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Winona Health plans to expand its community health services to support seniors with a new grant.

The Saint Paul & Minnesota Foundation’s (Foundation) partnership with the Taylor Family Farms Foundation is beginning to sow new seeds.

In 2023 the Foundation was named one of three community foundations responsible for the distribution of revenue produced from $172 million worth of farmland donated by the owner of the Minnesota Timberwolves and chairperson of the Taylor Corporation Glen Taylor to support organizations in southern Minnesota. The Foundation will direct grants across southern Minnesota focused on building capacity for communities to adapt to rapid change.

One of the first grants directed by the Foundation is to Winona Health in support of the Winona Community HUB.

Winona Community HUB (the HUB) offers support to all Winona County residents experiencing food insecurity, housing insecurity, mental health challenges and/or high emergency department utilization.

With support from the new grant, the HUB is now planning to expand services to better support its senior population by adding a community health worker to their team.

Supporting Seniors in Winona

As Winona’s population changes, so do their needs.

In the last three years Winona County has seen an increase in senior patient visits and ambulance calls due to falls. Isolation during the winter months in rural areas has also led to senior patients’ declining health. To address these issues the HUB plans to broaden its referral criteria and implement community-based care coordination specifically for seniors experiencing the greatest barriers to care.

“Our senior population can be socially complex, and then combine that with more complex health needs, it’s a lot to manage,” said Kelly Fluharty, Care Transformation Manager for Winona Health Services. “Having a supporter, educator, advocate and an extra set of eyes tracking alongside that patient is a very effective way to make sure chronic diseases are caught as early as possible and managed effectively.”

Community health workers play a crucial role in identifying and addressing care gaps, serving as a bridge between community and clinical settings. The new community health worker will work alongside healthcare practitioners such as doctors, nurses and social workers to navigate patients’ care, all while collecting data to ensure providers are giving them the highest levels of management and care.

Benefits of Having a New Community Health Worker

To track patients’ outcomes, the HUB utilizes a tool called pathways to systematically address their risk factors. These risk factors can range from health education to healthcare coverage and transportation.

“What happens is that once a risk factor is identified, then we open a pathway that corresponds to that risk factor,” Winona Health Community HUB Director Vanessa Southworth said. “The community health worker helps the participant walk through addressing the risk factor and removing any barriers to addressing that risk factor. We ask participants what their priorities are, and we make sure that we're working on the things that are most important to them. Our system is outcomes-based, so once a pathway has been closed, we are able to move to the next priority.”

With grant funding, Winona Community HUB will also serve as one of the sites for the statewide community health worker training program, which will hopefully serve as a network to recruit more community health workers to the region.

We know how valuable community health workers are to health equity workforce. Through their work, they help eliminate access barriers by improving the health of our most vulnerable neighbors in the state.

Learn More About Winona Health

“ We ask participants what their priorities are, and we make sure that we're working on the things that are most important to them.”

Vanessa Southworth, Winona Health Community HUB Director

In addition to the funds directed by the three community foundations, The Taylor Family Farms Foundation will also hold an open grant round.

The Taylor Family Farms Foundation will be accepting applications for their inaugural grant program between Sept. 1 and Oct. 1, 2024. The focus for this grant period is health and human services emphasizing emergency services. Organizations within 29 counties of southern Minnesota and 17 counties of northwest Iowa are welcome to apply.

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