Administration, and other governmental and non-governmental agencies play a large role in public health policy. These organizations perform research and implement education and health initiatives for a population—creating laws and policies that ensure the society has nutritious food to eat, clean water to drink, vaccines for the sick, and access to health care. Page 28 of 41 The Importance of Public Health Policy Public health policy is crucial because it brings the theory and research of public health into the practical world. Public health policies create action from research and find widespread solutions to previously identified problems. As a public health policy official, you are responsible for initiating strategies and policies around both health intervention and prevention. To allow your target population to flourish, you must address not only physical health, but mental, social, and economic well-being as well. Public Health Policy Examples Before public health policies are implemented, policymakers and officials will go through an extensive research process to determine what public health issues need to be addressed and formulate the best subsequent solutions. Here are a few common public health policies that have become a core part of society today: 1. Food Safety Policy: Food safety policies are very important to the general health of individuals and people in society. Food-related illnesses are a significant concern, and it is the job of public health officials to formulate policies to ensure that only food that is safe for consumption is made available for the public. 2. Tobacco Use: Many public health officials have put measures in place to reduce the risks of deaths and illnesses caused by tobacco consumption and smoking. Some of these policies include increasing tobacco prices and creating tobacco-free areas in communities to protect non-smokers from the effects of secondary smoking. 3. HIV: Public health policy plays an important role in educating the public about HIV prevention, how to live with the virus, treatment options, and preventing stigma. Public Page 29 of 41  health policies, including increased access to testing, birth control, and medicine, have been implemented to drastically reduce the impact and spread of the virus in various communities. 4. Alcohol: Alcohol abuse is one of the leading causes of vehicular accidents, violence, sexual assault, health complications, and more. Public health policies are crucial in the fight to curtail alcohol dependence and reduce its negative effects on users. Policies on alcohol differ depending on the community, but the most common example is age restrictions in the consumption and purchase of alcohol. 5. With a Master of Public Health Degree, graduates can pursue careers in government agencies, healthcare organizations, non-profits, higher education, and more. Students will use their knowledge of public health assessment and solutions to promote a healthier society and world at large. Through intensive study and expert curriculum, the Columbia Mailman School of Public Health’s MPH program provides students with the critical skills and knowledge to tackle a wide range of health challenges in society. Public health Planning and evaluation What Is Public Health Planning? Page 30 of 41 The Community Guide from USA.gov defines public health planning as “a multi-step process that generally begins with the definition of the problem and development of an evaluation plan.” Each stage requires evidence-based resources and informed action. Public health professionals may be involved in any or all steps of the process: assessing the community to determine objectives; developing and implementing plans; and monitoring the results to evaluate performance. What Are the 5 Stages of Public Health Planning? An easy framework for public health planning is the MAP-IT acronym by the Office of Disease Prevention and Health Promotion that helps plan initiatives for Healthy People 2030. The MAP- IT framework stands for mobilize, assess, plan, implement and track. 1. Assemble numerous community stakeholders and build relationships or partnerships to facilitate change. Bring representatives together to identify the community’s primary health issues and underlying social determinants. 2. Prioritize and select which issues to address within the skills, resources, timeframe or other constraints. Often a community may have too many health issues for a single project. Identify and collect baseline data before implementing any changes so you can measure improvement. 3. A good plan includes measurable, feasible and timely outcome objectives and a clear definition of success. Determine the community’s short-term, intermediate and long-term objectives and steps to meet the goals. The plan must also include a budget, timeline, potential barriers, resources and other items necessary for success. A strong marketing message can make or break a project. 