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A Community Health Needs Assessment

Prepared for Fauquier Health and Fauquier Health Foundation


By Community Health Solutions
May 2014

Table of Contents
Section

Page

Executive Summary

Part I. Community Interview Results

Part II. Community Survey Results

1. Survey Respondents

2. Community Health Concerns

10

3. Community Service Gaps

12

4. Vulnerable/At-Risk Populations in the Community

14

5. Vulnerable/At-Risk Regions in the Community

17

6. Additional Ideas and Suggestions

18

Part III. Community Indicators

19

1. Health Demographic Trend Profile

20

2. Health Demographic Snapshot Profile

21

3. Mortality Profile

22

4. Maternal and Infant Health Profile

23

5. Preventable Hospitalization Discharge Profile

24

6. Behavioral Health Hospitalization Discharge Profile

25

7. Adult Health Risk Factor Profile

26

8. Youth Health Risk Factor Profile

27

9. Uninsured Profile

28

10. Medically Underserved Profile

29

Appendix A. Zip Code-Level Maps

30

Appendix B. Community Interview Guide and List of Participants

47

Appendix C. Community Survey: Additional Ideas and Suggestions for Improving


Community Health

49

Appendix D. Defining a Healthy Community

53

Appendix E. Data Sources

55

Executive Summary

Executive Summary
This report presents the results of a community health needs assessment commissioned by Fauquier Health and
Fauquier Health Foundation. The study is focused on the geographic region encompassed by Fauquier County and
Rappahannock County. The study results are presented in three parts, including the results of Community
Interviews with selected community leaders; a Community Survey of a broader group of community stakeholders;
and Community Indicators containing dozens of community health status indicator profiles. This Executive
Summary outlines the major findings of the study. Details are provided in the body of the report, and the data
sources and methods are described in Appendix E.
The Study Region

Part I. Community Interviews


In March of 2014, Fauquier Health and Fauquier Health Foundation hosted three group interviews with a total of 21
community leaders from diverse organizations (see participant list in Appendix B). The purpose of these interviews
was to obtain participant insights about the characteristics of a healthy community, as well as vulnerable
populations, emerging health issues, community assets, and opportunities for community collaboration. The
interview participants expressed diverse perspectives on these topics, as presented in detail in Part I of the report.
Part II. Community Survey
In an effort to expand the range of community input for the study, a Community Survey was conducted with a
broad-based group of community stakeholders identified by Fauquier Health and Fauquier Health Foundation. The
survey participants were asked to provide their viewpoints on:
Important health concerns in the community;
Significant service gaps in the community;
Vulnerable/at-risk populations in the community;
Vulnerable/at-risk geographic regions in the community; and
Additional ideas or suggestions for improving community health.
The survey was sent to a group of 172 community stakeholders. A total of 80 (47%) stakeholders submitted a
response (although not every respondent answered every question). The respondents provided rich insights about
community health in the study region, as summarized below.

Page | 1

Health Concerns. The respondents identified over 20 important health concerns including obesity, mental
health conditions, diabetes, substance abuse and other concerns.
Community Health Needs Assessment

Executive Summary

Service Gaps. The respondents identified more than two dozen specific community services in need of
strengthening. Identified services included behavioral health services, aging services, transportation and
other services.

Vulnerable or At-Risk Populations. The respondents reported a number of vulnerable/at-risk populations


in the community. Identified populations included the elderly, low income residents and persons with
behavioral health needs, and other populations with particular health concerns.

Vulnerable or At-Risk Regions. The respondents reported a number of vulnerable/at-risk neighborhoods


or geographic regions in the community, including rural areas; areas with a large population of seniors; and
areas in central, northern, and southern Fauquier County. (See Appendix A for zip-code level maps of
selected demographic and health indicators for the region).

Ideas and Suggestions. Forty-three respondents offered open-ended responses with additional ideas and
suggestions for improving community health. These responses are listed in Appendix C.

Part III. Community Indicators


The community indicators in Part III present a wide array of quantitative community health indicators for the study
region. To produce the profiles, Community Health Solutions analyzed data from multiple sources. By design, the
analysis does not include every possible indicator of community health. The analysis is focused on a set of
indicators that provide broad insight into community health, and for which there were readily available data sources.
To summarize:

Demographic Profile. As of 2013, the study region included an estimated 74,567 people. The population is
expected to increase to 79,035 by 2018. It is projected that population growth will occur in all demographic
groups, including a 22% increase in seniors age 65+; a 21% increase in the Asian population; and a 22%
increase in the Hispanic ethnicity population. Compared to Virginia as a whole, the study region is more rural,
older, and less racially/ethnically diverse. The study region also has higher income levels than Virginia as a
whole.

Mortality Profile. In 2012, the study region had 553 total deaths. The leading causes of death were malignant
neoplasms (cancer), heart disease, and cerebrovascular disease (stroke). The age-adjusted rate for stroke
deaths in the study region was higher than the Virginia statewide rate.

Maternal and Infant Health Profile. In 2012, the study region had 925 pregnancies, 731 total live births and
four infant deaths. Compared to Virginia as a whole, the study region had a higher rate of births without early
prenatal care.

Preventable Hospitalization Discharge Profile. The Agency for Healthcare Research and Quality (AHRQ)
defines a set of conditions (called Prevention Quality Indicators, or PQIs) for which hospitalization should be
avoidable with proper outpatient health care. High rates of hospitalization for these conditions indicate potential
gaps in access to quality outpatient services for community residents. In 2011, residents of the study region
had 871 PQI hospital discharges. The leading diagnoses for these discharges were chronic obstructive
pulmonary disease (COPD) and asthma in older adults, bacterial pneumonia, and congestive heart failure. The
age-adjusted PQI discharge rates for the study region were higher than the Virginia statewide rates for most
PQI diagnoses.

Behavioral Health Hospitalization Discharge Profile. Behavioral health hospitalizations provide another
important indicator of community health status. In 2012, residents of the study region had 260 hospital
1
discharges from Virginia community hospitals for behavioral health conditions. The leading diagnoses for
these discharges were affective psychoses, alcoholic psychoses and schizophrenic disorders. The ageadjusted discharge rates for the study region were lower than the statewide rates.

Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data do not
include discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis.
Page | 2

Community Health Needs Assessment

Executive Summary

Adult Health Risk Profile. Local estimates indicate that substantial numbers of adults (age 18+) in the study
region have health risks related to nutrition, weight, physical inactivity, tobacco and alcohol. In addition,
substantial numbers of adults have chronic conditions such as high cholesterol, high blood pressure, arthritis,
diabetes and asthma.

Youth Health Risk Profile. Local estimates indicate that substantial numbers of youth (age 14-19) in the study
region have health risks related to nutrition, weight, alcohol, mental health, tobacco, and physical inactivity.

Uninsured Profile. An estimated 8,090 (13%) nonelderly residents of the study region were uninsured at a
given point in time in 2013. This included an estimated 1,188 children and 6,903 adults.

Medically Underserved Profile. Medically Underserved Areas (MUAs) and Medically Underserved
Populations (MUPs) are designated by the U.S. Health Resources and Services Administration as being at-risk
for health care access problems. The designations are based on several factors including primary care provider
supply, infant mortality, prevalence of poverty, and the prevalence of seniors age 65+. All of Rappahannock
County is designated as medically underserved. Part of Fauquier County is designated as medically
underserved. Part of Fauquier County is designated as medically underserved; two county subdivisions (minor
civil divisions or MCDs) meet the designation criteria. These MCDs are 94215 Lee District and 94511 Marshall
District.

Additional Information
Additional information on study results and methods is provided as follows.

Accompanying File of Community Indicators. A separate Microsoft Excel file contains all quantitative
indicators used in the report.

Appendix A. Zip Code-Level Maps. Appendix A provides a set of thematically colored maps displaying
variation in selected community health indicators by zip code. The underlying data for these maps are
provided in a separate Microsoft Excel file. Please read the important note about zip code-level data in
Appendix A.

Appendix B. Community Interview Guide and List of Participants. Appendix B provides a copy of the
guide used to conduct the community interviews for this study along with a list of participants.

Appendix C. Community Survey: Additional Ideas and Suggestions for Improving Community
Health. Forty-three survey respondents offered open-ended responses with additional ideas and
suggestions for improving community health. These responses are listed in Appendix C.

Appendix D. Defining a Healthy Community. On May 7, 2014, Community Health Solutions facilitated
a town hall meeting of community stakeholders on behalf of Fauquier Health and Fauquier Health
Foundation. As part of the meeting, participants were invited to share their vision of a healthy community.
Twenty-four responses were submitted. These responses are listed in Appendix D.

Appendix E. Data Sources. Appendix E provides a list of the data sources used in the analysis of this
report.

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Community Health Needs Assessment

Part I. Community Interview Results

Part I. Community Interviews


In March of 2014, Fauquier Health and Fauquier Health Foundation hosted three group interviews with a total of 21
community leaders from diverse organizations (see participant list in Appendix B). The purpose of these interviews
was to obtain participant insights about the characteristics of a healthy community, vulnerable populations,
emerging health issues, community assets, and opportunities for community collaboration. The interview
participants expressed diverse perspectives which are summarized below and listed in detail in Exhibit I-1. (Please
note that responses are paraphrased in Exhibit I-1.)
Q1. In your own words, how would you define the idea of a healthy community?

Interview participants used a variety of descriptors to define the idea of a healthy community. Summarizing
general themes, participants described a healthy community as a place where people have an expectation
of health; are engaged in health improvement; focus on both physical and behavioral health; have access
to services; are informed about existing services; are empowered to make healthy choices; practice healthy
living; and live in a physical environment that supports health.

Q2. From your perspective, who are the population segments within the community that are especially
vulnerable/at-risk for health problems?

Interview participants identified multiple population segments that are especially vulnerable/at-risk.
Participants identified subgroups of children, adolescents, adults, and seniors with specific health
conditions as well as socioeconomic and environmental risk factors. Specific health conditions identified by
interview participants include chronic disease and disability, various mental health conditions, and
addiction. Behavioral risk factors include smoking, sedentary lifestyle, poor nutrition, and substance abuse
including abuse of prescription drugs. Socioeconomic and environmental risk factors include low income,
lack of health insurance, and geographic isolation.

Q3. Are there health issues on the horizon that few people know about, but could cause serious harm today
or in the future?

Interview participants identified multiple emerging issues of concern, including perceived increases in
populations with health challenges due to aging; chronic disease, pain, and disability; mental health needs;
substance abuse problems; human papilloma virus and risk for cervical cancer; and sexually transmitted
disease. Associated socioeconomic concerns include a growing number of working poor, and increases in
the uninsured population.

Q4. Think of health assets as people, institutions, programs, built resources (e.g. parks), or natural
resources that promote a culture of health. In your view, what are the most important health assets within
the community?

Interview participants identified a variety of community health assets, including caring and engaged
residents; good community programs and services; committed healthcare providers; an attractive physical
environment; growing support for active living and healthy eating; existing community coalitions; and
individuals willing to invest their intellectual and financial capital in the community.

Q5. Thinking of a healthy community as everyones responsibility, please share one creative way that
people could work together to promote better health in the community.

Page | 4

Interview participants identified a range of creative ways that residents could collaborate to promote better
health in the community including setting community-wide goals; developing regional strategies; sharing
information across organizations; collaborating on community information campaigns; collaborating on
fundraising and interventions; and building on current collaboration efforts.

Community Health Needs Assessment

Part I. Community Interview Results

Exhibit I-1
Community Interview Results: Detailed Responses
Q1. In your own words, how would you define the idea of a healthy community?
1.

Community efforts enforce physical and mental health.

2.

Community members are engaged in improving health.

3.

Health promotion activities are present.

4.

It's easy for people to make good and healthy choices.

5.

People are empowered to make choices to have a healthy lifestyle.

6.

People are physically active and exercise.

7.

People eat nutritionally sound diets.

8.

People have access to good care (hospitals, mental health, dental).

9.

People have access to education (e.g. schools, health information, health care services, and health resources).

10.

People have access to transportation.

11.

People have an expectation of health in the community.

12.

People receive education regarding available services.

13.

People's basic needs are met.

14.

Services are available for everyone, regardless of risk or need.

15.

The environment is healthy.

16.

There are adequate resources available across the age span.

17.

There are opportunities and access to resources and activities that help people be healthy.

18.

There is a plan for an active community.

