The Rappahannock News and Foothills Forum revisits our past reporting projects to see where the county stands on everything from broadband to health care to housing
This shiny new calendar of 2019 marks Foothills Forum’s fifth year of raising community support for reporting on Rappahannock County.
We start Year Five by revisiting … looking back … checking in on the status of six different research and reporting projects on the front-burner issues as identified by residents. Spot reporting by the Rappahannock News has updated some of these developments, but this presentation ties them into one package.
This Rappahannock Snapshot brings us up-to-date on trends, unresolved items and remaining concerns. Each contribution by Randy Rieland and Sara Schonhardt is a refresher, a quick look at the status of everything from broadband (noticeable progress) to the local economy (much promise amid lingering concerns about tourism). The striking, award-winning graphics and data presentation you see here have been a constant highlight of this unique working arrangement between the owners of the News and the nonpartisan nonprofit led by local residents and volunteers. We’re grateful to Dennis Brack, John McCaslin, Laura Stanton, Luke Christopher and Roger Piantadosi for their top-notch contributions. But we’re also grateful to you, the community, for the consistent financial support that makes all this possible.
The benchmark Foothills Forum Survey, conducted with guidance from the University of Virginia’s Center for Survey Research, helped start us down this path, though much has changed locally – and nationally – in the three years when it was in the field. Residents across the county – every household – shared thoughts on 25 randomly presented local issues, plus services and quality of life. The resulting reports have twice won top awards at the Virginia Press Association.
We’re grateful for the hundreds of county residents who shared their thoughts with our reporting teams. We’re gladdened that so many of you turn out regularly for the forum gatherings held after each reporting project to discuss and consider the findings. We’ve heard and absorbed scads of comments, ideas and critiques and have benefited from them all.
And now, here’s another opportunity for YOU to weigh in. The survey validated a universal sentiment: We love Rappahannock, and we want to preserve and maintain it. Beneath that protective canopy lies an understory of varying concerns, realities and perceptions.
Add your voice. What else can you add to these updates? What are your biggest concerns right now? What are your views on the county’s future? Weigh in with a comment at email@example.com.
Larry Bud Meyer
Foothills Forum Chair
BROADBAND AND CELL CONNECTIVITY
Moving Ahead, Slow but Steady
This updates the Foothills Forum/Rappahannock News three-part series, “Rappahannock’s Digital Dilemma,” published July 21, Aug. 4 and Aug. 18, 2016.
By Sara Schonhardt
A lack of broadband connectivity and poor cellphone service has long plagued this hilly, sparsely populated county. Spotty signals or dead zones have become a public health and safety issue that worries residents, while the lack of reliable internet access also raises concerns about how much it hinders education, business development and the ability of workers to telecommute.
According to a survey commissioned by a broadband committee the Board of Supervisors appointed in 2016, 23 percent of respondents said they would work from home if they had better internet access and 21 percent of households indicated they need a broadband connection to support their children’s education.
Yet some residents have protested the building of towers needed to improve connectivity because of the impact they would have on viewsheds, and the supervisors have been divided on whether to spend limited tax dollars on what some do not yet view as a necessity.
Rappahannock is not alone in struggling to provide better connectivity to residents. A plan by the U.S. Department of Agriculture to fund internet providers who connect parts of the rural U.S. has been criticized for failing to address slow speeds, bad connections and expensive services.
But there has been progress in Rappahannock, most notably the linking of the county library and schools to a high-speed fiber network run by Sprint affiliate Shentel. Library director David Shaffer said people are happier with the speed and reliability of the new service. There’s been an uptick in the number of users who connect from the library’s parking lot, he added.
Made possible by the FCC’s E-rate program, which provides discounts to help schools and libraries pay for internet access, the fiber link has more than tripled the school district’s service to 500 mbps (megabits per second) with the ability to double the speed to 1 gigabyte. Every student now has either a Chromebook or laptop and teachers are using online programs such as Google Classroom to advance their instruction.
“We can even tap into technology that we haven’t yet, as we’re developing workforce training and more advanced coding and integrating computer science standards,” said School Superintendent Dr. Shannon Grimsley.
Robin Bolt, the school district’s executive director of administrative services, led the push to get the fiber connection, but her efforts were bolstered by the Broadband Committee. Chaired by Hampton District supervisor John Lesinski with six appointed members, its goal was to assess gaps in coverage in the county and identify specific community needs for improved broadband service.
