Authored by
Garth Kruger, Ph.D., Director, EvaluationGoup,LLC
EvaluationGroup,LLC * 29337 310
th
Ave NW * Warren, MN 56762
Tel (218) 437-8435 * e-mail gkruger@evaluationgroupllc.com
Authored by
Garth Kruger, Ph.D., Director, EvaluationGoup,LLC
EvaluationGroup,LLC * 29337 310
th
Ave NW * Warren, MN 56762
Tel (218) 437-8435 * e-mail gkruger@evaluationgroupllc.com
Table of Contents
Introduction Overview ............................................................................................................................ 1
LifeCare Medical Center Overview ......................................................................................................... 1
Service Area Geography ....................................................................................................................... 1
Service Area Demographics. .................................................................................................................. 2
Population Size/Age ......................................................................................................................... 2
Income ............................................................................................................................................. 2
Education ........................................................................................................................................ 2
Needs Assessment Methodology ........................................................................................................ 2-3
Key Informant Interview Findings ........................................................................................................ 3-7
Roseau County Community Mental Health Survey 2021. .....................................................................7
Roseau County Community Health Needs Assessment Survey 2022 ................................................... 7
Archival Data Findings ....................................................................................................................... 8-13
Access to Care .............................................................................................................................. 8
Weight Status ................................................................................................................................ 8
Physical Activity .............................................................................................................................. 9
Elevated Cholesterol ...................................................................................................................... 9
Elevated Blood Pressure ................................................................................................................ 9
Cardiovascular Disease Deaths .................................................................................................. 10
Diabetes....................................................................................................................................... 11
Tobacco Use ................................................................................................................................ 11
Alcohol Use................................................................................................................................... 11
Drug Use ...................................................................................................................................... 12
Summary .............................................................................................................................................. 12
Next Steps ......................................................................................................................................... 13
1
Service Area Demographics
Population Size/Age Roseau County
• Roseau County has a total population of 15,331 (a decrease of approximately 300 people
from Census 2010 to Census 2020)
o Population density of 9.3 people per square mile.
• 18.1% of the population is over the age of 65 compared to the statewide average of 16.3%.
• Approximately 92.6% of are white.
o Minority populations primarily include Asian, American Indian and Hispanic.
• The average family size is 2.54 people.
Income
• Roseau County has a median household income of $62,304 (Minnesota is $73,382).
• The poverty rate for Roseau County is approximately 7.3%, (Minnesota is 8.3%).
Lower to middle income, blue-collar workers are representative of a large demographic swath of the
population. The county’s economy is driven by agriculture and manufacturing businesses adding to the
financial climate. LifeCare is the 3
rd
largest employer in the service area and impacts the regional
economy along with Polaris, Marvin Windows, and Central Boiler. Roseau County is known for its social
and economic stability. Residents are generally aware of national and world events, local news about
the activities of youth teams, social fraternal organizations, church outings and high school sports that
dominate the local newspapers. Multiple generations of families live in and around Roseau County
and the surrounding towns comprising northwestern Minnesota.
Education
• 19% of Roseau County residents (aged 25 and older) have a bachelor’s degree or higher which
is significantly lower than the average of 37% of residents statewide.
o Approximately 91.5% of the population aged 25 and older in Roseau County have a high
school education or higher.
Needs Assessment Methodology
LifeCare identified current and unmet community health care needs by conducting community stakeholder
interviews and a community needs assessment survey. A wide range of available archival data and
reports were also reviewed to assist in identifying health care issues. Key data points were:
• Roseau County Key Informant Interviews/Discussion Groups
o The core CHNA group from LifeCare Medical Center conducted 13 key informant
interview meetings across a range of private companies and institutions
o 53 individuals participated in total.
• Community Needs Assessment Survey (2022)
o Community feedback on health services/needs for LifeCare was completed
through a convenience survey posted on social media.
o 136 individuals responded to the survey from April 15
th
to June 15
th
.
• Roseau County Community Mental Health Survey (2021)
o This was an online convenience survey with 106 respondents that was
constructed by Sue Grafstrom, Roseau County Homeland Security Emergency
Management Director.
• Archival Data
Ø Census Data 2020.