19.

There is an awareness of resources and needs of the population.

20.

There is intellectual stimulation for both children and adults.

Q2. From your perspective, who are the population segments within the community that are especially
vulnerable or at-risk for health problems?
1.

Adolescents who will suffer from the impact of bad habits, poor health choices, social pressures and social media

2.

4.

Caregivers
Children and adolescents with increasing levels of anxiety, attention deficit hyperactivity disorder, depression,
overweight and who lack good nutrition
Children in foster care

5.

Children who lack medicines

6.

Children with undiagnosed mental health issues

7.

Employees with absenteeism issues

8.

Employees with exhaustion due to outside responsibilities or activities

9.

Geographically isolated persons

10.

Immobile persons

11.

Issues related to the role of businesses providing health insurance

12.

Lack of mental and physical breaks

13.

Long commutes lead to sedentary lifestyles and contribute to poor nutrition.

14.

Older adults with disabilities

15.

People functioning outside the mainstream of communications

16.

People in need of dental care, especially children and low-income families

17.

People with mental health issues (e.g. depression, anxiety, suicide)

18.

People with mental illness who are put in jail because it is more easily available than a mental health facility

19.

People who are non-native English speakers

20.

People who can't speak for themselves

21.

People who lack transportation to services (e.g. veterans)

22.

People with chronic diseases (e.g. diabetes, obesity)

3.

Page | 5

Community Health Needs Assessment

Part I. Community Interview Results

Exhibit I-1
Community Interview Results: Detailed Responses
23.

People with disabilities

24.

People with a family history of disease

25.

Persons with lower socio-economic status (e.g. uninsured, working poor)

26.

Prisoners who are released without a follow-up plan

27.

Seniors with economic or social barriers, lack of healthcare and local venues (e.g. food stores)

28.

Smoking and physical exhaustion in the healthcare workforce

29.

Substance users

30.

The disabled

31.

The elderly

32.

The very young

33.

There's no separation between work and home and mobile devices keep people engaged 24/7.

34.

Individuals without education

Q3. Are there health issues on the horizon that few people know about, but could cause serious harm today or in the
future?
1.

Alzheimers and Dementia

2.

Children are being left out of accessing care because few providers see Medicaid patients.

3.

Chronic disease (e.g. cancer, diabetes, hypertension and obesity in both children and adults)

4.

Dental care needs

5.

Eating disorders

6.

Effects of drug mixing

7.

Environmental health

8.

Healthcare messaging is often overwhelming and is negatively skewed.

9.

If people are not served at the free clinic, then they use the emergency room for health care.

10.

In 15-20 years, we will see the unexpected outcomes of long term prescription and over the counter drug use.

11.

In the aging population, there are changes in reactions to drugs over time and with substance abuse.

12.

Palliative care options

13.

Persons with unmanaged chronic pain

14.

Population distrust of corporate medicine will have effects on health behavior.

15.

Population growth is slowing in both counties.

16.

Quality telephone service for people without cell phones or access to cell service

17.

19.

Sexually transmitted diseases (e.g. human immunodeficiency virus, human papilloma virus)
Since the recession, there has been an increase in people needing social services. Now there is a backlog because
Virginia has changed its eligibility system.
Substance abuse (especially heroin, methamphetamine )

20.

The ability of people with disabilities or mental health issues to navigate their life and health care system

21.

The long term impact of anxiety and depression on the population

22.

The outcome of long term use of recreational drugs

23.

The population age mix will result in a gap between the young and older adults.

24.

26.

There are growing needs for people with serious disabilities. There is especially a need for infrastructure.
There is an increase in children with anxiety and mental health issues which, unless treated early, will lead to teens
and adults with these same issues.
There is an increase in the elderly.

27.

There is an increase in the working poor.

28.

There will probably be an increase in uninsured patients at the free clinic in the coming year.

29.

There's a gap between the need and the bed space available for mental health patients.

18.

25.

Page | 6

Community Health Needs Assessment

Part I. Community Interview Results

Exhibit I-1
Community Interview Results: Detailed Responses
Q4. Think of health assets as people, institutions, programs, built resources (e.g. parks), or natural resources that
promote a culture of health. In your view, what are the most important health assets within the community?
1.
2.

Some Rappahannock schools have farm to table programs.


Banks

3.

County Health Fair

4.

Faith-based organizations

5.

Fire and Rescue

6.

Hospital and caring providers

7.

Infrastructure

8.

The community is getting more active.

9.

The community is a beautiful place to live.

10.

Local nonprofits

11.

Many influential people

12.

Medical professionals are responsible.

13.

New community members can be useful.

14.

Old Town Festival

15.

Park and Recreation

16.

People are generous with time and money.

17.

People are hard-working and caring.

18.

People are playing sports, walking, using trails and riding bikes.

19.

Providers use evidence-based care.

20.

Schools

21.

The community is moving towards consuming more fresh food and is willing to pay for it.

22.

The community and nature are pretty.

23.

The county is appealing to medical professionals.

24.

The food bank

25.

The free clinic is expanding to provide dental and behavioral health services.

26.

The hospital is progressive and engaged.

28.

There are a number of health and mental health-related community services such as: Community Service Board,
Adult and Child Protective Services, Home Instead, Department of Social Services, the Free Clinic, the Food pantry,
Warrenton shelters, Virginia Department of Health and the Healthy Families Program and the Red Cross.
There are lots of smart people in the community.

29.

There are many resources in the nearby Washington, D.C. metro area.

30.

There are opportunities to be active at the Warrenton Aquatic and Recreation Facility.

31.

There are retired baby boomers who want to be useful.

32.

There are three community collaboratives that focus on aging, children and community resources.

33.

There is an interest in community well-being.

34.

There is social capital and the community is helpful, compassionate, capable and committed.

35.

Wealthy people

27.

Page | 7

Community Health Needs Assessment

Part I. Community Interview Results

Exhibit I-1
Community Interview Results: Detailed Responses
Q5. Thinking of a healthy community as everyones responsibility, please share one creative way that people could
work together to promote better health in the community.
1.

3.

Assist people with needs to find resources.


Use a Care Medicine Approach and create a multi-disciplinary team (nurse, Emergency Medical Services, education,
nonprofit) to staff a mobile health care service to provide outreach services in high need communities.
Develop a five county strategy.