4. Action items should clearly list responsible parties and deadlines. Unexpected roadblocks, an ever-changing public health landscape and healthcare emergencies, such as the COVID-19 pandemic, may cause the plan to be delayed or even derailed. Page 31 of 41  5. Develop indicators to track the process and monitor the plan’s implementation so that you can make improvements or adjustments as necessary. Share these results with the project team and community partners. Changing plans or adapting is not a failure but a chance to refine the plan or meet a new or even higher priority issue. Part of the evaluation plan is to explore lessons learned as a final step in a health quality initiative. Review the process, results, group performance and even individual activity. Look for areas that worked well to use again or strategies to revise for future projects. Emergency Preparedness and Response. Emergencies, Disasters, and Hazards Page 32 of 41 The Federal Emergency Management Agency (FEMA) defines an emergency, disaster, and hazard as follows: Emergency “any incident, whether natural, technological, or human-caused, that requires responsive action to protect life or property.” Disaster is “an occurrence of a natural catastrophe, technological accident, or human-caused event that has resulted in severe property damage, deaths, and/or multiple injuries.” Hazard is “something that is potentially dangerous or harmful, often the root cause of an unwanted outcome.” A key differentiating factor between an emergency and a disaster is:- the availability of sufficient resources. While both emergencies and disasters can be sudden and catastrophic, emergencies have sufficient resources available to respond while disasters do not. Throughout this toolkit, the terms “emergency” and “disaster” are used interchangeably. Public health emergencies can include infectious disease outbreaks and other emergency situations such as mass casualty events, natural disasters, weather disasters, wildfires, and chemical spills. Emergencies can be of different sizes: There are smaller, more localized events that can be classified as minor emergencies as well as large-scale emergencies, which can be classified as major disasters. Emergencies can be time-limited (acute) or evolving (ongoing). Damage from emergencies can range from minimal to major. Public health emergencies can increase morbidity, mortality, and emotional distress for impacted communities. For examples of how these factors can vary in different situations. Four Phases of Emergency Management Emergency managers think of disasters as recurring events with four phases: Mitigation, Preparedness, Response, and Recovery. 1- Mitigation Page 33 of 41 The first phase in the emergency management cycle is mitigation. In this phase, communities take action to minimize the impact and consequences of an emergency or disaster event. Examples of mitigation activities include: 2- Preparedness The second phase in the emergency management cycle is preparedness. In this phase, communities implement a collection of actions, including planning, training, partnerships, and education, before an emergency or disaster event. In rural communities, planning activities may include: Convening planning meetings Standardizing protocols and procedures Engaging cross-sector partners and establishing agreements Educating the public about potential hazards and how to prepare Training community members and volunteers Testing communication systems and equipment Running practice During the preparedness phase, communities should establish plans; determine availability of equipment and supplies; determine roles and responsibilities, including with partners; determine priorities and goals; and establish plans. For detailed information on planning approaches and considerations, see Rural Community Planning for Emergency Preparedness and Response. 3- Response The response phase includes the actions taken after an emergency or disaster to help minimize the negative effects. During the response phase, communities implement the response plan developed in the preparedness phase. In a rural community, response activities may include: Coordinating first responders and volunteers Triaging patients and providing medical care Initiating emergency communications Distributing supplies and equipment Evacuating residents Page 34 of 41 4- Recovery The recovery phase focuses on restoring essential services and resuming normal operations. Following an infectious disease pandemic, this phase may be referred to as the post-pandemic environment. The short-term recovery period generally occurs within six months after a public health emergency and focuses on addressing the immediate needs of the community. Immediate needs may include restoring essential services such as healthcare and public health facilities, enabling the community to begin to function normally again. Resilience “a community's ability to withstand, adapt, and recover from a disaster or public health emergency.” By strengthening existing public health and health system infrastructure, local health departments can create a strong foundation of health and resilience within the community. All-Hazards Approach All-hazards and flexible preparedness plans support community resilience. The Centers for Medicare & Medicaid Services (CMS) provides the following definition of an all-hazards approach: “An all-hazards approach is an integrated approach to emergency preparedness planning that focuses on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters, including internal emergencies and man-made emergencies (or both) or natural disasters.” Instead of trying to plan for every possible emergency, an all-hazards approach