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2022 Community Health Needs Assessment. 1. EXECUTIVE SUMMARY. 8 vaccination rates than other western Massachusetts counties.
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Baystate Noble Hospital 2022 Community Health Needs Assessment
PEER (Parent Engagement, Enrichment, & Resources) Ambassadors of the Communities That Care Coalition at Unity Park in Turners Falls. Photographer: Sage Orville Shea.
Kamp for Kids An inclusive summer camp in Westfield, Massachusetts Photo Credit: Behavioral Health Network
Adopted by the Baystate Health Board of Trustees on September 13, 2022
Baystate Noble Hospital (Baystate Noble) is an 85-bed acute care community hospital providing a broad range of services to the greater Westfield community, offering direct access to world-class technology, diagnostics, and specialists. The hospital works to ensure that patients have access to exceptional health care, close to home. Skilled and compassionate nurses and medical support staff offer an ideal combination of “high tech” and “high touch,” complementing an outstanding team of doctors. Services include obstetrics and gynecology, emergency, laboratory, gastroenterology, surgery, cardiopulmonary services and rehabilitation, cancer care, behavioral health, urology, neurology, inpatient rehabilitation, and diagnostic imaging, including 3D mammography.
Baystate Noble is a member of Baystate Health , a not-for-profit, multi-institutional, integrated health care organization serving more than 800,000 people throughout western Massachusetts. Baystate Health, with a workforce of 13,000 employees, is the largest employer in the region and includes Baystate Medical Center, Baystate Franklin Medical Center, Baystate Wing Hospital, Baystate Noble Hospital, Baystate Medical Practices, Baystate Home Health, and Baystate Health Foundation.
Baystate Noble is a member of the Coalition of Western Massachusetts Hospitals/Insurer (Coalition), a partnership formed in 2012 that currently consists of nine non-profit hospitals, clinics, and insurers in the region to coordinate resources and activities for conducting their Community Health Needs Assessment (CHNA). The federal Patient Protection and Affordable Care Act (PPACA) requires tax-exempt hospitals and insurers to conduct a CHNA every three years. Based on the findings of the CHNA and as required by the law, each hospital develops a health improvement plan to address select prioritized needs. The CHNA data also inform County Health Improvement Plans (CHIPs) as well as other community-based initiatives to achieve health equity. The Coalition collaborated with a consultant team led by the Public Health Institute of Western Massachusetts (PHIWM) to conduct the CHNA. This assessment focused on Hampden County data, where ten of eleven the communities served by Baystate Noble are located, and Westfield and West Springfield data as available.
The communities served by Baystate Noble continues to experience many of the same prioritized health needs identified in Baystate Noble’s 2019 CHNA. The COVID- pandemic worsened many of the existing inequities related to these needs. Several prioritized needs receive deeper focus as described below. The prioritized health needs for communities served by Baystate Noble are:
COVID- It has been three years since the last community health needs assessment, and for two of those years and counting, our nation and region have battled a once-in-a-century health pandemic. COVID-19 has taken a tremendous toll on this communities served by Baystate Noble, and it continues to affect the status of health in western Massachusetts. The pandemic took the lives of at least 338 residents in the communities served by Baystate Noble, and more than 28,000 people were infected (see Table 1). It strained the ability of the regional health care system, from the doctor’s office to the emergency room, causing many people to have to delay care and treatment. Hampden County had lower
vaccination rates than other western Massachusetts counties. Barriers to vaccine access and vaccine hesitancy were factors.
In addition to affecting health outcomes, access to care, and quality of care, the pandemic undermined the region’s economy, causing unemployment rates to rise rapidly and business revenues to fall. Hampden County’s unemployment rate shot up to 18% in April 2020. Economic destabilization negatively affected other social factors, or determinants, of health, including housing affordability, food security, education quality, and safety from violence and trauma. It worsened existing inequities in many of these prioritized needs, especially for Black and Latino/a/e residents, people who are unhoused, LGBTQIA+ individuals, people with a disability, older adults, immigrants, and refugees, those with limited incomes, and other communities. The Massachusetts public health infrastructure, which is highly decentralized, had difficulties providing consistent pandemic response services such as contact tracing and vaccination clinics. The pandemic also took a toll on residents, from youth to older adults.