The committee’s November 2017 survey found that 70 percent of residential respondents say their service is expensive, unreliable or inadequate, and more than one fourth of all businesses consider their internet service unacceptable. It also helped identify the underserved and unserved areas of the county and raised awareness about how a lack of connectivity was a public-service issue.
Improving public safety was the impetus behind another major communications development: Approval in July of a communications tower in Sperryville. In addition to meeting the need for a public safety paging system, it will also host equipment for local wireless internet provider Piedmont Broadband and provide access to cellular broadband through Shentel and T-Mobile.
Community Wireless Service is finalizing its building permit and plans to begin construction soon, according to spokeswoman Hope McCreary. T-Mobile, which has signed a lease with CWS, is expected to begin providing service by mid-year.
A spokesman at CenturyLink said the provider is working on a project in Huntly using the FCC’s Connect America Funds that will bring broadband with faster download speeds to more than 100 residents this year.
Lesinski and county administrator Garrey Curry have already met with several IT providers to better understand the options for more communications improvements. They’re also working to identify potential funding sources.
“We’re just trying to learn who’s interested and what the right technology is,” said Lesinski, who has sought advice from a supervisor spearheading Fauquier County’s broadband expansion efforts on which providers to approach and what technologies might work best in Rappahannock.
After debating last June whether to disband, the Broadband Committee decided to first prepare an interim report to review what it has accomplished and suggest next steps. Among the recommendations it’s considering are that supervisors take a serious look at what would be involved in adding more towers while being mindful of their visual impact, address broadband in the comprehensive plan and consider guidelines to develop public-private partnerships. Lesinski said he’s hopeful Shentel could extend its fiber network into the agricultural extension office in Washington, giving businesses in the village a boost.
Shentel recently purchased the rights to provide Sprint wireless service throughout Rappahannock and is linking the legacy Sprint cell sites to the Shentel network, said Dan Meenan, the vice president of Shentel’s wireless development network. He wouldn’t confirm specific areas for expansion, but said the company plans to add more cell sites, such as the Sperryville tower, to improve coverage.
Lesinski recognizes that the areas of progress are the “low-hanging fruit,” and expanding speeds and service doesn’t necessarily address affordability issues. Emergency service personnel say the hollows are still in desperate need of cell connectivity. In some parts of Virginia, companies like Vienna-based Declaration Network Group are expanding newer technologies, such as the use of TV white space, unused radio frequencies of old analog TV broadcast bands. But company sales and marketing head Barry Toser says they don’t have any immediate plans for Rappahannock.
After preparing the interim assessment, Lesinski said the Broadband Committee decided it will continue to operate and focus more on finding residential solutions, which he said is a bigger challenge.
Better broadband will roll out over a long period of time, Lesinski added, but there is growing awareness that it is necessary. “We just have to find the right providers, we have to find the right technology before we start asking people to dedicate dollars.”
JOHN LESINSKI, Chair of Broadband Committee and Supervisor for Hampton District
His biggest concern: “If the government doesn’t have political will to tackle the problem, it’s not going to get solved and it’s not an easy problem, it takes dedicated time and energy, and eventually it takes the dedication of resources.”
What makes him hopeful: “The fact that the people want it.”
SHANNON GRIMSLEY, Rappahannock School Board Superintendent
Her biggest concern: “I worry a lot about our aging population and the emergency services and capability to get help if you need it.”
What makes her hopeful: “I think what we’ve done here is hopefully open the door to some more opportunities for providers to come in.”
COMP PLAN/LAND USE
A Plan, Still in Flux, Coming in for a Landing?
This updates the Foothills Forum/Rappahannock News series, “The Land, a Plan, a Future,” which was published March 9 and March 24, 2017.
By Sara Schonhardt
Throughout its history, Rappahannock has avoided the urban sprawl and rapid development of its neighbors. The comprehensive plan – the county’s guiding document – along with land-use tax deferments, conservation easements and restrictive zoning have played a role in helping Rappahannock maintain its unspoiled natural setting, while keeping out big-box stores and even stoplights.
The comprehensive plan sets out a vision of a county with agriculture as its backbone, wide open spaces and a much different style of development than Warren or Fauquier, which don’t have the 25-acre zoning that has kept land outside Rappahannock’s villages from being carved up into smaller parcels.
