Health Care

Karen Allen: In the Valparaiso University College of Nursing and Health Professions, preventive care is a major component of our graduate and undergraduate programs.

Our graduates incorporate preventative care in their lives and careers, and our faculty supports preventive-care initiatives. Recent and ongoing initiatives include starting ‘The Little Free Pantry’ in partnership with the local Church of the Latter Day Saints; contracting with the Indiana Department of Public Health for 20 years on the Tobacco Education and Prevention Coalition; partnering with the American Heart Association to provide a blood pressure hub in Northwest Indiana to address hypertension; a ‘Car Fit’ event with the local AARP to support safety measures among senior drivers; and research on hypertension among college students on campus.

Alan Witchey: Preventive care is critical to reducing long-term costs of care, but it isn’t always easy to get preauthorization approval or affordable coverage for patients. For example, Pre-exposure Prophylaxis (PrEP) is a medication that has been proven 99% effective in HIV prevention. The uptake of PrEP has likely reduced the spread of HIV through unprotected sex and drug use in our community, although it can be difficult to prove that preventive efforts are successful. Damien provides PrEP through in-person visits or exclusive telemedicine visits, and at extremely low cost or free in most circumstances. 

However, many people still think it is cost-prohibitive to secure. So, education is also important to prevention, and this can come through providers, peer channels, or outreach teams.

Alan Witchey: An aging population; a shortage of workers; growing salary costs; and the rising costs of equipment, supplies, and medications are all increasing overhead without increasing third-party reimbursements. To compensate for these costs, we continually strive to find new funding streams, such as grants and private donations, and we regularly assess spending efficiencies. Damien Center has its own 340B pharmacy, which allows us to generate critically needed program income. This safety net program allows pharmacies to generate income without passing costs on to patients or taxpayers, so it’s a win-win.

Karen Allen: The nursing shortage has been here for years and is now at crisis level. Prior to the pandemic, nearly 200,000 RN job openings were projected each year from 2020 to 2030. In 2023, AMN Healthcare conducted a study of nearly 18,000 registered nurses and found that career satisfaction among nurses had dropped to 71% from a steady range of 80 to 85%.

To address this, we need to provide compensation that recognizes the level of education; the preparation; and the personal, physical, and mental investment that goes into nursing.

We need to double down on resolving issues of danger and violence, such as discrimination, disrespectful treatment, patient attacks, inter-professional conflicts, and more. Ultimately, we need to change the experience and the environment of the profession so that nurses want to stay.

Alan Witchey: The looming nursing shortage is a very realistic threat to health care. For small clinics like ours, it can cripple day-to-day functions. But when nursing shortages happen, it can delay rooming of patients, collection of medical histories, ability to triage acute patient scenarios, and countless other critical functions. That can reduce the number of patients seen, which of course can decrease the overall revenue of the practice and cause the need for reductions in other ways. All this can lead to increasing wages for nurses. I’ve even known some nurses to “shop around” to get the best rates of pay. That can lead to instability in the workforce.

Alan Witchey: Health care providers must first recognize and understand that successful health outcomes cannot be achieved through the practice of medicine alone. Social determinants of health—such as food, housing, or employment—directly determine the health and well-being of individuals. This puts health practices in the position of either seeking funding and infrastructure to provide these other services or partnering with other community providers who do. These aren’t easy solutions.

Damien Center serves low-income populations, and we know that many patients can’t or won’t go to multiple sites to get clinical and non-clinical care that focuses on social determinants. Thankfully, Damien Center has robust programs that provide homelessness prevention, housing subsidies, food, employment support, mental health counseling, and other support services all under one roof.

Karen Allen: Health care providers can impact the landscape of social determinants of health in many ways. They can impact infant and maternal mortality from pre-natal care to birth, post-partum care, nutrition, health care visits, medication, and education. Pediatric specialists can ensure patients develop correctly, receive immunizations, eat well, and maintain their mental health.

Health care providers can weigh in on forces related to racism and other discrimination that affects health care. Providers need to take what they observe through their practices and view it through a diversity lens. For example, we did not know that pulse oximeters were providing inaccurate readings of oxygen levels for African-American patients until it was revealed by evidence during the pandemic.

Karen Allen: Bias does affect care for marginalized populations, but some biases and barriers to care are systemic.