Despite these challenges, many hospitals, health care providers, public health departments, grant makers, and non-profit agencies rose to the challenge, adapting and pivoting to provide resources, services, care, and prompt, accurate information to residents in the communities served by Baystate Noble.
The COVID-19 pandemic exacerbated mental health as a prioritized health need for youth and young adults in communities served by Baystate Noble, and across the region. The mental health challenges of youth and young adults (age 12–24) are acute. For example, almost half of students in grades 8, 10, and 12 (49%) surveyed in the Gateway school district (serving Huntington, Russell, Blandford, Chester, Montgomery, Middlefield, and Worthington) felt sad or depressed more often during the COVID-19 pandemic. Additionally, more than half (55%) of 8th, 10th, and 12th grade students in West Springfield reported feeling worried, nervous, anxious, or unable to relax, which was affected by COVID-19. Key informant interviews with providers revealed an overwhelming sense that the larger systems are failing youth, families, and providers and, as a result, the pandemic resulted in youth mental health and well-being worsening overall.
Positive signs are that providers see a rise in youth who show high social emotional intelligence, form relationships with like-minded youth, and can interpret personal, political, and social experiences with complex perspectives, often with language or lenses
more profound burnout. In a regional survey of health officials, 35% of Hampden County respondents cited the limited availability of providers as the most pressing health issue facing their community. This is especially true for areas of high need, such as mental health. One in five Noble communities served by Baystate Noble respondents to the MDPH COVID-19 Community Impact Survey (CCIS) that sought health care during the pandemic reported not receiving care due to COVID-19-related barriers.
Residents with limited incomes, rural residents, Black and Latino/a/e residents, LGBTQIA+ individuals, those with a disability, and others often face added barriers that can further limit access to providers. These may include unaffordable, out-of-pocket health care costs, unconscious bias among providers, reliable and affordable transportation, and lack of access to care that is culturally and linguistically appropriate. Telehealth has mostly been a positive development in access to care. However, some populations face barriers to using the internet and other technology, such as residents with limited means, immigrants, those living in rural communities, and older adults. Older adult focus group participants reported having trouble paying for care during the pandemic because they were uncomfortable with online banking and did not have debit or credit cards, which became the primary modes of payment with the shift away from cash and checks. Refugees may also face barriers to accessing care because of limited, and sometimes temporary, health care coverage.
Access to and affordability of basic needs such as housing, food, and transportation are key building blocks of health, and they continue to be a prioritized need for many residents in both urban and rural communities in the Noble communities served by Baystate Noble. People with limited resources are forced to make trade-offs and to prioritize their needs. Older adults who took part in a focus group reported spacing out necessary medical appointments so they could afford to feed themselves. The Noble communities served by Baystate Noble also continues to have food deserts (lack of nearby grocery stores), limiting access to affordable, healthy choices such as fruits and vegetables.
COVID-19 caused high rates of unemployment, further undermining the ability of residents to meet their monthly expenses. It also triggered inflation, raising the cost of many basic needs. In 2021, home prices in Hampden County rose almost 14% from the previous year. Half of CCIS respondents in the Noble communities served by Baystate Noble were worried about paying at least one of their upcoming expenses when the survey was
administered early in the pandemic. The pandemic also affected access to food—food insecurity in Hampden County jumped 42% from 2019 to 2020. Beginning in March 2020, The Food Bank of Western Massachusetts played a key role, distributing on average 877,000 meals per month to 91,000 clients, peaking at 1.1 million meals in October 2020. People who do not have access to transportation have an even harder time meeting basic needs. Census data show that consistently 14% of Hampden County residents do not have access to a vehicle. Since the 2013 CHNA, transportation continues to be one of the largest barriers to medical care. Telehealth offers a potential solution to that barrier for some residents, depending on the type of care they need.
