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Taking care in Tamworth

Town's Community Nurse Association provides basic health care for all – for free

December 31, 2009
TAMWORTH — Residents of Tamworth don't have to imagine universal healthcare because they already have a community-sized version of their own.

The Tamworth Community Nurse Association is a nonprofit 501c3 organization that has been providing basic medical coverage to town residents for nearly 90 years. Today, the population of Tamworth is about 2,600. The care includes checkups, blood draws, first aid, suture removal, diet and exercise counseling and more.

In Tamworth, almost all that care is available for free and doesn't require health insurance, Medicare, or Medicaid. (Seasonal flu shots are given at cost.) But TCNA should not be considered an alternative to having medical issuance and a primary care doctor. Nurses aren't able to write prescriptions, according to TCNA Director JoAnne Rainville.

TCNA is located in the rear wing of Tamworth Town Hall at 84 Main Street. It holds walk-in office hours from 9 a.m. to 2 p.m. But nurses assist residents at all hours of the day and night.

New residents are given information about TCNA when they move to town. But there's a good reason why most people have never heard of it when they arrive, said Rainville, who has held the director's post for nine years.

"There is certainly not anything like it in New Hampshire," said Rainville. "We may be the only one of our kind in the United States."

Word of the program is beginning to spread. In November, New Hampshire Public Radio ran a feature on TCNA and then National Public Radio picked up the story.

But TCNA is already well known and well used in Tamworth. The organization makes over 6,900 patient contacts per year. That includes walk-in clinic visits, house calls, and participants in its meals on wheels and fuel assistance programs. Sometimes nurses will just talk over the phone to a resident who needs some emotional support.

"We are not only doing nursing, we are doing a lot of what a social worker would do," said Rainville. "Because we don't accept money from Medicare or Medicaid we don't have to follow the guidelines, so we're free to determine what health is on the broadest of scales."

That freedom allows the nurses to look at a patient's overall wellbeing and go beyond what Medicare and Medicaid would allow. For example, if a resident's living conditions are unhealthy, then the nurses will try and find that person a better alternative. TCNA is regulated by the state of New Hampshire.

In addition to Rainville, TCNA has two other nurses, Carol Eldridge and Joan Peters, and a part time administrative assistant. When town officials conducted a master plan survey, TCNA was voted the second best thing in town next to the Cook Memorial Library.

"The Cook Library never has to give injections, clean wounds or make people take bad tasting medicine," said Rainville. "We thought that was a pretty good plug in our favor."

Sixty-five-year old Elva Parks says having the TCNA in town provides her with a sense of security because she know someone will respond anytime she or her husband, Lee, calls for help.

Elva Parks has lived in Tamworth for a total of 62 years and over the years the nurses have helped her and her family with deal with everything from her mom's poison ivy to her brother's rheumatic fever. When Lee was laid up following leg surgery, the nurses would come over frequently to check up on him.

"It's like having family in the medical business," said Parks adding in 62 years she never met a Tamworth nurse who wasn't a good person. In fact, Parks said when she had a baby while living in Methuen, Mass., it felt strange not having a Tamworth nurse come for a visit.

At a recent meeting, Selectman Willie Farnum praised TCNA. He said the program allows many residents to stay in their home that otherwise could not. It also gives people with elderly relatives "peace of mind" because they know their relatives are being taken care of.

But Rainville stressed the nurses help people of all ages.

Selectmen's chair Tom Abugelis called it "the crown jewel" of Tamworth in a phone interview.

For Nancy Plauche, having TCNA available meant coming home from Memorial Hospital in Conway sooner than would otherwise be possible after a major surgery on Christmas of 2007. Doctors told her she'd have to stay in the hospital unless she could hire a home nurse.

"I panicked and said I can't afford that," said Plauche who doesn't have health insurance.

But a hospital nurse told her, since she lived in Tamworth, she could have a home nurse and it would be free. The TCNA nurses came over every day for three weeks to provide care including changing Plauche's dressings, checking her temperature, and watching for infections.

"They were here every day rain, snow, it didn't matter," she said.

Having the nurses nearby is a big comfort because the nearest hospitals to Tamworth are in Wolfeboro and Conway and it takes 40 minutes to get to either one, said Plauche.

Resident Don McGarity, 71, recalled how the nurses tended to him after he suffered injuries from a recent motorcycle accident. When he returned home from the hospital he couldn't remember the instructions the doctors had told him. Not only did the nurses help him get the information, they also detected swelling in his leg. McGarity also uses TCNA for regular checkup-type appointments. He says going to TCNA is more like visiting a friend than a doctor's office.

"I can't speak highly enough about them," he said.

This year TCNA has been especially busy because it's been giving H1N1 inoculations to residents. And there has been a "fair amount" of the virus in town. Sufferers have ranged in age from children to adults around 60-years-old.

The best part of the story, according to Rainville, is such a program could be fully replicated in other rural communities for an initial cost of between $1 million and $2 million. That may sound like a lot of money, but Rainville said a community nursing services would save the healthcare system much more.

An endowment funds another 30 percent of TCNA's $150,000 per year operational costs. Another 30 percent comes from taxes, which is approved annually at town meeting. The remainder comes from fundraising.

"I have to write grants and sing for my supper for donations to raise the rest of the money," said Rainville. "That's a significant chunk of cash to raise every single year."

The endowment came from TCNA's founder Elizabeth Lane Whittemore, who started a forerunner of TCNA in 1921 when she and a group of other summer residents hired several visiting nurses to cover the town.

Upon her death, Whittemore provided TCNA an endowment, which is now managed by the Tamworth Foundation. Today, that endowment is worth about $1 million. Rainville said the organization is trying to boost the endowment to $3 million, which would make TCNA sustainable for the next 100 years.

Recently, TCNA was awarded a matching grant from the Ham Charitable Foundation in North Conway. The Ham Charitable Foundation will give $10,000 to TCNA if it can generate $20,000 in its holiday appeal. It will donate a lesser amount if TCNA doesn't raise the full $20,000. Donations toward the HCF's match may be made until Jan. 31.

"Think of the generations of people it has affected since 1921. We are talking tens of thousands of people who have had their hearts and lives touched by the Tamworth Community Nurse Association," said Rainville. "It's our responsibility to make sure that people 100 years from now are still having that kind of care."

Tax deductible donations can be mailed to TCNA at PO Box 352, Tamworth, NH 03886 or click on a button on their Web site (www.tamworthnurses.org) to make a donation by credit card or PayPal.

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Varney Smith
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