4.

Develop a packet of information for Emergency Medical Services to use to locate services and resources.

5.

Distribute the Department of Social Services' resource list.

6.

Emergency Medical Services could set up education tables at the town fair.

7.

9.

Every patient discharged should receive a booklet listing services and receive assistance in setting up appointments.
Free clinics have received 'bonus bucks' that can be used at farmers markets. This program could expand across the
area.
Guidance counselors from schools could share resources.

10.

Identify the gaps in services and resources.

11.

Improve health literacy.

12.

Look beyond political boundaries.

13.

Make sure everyone knows the issues and people will fill the need.

14.

Nonprofits could collaborate on fundraising and interventions.

15.

Organize a "health season" launch.

16.

Organize a health fair with stations for screenings and education on health topics.

17.

Organize a service-oriented fair for county government employees to volunteer for other organizations.

18.

Organize Mental Health First Aid trainings for community members.

19.

Other organizations can participate in Emergency Medical Services monthly meeting.

20.

People need to spend time in someone else's shoes to get out of working in silos.

21.

People need to work together even if there is no crisis.

22.

Provide educational information about resources.

23.

Provide follow-up care after discharge from hospital.

24.

Set community goals related to community health and engage the community to achieve those goals.

25.

Sometimes the government needs to get out of the way.

26.

Start early with health education for children.

27.

The collaborative on aging crosses barriers, is broad based and focuses on planning.

28.

The community needs to do something like Michelle Obama's healthy food and habits initiative.

29.

There is a request for the hospital to consider medical practice support.

2.

8.

Page | 8

Community Health Needs Assessment

Part II. Community Survey Results

Part II. Community Survey


In an effort to expand the range of community input for the study, a Community Survey was conducted with a group
of community stakeholders identified by Fauquier Health and Fauquier Health Foundation. The survey participants
were asked to provide their viewpoints on:

Important health concerns in the community;


Significant service gaps in the community;
Vulnerable/at-risk populations in the community;
Vulnerable/at-risk geographic regions in the community; and
Additional ideas and suggestions for improving community health.

The survey was sent to a group of 172 community stakeholders. A total of 80 (47%) stakeholders submitted a
response (although not every respondent answered every question). The respondents provided rich insights about
community health in the study region. The results are summarized in the remainder of this section.
1. Survey Respondents
Exhibit II-1 below lists the organizational affiliations of the survey respondents.
Exhibit II-1
2
Reported Organization Affiliation of Survey Respondents
Aging Together
Bealeton Baptist Church
Boys and Girls Club of Fauquier
Branch Banking and Trust Company
Capital Caring
Christian Science Reading Room
Chrysalis Counseling Centers, Inc.
Community Touch, Inc.
County of Rappahannock
Fauquier Bridges
Fauquier CADRE
Fauquier County Department of Social Services
Fauquier Community Child Care, Inc.
Fauquier County
Fauquier County Government
Fauquier County Government and Public Schools
Fauquier County Parks and Recreation
Fauquier County Public Schools
Fauquier County Sheriff's Office
Fauquier Domestic Violence Services
Fauquier County Fire Rescue & Emergency Management
Fauquier FISH (For Immediate Sympathetic Help)
Fauquier Free Clinic
Fauquier Health (3)
Fauquier Health Home Care Services
Fauquier Health Wellness Center
Fauquier Hospital (2)
Fauquier Sheriffs Office
Fauquier Trails Coalition, Inc.
FCAC Head Start/Bright Stars Program
Fauquier Health Physician Services (2)
Flint Hill Volunteer Fire and Rescue Company
Highland School
Hospice of the Rapidan
Hottle and Associates

Lifepoint Fauquier Hospital


Marianne Clyde, Licensed Marriage and Family Therapist
Marshall Volunteer Fire Department, Inc.
Mental Health Association of Fauquier County
Oak Springs of Warrenton
People Helping People of Fauquier County
Piedmont Dispute Resolution Center
Piedmont Family Practice
Piedmont Internal Medicine (2)
Piedmont Pediatrics
Piedmont Press and Graphics
Piedmont United Way
Advanced Practice Psychiatric Nurse
Rappahannock County Department of Social Services
Rappahannock County Public Schools (2)
Rappahannock Food Pantry
Rappahannock Historical Society
Rappahannock Office of Emergency Management
Rappahannock Rapidan Community Services (3)
Rappahannock-Rapidan Regional Commission
Saint James' Episcopal Church
School Health Advisory Board
Sperryville Volunteer Rescue Squad
The Villa at Suffield Meadows
Town of Washington
Trinity Episcopal Church
Virginia Department of Health, Rappahannock-Rapidan District
Virginia Cooperative Extension (2)
VOLTRAN
Wakefield School
Walgreens #9383
Warrenton Volunteer Fire Company
Women of Wonder (WOW)
Unknown Organization (3)

A count is provided for organizations with multiple survey respondents.

Page | 9

Community Health Needs Assessment

Part II. Community Survey Results

2. Community Health Concerns


Survey respondents were asked to review a list of common community health issues. The list of issues draws from
the topics in Healthy People 2020 with some refinements. The survey asked respondents to identify from the list
what they view as important health concerns in the community. Respondents were also invited to identify additional
issues not already defined on the list. Exhibit II-2 summarizes the results, including open-ended responses.
Exhibit II-2.
Important Community Health Concerns Identified by Survey Respondents
Answer Options
Adult Obesity

Response Percent
69%

Depression

55%

Response Count
54
43

Mental Health Conditions (other than depression)

54%

42

Diabetes

53%

41

Childhood Obesity

51%

40

Substance Abuse - Illegal Drugs

50%

39

Substance Abuse - Prescription Drugs

50%

39

High Blood Pressure

42%

33

Alcohol Use

36%

28

Heart Disease

36%

28

Alzheimer's Disease

35%

27

Cancer

30%

23

Chronic Pain

30%

23

Tobacco Use

27%

21

Domestic Violence

26%

20

Dental Care/Oral Health-Adult

22%

17

Autism

21%

16

Arthritis

18%

14

Dental Care/Oral Health-Pediatric

18%

14

Infant and Child Health

18%

14

Teen Pregnancy

17%

13

Asthma

15%

12

Physical Disabilities

15%

12

Stroke

15%

12

Orthopedic Problems

14%

11

Intellectual/Developmental Disabilities

13%

10

Respiratory Diseases (other than asthma)

13%

10

Injuries

12%

Infectious Diseases

10%

Sexually Transmitted Diseases

8%

Renal (kidney) Disease

6%

Prenatal & Pregnancy Care

5%

Environmental Quality

4%

Neurological Disorders (seizures, multiple sclerosis)

4%

HIV/AIDS

3%

Other Health Problems (see next page)

15%

12

Note: When
interpreting the
survey results,
please note
that although
the relative
number of
responses
received for
each item is
instructive, it is
not a definitive
measure of the
relative
importance of
one issue
compared to
another.