But a question now facing residents is whether Rappahannock will be able to maintain its unique rural identity in the face of challenges related to health care, emergency service and broadband access as the rest of the world moves forward. Should it more aggressively embrace agritourism? What role can the local business community play? What adjustments does the county’s zoning strategy need?
Rappahannock is not alone in trying to forestall the influx of urban creep. Preserving the expansive, agricultural nature of the county does come with consequences, however, namely keeping the county heavily dependent on personal property taxes and making housing and land more expensive.
Under Virginia state code, every community must adopt a comprehensive plan and review it every five years. Rappahannock hasn’t formally revised its plan since 2004. The plan has come under review several times, but changes to county administrative staff and modest input during public forums have stalled the process.
By early December, the Planning Commission had reviewed a completed revision of the plan and requested that zoning administrator Michelle Somers make a final set of edits. Somers and County Administrator Garrey Curry have worked to update the demographic data, and the commission has modified a number of goals, objectives, and policies based on the latest information as well as input from several public meetings in 2018. They’ll consider the plan for a public hearing at January’s meeting (link to plan: https://www.boarddocs.com/va/corva/Board.nsf/Public)
“At the highest/broadest level, the plan has not changed much,” Planning Commission Chairman Gary Light wrote in an email. “We envision Rappahannock County as a rural and scenic community with an economy centered on low-impact tourism and agriculture.”
Within that framework, the revisions attempt to address the latest challenges the county faces, including an aging, shrinking population and limited public services. They also try to account for development issues Rappahannock may encounter in the future, such as utility-scale wind and solar facilities.
Light said the commission deemed it prudent to consider this type of land use given some public concerns that Rappahannock could face proposals for solar projects similar to those in Fauquier and Culpeper counties.
There are subtle changes, like sharper language around the need for broadband and cellular technology. One addition from a 2014 review that’s been retained refers to such technologies as “essential components of the 21st century economy” and encourages the means to provide for their expansion. It also raises concerns about the deteriorating quality of landline telephone service.
The revisions include added support for venues and services that serve the county’s youth and families. While the plan sticks to preserving the county’s natural beauty and landscape, with updates on conservation measures, there is more of an emphasis on the need for economic progress and sustainable growth that encourages sensitive tourism, such as low-impact tourist housing.
“I think there is a recognition that you need a certain amount of economic activity to have a robust community. And some of that is reflected in the revisions,” Light said.
Among economic development goals outlined in the plan is adaptive use of the old Aileen factory. Curry says owner Alex Sharp and the county are looking to get the facility listed as an opportunity for development on a database the Virginia Economic Development Partnership (VEDP) maintains that helps put property owners in touch with private companies looking for space.
“We know that we don’t want factories on every corner,” Curry said. “But where we can we want to be able to provide additional opportunities for jobs and additional opportunities for revenue that is coming from somewhere other than residences.”
Curry says he has met with people at VEDP to paint a better picture of what Rappahannock is and isn’t and let them know that it has different economic development goals than localities interested in large industrial plants.
As the Planning Commission reviews county zoning regulations in the future, including those regarding short-term rentals, event facilities and the ordinance around signs, any changes to the comprehensive plan would serve as the guiding framework for addressing those matters. But ultimately, decisions related to specific issues, such as broadband access and restrictions on Airbnbs, would likely come through more targeted zoning and regulation.
While there is no major shift in the latest revision of the comprehensive plan that would impact land use in Rappahannock, it does address issues such as communications and agritourism that people are divided over, and Curry says he expects and hopes there will be community feedback.
GARREY CURRY, County Administrator
His biggest concern: “The decisions we make today, how do they affect that long play? Those are hard questions to answer, but ones we really need to think about asking.”
What makes him hopeful: “I have comfort in knowing that the community is not likely to change in any knee-jerk way because of the special place that it is.”
GARY LIGHT, Planning Commission Chairman
His biggest concern: “We are highly dependent on private investments and potentially vulnerable to disruptive changes caused by the potential decisions of a few individual landowners or outside developers.”
What makes him hopeful: “If we listen to one another, recognize what sets us apart from surrounding communities, and work together on the specific challenges we face, I am confident that we will find ways to embrace needed changes while protecting the things that raise a smile and lower the heart rate when we head out on the farm or into the woods.”
