Caring for Our Communities Program Connects Individuals in Need With Helpful Resources

Many people who arrive at Methodist Jennie Edmundson Hospital with chronic health issues may find it difficult to navigate their care. The challenges can be even greater if they don’t have a primary care provider, are underinsured or have no insurance at all, or struggle with health-related social needs such as housing, food or transportation.

Caring for Our Communities (CFOC) connects these individuals with community health coaches and/or appropriate nonprofit organizations or agencies, all with the goal of setting them up for success and improving their quality of life.

Funded by generous donations to the Jennie Edmundson Foundation and a financial investment from the hospital, CFOC services are provided at no cost to individuals.

“Philanthropy is critical to our ability to meet the health care needs of our region,” said Tara Slevin, chief philanthropy officer for the hospital and president of Jennie Edmundson Foundation. “Donations inspire hope and support the health and healing of some of our most vulnerable community members.”

CFOC health coaches and agency representatives provide support by working with individuals and families to create patient-centered health plans while connecting them to appropriate community resources.

The main focus of the program is to empower people to take charge of their health. This can include help with determining when to contact a provider if flare ups occur, following dietary restrictions, taking medications as prescribed or identifying concerns based on education provided.

For the most vulnerable individuals, CFOC services are a continuation of what starts in the hospital and aimed at preventing acute events.

Health coaches provide resources that improve access to groceries, gas, medications and necessary medical equipment, such as oxygen tanks, walkers and safety bars. They may also connect people with job opportunities that can help them pay for rent, utilities and transportation.

“It’s hard to say you’ve totally changed their lives around,” said Robin Shaver, the service leader for care management at Jennie Edmundson and a member of the CFOC steering committee. “But what we can say is that there are a great deal of success stories that include individuals gaining access to employment, housing and even reconnecting with their families.”

While many of the referrals to CFOC come from the care management team at Jennie Edmundson or a case manager in the hospital’s Emergency Department, community partners like the Council Bluffs Police Department also refer people who might qualify for assistance.

CFOC also works with Methodist Physicians Clinic locations throughout western Iowa, equipping providers with information to connect patients to appropriate resources and suppling them with vouchers that provide access to lifestyle needs such as groceries, transportation and medications.

One example of the program at work involved an individual who had trouble getting out of their bathtub at home. Their first reaction was to call 911 for help, but instead, they called their CFOC community health coach, who was able to contact a family member and arrange assistance.

Other individuals who’ve found success in the program are ones who are committed to improving their lives by building relationships with case managers and health coaches, which allows them to create manageable steps and celebrate milestones.

“We know this is working because we see people being able to take care of themselves the right way,” Shaver said.

More than 13,500 individuals have received some type of assistance through CFOC since the program launched in 2014, including more than 1,400 last year.

To support Caring for Our Communities and help provide necessary resources to high-risk, low-income individuals, visit jehfoundation.org.

CFOC Community Stakeholders

• Connections Area Agency on Aging
• Council Bluffs Fire Department
• Council Bluffs Police Department
• Horizon Behavioral Health Agency
• Jennie Edmundson Foundation
• Methodist Jennie Edmundson Hospital
• Methodist Physicians Clinic
• Mills County Public Health
• Pottawattamie County Public Health
• Southwest Iowa Mental Health & Disability Services Region