COMMUNITY DESCRIPTION

 

The Oxbow service area is located in extreme western Virginia.  It is bounded by Kentucky on the north and Tennessee on the south.  The terrain is very mountainous, with numerous small towns and villages.  The population within an hour’s drive of St. Paul, the regional service center, is roughly 50,000.  Given the size of the region, the overall density is fewer than 12 people per square mile.

 

BACKGROUND HISTORY

 

The Oxbow Corporation was created in 1989 through a Virginia General Assembly planning grant to the state Department on Aging.  The local citizens strongly believed in the basic concept of shared services as being a progressive and innovative way to serve people living in this very rural area.  The idea was to construct a multi-purpose building to be used by local and regional health and human service programs.

 

The Consortium currently consists of a number of organizations: two area agencies on aging (Appalachian Agency for Senior Citizens, Inc. and Mountain Empire Older Citizens, Inc.), three community services boards (Cumberland Mountain, Dickenson County, and Planning District 1), two public health departments (Cumberland Plateau and LENOWISCO Health Districts) and one housing authority.  This portion of Virginia historically has been either underserved or not served at all.  The primary service area is a portion of two state planning districts (the LENOWISCO and the Cumberland), both of which provided advice and/or technical assistance with planning and operational grants.

 

The Oxbow member agencies “strongly believe that neither artificial boundaries nor geography should serve as barriers to people needing health or human services.”  In other words, where one chooses to live should not dictate the services being offered.  Providing services regionally is far better, and more cost effective, than not having services at all.

 

PROJECT INITIATIVE

 

During the mid-1980s, several health and human service agencies began talking about combining their services for better efficiency.  A task force was created to explore ways to unite programs for older and disabled adults.  Grants were sought with the assistance of the two regional planning agencies, two area agencies on aging and the state government.  In addition, these planning groups sought funding from other sources, such as the Tennessee Valley Authority (TVA), the US Department of Housing and Urban Development (HUD), and the Rural Development Administration of the Department of Agriculture.  A seven-member Board of Directors was created to coordinate and govern these efforts.

 

Initially, health and human services were provided to older citizens, people with a mental illness, and those with mental retardation.  Family members have been involved, when applicable.  Public health and drug and alcohol services were added later.  Recently, services for the deaf (i.e., as a resource center) have been added.  A more detailed list of services is provided in the appendix. 

 

FUNDING

 

The primary focus was to cooperatively share efforts to serve a greater number of citizens.  The state Department on Aging provided the initial planning grant of $29,000. Afterwards, a $1,000,000 construction grant was awarded through HUD, a $329,000 matching appropriation came from the state assembly through the Department on Aging, and other funds came from various resources--e.g., a $55,000 grant from the TVA, an award from the Brookdale National Respite Foundation, and local matching dollars.  These monies were used to construct a 20,000-square foot, 1.4 million dollar structure.  In addition, another $150,000 was provided for equipment, furnishings, and initial operations.  Two acres of land were donated for the Center by the St. Paul Town Council and the St. Paul Industrial Development Authority. 

 

Additional state funding of $270,000 has been provided for 1996-98.  This is in addition to regular agency funding.  Thus, an effective union of local, state, and federal governments was created to meet local needs.  Although the structure itself was not yet built, this project won the 1993 Commissioner’s award from the state Department of Aging for “its creative and effective partnership for bringing resources and services to the citizens of southwestern Virginia.”

 

CHALLENGES 

 

This area of the state is very poor; in fact, it has the lowest per capita income and highest unemployment in the state.  Services usually are truly needed.  It has been a struggle to keep existing programs running while trying to secure money for expansion.

 

The greatest challenge has been convincing those outside the region that the seven agencies wanted to work together.  But, as stated previously, the citizens have a long history of working together and they believe that “with trust, cooperation, creativity and coordination, obstacles to the delivery of needed [health] and human services” can be overcome.  This evolutionary process has snow-balled.  New ideas are being discussed that were never considered before.  For example, local health professionals are talking about a managed care program, perhaps a “PACE” type (capitation of the Medicare and Medicaid), whereby dollars are blended together to benefit the low income and elderly.

 

CURRENT STATUS 

 

After six years of planning, the Oxbow Center opened in July 1995.  The structure includes offices; meeting space; separate activity rooms for Alzheimer’s groups, mental health and mental retardation programs, and the senior citizens quilting project; and other space used by the various health and human service agencies.  In addition there is a large kitchen where congregate meals are prepared and where individuals who want to become em­ployed in the foods industry may train.  When the program-specific rooms are not in use (primarily late afternoons, evenings, or weekends), they may be rented by the general public for special purposes.  Thus, the Center provides a continuum of programs and services for area residents.

 

Services have been added for people with developmental disabilities and hearing-impairments.  The family practice program of East Tennessee State University School of Medicine (Johnson City, TN) sends physicians to the Center as part of their training.  This could expand into a telemedi­cine program, which is popular in rural America.

 

In addition, the Board has expanded to include the Wise County Housing and Redevelopment Authority.  This organization has secured federal funds to help area citizens and now oversees daily operations of the Center (i.e., scheduling and maintenance).

 

The Center could not function so well if residents could not get to the facility.  Therefore, the Area Agencies on Aging (Mountain Empire and Appalachian Agency) for many years have worked hard to create and operate public transportation systems.  Mountain Empire’s efforts began in 1974 with Older American’s Act Title VII grants.  Later, federal and state dollars were provided from various sources.  The Agencies continue to seek both federal and state dollars to support this vital component.  These van systems are not used exclusively to transport users to and from the Center but are for public use for trips through­out the region.

 

This facility is unique in that it has linked organizations that had never before shared staff and resources nor actively worked together to identify funding sources.  The consortium is committed to sharing staff, space, and transportation, and to locating additional funding and other resources to meet health and human service needs of this very rural area.