Seventy-eight (78) of the 80 survey respondents answered this question.

Page | 10

Community Health Needs Assessment

Part II. Community Survey Results

Exhibit II-2.
Important Community Health Concerns Identified by Survey Respondents (continued)
Other Important Community Health Concerns Identified by Survey Respondents
Response #

Reponses

1.

Attention deficit hyperactivity disorder


Other school difficulties

2.

Attention deficit hyperactivity disorder


Anxiety

3.

Affordable health insurance


Access to care for the elderly
Inactivity leading to other community health concerns for adults and pediatric

All of the above-mentioned community health concerns are important in our community.
Some of the least served issues would be in the area of mental health and substance abuse.
Social issues with access to health care remain due to lack of transportation in many areas of our county
and there is little access to inter-county transportation for services.
There is also very little in the way of assistance for dental treatment for the indigent in our community.

4.

5.

All of the above-listed community health concerns are concerns within our community. The items I checked
[Alzheimer's disease, mental health conditions (other than depression), substance abuse-illegal drugs and
substance abuse-prescription drugs] represent issues that I often address and have found room for
improvement as far as services available.

6.

7.

Eating disorders

8.

From the emergency response side, we are typically not aware of these issues as we handle their post effects.
However, [we] do get training and are aware of current trends so we can stay up to date on possible issues.

9.

I believe that [lack of] access to mental health and substance abuse services is a major health problem in our
area.

10.

I don't have direct experience or information on health concerns in the community.

11.

I feel that physicians over-prescribe medications to the elderly.

12.

We are dangerously deficient in mental health access.

Page | 11

Chronic diseases (multiple)


Specific to injuries - those caused by falls

Community Health Needs Assessment

Part II. Community Survey Results

3. Community Service Gaps


Survey respondents were asked to review a list of community services that are typically important for addressing
the health needs of a community. Respondents were asked to identify from the list any services they think need
strengthening in terms of availability, access, or quality. Respondents were also invited to identify additional service
gaps not already defined on the list. Exhibit II-3 summarizes the results, including open-ended responses.
Exhibit II-3.
Important Community Service Gaps Identified by Survey Respondents
Answer Options
Behavioral Health Services (including mental health, substance
use and intellectual disability)
Aging Services
Transportation
Health Care Insurance Coverage (private and government)
Health Care Services for the Uninsured and Underinsured
Health Promotion and Prevention Services
Early Intervention Services for Children
Homeless Services
Chronic Pain Management Services
Home Health Services
Job/Vocational Retraining
Long Term Care Services
Patient Self-Management Services(e.g. nutrition, exercise,
taking medications)
Social Services
Dental Care/Oral Health Services-Pediatric
Dental Care/Oral Health Services-Adult
Food Safety Net (food bank, community gardens)
Cancer Services (screening, diagnosis, treatment)
Hospice Services
Primary Health Care Services
Specialty Medical Care (e.g. cardiologists, oncologists, etc.)
Family Planning Services
Domestic Violence Services
Public Health Services
Chronic Disease Services (including screening and early
detection)
School Health Services
Pharmacy Services
Maternal, Infant & Child Health Services
Hospital Services (including emergency, inpatient and outpatient)
Physical Rehabilitation
Workplace Health and Safety Services
Environmental Health Services
Other Health Problems (see next page)

Response Percent

Response Count

71%

55

49%
44%
31%
31%
30%
27%
27%
26%
24%
24%
23%

38

23%

18

23%
21%
19%
18%
17%
17%
17%
17%
15%
14%
14%

18
16
15
14
13
13
13
13
12
11
11

13%

10

12%
8%
6%
5%
3%
3%
1%
17%

9
6
5
4
2
2
1
13

34
24
24
23
21
21
20
19
19
18

Note: When
interpreting
the survey
results,
please note
that although
the relative
number of
responses
received for
each item is
instructive, it
is not a
definitive
measure of
the relative
importance of
one issue
compared to
another.

Seventy-eight (78) of the 80 survey respondents answered this question.

Page | 12

Community Health Needs Assessment

Part II. Community Survey Results

Exhibit II-3.
Important Community Service Gaps Identified by Survey Respondents (continued)
Other Important Community Health Services Gaps Identified by Survey Respondents
Response #

1.

2.

Responses

Affordable medications and outpatient medical treatments


Affordable Herpes Zoster vaccine for adults
We need access to [a] safe haven for victims of domestic violence, such as a women's shelter.
Other communities our size have this.

The county has no urgent care clinic, no pharmacy, no hospital, little home care and no public
transportation; all of which are critical to an aging population profile.
The county is "no country for old men" (or women).

3.

Dental care is an issue for adults without insurance coverage for dental services and for children with no
coverage or with Medicaid coverage (since the health department ended its pediatric dental services).

4.

5.

Orthopedic services

6.

Palliative care

7.

[There is a need for] safe and healthful housing for very low-income and extremely low-income, including
seniors living only on Social Security. There is no source of assistance for these households to find
affordable safe housing.

8.

Teaching children and parents the value and importance of eating healthy and buying local.

9.

Integrated, all inclusive care offered in single locations


Emergency mental health care and evaluations

There are few primary care physicians who accept Medicaid and access for Medicare recipients is
becoming more limited.
We have some problems with access to certain specialties such as psychiatry and neurology.

10.

There is a huge need for a good psychiatrist.

11.

Under specialty medical care, I think we need more oncology, and neurology services.

12.

We need more endocrinology, neurology, psychiatry and urology physicians.

13.

We need more psychiatry, chronic pain [services], orthopedic [services], gastrointestinal [services] and
pharmacies.