Our curriculum incorporates care of LGBTQ, seniors, impoverished, disabled, and people of color into didactic, clinical, skills lab, and simulation education. For example, the skills lab has manikins that are of different races, ages, and more. Students learn at early stages in their education the importance of valuing individuals and caring for their specific needs. In doing so, they learn what their own biases may be and how to address them.

The preparation of health and health care professionals is not only task oriented, but also thought changing and behavior changing. Being part of an organization that prioritizes diversity, equity, inclusion, and belonging creates an atmosphere that shapes the lives of students who love their neighbors as themselves.

Alan Witchey: LGBTQ+ populations can face stigma and bias in the health care system, making them less likely to seek the care they need. LGBTQ+ people also face higher risk for sexually transmitted diseases like HIV, substance-use disorders, obesity and related diseases, some cancers, and heart disease.

I think it’s important for providers to remember that we can disenfranchise patients if they don’t feel safe in our environment. Health care providers often ask questions that assume patients have a heterosexual partner, and that’s all it takes to make someone feel unsafe or unwelcome.

That’s why we hire from the population we serve, host patient advisory groups, conduct regular surveys, and seek to listen first and respond second. We are proud to serve LGBTQ+ populations with HIV care, gender affirming care, and other programs—and to do this in a safe place for anyone seeking care.

Alan Witchey: I prefer the term cultural humility or cultural inclusion, as opposed to cultural competence. The word “competence” implies that you achieve a moment of skill or ability in serving diverse populations through a training or process, while humility suggests that you take time to understand your own culture and biases as well as meeting different cultures in dialog. The goal in cultural humility is to be open to and try to understand how cultural differences and biases impact the work you do. Damien Center seeks first to listen to the voices of those most marginalized so that we can better deliver services. We do this one-on-one with clients and patients, as well as through advisory groups, staff trainings, open forums, and by setting expectations that cultural humility is part of the way we do business, not something extra or special that we must do.

Karen Allen: Cultural competence in providing care has long been considered necessary. Now, we must consider intersectional identities of individuals, families, and communities. One finds themselves not only caring for a Hispanic person, but a Hispanic, LGBTQ individual who is a senior citizen.

To be truly culturally competent means including all cultures and incorporating all aspects of diversity.

We should put forth concerted efforts to recruit, retain, and resource individuals from all walks of life. This will help increase trust in our systems and provide care that is tailored to specific groups.

Karen Allen: At the Valparaiso University College of Nursing and Health Professions, we recently partnered with the University of Chicago Medicine health systems, giving our programs first access to experiential learning opportunities. We also work with health care organizations on contract to train personnel for their organizations and address shortages across health care disciplines.

The Indiana Center for Nursing brings together health-related organizations, educational institutions, regulatory bodies, and professional organizations to address how we can work together to improve health care in the state of Indiana.

Alan Witchey: So often, schools no longer teach meaningful sex education, so young people are growing up without information or getting the wrong information from friends, social media, or even just making incorrect assumptions. Partnering with educational institutions is critical, especially for sexual health. We continue to see higher rates of sexually transmitted infections among young populations, so we are excited to provide HIV and STI testing on campuses, education at campus health fairs and events, and even a leadership training program for young individuals struggling with HIV or at high risk for HIV. While K-12 schools may find it difficult to address sexual health, colleges and universities seem much more open and excited to partner with us.

Karen Allen: Congress has appropriated billions of dollars to fight wars around the world and must make this same commitment to fight illness, disease, and death.

Health care systems are fighting these wars on their own. They rely on payments from insurance companies, Medicare, and Medicaid, resulting in low compensations, under-equipped facilities, and lack of facilities in underserved areas.

Unless prioritization of health and health care becomes the top focus of the federal government, shortages across health professions will explode and we will be in crisis.

Alan Witchey: For us, the biggest looming issue is the growing number of people needing care for age-related conditions. For instance, HIV is no longer a death sentence like it was in the early years of the epidemic (thankfully), and now we’re working to create a new model of care that includes the needs of aging populations with HIV. We are also focusing on the aging needs of LGBTQ+ populations who have lived relatively healthy lives and are now in need of various health services but may not feel safe in traditional medical settings. We expect a growing number of aging populations with less resources than in the past. How will we adapt and change to accommodate that? All I can say for now is that we’re working on it.