THE RAPPAHANNOCK ECONOMY
Building Markets and a Future Together
This updates the Foothills Forum/Rappahannock News four-part series, “Work in Progress,” which was published June 28, July 12, July 26 and Aug. 9, 2018.
By Sara Schonhardt
Rappahannock is not alone in confronting a social and economic transition as its population ages and thins out. But change has been a constant in the county, and its ability to adapt has, in many ways, allowed it to maintain its unique identity.
Residents generally agree about the things they embrace here – the bucolic landscapes and open spaces, dark skies and lack of commercial development. They are less aligned about what is needed to maintain those characteristics and continue drawing in revenue to fund services. Neighboring counties are turning to tourism, but that doesn’t sit well with residents who worry how Rappahannock would cope with an influx of outsiders, even if only for a weekend. And increasingly hard questions are being asked about how the county can maintain its agricultural roots at a time when farmers struggle to make a living.
A lack of affordable and available housing to accommodate young families remains among county concerns. Some residents argue the county needs to prioritize quality of life and affordability to draw in and retain residents who bring new ideas and vibrancy. But the county remains persistently expensive and has limited job opportunities.
It was a bad year for farmers, hit by a barrage of unseasonable and often torrential rain.
But some county businesses have seen progress and the Art Tour, now entering its 15th year, drew around 1,200 visitors in early November. March’s sixth Yeaster, the beer and food festival hosted by Pen Druid Brewery, attracted its biggest crowd yet with 1,800 guests.
The culinary scene has also drawn attention with the opening of two new restaurants — Three Blacksmiths in Sperryville and the Blue Door in Flint Hill —and the Inn at Little Washington earning its third Michelin star in the fall. Meanwhile, the Thornton River Grille in Sperryville has closed to make more space for the popular RPK pizza.
There remains some wariness about the potential impact of tourism. “Be careful what you wish for,” said Matthew Black, board president of the Rappahannock Association for Arts and Community, the arts nonprofit that produces the Art Tour. “We want tourism, but we don’t want too many tourists.”
Yet Theresa Wood, president of Businesses of Rappahannock (BOR), said she sees a “renewed energy” from the county’s businesses and more receptiveness to tourism.
In the past two years, BOR membership has gone from around 130 to more than 200, and the organization has put more effort into boosting its social media presence, Wood said. Its most recent networking social drew about 80 people. The organization has also started offering “Lunch and Learn” classes that have drawn standing-room only crowds, according to Wood. They’ll continue those in 2019 with sessions on photography and Instagram, an advanced class on how to use features in Facebook for promotion and sales, and a class on accounting and business law.
In August, Wood took representatives from the Virginia Tourism Corporation on a tour of some county businesses, including Before & After cafe, Wild Roots Apothecary and Gay Street Gallery.
Having BOR take more of a role in helping businesses, irrespective of the county government’s support, has also helped raise awareness and interest in having businesses promote themselves, Wood adds.
Still, says Colleen O’Bryant, herbalist and owner of Wild Roots, there’s not much guidance in the county for small local companies when it comes to scaling up a business. She now has a shopfront and online sales, as well as workshops in D.C., wellness consultations, signature cocktail events. This year, she will add online classes. Wild Roots has seen 25 percent growth every year since it opened in 2015 – though with rising staff expenses, it’s still at the “break-even point.”
Soon BOR’s tourism committee will identify a few marketing firms they could work with to create a countywide brand for Rappahannock. In February, the organization is planning a joint mixer with business owners in Page and Fauquier counties. BOR now allows businesses outside Rappahannock to join, which Wood thinks is a good way to generate ideas and draw on one another’s efforts since they face many of the same challenges.
“They are driving people to their counties and that benefits us,” Wood said.
Some business owners say the best thing the county can do is not stand in their way. On their own, they are building relationships and starting to create markets where they can learn from and support one another.
“Both apiarists and orchardists are having a very difficult time … and if we can create a market to help support them and do good by them, we do good and everybody is happy and we can keep Rappahannock agricultural for a little while longer,” said Dennis Kelly of Hinson Ford Cider and Mead in Amissville.
He and his partners launched during this year’s Farm Tour and are now integrating with other county businesses, such as Thornton River Orchards for custom-pressed cider and Windsong Apiaries for honey.
