WILLIAMSVILLE — I recently participated in the Townshend Community Conversation about "Vermont's healthcare system to support hospital transformation." For two hours, residents of rural Windham County testified to the extraordinary way medical services are delivered at Grace Cottage Family Health and Hospital.
It was a remarkable expression of gratitude and pride for an institution that delivers essential health care services to the rural community it serves. And for good reason.
People can access a lot of primary care in Townshend, including pediatrics, adult medicine, gerontology, hospice, mental health, and substance abuse treatment. Wraparound services include laboratory, imaging, occupational and physical therapy, emergency care, in-patient care, social services, and end-of-life hospice care.
There's a pharmacy where patients can pick up prescriptions without adding an extra 40 miles to fetch medicine at the cost of an hour's time and two gallons of gas. For many in our rural hilltowns, transportation is a barrier to accessing health care.
I live in Newfane and have been going to Grace Cottage for primary care since 1984. I gave birth in the old hospital, brought my kids for casts, stitches, and wellness care, and I sat vigil for my father in the Hospice Suite, where he was able to die as he wished, with no heroic measures.
Grace Cottage provides family medicine from cradle to grave.
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For 16 years, I managed a private family practice in Townshend and learned firsthand how, when primary care is accessible, welcoming, and within the community it serves, it's a bargain compared to the cost of after-the-fact intervention - not just financially, but also in quality of life.
Health care is a service; it's the financing of health care that's become an industry.
By concentrating on delivering excellent primary care that attracts patients, practitioners, and staff, Grace Cottage has outgrown its clinical space. It's now up to the Green Mountain Care Board to allow Grace Cottage to build a new clinic building to meet a growing 21st-century demand for primary care.
The hospital building and emergency department have been recently expanded to meet this increasing demand, but the clinics are in two 19th-century buildings that have been renovated so often that all that remains of the original structures are their uneven floors.
When practitioners need to have one of medicine's difficult family conversations regarding a serious diagnosis with patients and family, they all cram into a small exam room that others are waiting to use. The clinic needs a conference room and more exam rooms - and a conference room as well.
Grace Cottage has 13 primary-care providers - family physicians, nurse practitioners, and physicians' assistants - who are shoehorned three to an office, where they dictate, make phone calls, do research, and concentrate all within earshot of one another and with a complete lack of privacy.
One nurse practitioner does have her own office. The room has no window; in any other building, this would be called a closet.
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Nevertheless - and despite a national shortage of family physicians - family doctors and advanced practitioners want to work at Grace Cottage Family Health, and patient demand continues to increase, but there is no space to accommodate them.
The current clinic is inadequate and worn out. Plans for a new primary care clinic were submitted in April to the Green Mountain Care Board, which has yet to issue a Certificate of Need.
While Grace Cottage is small by today's health care standards, its size and independence allow it to be nimble and resilient, as evidenced by its response to the COVID-19 pandemic. It's a highly successful model for delivering health care in a rural area. And unlike some larger hospitals in Vermont, Grace Cottage is solvent.
At the recent Community Conversation about Healthcare Sustainability, the consultant facilitating the meeting assured us this meeting was part of a long-range data-collection process.
All well and good, but Grace Cottage Family Health needs a new building now.
Deborah Lee Luskin, one of this newspaper's original columnists, blogs at deborahleeluskin.com.
This Voices column by Deborah Lee Luskin was written for The Commons.