Ø 2017 Northwest Regional Adult Behavioral Health Survey (NRABS)
o The NRABS survey was the first randomized household survey of adult
health of its kind in northwest Minnesota and was a vast improvement
in data quality. It captured a broad snapshot of the health of adults in
the region.
Ø CDC Interactive Atlas of Heart and Stroke
2
o CDC’s Interactive Atlas of Heart Disease and Stroke is an online
mapping tool that allows users to create and customize county-level
maps of heart disease and stroke by race and ethnicity, gender, age
group, and more.
o Interactive Atlas of Heart Disease and Stroke (cdc.gov)
Ø Minnesota Adult Tobacco Use Survey 2018.
Ø Minnesota Student Survey 2016, 2019.
Ø LifeCare Diagnosis Related Group (DRG) treatment data from emergency room
encounters from 2020 and 2021.
Ø LifeCare Chief Diagnosis for inpatient admissions 2020-21
Roseau County Key Informant Interview Findings
The CHNA core group conducted 13 individual meetings with 53 individuals participating in total.
The following table illustrates the depth and breadth of those interviewed. Input was solicited from
organizations serving all age groups and geographic areas for the LifeCare service area in order to
get the most complete information (e.g., Roseau County Social Services, Northwest Community
Action and Roseau Police Dept.). Everyone participating in the interviews was given a list of
specific health indicators/needs based on past responses from previous needs assessments and
asked the following open-ended questions on community health needs:
1. What do you believe are the 2-3 most important issues that should be addressed
to improve the quality of life for people in our community? areas
2. After reviewing the Health Indicators List, what items do you think are the most
pressing health concerns for our citizens and why? Are there any not on the list
that you believe are a concern?
3. What (if anything) is holding our community back from doing what needs to be done
to improve health and quality of life for residents?
4. If you could create the healthiest community what would that look like to you?
5. Please share a few things our community could do better to enhance the health of
our residents:
The responses from these individual meetings were then forwarded on to Garth Kruger,
EvaluationGroup, LLC and he compiled them into a comprehensive list of community health needs and
suggestions.
3
What do you think are the most pressing health concerns for our citizens and why?
Mental Health/Illness
Mental Health concerns were discussed at length across all meetings. Participants indicated that
distance to mental health services, lack of access to services, inappropriate service utilization,
problems at home, school, and work were all pressing health concerns. COVID was mentioned time
and again as exacerbating mental health problems. And county jails were believed to be housing large
populations of the region’s mentally ill. Issues were summarized under the following topics:
• Distance to Services
• Lack of Access to Services
• Prison Population
• Mental Health Concerns at Home
• Mental Health Concerns in Schools
• Mental Health Concerns at Work
Discussions confirm that low-income individuals, and especially those with chronic illness, are having
greater needs for mental health services. This is consistent with past needs assessment findings.
Affordable Childcare
Lack of affordable childcare options were reported to be exacerbating workforce availability concerns.
Issues identified were:
• Birth to Kindergarten childcare is difficult to find due to lack of providers
• Child-care centers have not proven to be profitable in Roseau.
Roseau County Key Informant Interview Participants
Organization
Age Demographic
Roseau County Group (5 representatives)
18-65
Warroad School Nurse/Staff
(3 representatives)
0-18
NW Community Action Energy Assistance
Manager (6 representatives)
25-Elderly
Roseau Police Dept. (2 representatives)
Birth - Elderly
Badger/Greenbush School
(3 representatives)
Preschool - 18
Marvin Windows and Doors (2 HR reps)
18 - 65
Roseau School District (5 representatives)
Preschool - 18
Central Boiler, Inc (2 HR representatives)
18-65
Polaris Industries (HR rep and on-site nurse)
18-65
LifeCare Public Health
(3 representatives)
Birth-Elderly
Roseau Ministerial Association:
(9 representatives)
Birth-Elderly
Roseau City Council Group
(6 representatives)
Birth-Elderly
Roseau County Social Services
(5 representatives)
Birth – Elderly
4
• More difficult during COVID with quarantine parameters.
o People could not always make it work.
• Jobs available are not compatible with childcare hours.