focuses on building community capacity to be prepared for a broad range of emergencies and disasters. Page 35 of 41 Health in Aging Every person – in every country in the world – should have the opportunity to live a long and healthy life. Yet, the environments in which we live can favor health or be harmful to it. Environments are highly influential on our behavior and our exposure to health risks (for example, air pollution or violence), our access to services (for example, health and social care), and the opportunities that aging bring. The number and proportion of people aged 60 years and older in the population is increasing. In 2019, the number of people aged 60 years and older was 1 billion. This number will increase to 1.4 billion by 2030 and 2.1 billion by 2050. This increase is occurring at an unprecedented pace and will accelerate in the coming decades, particularly in developing countries. This historically significant change in the global population requires adaptations to the way societies are structured across all sectors. For example, health and social care, transportation, housing, and urban planning. Working to make the world more age-friendly is an essential and urgent part of our changing demographics. Healthy aging is the process of maintaining good physical, mental, and social health and well- being as we grow older. Healthy aging starts early on in life. It means adopting healthy habits and making positive lifestyle choices that contribute to overall well-being as we age. Starting early is important to avoid many health complications that may arise in later life. But it is never too late to adopt healthy habits for positive change. CDC offers information and programs to promote healthy aging and longer lives. Common conditions in older age include: - ▪ hearing loss. ▪ Cataracts. ▪ refractive errors. ▪ back and neck pain. ▪ Osteoarthritis. ▪ chronic obstructive pulmonary disease. ▪ Diabetes. ▪ Depression. ▪ dementia. Page 36 of 41  ▪ Older age is also characterized by the emergence of several complex health states commonly called geriatric syndromes. They are often the consequence of multiple underlying factors and include frailty, urinary incontinence, falls, delirium, and pressure ulcers. ▪ A longer life brings with it opportunities, not only for older people and their families but also for societies as a whole. Additional years provide the chance to pursue new activities such as further education, a new career, or a long-neglected passion. Older people also contribute in many ways to their families and communities. Yet the extent of these opportunities and contributions depends heavily on one factor health. These habits may include: 1. Nutrition. Maintain a healthy, balanced diet. 2. Physical activity. Keep your body active by doing regular exercise. 3. Mental functioning: Keep your mind stimulated and get enough sleep. 4. Social well-being: Stay socially connected and engaged with others. 5. Emotional well-being: Take care of your emotional well-being, including managing stress, having a positive outlook, and seeking support when needed. 6. Injury prevention: Try to avoid falls and other injuries by taking precautions and practicing safe driving. 7. Health care routine: Keep up with regular health checkups, vaccines, and screenings; and manage any chronic conditions. Four Challenges Faced by Long-Term Care Facilities in 2024 Our current time presents unique challenges and opportunities for SNFs, CCRCs, and other long-term care facilities in the United States. On one hand, the industry faces a surging demand for services driven by the aging population. A 2023 report by the Population Reference Bureau projects that the number of Americans aged 65 and older will balloon to over 80 million by 2030, a significant increase from the current 57 million. This translates to a growing need for skilled nursing care, assisted living facilities, and other long-term care options. On the other hand, facilities and communities grapple with a multitude of challenges that threaten their stability and quality of care. Staffing shortages, financial constraints, and evolving resident needs all contribute to a complex landscape that demands innovative solutions. Today, we will explore these key challenges and how partnering with a contract Page 37 of 41  therapy provider like TMC can empower facilities to navigate this critical time in long- term care. Challenge #1: The Workforce Crisis pandemic exacerbated the problem. Burnout, low wages, and demanding workloads led to an exodus of personnel. In an interview with Skilled Nursing News:- Staffing is one of the greatest challenges in health care, and bad policies aren’t helping. “In fact, it threatens to close centers and reduce access to care for hundreds of thousands of Americans,”. ▪ The potential consequences of understaffing are dire. ▪ Reduced staffing ratios compromise resident care, leading to higher rates of infections, falls, and hospital readmissions. ▪ Overworked staff experience increased stress. ▪ Decreased job satisfaction, contributing to a vicious cycle. Solution: How TMC Can Help Meet Staffing Needs TMC offers a comprehensive solution to the staffing crisis. As a contract therapy provider, TMC handles all hiring of qualified physical, occupational, and speech-language therapists, freeing up facility