We continue to see inequities in social and economic factors that affect health, resulting in the prioritization of employment and income, violence and trauma, environmental exposures and climate change, chronic health conditions such as Alzheimer’s disease and asthma, and more. Since the 2019 CHNA, overall educational attainment in Hampden County is still relatively unchanged, and 91% of residents in the communities served by Baystate Noble graduated high school (equal to the statewide rate). In both Westfield and Springfield, Latino/a/e residents had unemployment rates double that of their White counterparts, while Black and Latino/a/e households had lower incomes than White households. The pandemic affected violence and trauma in ways yet to be understood fully, but people at risk of intimate partner violence or child abuse were more unsafe during the lockdown and shift to remote work and school. Being at home full time also has implications for residents in homes that have elevated lead levels and allergens that contribute to asthma—two conditions that are already at higher levels in the largest cities in the communities served by Baystate Noble. Five of the communities served by Baystate Noble municipalities have environmental justice designations, showing populations who experience disproportionate exposure to environmental hazards. Regarding barriers to care, access to health insurance, affordability of care, and lack of care coordination continue to be a problem. Chronic health conditions are still prioritized needs, especially asthma; hospital admissions rose among Black asthma sufferers compared to other groups. Chronic Obstructive Pulmonary Disease (COPD), cardiovascular disease, and other chronic conditions that are also a risk factor for heart disease—such as diabetes and obesity—also show disparities, with much higher rates among Black residents. Another chronic condition, Alzheimer's disease appears to have been affected by COVID-19, with the CDC reporting that there were 16% more deaths from this and other forms of dementia in 2020 compared to the prior five-year average. The communities served by Baystate Noble saw hospitalization rates for Alzheimer’s-related concerns at a rate of nine per
youth, youth with disabilities, and older adults experienced high rates of depression and anxiety during COVID-19 compared to other groups.
Prior to COVID-19, many of the socioeconomic conditions in the communities served by Baystate Noble had not changed much since the 2019 CHNA. As this report describes, income, housing, food security, and many other conditions worsened during the pandemic. COVID-19 caused immense suffering for many residents, who faced dire health outcomes and financial hardship. One of the county’s leading economic engines—health care services—was severely affected with impacts on its workforce and subsequent availability of providers for residents. The shortage of behavioral health providers exacerbated the mental health crisis faced by young people in the community. Virtually every prioritized health need was affected by the pandemic, and people with one or more marginalized identities often felt the compounding effects. Disparities in chronic disease outcomes for people of color persisted. In sum, for so many facets of health and health care, COVID-19 deepened inequities.
The communities served by Baystate Noble includes eleven communities, ten of which are in the western part of Hampden County, with most of this population living in the cities of West Springfield and Westfield (Figure 1). There is a mix of rural and urban populations, and the communities served includes part of the Hilltowns rural cluster (Appendix 1, Figure 29). The U.S. Census defines urban areas as consisting of census tracts and/or blocks which meet the minimum population density requirement (2,500–49,999 for urban clusters and over 50,000 for urbanized areas) or are adjacent and meet additional criteria. Eighty-two percent of the population lives in urban areas^1 , and the median age of residents in the communities served by Baystate Noble is approximately 42 years.^2
According to Census estimates, the communities served by Baystate Noble has the same racial and ethnic diversity since the last CHNA. The region is 86% White, 8% Latino/a/e, 2% Black, and 5% some other race (Appendix 1, Table 4). More than 200 residents in the Baystate Noble communities identify as American Indian and Alaska Native alone.^3 The proportion of foreign born residents in the area is close to 10%, half the statewide proportion, and 85% of foreign-born residents were born in Europe or Asia.^4 The
Baystate Noble Hospital Campus 115 West Silver Street, Westfield, Massachusetts
population has a median family income of $85,255, about 15% lower than that of the state ($103,126)^5 , and 8% of residents live in poverty.^6 The majority of residents in the communities served have health insurance, with 57% on private insurance, more than 35% on public insurance, and 3% without any health insurance.
FIGURE 1: Communities Served by Baystate Noble: 2019 Population Estimates
Source: U.S. Census, ACS 2019 5-Year Estimates Data Profiles, specifically table DP05, Demographic and Housing Estimates
The CHNA was conducted by the Coalition in partnership with a consultant team led by the Public Health Institute of Western Massachusetts that consisted of: Collaborative for Educational Services, Franklin Regional Council of Governments, and Pioneer Valley Planning Commission. (See Appendix 2 for more about the consultant team.)
Community leaders and residents were also integral to the process. They provided input through the Regional Advisory Council (RAC), interviews, focus groups, and Community Chats. The Coalition engaged hundreds of residents across the counties of western Massachusetts in data collection and outreach about the CHNA.
Cheryl L. Dukes , UMass Amherst Elaine Marieb College of Nursing RAC Member, Baystate Franklin CBAC Member
FIGURE 2: Communities Served by 2022 CHNA Coalition Members