Alcohol, Tobacco, and Illegal Drug Use
Consumption of alcohol and drugs is reportedly up since COVID. Substance use has been used as a
method for coping. While interviewees stated that alcohol consumption may not necessarily be affecting
work, it’s certainly grown as part of culture “where we live”. It appears that drug use may be growing
more extreme as well. Kids without extra-curricular activities or those that don't have a group are
identified as most at risk. Specifically, the following issues were discussed:
• Vaping is still a thing, but kids are getting better at hiding it.
• Drug use (all kinds) and alcohol/tobacco use (including vaping) are all on the increase.
o Often goes along with mental illness and domestic violence.
• Chewing Tobacco is at all-time high.
• Pre-employment failed drug tests are prevalent.
Housing Affordability, Availability and Homelessness
Interviewees stated that people want to work, but for many there is no place for them to live.
Housing that is available is often not ideal, so some people end up living in hotels. Many make just
enough money that they do not qualify for assistance. They are the working poor. Common themes
include:
•
People living several families to a house.
• In the winter, people in hotels are displaced on weekends to make way for hockey teams
coming in.
• We have a lot of “couch hoppers” in our community; this is the face of homelessness.
• People are here for 3 months, then they leave as there is no place to live.
Lack of Healthcare Access/Services:
A wide range of access to healthcare concerns were expressed but also a feeling that residents are
fortunate to have the services they do. Issues discussed were similar to past health assessments
and included:
• Limited number of dentists / not taking new patients
• Long term care/assisted living affordability
• Lack of staffing affects availability of long term care/assisted living utilization
• Lack of Personal Care Services
o People need someone to help in order to stay home
• Availability of EMS and Ambulance service on the West side of the county is challenging
COVID
The onset of COVID was discussed frequently as pervasive in its detrimental influence on all
aspects of life. Covid’s onset was abrupt and disruptive of the delicate balance between work, day
care, school, and social events to name a few. Several comments regarding Covid that exemplify
this pervasive influence included:
• Childcare options were more difficult during COVID with quarantine parameters. People
could not always make it work.
• Technology addiction; kids were on phones so much more during COVID.
• Kids are away from school more than they used to be; the online world from COVID might
have made it easier to be gone.
5
• Consumption of alcohol is up since COVID.
Other Concerns
Income and transportation are two additional areas that significantly impact access to health care. As
in the 2019 CHNA report, a number of interviewees remarked that transportation to and from medical
facilities was of significant concern. These transportation issues stem from a variety of factors,
including age and income limitations -both of which substantially impact Roseau County residents. As
noted previously, Roseau County has a greater proportion of population age 65 and older compared to
statewide. Coupled with residents’ median income below the state average, concerns of healthcare
access are not surprising.
Things our community could do better to enhance the health of our residents.
Recurring themes brought up in interviews:
• More Activities to increase social interactions
o More things to do in general in the community; family-friendly community events
without alcohol.
• Community centers
o A Community Center that people could go to; big enough to walk; socialize; for all
ages all year long.
• Improving access to healthcare
o More resources available for all things mental health-related, including substance
abuse; a place for people to go if needing different levels of care such as detox.
• Improved communication
o Build a communication hub to bring people together – so everybody knows what’s
going on in our communities.
Roseau County Community Mental Health Survey (2021)
An online convenience survey assessing community mental health was conducted by Sue Grafstrom,
Roseau County Emergency Response Manager in the fall of 2021. There were 106 respondents
representing a broad swath of community members. Respondents reported that the areas their lives
most impacted by the COVID pandemic were (in order of greatest to least impact): social connections,
trust in traditional medial (newspaper, TV, radio), trust in systems (healthcare, education, local
government, state government), and community involvement. Over 80% of respondents reported
moderate or severe impacts on their mental health over the past 20 months prior to the survey.
Suggestions for addressing mental health needs in Roseau County included:
• More community outreach on managing mental health e.g., seminars or groups.
• Encouraging employers to support employees working from home.
o Respondents felt their mental health improved when working from home.
• Helping people identify ways to better take care of themselves.
• More awareness and compassion about mental health issues.
• More therapists and psychologists to work with school age children.