staff to focus on other crucial tasks. However, TMC goes beyond just therapy. We also offer nurse and staff recruiting assistance, a unique service that has helped facilities hire hundreds of positions beyond just therapy. This holistic approach can significantly alleviate the overall staffing burden in various settings. Challenge #2: Financial Pressures and Medicaid Shortfalls SNFs and other facilities operate on tight margins, and the pandemic further strained their financial viability. Medicare reimbursement rates often fall short of the actual cost of care, leaving a gap that must be filled by Medicaid or private pay. Medicaid funding, however, is often inadequate and subject to complex regulations. Additionally, the Patient-Driven Payment Model (PDPM), implemented in 2019, ushered in a new era of reimbursement for long-term care facilities. The switch to PDPM in long-term care upended reimbursement for some facilities, and the effects are still felt in 2024. Page 38 of 41  While overall funding increased, it wasn’t evenly distributed. Facilities caring for complex residents may have benefited, but those with less-acute populations might have seen a decrease. This financial disparity arose because PDPM prioritizes individual patient needs over therapy volume (minutes per day), a shift that some facilities still haven’t interacted with. What’s more, the need to adapt to PDPM’s new coding system added another layer of complexity, impacting finances. Solution: How TMC Therapy Can Help Close the Gap TMC understands the financial pressures facing facilities today. By partnering with TMC for therapy services, facilities can potentially improve their efficiency without compromising on quality of care. TMC therapists are highly qualified and experienced, ensuring efficient treatment. Furthermore, TMC offers valuable support with navigating the complexities of Medicaid billing and ensuring proper documentation for reimbursement. Our MDS Coding department can significantly improve a facility’s reimbursement challenges. TMC’s MDS specialists make. recommendations, offer training and provide other support that helps your coding department drastically increase revenue while more accurately billing MDS, potentially leading to an increase of over $30 per patient, per day. Challenge #3: The Changing Needs of Residents The population entering long-term care today is demonstrably different from previous generations. They are often living longer and entering care with more complex medical conditions. Residents may require a wider range of therapies, including cognitive rehabilitation, cardiac rehabilitation, and specialized wound care. This evolving landscape demands a highly skilled and adaptable team of clinicians. Solution: Improved Outcomes With “Mindful Care” At TMC, we pride ourselves on our diverse pool of highly skilled therapists. We employ a “Mindful Care” approach, which considers cognitive ability when choosing the appropriate programs, protocols, and pathways to follow with each individual resident. This ensures that Page 39 of 41 each resident receives the most effective therapy services to meet their specific needs and goals, and has resulted in significantly improved outcomes. Challenge #4: The Rise of Telehealth and Technology Technology is rapidly transforming the healthcare landscape, and facilities are presented with both opportunities and challenges in this domain. Telehealth, for instance, allows for remote consultations with physicians and therapists, potentially improving access to care for residents with limited mobility. Technology can also be used to implement remote monitoring systems, allowing for earlier detection of health issues. However, integrating new technologies requires investment in equipment and staff training. Additionally, concerns exist regarding the digital divide and ensuring equitable access to technology for all residents. Solution: TMC’s Culture of Innovation At TMC, one of our core values in innovation. We utilize a proprietary therapy software called Ignite that is unique in the industry. What sets Ignite apart from standard programs is the ability to modify and customize the program as needed. This allows TMC to rapidly keep up with industry changes, customer demands, and improved practice patterns. Additionally, Ignite can provide a full suite of outcomes reporting for specific DRGs including LOS, functional gains, re-hospitalization rates, and discharge patterns. This data empowers LTCF administration to identify opportunities for improvement and mitigate potential risks. For Every Challenge, a Solution We have all seen the struggles. Staffing shortages, financial constraints, evolving resident needs, and the integration of technology are just some of the challenges demanding innovative solutions. Partnering with a reputable contract therapy provider like TMC can be a strategic step towards addressing these critical issues. TMC offers a comprehensive approach that includes staffing solutions beyond therapy, financial expertise with maximized reimbursement, a “mindful care” approach for resident therapy, and cutting-edge technology to optimize care delivery. Ultimately, by embracing these solutions, facilities can empower their staff and deliver the highest quality of care to their growing resident population. Page 40 of 41