Long-time resident Hal Hunter is focused on drawing more young people to Rappahannock. And he’s been talking with Ben Winchester at the University of Minnesota Extension about house-sharing as a partial solution to creating affordable residences.
DENNIS KELLY, Co-founder and mead maker, Hinson Ford Cider and Mead
His biggest concern: “We remain steadfastly dependent on wealthy weekenders and tourists, which is a fraught proposition as demonstrated by the impact of the 2008 recession on county businesses.”
What makes him hopeful: “The community of businesses out here … Everybody has been more than generous with their experience and insights and ideas and recommendations.”
COLLEEN O’BRYANT, herbalist and owner, Wild Roots
Her biggest concern: “If I did build this business to a $1 million business how could I actually staff that? Right now all my employees work at least three jobs and don’t quite have the skills that I need to help my business grow.”
What makes her hopeful: “I love the uniqueness of our business. I love to call our part of “town” the maker’s alley because we are all crafting handmade products because of our passion. There is a beauty in that for sure, and people are attracted to it.”
FIRE AND RESCUE
A ‘Teeter-Tottering’ Volunteer System
This updates the Foothills Forum/Rappahannock News three-part series, “A Troubling Diagnosis,” published July 20, Aug. 3 and Aug. 17, 2017.
By Randy Rieland
When it comes to its fire and rescue service, Rappahannock County remains a rarity — it’s one of a very few counties in Virginia that relies solely on volunteers to respond to emergencies.
Not having to pay EMTs and firefighters has clearly saved the county a lot of money. But dependence on volunteers brings with it a hard reality – the ability to provide this critical service hinges on the availability and commitment of people not being compensated for answering calls at all hours of the day and night.
And, as Rappahannock has evolved into more of a retirement community, the age of those responding to emergencies continues to rise. According to the most recent review, about a quarter of the 220 volunteers on department rosters here are older than 60. Forty-six percent are at least 50.
More tellingly, those who respond most often tend to be older. Roughly 28 percent of the volunteers answered more than 10 percent of the calls last year, and 54 percent of them were 50 or older. The prospect of active and more experienced responders aging out in the coming years continues to worry the system’s leaders that Rappahannock may need to look at shifting to at least some paid emergency workers sooner rather than later.
The county took a step in that direction in February 2018 when it signed an updated agreement with the seven independent volunteer fire and rescue companies in Rappahannock, the first one since 1998. To relieve some of the fund-raising burden on volunteers, the county agreed to fully cover operational costs of the fire and rescue companies. But while county officials reiterated the commitment to an all-volunteer service for as long as possible, the agreement noted that it may “need to be supplemented by career fire, rescue and emergency medical services employees in the future.”
No big surprise there, but the agreement also includes guidelines meant to serve as an early warning signal if volunteer attrition starts to affect the quality of service. It stipulates a countywide goal that 90 percent of the time, fire and rescue companies will respond within eight minutes and are on the scene of an emergency within 25 minutes. It also notes that they must be able to respond to two simultaneous events in the county and be able to administer medical aid and transport victims to the hospital, if necessary.
So far, the volunteer companies have remained up to the task. According to the most recent response time report, covering the first six months of 2018, both ambulances and fire trucks got to the scene within 24 minutes of emergency or fire calls 99 percent of the time.
But those statistics can mask a precarious situation. In some companies, a handful of volunteers handle most of the calls, and if one or two call it quits, service could deteriorate quickly. That’s why Kevin Williams, the county’s Emergency Services and Emergency Management Coordinator since last May, wants to start tracking more closely the response times of individual companies. That’s not required by the agreement, but Williams, a longtime volunteer and officer with the Chester Gap company, said, “I want to see if all the departments are meeting the standard or if a department is picking up the weight of other departments.”
There’s already a “dual dispatch” policy for the Flint Hill Volunteer Fire Department, which has found itself short-handed as it struggles to recruit new volunteers. When calls come in there, another company – Washington, Amissville or Chester Gap — is always dispatched with them.
Williams thinks it’s time for the county to start preparing to make the transition to paid responders. “We’re behind the eight ball as far as planning for it,” he said. “Working on a plan doesn’t mean you’re going to start switching to paid. But we don’t even have a plan.
“Because this is going to come,” he added. “And when it does come, if we haven’t done any planning, it’s going to hit us like a dump truck. Transition can take two or three years. You have to be very careful when you do this. You’d have to find the right people who will work with the volunteers. If you bring in a person who was never a volunteer or doesn’t like volunteers, that’s never going to work.