• More community activities to provide opportunities for social interactions
Roseau County Community Needs Assessment Survey (2022)
In April 2022, an online community needs assessment was conducted using a Survey Monkey
link from the LifeCare Facebook site. Survey participants were asked to 'please rate the level of
concern you have about the following issues.' Mental Health issues were rated by 89% of the
respondents as being a ‘Moderate Concern’ or ‘Great Concern.’ Seventy-eight percent felt that
Drug Use/Abuse was of moderate/great concern. There were 136 respondents to the survey.
6
Archival Data Findings
Access to Care
Roseau County is designated a geographic Health Provider Shortage Area (HPSA) for primary care and
mental health. The recruitment and retention of qualified healthcare staff is an ongoing concern.
Weight Status
36.2 percent of the adult population in Roseau county is estimated to be obese according to the CDC
statistics. Unfortunately, the data is drawn from the BRFSS survey conducted in 2020 and is a synthetic
estimate extrapolated to individual counties but is drawn from all rural respondents across the state. The
estimate assumes that rural Minnesotans are the same in Roseau County as they are in other rural
counties.
Survey respondents to the 2017 Northwest Regional Adult Behavioral Health Survey (NRABS)
found that 70.9% of all individuals residing in the Quin County region are considered either overweight
(37.4%) or obese (33.5%). This is a generally flat trend from 2014 and is higher than the state average
of 64.5% (36.7% overweight: 27.8%, obese). In terms of
gender and age as related to weight, older males tend to be the most overweight while younger females
are the least.
7
According to the 2016 and 2019 Minnesota Student Survey (MNSS) data shown in the table below, the
percent of 11
th
grade students overweight and obese in the 5-county Quin CHS region is higher than the
state average. Individual data for each county is listed in the table below. The 2019 data for Roseau
County confirms a trend seen in previous data whereby individuals considered overweight decrease, but
it’s because the number of obese increases. However, the overall trend of obese + overweight continues
to increase.
Overweight
Obese
Total
Roseau 2016
20
13
33
Roseau 2019
16
18
34
Red Lake
15
23
38
Pennington
13
19
32
Roseau
17
14
31
Kittson
13
17
30
CHB
17
15
32
State
14
11
25
Physical Activity
In Roseau County only an estimated 27% of individuals are getting their recommended levels of physical
activity (NRABS 2017). This is far lower than the average rate of 55% of all Minnesotans. Overall
similarly low rates of Physical activity are found irrespective of demography like income, age or gender.
Workplace wellness initiatives are popular efforts and efforts should continue to focus resources on
areas that develop and encourage physical activity across working adult populations and in workplace
settings.
Elevated Cholesterol
The 2017 NRABS study found that approximately 33% of Roseau County residents had been informed
they had elevated cholesterol which is 50% higher than what was reported by the 2012 MN All Payer
Claims Database (MN APCD). Potential explanations for this difference include: 1) an under-estimation
by the MN ACPD study, (which the authors concede is highly likely), or 2) many more people are
diagnosed with high cholesterol than who are receiving reimbursed medical care for that condition.
Elevated Blood Pressure
The MN APCD study indicated that 2,508 people in Roseau County received treatment for blood
pressure in 2012 (approximately 30% of the population). This places the county in the range of between
15% and 25% above the statewide rates of elevated blood pressure as shown in the figure below.
Corroborating evidence for this level of pathology was found in the 2017 NRABS study. That survey
found 42% of respondents reported having at one time or another been informed by a healthcare
provider they had high blood pressure (non-pregnancy related).
8
Total Cardiovascular Disease Deaths
Total cardiovascular disease deaths per 100k from 2017-2019 are depicted on the following page. This is
age adjusted data, meaning that it considers the slightly older bias of Roseau County and adjusts data
for that factor. The northwest corner of Minnesota contains a group of counties that take the cake for
being highest in death from heart disease. 384.9 is the death rate per 100k people for Roseau County;
which can otherwise be expressed as 38.49 people per 10,000.
Source: MN All Payers Claims
Database
Total cardiovascular disease deaths per 100k from 2017-2019 in Minnesota
9
Diabetes
The MN APCD Database study indicated that 701 individuals in Roseau County received treatment for
diabetes (among the insured population in 2012). This rate ranged between 5 and 15% above the
statewide rates of diabetes treatments reimbursed during that similar time frame.