Page | 13

Community Health Needs Assessment

Part II. Community Survey Results

4. Vulnerable/At-Risk Populations in the Community


Survey respondents were asked if there are particular populations within the community who are vulnerable/at-risk
for health concerns or difficulties obtaining health services. Exhibit II-4 summarizes the results, including
5
representative comments.
Exhibit II-4.
Vulnerable/At-Risk Populations Identified by Survey Respondents
Vulnerable/At-Risk
Population Category

Elderly

Representative Comments
1.

An aging population demographic in need of services now delivered in Culpeper, Warrenton and
Front Royal

2.

Elderly and low income

3.

If [an individual is] fortunate to have Medicaid, not all health care providers are willing to accept
it. This can result in clients having to travel some distance to receive medical services. The
problem is then compounded by inadequate transportation.

4.

Elderly eligible for Medicare but unable to afford medicines or recommended vaccines

5.

Elderly living in rural areas

6.

Elderly patients with underserved needs such as caregiver assistance and transportation needs

7.

Older adults who are isolated and don't have family support

8.

Rappahannock is aging and graying. It has relatively few children, relatively few young families
with growing children, and an enlarging population of senior citizens. [These are] trends that are
projected to continue for the next couple of decades. Seniors with chronic health conditions have
little choice but to move away, as we did last year, to be convenient to medical care, senior
services, appropriate housing, transportation and services.

9.

Resources for seniors with behavioral health issues

10. The elderly need constant supervision. If they want to maintain their independence, they need
help in doing so.
11. The elderly, especially CTC residents [are vulnerable or at-risk]. It is hard to find services for
residents already in CTC setting, especially with Medicaid.
12. We often see frail elderly and disabled trying to continue living in their homes without adequate
care resources. We coordinate with Social Services [staff] who provide what help they can, but
their resources are very limited.

Low Income

1.

Fixed income adults, age range 25-59, who have medical issues and can't afford all their
medications and living expenses [are vulnerable or at-risk].

2.

I feel that all low income residents, and even middle class families of the community, are at-risk
for health problems due to poor preventative care (due to the inability to afford the same
[prevention care]). That same group has difficulties obtaining health services, preventative and
affordable services for economic reasons.

3.

In my short experience, the working poor struggle mightily in this county due to the limited
affordable housing and basic high cost of living.

4.

Lack of adequate housing and basic needs like food, clean water, and indoor plumbing

5.

Low income families and those on Medicaid would be included in this group.

6.

Low income or indigent persons who do not have a category for Medicaid.

7.

Persons who are working but do not earn enough to pay for insurance.

Sixty-four (64) of the 80 survey respondents answered this question. Most responses included multiple at-risk populations.
Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed in the
Exhibit represent the range of populations identified.
6

Page | 14

Community Health Needs Assessment

Part II. Community Survey Results

Exhibit II-4.
Vulnerable/At-Risk Populations Identified by Survey Respondents (continued)
Vulnerable/At-Risk Population
7
Category

Representative Comments
1.

Availability of inpatient behavioral health services

2.

Children, adolescents and adults who have symptoms of mental illness but who can't
access services because of stigma, wait times to get into care or lack of resources.

3.

[There is] difficulty obtaining mental health and substance abuse intervention for
those with limited financial resources.
Doctors familiar or experienced with individuals with cognitive and physical
disabilities

4.
Behavioral Health
5.
6.

Community Services Board is unable to keep up with the needs of dual diagnosed
mental health and substance abusers.
The elderly population will not seek medical attention due to not having medical
insurance. Most of our elderly population has an extensive medical history.

7.

Individuals with developmental and intellectual disabilities

8.

The mentally ill have problems accessing mental health and physical health services.
The mental health population is much more [at-risk for] chronic diseases due to their
lack of access to health care.

9.

There is a lack of dependable, holistic psychiatry.

10. Those [individuals] needing behavioral medicine have few choices.


11. Those [individuals] with mental health issues, including substance abuse, have few
services available to them; especially on an immediate need basis.

Uninsured

Residents without
Transportation

1.

The uninsured who fall into [the] gap due to Virginia not expanding Medicaid.

2.
3.

Women age 50+who have separated or become divorced and do not have any type
of health insurance
Yes, children who don't qualify for Medicaid [are vulnerable or at-risk] because their
parent, or parents, work and are over the guidelines but no insurance is offered on
the job.

1.

Anyone dependent on public transportation not living in Warrenton City proper

2.

Older adults without transportation

3.

We have a large aging population and our area is very rural with no public
transportation.
If we lose dental service from the county or state health services many of our
children will be without dental care.
Our rural students, without access to local food banks, may not have access to
sufficient food and nutritional services when school is not in session.

1.
Children

Immigrant Community

2.
3.

We have children in the schools who do not have access to healthy and regular food
choices.

4.

Young children from single parent homes

1.

Folks coming from outside the U.S.

2.

People who speak a language other than English

3.

The Latino community [is vulnerable or at-risk] because they may not be aware of
existing services or because of language, cultural barriers or legal implications, they
do not or cannot seek services.

4.

Undocumented migrant workers

5.

Undocumented workers

Sixty-four (64) of the 80 survey respondents answered this question. Most responses included multiple at-risk populations.
Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed in the
Exhibit represent the range of populations identified.
8

Page | 15

Community Health Needs Assessment

Part II. Community Survey Results

Exhibit II-4.
Vulnerable/At-Risk Populations Identified by Survey Respondents (continued)
Vulnerable/At-Risk Population
9
Category

10

Representative Comments
1.

Dental

2.

Caregivers

3.

Families in crisis

4.

Homeless

5.

No internet access or understanding

6.

People who are nonwhite

7.

People who have religious traditions other than Christian

8.

Persons re-entering the community after incarceration

9.

Prescription drug abuse is a substantial, but largely hidden, health problem in our
community.
10. Rappahannock County is underserved by health professionals. [There are] two
doctors, one of whom is retiring.
Other

11. Single mothers with children


12. Single males
13. Those families who are geographically isolated.
14. Those with "pre-diabetes" are often in need of "healthy living" information; such as
what is provided in our diabetes services. However, most commercial insurances and
Medicare do not cover any sort of health or nutrition counseling for those with a
diagnosis of pre-diabetes. Those services, unfortunately, are only paid for once
someone has diabetes. Some people referred here will pay out of pocket for a one on
one visit with our Registered Dietician, but some won't do it if their insurance doesn't
cover. Often, one visit isn't enough to learn about an entire lifestyle change over time.
15. Those with advanced stage diseases
16. Victims of domestic violence
17. Victims of sexual violence
18. We need primary care services.
19. Working with Fauquier Social Services and the Virginia Health Department will also
provide us this information.