“The volunteers we currently have who run calls are doing an outstanding job. But the worst thing from my perspective would be to keep kicking this can down the road. This is not something we can keep kicking down the road.”
KEVIN WILLIAMS, County Emergency Services and Emergency Management Coordinator
His biggest concern: “Aging of the volunteer system. We’re at the top of a cliff. We’re teeter-tottering.”
What makes him hopeful: “Knowing that our fire chiefs who have been in that position for years have the same vision that I do that we need to start planning for a transition.”
HAROLD BEEBOUT, Chief of the Sperryville Volunteer Rescue Squad
His biggest concern: “Will there be enough younger people to take over as the older volunteers retire or are unable to continue?”
What makes him hopeful: “The new young volunteers in several companies who have shown a strong interest by becoming EMTs and firefighters. As long as they continue their commitment, the need to supplement volunteers with paid staff may be postponed.”
Not So Healthy
This updates the Foothills Forum/Rappahannock News three-part series, “A Troubling Diagnosis,” published July 20, Aug. 3 and Aug. 17, 2017.
By Randy Rieland
These are turbulent times for health care in rural America. Its supply of doctors is dwindling, and its hospitals are closing at an accelerating rate — almost 90 have shut down since 2010.
That disheartens Dr. Jerry Martin, who before retiring last month, had spent almost half a century as an archetypal country doctor in Rappahannock. His career here dates to 1974, when he joined Dr. Werner Krebser in opening a practice on Gay Street in Washington.
Dr. Martin’s worried not only about what will happen with his patients, but also, more broadly, about where health care is headed. He’s seen how the enormous cost of a medical education has discouraged people from becoming primary care physicians, particularly in rural areas, where doctors earn less and can struggle to pay off their debts. And, he’s witnessed firsthand how already staggering medical costs keep climbing.
“What concerns me the most about the state of health care is that when a patient comes in, I should be able to give them my undivided attention,” he said. “But the big medical organizations and the insurance companies have become beholden to their stockholders instead of the people you’re trying to serve.
“Reimbursement is skewed toward procedures,” Martin added. “You don’t get paid for sitting and talking to someone for 20 minutes.”
The impact of these trends is likely to be particularly profound in rural communities, where doctors like Martin will increasingly be replaced by nurse practitioners and physicians’ assistants, and more and more medical appointments will occur online.
Overall, there’s good news and bad news regarding the state of the county’s health and care. According to the 2018 County Health Rankings and Roadmaps, an annual report sponsored by the Robert Wood Johnson Foundation, Rappahannock ranks 15th among the state’s 133 counties and cities in a category called “Health Behaviors.” It reflects tobacco and alcohol use, physical activity, access to healthy foods, and sexually transmitted diseases. In the previous report, the county ranked 30th.
Rappahannock also rose to 12th place from 27th in a category called “Length of Life,” which measures the risk of dying before 75, and is based on the number of years lost by people who have died before then.
On the negative side, the county dropped all the way down to 110th in a category called “Clinical Care,” where it had ranked 80th. This reflects access to doctors, dentists and mental health professionals. In a county like Rappahannock, which has so few health professionals, a small change can have a big impact on its ranking. The category also takes into account the percentage of residents without health insurance. That’s estimated at 15 percent, while the Virginia average is 10 percent.
Rappahannock’s obesity rate of 30 percent, according to the report, is also above the state average, as is the percentage of residents over 20 who have been diagnosed with diabetes — 12 percent.
Dr. Martin’s retirement leaves the county with just three primary care physicians — Dr. John McCue, who began practicing here in 1998; Dr. Brooke Miller, who with his wife, Ann, a nurse practitioner, sees patients at the Valley Health System clinic near Washington; and Dr. Christopher Nagle, who last year opened his Wilderness Medicine practice in the Mountainside Physical Therapy building on Route 211.
Dr. Nagle hopes to soon begin accepting payments through Medicare and some private insurers after initially exploring the concept of having patients pay him directly. He felt that by avoiding the administrative costs and time demands of dealing with insurance claims, he could keep his expenses low. But he concluded that the model probably wouldn’t work in an aging, sparsely populated community like Rappahannock.
