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***Notethatthisformofthedocumentisnotalignedcorrectly,butallwordsandmaterials

arecurrenttotheemailwithattachmentthatIsentat7:45pm.Natalie
Thepurposeofthisdocumentistoperformaneedsassessmentinpreparationforthegrandopeningof
SummitPlace.ThiswillbecarriedoutbyErinFord,ZeShen,NatalieWoodford,ElaineMeredith,
LindseyKummer,SusanAshleyFrancis,andCarlyMacDougall.ThetargetlocationisGilesCounty,
Virginia(VA).Thetargetpopulationwithinthislocationistheverylowandlowincomesubset
($14,560$29,120)ofadultsages62andolder.Thegoalofthisassessmentistoaddressacommunity
levelconcernpertainingtodiminishedphysicalcapacityofthelowandverylowincomeelderly
populationinGilesCounty,VA.Whilethisassessmentwillhavemultiplecomponents,ourfocuswill
beevaluatingthenutritionalstatusofourtargetpopulation.TableCoutlinespersonnelresponsiblefor
variousactivitiesthattakeplaceduringthisprocedure,basedontime.

Objectives
1. Definetargetpopulationintermsofage,income,healthliteracy,education,accessto
transportation,andavailabilityofcommunityhealthservices.
2.Identifyexistingresourceswithinthecommunitythatpromotehealthybehaviorsandassess
theaccessibilityandeffectivenessoftheseexistingresources.
3.Collectdataaboutandwithincommunity:
1. Conductinterviewswithlocalphysiciansand/ordietitians
2. Qualitativedata:Whoarethestakeholdersandkeyinformants?Whataretheneeds
andwantsofpopulation?
3. Quantitativedata:Placingspecificemphasisonsocioeconomicstatus,incomelevel,
andpovertylevel,whatcharacterizesthegroupoffocus?Howappropriatearefood
patterns,andhowphysicallydependentareindividuals?
4. Holdfocusgroupsamongagreeableindividualsfromlocalcommunitycentersand
churchgatheringstogainknowledgeonwhatthecommunityinquestionwould
acceptandaligntowards
4.Analyzecollecteddata,andnarrowthepopulationoffocusdowntoaclearlydefinedgroup.
Ifnecessary,performmoredatacollectionsorsearchesforfurtherneededinformation.
5.Improveexistingcommunitynutritionresources,andplanfornewnutritionalservicesbased
oncommunityneedsanddesires.Implementationwillbeconstructedaroundthebasisofdata
assembledandanalyzed.

IdentifyingKeyStakeholders
Keystakeholdersareindividualswithfundamentalimpactonperformanceandexistenceofan
organizationoracompany.Eachindividualinvolvedintheprocessofestablishmentandongoing
functionofacompany/facilityprovidesvaluableresourceresourcescanexistasfinancialcapital,or
simplymeasuresofsupport.SummitPlacehaskeystakeholdersinprivatedonors,andthelocalNew

RiverValleygovernment(basedintheimmediatelysurroundingareasinandaroundGiles,aswellas
Blacksburg,VA)becauseoftheirlargecontributiontothefundingofthisALF.Anotherimportant
playeristhetargetpopulation,whicharekeystakeholdersonthebasisthatthesuccessofthisneeds
assessmentandfutureprogramsrequirestheirdirectinput.Branchingabitoutsideofthetarget
population,itisimportanttonotetheimportanceofcommentarythatcanbegainedfromfamiliesand
caregivers.Theydonotholddirectstakeintheassessmentasdescribed,buttheydoofferemotional
andfinancialassistancetothosewhoareofinterest,whichcannotbeneglected.Otherswithstakethat
lieoutsideofthefinancialcapitalscopearecommunitynutritionists,whowillplaylargerolesinthe
developmentofnutritionalmaintenanceandestablishmentoffoodserviceinandofthisALF.Local
and/orstategovernmentwillbeinvestedintheoutcomeofourneedsassessmentasitcorrespondsto
futureimplementationatSummitPlace.Ifaneedisbeingunmetwithinthepopulation,itwillbe
criticalforadministratorsinSummitPlacetobeinformedbecausetheywillbeservingthispopulation.