Sixty-four (64) of the 80 survey respondents answered this question. Most responses included multiple at-risk populations.
Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed in
the Exhibit represent the range of populations identified.
10

Page | 16

Community Health Needs Assessment

Part II. Community Survey Results

5. Vulnerable/At-Risk Geographic Regions


Survey respondents were asked if there are particular neighborhoods or geographic regions within the community
where residents may be vulnerable/at-risk for health problems or difficulties obtaining health services. Exhibit II-5
11
summarizes the results, including representative comments.
Exhibit II-5.
Vulnerable/At-Risk Neighborhoods or Geographic Regions Identified by Survey Respondents
Vulnerable/At-Risk
Neighborhood/Geographic
Region

12

Representative Comments
1.

Rural/Remote Areas In General

2.

Outlying areas of the county [are at-risk] because transportation to health care
services may be a significant problem.
Remote mountain areas and hollows

3.

Rural uninsured or underinsured with rabies exposure

4.
5.

Rural, low income areas


Those [individuals] whose geographic location (rural, isolated) makes it difficult to
access health care.
The southern end of Fauquier County including Bealeton, Midland, Goldvein, etc.
The central and southern regions of our county have a higher population and,
therefore, require more services.
Bealeton area and Northern area

1.
2.
Central, Northern, and Southern
Fauquier County

3.
4.
5.
6.

Central and southern areas of the county [have] poor access and transportation.
Southern and Northern Fauquier do not have adequate transportation for patients to
obtain needed services in Warrenton.
It is more difficult for residents of Marshall to access health care resources.

7.

Marsh Run Mobile Home Community

1.

In outlying areas, seniors have particularly difficult times getting to medical services.

2.

One of our areas that we see an issue with is the local nursing homes. There seems
to be a lack of education on when and when not to call 911. We have had incidences
where we have [been] called to a nursing home at 2 am and transported them
[nursing home residents] to the emergency room because the blood labs came back
abnormal. The Medic unit had to wake the resident up from a comfortable sleep to
take them to the emergency department.

3.

Housing designed for aging seniors with mobility problems is also badly needed.

4.

Our community is a retirement community.

1.

Homeless people who do not meet the Family Shelter's rigid requirements

2.

People who are in treatment

3.

None I am aware of. Geography is not the issue, economics is, I believe.

4.

The whole county is one under-served community bypassed by modern medical


care. We desperately need an urgent care clinic and pharmacy at a minimum.
I am only familiar with the health problems in Rappahannock County. The problems
appear to be county wide.

Areas with a large Senior


Population

Other

5.

11

Thirty-nine (39) of the 80 survey respondents answered this question. Most responses included multiple at-risk populations.
Many respondents identified the same types of geographic regions (e.g. southern Fauquier), although with slightly different language. The
populations listed in the Exhibit represent the range of populations identified.
12

Page | 17

Community Health Needs Assessment

Part II. Community Survey Results

6. Additional Ideas and Suggestions


Forty-three respondents offered open-ended responses with additional ideas and suggestions for improving
community health. These responses are listed in Appendix C.

Page | 18

Community Health Needs Assessment

Part III. Community Indicators

Part III. Community Indicators


This section of the report provides a quantitative analysis on a wide array of community health indicators. To
produce the profiles, Community Health Solutions analyzed data from multiple sources. By design, the analysis
does not include every possible indicator of community health. The analysis is focused on a set of indicators that
provide broad insight into community health, and for which there were readily available data sources.
The results of this profile can be used to evaluate community health status compared to Virginia overall. The results
can also be helpful for determining the number of people affected by specific health concerns. In addition, the
results can be used alongside the Community Interview and Community Survey results, as well as the zip codelevel maps in Appendix A to help inform action plans for community health improvement. This section includes ten
profiles as follows:
1. Health Demographic Trend Profile
2. Health Demographic Snapshot Profile
3. Mortality Profile
4. Maternal and Infant Health Profile
5. Preventable Hospitalization Discharge Profile
6. Behavioral Health Hospitalization Discharge Profile
7. Adult Health Risk Factor Profile
8. Youth Health Risk Factor Profile
9. Uninsured Profile
10. Medically Underserved Profile

Page | 19

Community Health Needs Assessment

Part III. Community Indicators

1. Health Demographic Trend Profile


Trends in health-related demographics are instructive for anticipating changes in community health status.
Changes in the size, age and racial/ethnic mix of the population can have a significant impact on overall health
status, health needs and demand for local services.
As shown in Exhibit III-1, as of 2013, the study region included an estimated 74,567 people. The population is
expected to increase to 79,035 by 2018. It is projected that population growth will occur in all age groups, including
a 22% increase in seniors age 65+. Focusing on racial background, growth is projected for all populations, including
a 21% increase in the Asian population. The Hispanic ethnicity population is also expected to grow by 22%.
Exhibit III-1.
Health Demographic Trend Profile for the Study Region, 2010-2018
2010 Census

2013
Estimate

2018
Projection

% Change
2013-2018

72,576

74,567

79,035

6%

79.0

81.2

86.1

6%

25,909

27,544

29,440

7%

Children Age 0-17

17,512

17,977

18,311

2%

Adults Age 18-29

8,853

9,021

9,876

9%

Adults Age 30-44

13,463

13,414

13,516

1%

Adults Age 45-64

23,051

23,833

24,734

4%

Seniors Age 65+

9,697

10,322

12,598

22%

875

1,015

1,226

21%

Black/African American

5,642

6,400

7,232

13%

White

62,441

63,299

66,102

4%

Other or Multi-Race

3,618

3,853

4,475

16%

13

4,406

4,685

5,698

22%

Indicator
Total Population
Population Density (per Sq. Mile)
Total Households
Population by Age

Population by Race/Ethnicity
Asian

Hispanic Ethnicity

Source: Community Health Solutions analysis of US Census data and estimates from Alteryx, Inc. See Appendix E.
Data Sources for details.

