A Troubling Diagnosis: Care Tactics

The Rappahannock community takes on an uncertain future, where the health of most of its residents is more likely to get worse than better

Third in a three-part Foothills Forum/Rappahannock News Special Report


It’s a short loop around the main shelf in the Rappahannock Food Pantry — probably fewer than 50 steps — but in that tiny trip, a lot of ground is covered.

Every Tuesday, Thursday and Saturday afternoon, folks come through the front door of the building just west of Sperryville, and, after an open-armed welcome from director Mimi Forbes, they move on to one of the volunteers waiting with a cart nearby. For the next 20 minutes or so, the two make their way together, slowly circling the island of food, choosing from cans of green beans and black-eyed peas, boxes of cereal and cake mix.

Luke Christopher | Rappahannock News
Shelves lined with canned goods at the Food Pantry.

There are also baskets of fresh produce — eggplant, zucchini, yellow squash, oranges — on a table along the wall. It’s a vibrant display, but its purpose goes beyond adding color to the room. The shiny fruits and vegetables are part of the pantry’s effort to help make Rappahannock a little bit healthier.

The goal of the pantry, Forbes explained, is to provide food to families who need it. But this also presents an opportunity to introduce other options. That can be tricky. How do you suggest nutritious alternatives without sounding preachy or judgmental? How do you avoid saying things that make people feel bad about what they’re feeding their families?

Montse Vittitow, a native of Chile, has been a volunteer at the Food Pantry for seven years. She’s learned how to navigate this delicate conversation. “It’s a give and take,” she said. “It’s not just us telling them what to get.”

Luke Christopher | Rappahannock News
Rappahannock Food Pantry director Mimi Forbes, right.

Vittitow brought up coconut oil. “We have little bottles of it. And people will look at a bottle, but I wait for them to ask about it. Some people will ask me what do you use it for. I tell them it’s a wonderful salve. And it’s good for the brain. I tell them how I use it. I pop popcorn with it. And, they’ll ask, ‘What else?’”

It’s a simple exchange, but one that opens up possibilities. And, it’s built around the kind of connection at the heart of many of the volunteer operations that help boost the health and well-being of Rappahannock residents, a role that will become more critical as the county ages.

“So much of this,” said Forbes, “is about trust.”

Shifting to organized help

The challenges of Rappahannock County are well-known. It’s now as much a retirement community as a farming one, and over the next decade, a growing segment of its population will hit the age when health problems start to tip like cruel dominoes. The county has no hospital, no pharmacy, a handful of health professionals and sketchy cell phone and broadband service — technology widely seen as a crucial component of rural health care in the future.

This also is a county where the top priority has long been to trim expenses and keep taxes low, although, in truth, there’s only so much local officials can do when it comes to health care. So, the job of attending to the health needs of its residents largely falls to the community itself.

Not that that’s anything new. But today, “community” here means something different. In times past, it was about families and long-time neighbors and Rappahannock’s churches. It’s still about the churches, but for those in need, help is more likely to come from nonprofits and volunteer organizations.

“Help used to happen more organically. Now you have to organize it and work at it,” said Jennings “Jenks” Hobson, the retired Trinity Episcopal Church rector who has lived here since 1973. (He is also a member of the Foothills Forum board). “That’s a fundamental change.” And, he adds, people in the past were more reluctant to seek help. “They took care of things themselves. Or they thought help was for people who really needed it. Expectations have changed.”

Luke Christopher | Rappahannock News
Jennings “Jenks” Hobson, retired Trinity Episcopal Church rector,
talking with Washington resident Ray Gooch.

The shift to more organized help started to gain traction with the launch of the Rappahannock Benevolent Fund in late 2008, and, not surprisingly, it’s local pastors who make it work. Boosted by a grant from the William and Mary Greve Foundation and working with the county’s Department of Social Services, pastors from Trinity Episcopal, Washington Baptist and Reynolds Memorial Baptist in Sperryville, began providing help to people facing financial emergencies. A fourth, Father Tuck Grinnell, of St. Peter Catholic Church in Washington, has since joined the board that decides how the money is distributed.

It might be somebody in danger of having their heat turned off because they couldn’t pay a utility bill, or a person at risk of eviction. At times, the fund has been used to cover medical expenses, although it’s generally been only one-time payments to discourage people from depending on it to cover expensive, ongoing treatments.

“Most of the help with health care has been to pay for prescriptions when someone’s not able to. Mainly to supplement what they can pay,” explained Rev. Jon Heddleston, pastor at Reynolds Memorial Baptist. “Or maybe we use it to encourage someone to get an initial treatment.”