Dr. Nagle’s practice is part of a small network of health-care services located in the Mountainside building, with the core component being the physical therapy business owned by Anne Williams. She said it now gets about 500 patient visits a month, but could handle more if she could find more certified physical therapists in this area.
A state law passed in 2015 allowing patients direct access to physical therapy without a referral from a doctor could be a boon to the Mountainside business. “People with orthopedic problems can now come to a physical therapist as a first point of access into the medical system,” Williams said. “A lot of people still aren’t aware of that.”
Given the growing shortage of rural doctors, it has become that much more critical to train local residents for health-care careers, according to Travis Clark, vice president of operations for Valley Health’s Southern Region and president of Page Memorial Hospital in Luray. He cited the efforts of RappU, where in the past two years, 52 people have enrolled in classes to become certified for such health-care jobs as nurse aide or clinical medical assistant. Another 16 students have taken a nurse aide course at Rappahannock High School.
Another development that will likely have an impact is the decision by the Virginia legislature in May 2018 to expand Medicaid; an estimated 300 to 400 additional Rappahannock residents are now eligible for coverage. A work requirement included in the law still needs to be approved by the Trump administration.
The effect will also be felt by Virginia hospitals, Clark noted. About 11 percent of his hospital’s revenue, he said, is lost to “uncompensated care” when patients can’t pay.
“If we can get a person established with Medicaid instead of them using the emergency room for primary care, that’s a big win for us, and more importantly, the patient,” he said.
As in any aging community, more of the focus of health care in Rappahannock will be on managing chronic conditions, such as diabetes, heart disease and cancer. That can really be a challenge when patients have to travel long distances for doctors’ appointments or to pick up prescriptions.
One promising development is that the Valley Health clinic is considering providing limited pharmacy services, according to Dr. Miller.
Dr. Nagle said he hopes that eventually much of his practice will be built around telemedicine. But for it to be effective, a health professional needs to know the patients he or she connects with digitally.
“It’s key that I know the person before I can remove the face-to-face aspect,” he said. “You need to know their physical state. You need to know if they tend to be more stoic in their description of their health concerns. Maybe they typically understate things.”
Another telemedicine approach is a chronic care management program called RevUp. It’s available to Medicare patients with at least two chronic conditions. Once a person signs up, he or she is contacted by a “nurse navigator” once a month to see how the patient is doing in sticking to their treatment plan.
RevUp became available at the Valley Health clinic last May, and so far about 10 percent of the eligible patients there have signed up, according to Clark. He thinks it has promise as a way to keep more isolated people engaged with their health care.
“A nurse navigator can answer questions and maybe make a doctor’s appointment unnecessary,” Clark said. “And, it could help avoid unnecessary trips to the hospital. That’s what really drives up the cost of health care.”
But Brooke Miller, who is increasing his time at the Valley Health clinic from four to six days a month, is less sanguine. He grew up in Rappahannock and knows how a lot of locals feel about calls from strangers.
“I already see my chronic care patients every three months,” he said. “I do tell people about this program if I think it will help them. But a lot of people think it’s an intrusion and don’t want to be bothered with the calls.”
DR. JERRY MARTIN, recently retired after 44 years as Rappahannock physician
His biggest concern: “There are just so many things wrong with the health-care system. I think the way it’s going is going to bankrupt the country.”
What makes him hopeful: “I’m always amazed at the progress being made in unraveling the myriad configurations of the human condition in sickness and health.”
TRAVIS CLARK, Vice president of operations for Valley Health’s Southern Region and president of Page Memorial Hospital in Luray
His biggest concern: “We don’t just have an aging population. We also have an aging health-care workforce.”
What makes him hopeful: “If we can keep people local and help them get health-care training. Whatever we can do to encourage people to look at careers in health care will help.”
One Ride at a Time
By Randy Rieland
This updates the Foothills Forum/Rappahannock News two-part series “Going Nowhere?,” published Feb. 9 and 23, 2018.
When people talk about the challenges facing communities like Rappahannock, transportation rarely tops the list. For our aging population, it’s not up there with inadequate access to health care or the slow drain of social isolation.
Yet lack of mobility is at the root of many of the struggles of rural seniors, which is why providing rides to medical appointments and food shopping is such a critical service of the Rappahannock Senior Center and nonprofits like Rapp at Home. But making sure people can get where they need to go ultimately depends on small networks of volunteer drivers, and sustaining them means continuously searching for new recruits.