JustificationofLocationandTargetPopulation
Currently,theportionoflowincome,elderly,andlesshealthyindividualslivinginGilesCounty,VA
ishigherthanthemajorityofVAandtheUnitedStates.Accordingto2013U.S.Censuspopulation
estimates,therearecurrently3,316peopleovertheageof65livinginGilesCounty.Thisrepresents
approximately16.9%ofthepopulationinGilesCounty.Thisvalueishigherthanthestatewideaverage
of13.4%ofVAresidents.Additionally,14.1%ofGilesCountyresidentslivebelowthefederalpoverty
levelascomparedto11.1%ofVAresidents(USCensusBureauGilesCounty,VA).Duringa2012
GilesCountyCommunityNeedsAssessmentconductedbytheCarilionClinic,68.5%ofrespondents
reportedearninglessthan$20,000peryear.Thisassessmentalsoindicatedthedifficultythatpeoplein
theAppalachianregionhaveinregardstomanagementofhealthconditionsandmedications.Many
residentsofGilesCountyhavelowratesofeducationandgreatculturalpride,whichresultsinpoorer
understandingofhealthcare,preventativemeasures,andnecessarycomplianceandmaintenance(such
asscreenings,physicals,andregularmedication).Furthermore,poorhealthisprevalentas60.9%of
surveyrespondentsinGilesCountyweretoldthattheyhadhighcholesterol,comparedto36.7%of
Virginians.Additionally,38.6%ofGilesCountyadultsreportedhighbloodpressure,comparedto
27.5%ofVirginians.ObesityratesinGilesCountyalsoexceedstatewideaveragesas38.5%of
residentsareobesecomparedto26.3%inVA(CarilionClinicGilesCounty2012Needs
Assessment).

Inadditiontohealthandsocioeconomicbarriers,theelderlylivinginGilesCountyfaceadditional
challengesastherearezeroassistedlivingfacility(ALF)bedsavailableforresidentsinthecounty.
Currently,thereare21.3ALFbedsper1,000elderlyindividualslivingintheNewRiverValley.This
meansthatopeningsatfacilitiesareatapremiumandresidentsofGilesCountymustleavetheirhome
regioninordertosecurenecessaryaccommodations.Manyfacilitiescharge$3,0006,000permonth
forrentanamountwhichisnotfeasibleforlowincomeresidentsofGiles.TheSummitPlaceplansto
offerresidentsaslidingscalerentpriceof$1,1001,900permonthbasedonincome.Thisistoensure
thatresidentsareabletoaffordablemakepayments.Additionally,prioritywillbegiventoresidentsof
GilesCountysothattheywillnothavetoleavetheirhometownduringapotentiallyalreadydifficult
transition(TheSummitPlaceMarketStudy).TheSummitPlaceestimatesthatevenatalow
demand,theplannedALFwillhave37%marketpenetrationduetothehighneedsofthearea.


HighlightedIssuesExaminedandAssessmentMethodsSelected
Twoareasoffocusareidentifiedwhendeterminingmethodsandlocationofassessmentofthe
respectivetargetpopulation.Thefirstcentersaroundtheagriculturallybased,ruralnatureofGiles
County,deemingthepopulationwidelydispersed.Geographiclocationindicatesthattransportationis
criticalforaccessinghealthandnutritionalservices,suchashospitalsandcommunitycenters.Even
individualsthatareabletotakecareofthemselveshavelimitedaccesstopublictransportation
extremelyruralareasintheareaseethisatagreaterextent.Basedonthefactthatthepopulationis
elderly,physicaldisabilitiessuchaslossofeyesightorlackofphysicalabilitytomoveaboutcould
limitopportunityoftransportation.ThereisalsolimitedpublictransportationavailableinGiles
County,particularlyinthemostruralportions,whichmakesitdifficulttoaccesshealthfacilities.There
isacaveatGilesCountyisintricatelywovenamongtheBibleBelt,meaningthatchurchescouldserve
astargetcommunityresourcesforassessinganddeliveringnutritionneedsandinterventions.Another
areaoffocusdrawsattentiontohealthliteracy.Whenworkingamonganelderlypopulation,adecrease
inliteracylevelcanbeobserved.Ofparticularinterestishealthliteracy,whichreferstotheabilityto
applyagroupofskillstohealthinformationandthedecisionsthatcomealongwithit.Thisareais
constantlyevolving,andtypicallystabilizesinsmallercommunitiesthatareimmersedinsimilaraccess
toopportunity.Thismeansthatnutritionassessmenttoolsshouldbetailoredtothispopulationby
usingsmallerwordsthatarefreefromnutritionjargon.Afurtheradjustmentshouldbefontsizesothat
textisclearertotheelderlypeoplebeingassessed.Assessmentofthehealthyliteracylevelofthetarget
communityallowspivotaldecisionstobemaderegardingthemethodandmannerofcarryingout
assessments.