In that way, he said, the fund can help people take the critical first step in dealing with a health issue. “I counsel people, but I’m not a clinician,” he said. “If I’ve talked with someone, and I feel they need to see a professional therapist, the fund can serve as a bridge for them to the health care community.”

According to Hobson, who helped oversee it until his retirement from Trinity in 2015, the Benevolent Fund has provided an average of more than $50,000 a year to support people in the community.

Volunteering to drive

For many years, Hobson was also an EMT here, and he remembers times when rescue vehicles were used to transport local residents to medical appointments. Once, he said, he and a driver even took a woman to the University of Virginia Medical Center in Charlottesville for a treatment.

But with more demands on the emergency crews these days, that’s no longer an option. Instead, people who can’t drive often have to scramble to arrange rides to appointments in another county. Sometimes, they end up not going.

In recent years, though, volunteer drivers have started to pick up the slack. Darcy Canton, director of the Rappahannock Senior Center in Castleton, also oversees RappMedRides — which means she spends a lot of time connecting Rappahannock residents 60 years and older with people willing to take them to their appointments. Canton now has 15 volunteer drivers handling medical trips, and said she’s in the process of vetting a half dozen more. Demand varies from month to month, but through July, they had made 80 trips this year, with the majority to drive people to checkups, tests or treatments in Warrenton or Culpeper.

There are other free ride-sharing options. VolTran is based in Fauquier County, but serves Rappahannock too, and it will also transport people younger than 60 for “critical” needs, say a visit to the Social Security office. In July, VolTran handled 21 trips from Rappahannock. The American Cancer Society has a program called Road to Recovery, through which volunteers take people to their cancer treatments.

Then there’s Rapp at Home, the nonprofit organization launched last year which focuses on helping Rappahannock residents stay in their homes as they age. Its members — there’s no fee for those under the federal poverty level — can receive a range of volunteer services, from making a home safer after a person has a fall, to doing minor repairs. But it also lines up patients needing rides with volunteer drivers.

Lindsay Sonnett, Rapp at Home’s volunteer coordinator (she’s also a contractor for Foothills Forum), said she has about 20 people who have signed up to be drivers, but she relies mostly on a small core group. This month, they’re scheduled to make 24 trips, although half of those are for taking a Rapp at Home member to Front Royal for dialysis three days a week.

So many choices is a good thing. It can also be confusing to someone trying to figure out which one to use. But the Rappahannock Rapidan Regional Commission has simplified matters through a program based in Culpeper called the Foothills Area Mobility System (FAMS). Its staff gathers information from callers about their transport needs — purpose of the trip, where and when they’re going, any special needs, etc. — then arranges for a volunteer driver from the appropriate organization.

FAMS hasn’t had a lot of calls from Rappahannock residents yet, largely because until recently, the program wasn’t widely promoted. Through July, it had handled 132 requests from Rappahannock for volunteer drivers this year. Two were to get rides to jobs, and 13 were for shopping or social occasions. The remaining 117 were medical trips.

Committing to fitness

Two of those organizations, Rapp at Home and VolTran, recently received grants from the PATH Foundation, which is based in Warrenton, but also supports health-related programs in Rappahannock and northern Culpeper County. That includes services that provide access to care, focus on mental health treatment, help seniors, or deal with children’s health and wellness.

In line with that last priority, PATH also provided a $110,000 grant to Rappahannock County Public Schools last year to launch Commit to Be Fit, an ambitious project that believes it can use the school district’s influence to help make Rappahannock a healthier place.

“It made sense to do it here,” said Shannon Grimsley, who before she was hired as the school district’s superintendent this summer, had written the grant application for Commit to Be Fit, in her capacity as executive director of academic services. “I think we can help shape the mindset about nutrition and exercise. We’re in the best position in the county to do that.”

For starters, the school cafeteria, in response to input from the students, added 10 new items to its menu, including cinnamon fruit nachos and chicken stir fry with brown rice, and plans to add a new food each month this school year. And, teachers began incorporating what’s known as “kinesthetic learning” in the classrooms. It’s designed to keep kids more physically active instead of sitting at their desks all day. Finally, the program has made a point of also reaching out into the adult community — not just school employees and parents, but anyone who wants to get into better shape.

