Healthcare professionals say working in economically deprived areas of the Delta is one of the biggest challenges faced in the home health arena.
  "There's a lot of poverty and there are a lot of environmentally challenging situations in which to provide healthcare to the patient population in the Delta," said Joan Hamilton, regional administrator for the Delta region of  Jackson-based Sta Home Health Agency. "We have to be extremely resourceful sometimes to get the support we need in these environments."
  Because many patients served in the Delta do not have running water in their homes, Certified Nurse Assistants (CNAs) that provide personal care must pump water and then heat it. And that's possible only if wood-burning stoves are located in the homes and plenty of wood is available for heating and cooking, she said.
  "There are still a good number of situations like that around," said Hamilton. "Poverty is certainly significant because it brings on all kinds of environmental problems, such as homes infested with insects or rodents. Ironically, some of patients in these environments are the sickest, most critical care patients."
  Hamilton said it creates a challenge to implement proper plan and treatment care dispersed by physicians who may not know patients' home situations.
  "For example, wound care patients or patients who have had amputations that are in a bad environment with insects or rodents present must have these situations taken care of first because it's going to affect the wound-healing process," she said.
Poverty often means lack of proper nutrition because of a gross lack of protein in the diet, Hamilton said.
  "The proper nutrition has everything to do with the healing process," she said.
  Hypertension, prevalent in the black population, is very significant in the Delta, she said.
  "A lot of research attributes hypertension to the diet, the way vegetables are seasoned, and eating a lot of pork and fried foods," she said.
  Diabetes is a major health concern in the Delta, she said.
  "Social workers work with patients to get them what they need," Hamilton said.
  Every month, caregivers support groups meet in one of the Delta offices of Sta Home Health Agency to help them in various situations, such as emergency preparedness in the wintertime and what to do if an ice storm occurs.
  "Nobody knows until they are in a caregiver's situation how challenging it is," she said. "The caregivers support groups help them help us."
  Jean McCarty, executive director of Mississippi Association of Home Care, said poverty and illiteracy increase the severity of poor health. It's an economic malady that's not recognized by reimbursement agencies.
  "Because the Delta has small rural towns that do not offer many social amenities, it's harder to attract healthcare professionals," McCarty said. "You have to give them monetary incentives to go to the Delta and that's not recognized by the reimbursement agencies, either."
  Sharon Healan, director of program development for Continue Care Home Health, said there are 50% fewer physicians per 100,000 population than the national average.
  "Budget constraints are our biggest challenge - balancing the home health care we know the patient needs with the limitations that have been placed on us," she said.
  The Balanced Budget Act "s what pulled the rug out from under us," Healan said.
  The Balanced Budget Refinement Act "has prevented what future disasters we saw coming," she said. "Those cuts and downsizings that were going to occur initially when the Balanced Budget Act was put in place have already happened. We've seen agencies and offices close and combine. In Mississippi, we have a few large agencies with a lot of branches. Other states aren't like us, so we probably had the ability to maintain corporations better because companies with 12 to 15 offices can combine resources instead of a ma-and-pa on one corner."