TypesofDataGathered
Perceptivequestionsaredevelopedtoguideaperiodofobtainingdata.SeeTableAforproposed
questions.Thiscomprehensiveneedsassessmentwillincludebothqualitativeandquantitativedata.
Qualitativedatawillbecollectedtodeterminekeystakeholders,keyinformants,healthstatusofthe
population(generalhealthandnutritionspecific),andtheintricatedesiresofthepopulation.Specific
nominaldata(gender,race,ethnicity,namesofstoresandpublicfacilities,generalcharacteristicsof
livingareas)willbevaluable.Quantitativedatawillbeexamined,especiallysocioeconomicstatus,
incomeandpovertylevels,accesstotransportation,andaveragedistanceandavailabilityofhealth
care.GeographicInformationSystems(GIS)willbeusedfordeterminingabilitytoreachhealthcare
basedondistanceandtransportationabilitiesofourpopulation.ExtendingGISanalysis,discussion
withkeystakeholderswilllendanhonesteartojusthowaccessiblecertainlocationsareattimesan
areamaybebetteroffthanthisquantitativemeasureshows.Asubjectivemeasureofnutritionalstatus
isimperativeknowingwhatthetargetpopulationbelieveshealthyandnutritiouslookslikewillseta
baselineforimplementationoffindings.Willingnesstodiscussandaskquestionsatthispointwill
allowapossibleinterventiontobelaidoutinawaythatsupportstherespectivecommunitiescomfort
level.

QuestionnaireswillbegiventoGilescountyresidentsovertheageof62atlocalhospitals,physicians
offices,churches,andseniorcenters.TheMiniNutritionalAssessment(MNA)willbeoffocusasitis
themostvalidatedmeasureofelderadultfunctionandhealth.Thesurveywillbeimplementedbya

trainedcommunitynutritionist,sensitivetoculturalbarriers,andanincentiveintheformofahealthy
snackwillbeofferedforcompletion.Thisscaledquestionnaireallowsthetrainednutritionistto
evaluateawidearrayofconditions,allowingflexiblestructure.Othersupportivemeasureswillbe
screeningsofincomeandhealthstatus.Structuredquestionnairesdirectlypertainingtonutritionwill
beusedtogainqualitativedatabasedonnutritionalknowledge.Forexample,questionnaireswillassess
nutritionrelatedquestions,suchasWhichofthefollowingfoodscontainsmorepotassiumandless
sodium:onepieceofbanana,oneounceofFrenchfries,oronesliceofwholewheatbread?
Qualitativedatacanalsobecollectedthroughfocusgroups.Discussionsessionsamongstakeholders
(therepresentativesfromthelocal/stategovernment,localhealthcareproviders,membersfromthe
facility,andmembersfromourtargetpopulationandtheirfamilymembers)canconservetimeand
money,andoffervaluableinformation.Interviewswiththelocalhealthcareproviderscanalsobea
supplementalmethodofdatacollection.Generalhealthdatafromlocaldietitiansandotherhealthcare
providerswillberequested,suchascommonhealthconcernsand/ornutrientdeficiencies(ifthereare
any)ofthetargetpopulation.Specificitiesregardingdatacollectionmethodsastheyrelatetothe
socioecologicalmodelcanbefoundinTableB.