Throughout the school year, Commit to Be Fit held workshops on such things as making sense of nutrition labels, and staged a number of events, including a 5K run, a two-mile “Turkey Trot” and a four-hour Dance-a-Thon. It also ramped up free, public workout sessions, which grew to an average of almost 50 a month at the high school and elementary school. And, it attracted more than 150 people to participate in a six-month long Commit to Be Fit Challenge. The group lost a total of 338 pounds, including 60 by the winner.

Based on the success of the pilot program, PATH has committed $250,000 a year to fund Commit to Be Fit for the next four years. This school year, more free exercise classes will be added, such as a martial arts cardio class and a barre class, and a course about nutrition will be offered as an elective at the high school. Rappahannock schools already get apples from Thornton River Orchard, but school nutritionist Amanda Grove said the program is now looking to develop more partnerships with local farms. She also wants to start something called “Farmer Fridays” for which local farmers would visit the cafeteria and showcase their produce.

Overall, the focus for Year 2 will be on teachers as role models. “We hope the healthy behavior of teachers will go beyond the students and trickle into the families,” said Jackie Tederick, the program’s coordinator. “We’re trying to get the community involved as much as possible. Let’s face it, if the parents aren’t on board, it’s really hard to get a child on board.”

The Food Pantry likewise is stepping up its efforts to promote healthier diets among the roughly 200 families who pick up food there. It’s converting its back room into a space where later this fall, chefs will start doing demos on how to prepare more nutritious meals.

“The whole idea behind the cooking classes,” said Mimi Forbes, “is to take foods that we have here and show people how to make them healthier. That’s all.”

Helping people is complicated

For people like Forbes, and Darcy Canton and Lindsay Sonnett, it’s a campaign of small victories. They, like many of those involved in the community’s resolve to care for its own, have had to face a confounding reality: Helping people is complicated.

Hal Hunter certainly knows this. Described as an “uber volunteer,” he started the Food Pantry eight years ago and was one of the founders of Rapp at Home. At 82, he still drives for RappMedRides.

“The tough part, I’ve discovered, is getting people to accept services,” he said. “I drive lots of people to medical appointments. There’s one woman I drive to the orthopedic center in Warrenton. Once, I asked her if she would like to go shopping some time. She said, ‘Oh yes. But if I don’t know the driver, I’m not getting in the car.’”

Sharon Pyne understands this, too. Before her retirement in May, she worked in the county’s Department of Social Services for 21 years, primarily focusing on Rappahannock’s seniors. She’s also on the board of the Benevolent Fund.

“It could be very difficult,” she said. “You go out to visit someone and it’s almost like seeing a train wreck coming. You know they need help, but they don’t want it. They don’t want somebody in their house. Someone bathing them? Are you kidding me? Someone cooking for them? They’ll tell you ‘I’m a good cook.’

“Most are older women,” Pyne continued. “They’re just trying to live. They’re trying to pay for their meds. They’re trying to keep themselves fed. And they are not going to speak up for themselves. Part of the problem, too, is that they don’t want anyone to know they’re getting help. And, they’re not going to agree to have someone come into their home, even if it’s just to help write out Christmas cards. Or just talk to them.”

Luke Christopher | Rappahannock News
Sharon Pyne,
longtime Rappahannock County Department of Social Services worker.

That’s the trapdoor of aging, the spiral into social isolation. Strategies for helping people stay engaged range from the structured — such as the activities at the Senior Center or the monthly book club and other events set up by Rapp at Home — to more informal reaching out by church pastors and volunteers. The county sheriff’s office even has a check-in program, although it’s geared more to checking on a senior’s physical condition than his or her mental health. People who sign up are asked to call the sheriff’s department every morning. If they don’t hear from a person on the list by 11 a.m., they call them. If no one answers, the department sends out a deputy.

But there are plenty of others here whose social connections wither. That can have consequences beyond the ache of loneliness.

“When people get sick, they become isolated,” said Father Grinnell, at St. Peter’s. “And that can bring depression. You’re sick, you can’t move well. Emotionally, you’re not up to speed. It’s a snowball effect. Some people become isolated so much that they simply begin to fade away.”

Seeing patients — virtually

Unfortunately, treatment of depression and other mental health conditions is one of the growing holes in rural health care. As with doctors, the number of professional therapists outside cities keeps shrinking, and the long drive usually required to see one now gives a person already reluctant to seek help another reason to avoid doing so.

But a new approach introduced at the Fauquier Free Clinic in Warrenton last fall is likely a glimpse at the future. It incorporates telemedicine — in this case, connecting patients and mental health professionals through the internet. The latter may be in another area code, say in Fairfax or Richmond, but they’re able to meet with patients virtually, through a computer screen.