While only 701 individuals received paid treatment for diabetes (MN APCD), approximately 1,413
individuals reported that they were told by a healthcare professional they had diabetes (according to the
NRABS study). And in fact, the data from the NRABS study may be underestimating the actual incidence
of diabetes because it reports only those who have been told they have it by a healthcare professional.
In the case of the MC APCD, the data is taken from reimbursed expenses for those who are actively
seeking treatment for the disease. The disparity between these two numbers may be due in part
because initial treatment for Type II diabetes includes diet and exercise modification (not paid medical
care). However, given the extent of overweight residents, untreated and undiagnosed Type II diabetes
remains as a significant concern in terms of health and medical care costs. And while diabetes tends to
be higher in older populations, data from both studies have been age adjusted to reflect accurate
comparisons across counties and the state. In other words, even if Roseau County did not have an older
than average population, it would still have a higher-than-average rate of diabetes
Tobacco Use
Roseau County has the highest smoking rates in the five-county region in northwest Minnesota at 21%
(NRABS). Results also found that 7.3% of adults are smokeless tobacco users. Of the 85 smokeless
tobacco users in the sample, all but one of them were males. Statewide surveys estimate adult e-
cigarette use in Minnesota at 6%
1
. Northwest Minnesota estimates range from 2-6% from the 2014 MN
Adult Tobacco Survey.
2
The 2018 MATS Survey did not explore e-cigarette use by region.
Alcohol Use
On the NRABS survey Participants were asked “during the past 30 days, have you had at least one drink
of any alcoholic beverage such as beer, wine, a malt beverage or liquor?” Respondents indicated that
66.5% of them had consumed alcohol. A further twenty-two percent of respondents indicated that alcohol
had a ‘harmful effect’ on themselves or a family member. Harmful effects seemed to be modestly
impacted by income, educational level and age. For households with less than $50k income, 27% were
adversely impacted by alcohol versus 20.5% (households >$50k). Respondents aged 34 or less
reported 16% were adversely impacted compared to 24% of those aged 35+. Similarly, 25.8% of
individuals with a high-school diploma or less experienced harmful effects compared to 18% of those
with greater education.
It should be noted that ‘any drinking’ does not mean problem drinking. Future surveys should include
questions pertaining to binge drinking as were included in 2013 to get a better handle on dangerous
drinking.
1
http://www.health.state.mn.us/ecigarettes
* Minnesota Adult Tobacco Survey, 2014
2
http://www.mntobacco.nonprofitoffice.com/vertical/Sites/%7B988CF811-1678-459A-A9CE-
34BD4C0D8B40%7D/uploads/MATS_2014_Technical_Report_Final_2015-01-21.pdf
10
Drug Use
Between 2017 and 2019 northwest Minnesota had the second highest rate of overdose drug death rates
by region at 14.4 deaths per 100k. From 2011 to 2019 deaths grew more prevalent in the 25-34 year-old
age range, with males being twice as likely to overdose.
Summary
Many of the highest risk individuals in the LifeCare service area are in lower wage jobs, have treatable
conditions such as high cholesterol or high blood pressure, and delay getting treatment due to a range of
factors or may not adhere to treatment regimes. Many of these same clients may have overriding mental
health issues such as substance use/abuse and depression/anxiety.
Potential solutions could incorporate:
ü Addressing mental health issues through multi-disciplinary cross collaborative efforts.
ü Focusing additional resources and ideas on areas that develop access to and encourage physical
activities and increased social interactions in all populations.
ü Use services similar to “Healthcare Marketplace Care Partners”: a resource available 24/7 to talk
to when needed.
11
Next Steps:
LifeCare is required to adopt a specific implementation strategy in response to the needs covered in
the 2022 Community Health Needs Assessment report. This implementation strategy is currently part
of LifeCare’s strategic plan and will be repeated every three years as required by federal regulations
Based on the health needs identified in the review of available health statistics and responses from the
interviews, the following were identified as priorities LifeCare Medical Center can address.
• Mental Health
• Alcohol, Drugs, and Tobacco
• Chronic Disease Management
Community members who are interested in providing any feedback on the results of the
assessment are encouraged to contact LifeCare Community Relations or LifeCare Public Health at
218-463-2500 with their questions, suggestions or comments.