Tables
TableA:ProposedQuestions
Whatinfluencesthenutritional
problem(s)?

Whatisthehealth
literacylevel?

Whatiscommonculturalpracticeamong
thispredominantlyCaucasian
community?

Whatismostcriticalnutritionalneed? Howdoesclimateand Howdoescultureimpactfoodchoices,


Canmorethanoneneedbeadequatelygeographyaffectaccess illness,viewofhealth,andoverall
addressed?
tofoodandoutdoor
lifestyle?
exercise?
Arecertainfoods/foodstylespreferredHowdoespopulationofWhatdoesthesocialsupportsystemlook
ordemanded?
focuscurrentlyresidedue
likeinthiscommunity?

tolackofALFbeds
open?
Arecertainchronicdiseases,illnesses,Howstableandusable Isthereahighlevelofstresspresent?
orallergiesprominent?
areresourcesthatare
currentlyavailable?
Doespopulationbelievenutritionis
important?

Areindividualsopento Howcommunityorientedisthisspecific
change?
subset?

TableB:CollectedDataandtheSEM

TypeofData
Gathered

MethodofStrengths&Weaknesses Whi
Obtaining ofMethod

SEM
layer

Social,Family
Living& BroadSocial,
Indiv
&Community
Working Economic,
idual
Networks Conditions Cultural,Health
and
Environmental
Conditionsand
Policies
Socioeconomic
status,poverty
level,average
income,etc.

Census
Bureau

StrengthGainoverall
snapshotofcounty,can
comparetonational
averages
WeaknessMostrecent
datais2012,muchofdatais
averagedover4years

Availabilityand GeographicStrengthAccesstomapof
accessibilityof Informationcountytoseeavailabilityof
healthandnutrition
Systems healthcareoptions
care
(GIS)
WeaknessMaygivefalse
conclusionsofhow
communityactually
functions

Needsof
population

Survey

StrengthMiniNutritional
Assessmentis
comprehensive
WeaknessDependson
willingness/abilityto
participate,andhonestyof
participantsaswellas
needingtrained
implementation

Commonhealth Interviews StrengthCanspeakwith


conditionsand/or
keyinformantswhocan
nutritionalconcerns
speakobjectivelyabout
commonhealthand
nutritionneeds
WeaknessWillingnessto
interview

TableC:Timeline
Week NeedsAssessmentActivity
1

Definetargetpopulation

Whowouldberesponsible?
Everyone

23

48

10

Identifyexistingresources
withinthecommunity

Everyone

Collectdataaboutand
Everyone
withincommunity,including
bothqualitativeand
quantitativedata(interviews,
focusgroups)
Analyzecollecteddata,and
narrowthepopulationof
focusdowntoaclearly
definedgroup

Everyone

Improveexisting
communitynutrition
resources,andplanfornew
nutritionalservicesbasedon
communityneedsand
desires

Everyone

*Addmorerowsandcolumnsasyouwishtoaddmoredetail.

References

1.CarilionClinic.(2012).GilesCountyCommunityHealthNeedsAssessment.Retrievedfrom:
http://issuu.com/carilionclinic/docs/giles_chna_2012.

2.CommunityPlanningPartners,Inc.(2011).Atargetedmarketstudyforanassistedlivingfacilityin
RichCreek/GilesCounty,VA.

3.UnitedStatesCensusBureau.(2014,July8).StateandCountyquickfactsGilesCounty,VA.
Retrievedfrom:http://quickfacts.census.gov/qfd/states/51/51071.html.

4.UnitedStatesCensusBureau.(2014,July8).StateandCountyquickfactsUSA.Retrievedfrom:
http://quickfacts.census.gov/qfd/states/00000.html.

5.NestleNutritionInstitute.(2014).MNAForms:Forhealthcareprofessionals.Retrievedfrom:
http://www.mnaelderly.com/mna_forms.html