Rob Marino, the clinic’s executive director, admitted that he wasn’t sure how open people would be to long-distance therapy. “I wondered at first, ‘What are they going to think?’ But I did it myself, and after the first few minutes, you don’t notice the computer anymore.”

Marino said the program is working “dramatically well.” Now the majority of patients who come to the clinic for mental health therapy — including some from Rappahannock — do it over the internet in a private office. And, he said, more people are able to get help.

“The number of mental health professionals in this region is pathetic,” he said. “It’s nowhere close to what is needed. We can’t hire five psychiatrists and 14 counselors to come work for us. But we can provide remote access to them.”

Luke Christopher | Rappahannock News
Rob Marino, Fauquier Free Clinic .

In fact, it’s generally believed that telemedicine will become a key part of rural health care. Dr. Karen Rheuban, director of the University of Virginia Center for Telehealth, has no doubt about that. She pointed out that the center already connects patients to doctors in more than 60 specialties — from neurology to sleep apnea to dermatology. By her estimate, the center, since it opened 20 years ago, has saved Virginians almost 17 million miles of driving.

“We feel we leveled the playing field for our rural partners,” she said.

The expectation is that eventually doctors will be able to use telemedicine to diagnose and treat patients in their homes. But that will require good broadband connections, which can be spotty at best in many rural communities, including Rappahannock.

There is some progress on that front, however. Next month, the county’s broadband committee will hold several public forums to explain an upcoming survey that will be accessible to county residents. It will be designed to determine who now has broadband access, who doesn’t, where the demand is the greatest, and how people would use it.

Facing an uncertain future

It’s all part of the challenge Rappahannock faces as it wrestles with an uncertain future, one where the health of most of its residents is more likely to get worse than better — while access to medical professionals becomes more limited. For many seniors, it will become harder to maintain, and ultimately stay in, the homes they’ve made in a place they love.

One promising development is the training here of more potential health care workers and caregivers. RappU is now offering courses that can enable a person to become a certified nursing aide or a home health aide. Fifteen Rappahannock High School students and 11 adults have signed up for nursing aide courses for the fall semester than began this week. Another nursing aide class will be offered in the winter semester, which begins in November, but the scheduling of the next home health aide course will depend on demand. There’s a $25 application fee, but tuition for both courses is free to county residents.

“I’d like to be able to look back five years from now and say, ‘Look what we’ve trained,’” said RappU founder Doug Schiffman. “And ideally these people will stay and be able to work in the county.”

The county also has the benefit of an active and committed network of volunteers that continues to extend its reach. In the process, it’s finding ways for an aging community to help sustain itself.

But many of the volunteers themselves are older. Or, as Sharon Pyne put it, “We have drivers who are turning into riders.”

She said she’s worried that, even with all the dedication, all the good intentions, Rappahannock may not be ready for where its demographics are taking it. She asked the question that hangs over any discussion of the community’s health.

“What,” she said, “is going to be happen to all those 70- and 80-year-olds?”

What is Foothills Forum?

Foothills Fo­rum is an in­de­pen­dent, non­partisan non­profit sup­ported by the Rap­pa­han­nock County com­mu­nity providing fact-based, in-depth cov­er­age of coun­ty­wide is­sues. The group has an agree­ment with Rap­pa­han­nock Me­dia, owner of the Rap­pa­han­nock News, to present this se­ries and other re­port­ing projects. Funding in part for this series on rural health care comes from the PATH Foundation. A grant from the Northern Piedmont Community Foundation’s Richard Lykes Fund provided partial support for 2017 summer intern Monica Marciano. More at foothills-forum.org

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About Randy Rieland 10 Articles
Randy Rieland was a newspaper and magazine writer and editor for more than 20 years, including 12 years as senior editor for The Washingtonian magazine. He also has more than 20 years of experience in digital media, including serving as SVP of Digital Media for the Discovery Channel. He and his wife, Carol, have owned a home off Tiger Valley Road for more than 10 years.

2 Comments

  1. This is an excellent article and very important information for those of us in the County. Thank you for highlighting the problems and concerns, and for offering some solutions. Only if we know about it can we help.

  2. Thanks for your terrific work Randy. And thanks RappNews for welcoming an innovative partnership that supports a quality of local journalism beyond what is available to most small communities. It is great to see a growing number of neighbors adding their support to Foothills Forum. We’re all looking forward to the next public forum, when you’ll have an opportunity to answer reader questions.

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