“We do quite a lot of outreach,” said Kristin Lam Peraza, who, since last July, has been coordinator and mobility manager of the Foothills Area Mobility Center (FAMS) in Culpeper. It operates a call center that helps find rides for people in a five-county region, including Rappahannock. “We’re asking a lot of these volunteers.”
Judging from FAMS data, demand for transportation help is growing, perhaps because the operation has been trying to raise awareness of the call center beyond Culpeper. In 2016, it handled a total of 700 requests; in 2017, the number of inquiries for the five counties jumped to almost 2,400. Through October 2018, it had already risen another 25 percent to almost 3,000 requests.
Rappahannock remains at the low end — 266 inquiries came from county residents through the first 10 months of 2018. But it’s still a 53 percent increase over the total from Rappahannock for all of 2017.
It also doesn’t include people who directly contacted Darcy Canton, who oversees the Rappahannock Senior Center and schedules volunteer drivers for county residents 60 or older to use RappMedRides, for doctor appointments and medical treatments, and RappRides, for shopping trips. Through November, she scheduled 144 rides in 2018; almost three out four were for RappMedRides.
“People in Rappahannock know to call me,” said Canton. “We’ve gotten some new riders through FAMS. It helps a bit, but not as much in Rappahannock.”
Peraza said part of the challenge of raising the call center’s profile here is that the county lacks a town center. “Rappahannock is a place where people live far away from each other. If I put information in a school or library here in Culpeper, a lot more folks will see it. That takes longer in Rappahannock.”
For those under 60, the best option is VolTran, a nonprofit service that arranges free rides for Rappahannock, Fauquier and northern Culpeper residents. About 20 percent of the 579 rides its drivers provided through October last year originated in Rappahannock, but requests from county residents are on the rise – two-thirds have occurred since last summer. Most were for medical appointments, but Melissa Whipkey, who has been VolTran’s program coordinator since August, said it also handles rides for other purposes.
“We’ve taken people to food pantries, to Walmart,” she said. “We take one woman to get her hair done. The social aspect of providing transportation is important.”
About one out of every five ride requests that came into VolTran through October, however, couldn’t be met because no volunteer drivers were available. There are now about 15 “active” volunteers driving for VolTran, but Whipkey said she could use at least 10 more to meet demand.
Lately, she’s been recruiting at churches. Usually she brings along a volunteer to share their experiences.
“If I can get one person from each church to volunteer to drive,” she said, “I’m a happy camper.”
Peraza said FAMS now uses more sophisticated software that can gather more detail about the region’s transportation needs. “It will be able to create maps showing where there are greater demands,” she said, “and help show the counties where there’s a consistent need.
“It will also help us to break down medical rides more precisely,” she added. “Is it for cancer treatments? Is the need based on a chronic illness or more of a short-term situation?”
A key goal is to find ways to ease the burden on volunteer drivers. “If someone in Chester Gap needs someone to take them to Warrenton for an appointment, then the driver has to wait there, and then take them back home. That becomes a big time commitment for the volunteer.”
So, Peraza is pursuing ways to bring health-care access closer to those who need it. She has submitted a grant proposal to the Federal Transit Administration (FTA) to support the formation of a Health Transportation Cooperative Partnership that would explore more innovative strategies. One possibility would be the creation of “Live Health Access Stations” in rural communities where patients could go to have video chats with physicians. That could help reduce the need for long drives.
“We have to think very innovatively and collaboratively to solve these transportation issues,” she said. “Is it a daunting task? Absolutely. But I feel we’re on the right track in terms of collaboration and trying to ensure that what we do is long-lasting.”
DARCY CANTON, Rappahannock Senior Center Supervisor
Her biggest concern: “The whole system is pretty fragile. I know all the drivers, and it would probably take a while for a new person to be able to develop the relationships with everybody. Will those drivers keep driving? I just don’t know.”
What makes her hopeful: “People who care about other people. And that’s pretty much what you have to have. I’m hopeful about people. I’m a little concerned about society.”
MELISSA WHIPKEY, VolTran Program Coordinator
Her biggest concern: “The big challenge is finding volunteer drivers who are willing to take requests for longer drives.”
What makes her hopeful: “Our current roster of volunteer drivers provides me hope and inspiration every time they volunteer over and over and over to fulfill the ride requests that come in.”