13

Classification of ethnicity; therefore, Hispanic individuals are also included in the race categories.

Page | 20

Community Health Needs Assessment

Part III. Community Indicators

2. Health Demographic Snapshot Profile


Community health is driven in part by community demographics. The age, sex, race, ethnicity, income and
education status of a population are strong predictors of community health status and community health needs.
Exhibit III-2 presents a snapshot of key health-related demographics of the study region. As of 2013, the study
region included an estimated 74,567 people. Focusing on population rates in the lower part of the Exhibit,
compared to Virginia as a whole, the study region is more rural, older, and less racially/ethnically diverse. The study
region also has higher income levels than Virginia as a whole. Note: Maps 1-13 in Appendix A show the geographic
distribution of the population by zip code.
Exhibit III-2.
Health Demographic Snapshot Profile, 2013
Study
Region

Fauquier
County

Rappahannock
County

Virginia

Population

74,567

67,137

7,430

8,246,990

Children Age 0-17

17,977

16,525

1,452

1,889,997

Indicator
Population Counts
Total
Population

Adults Age 18-29

9,021

8,214

807

1,411,537

Adults Age 30-44

13,414

12,281

1,133

1,673,982

Adults Age 45-64

23,833

21,252

2,581

2,244,242

Seniors Age 65+

10,322

8,865

1,457

1,027,232

Ethnicity

Female
Male
Asian
Black/African American
White
Other or Multi-Race
Hispanic Ethnicity14

37,741
36,826
1,015
6,400
63,299
3,853
4,685

34,025
33,112
970
6,015
56,519
3,633
4,429

3,716
3,714
45
385
6,780
220
256

4,197,377
4,049,613
478,144
1,607,903
5,606,007
554,936
696,403

Income

Low Income Households (Households with Income < $25,000)

3,160

2,605

555

581,266

5,376

4,317

1,059

668,407

Population Density (pop. per sq. mile)

81.2

103.1

27.8

204.5

Children Age 0-17 pct. of Total Pop.

24%

25%

20%

23%

Adults Age 18-29 pct. of Total Pop.

12%

12%

11%

17%

Adults Age 30-44 pct. of Total Pop.

18%

18%

15%

20%

Adults Age 45-64 pct. of Total Pop.

32%

32%

35%

27%

Seniors Age 65+ pct. of Total Pop.

14%

13%

20%

12%

Female pct. of Total Pop.

51%

51%

50%

51%

Male pct. of Total Pop.

49%

49%

50%

49%

Asian pct. of Total Pop.

1%

1%

1%

6%

Black/African American pct. of Total Pop.

9%

9%

5%

19%

White pct. of Total Pop.

85%

84%

91%

68%

Other or Multi-Race pct. of Total Pop.

5%

5%

3%

7%

Hispanic Ethnicity pct. of Total Pop.

6%

7%

3%

8%

Per Capita Income

$42,467

$43,103

$36,716

$34,707

Median Household Income

$85,784

$89,397

$60,802

$63,146

Low Income Households (Households with Income <$25,000)


pct. of Total Households

11%

11%

18%

18%

Pop. Age 25+ Without a High School Diploma pct. of Total


Pop. Age 25+

11%

9%

19%

12%

Age

Sex

Race

Education
Population Age 25+ Without a High School Diploma
Population Rates
Total
Population

Age

Sex

Race

Ethnicity

Income

Education

Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix E. Data Sources for details.
14

Classification of ethnicity; therefore, Hispanic individuals are also included in the race categories.

Page | 21

Community Health Needs Assessment

Part III. Community Indicators

3. Mortality Profile
Mortality is one of the most commonly cited community health indicators. As shown in Exhibit III-3, in 2012, the
study region had 553 total deaths in 2012. The leading causes of death were malignant neoplasms (cancer) (125),
heart disease (117), and cerebrovascular disease (stroke) (36). The age-adjusted rate for stroke deaths in the study
region was higher than the Virginia statewide rate. Note: Maps 14-17 in Appendix A show the geographic
distribution of deaths by zip code.
Exhibit III-3.
Mortality Profile, 2012
Study Region

Fauquier
County

Rappahannock
County

Virginia

553

469

84

61,101

Malignant Neoplasms Deaths

125

106

19

14,209

Heart Disease Deaths

117

92

25

13,289

Cerebrovascular Diseases Deaths

36

28

3,390

Unintentional Injury Deaths

28

24

2,779

Chronic Lower Respiratory Diseases Deaths

27

23

3,046

Nephritis and Nephrosis Deaths

18

17

1,518

Septicemia Deaths

18

18

1,308

Suicide Deaths

14

11

1,056

Alzheimer's Disease Deaths

12

1,708

Influenza and Pneumonia Deaths

11

10

1,302

Chronic Liver Disease Deaths

10

809

Diabetes Mellitus Deaths

1,589

Parkinsons Disease Deaths

561

Primary Hypertension and Renal Disease Deaths


Age Adjusted Death Rates per 100,000
15
Population
Total Deaths

639

686.0

676.0

778.1

724.9

Malignant Neoplasms Deaths

143.2

142.5

--

164.1

Heart Disease Deaths

143.9

131.6

--

157.4

Cerebrovascular Diseases Deaths

46.4

--

--

40.7

Unintentional Injury Deaths

--

--

--

33.3

Chronic Lower Respiratory Diseases Deaths

--

--

--

36.6

Nephritis and Nephrosis Deaths

--

--

--

18.2

Septicemia Deaths

--

--

--

15.6

Suicide Deaths

--

--

--

12.5

Alzheimer's Disease Deaths

--

--

--

21.1

Influenza and Pneumonia Deaths

--

--

--

15.8

Chronic Liver Disease Deaths

--

--

--

8.8

Diabetes Mellitus Deaths

--

--

--

18.5

Parkinsons Disease Deaths

--

--

--

7.1

Indicator
Total Deaths
Deaths by All Causes
Deaths by Top 14 Causes

Primary Hypertension and Renal Disease Deaths


---7.6
Source: Community Health Solutions analysis of mortality data from the Virginia Department of Health. See Appendix E. Data
Sources for details.

15

-- Age adjusted rates are not calculated where the number of deaths is less than 30.

Page | 22

Community Health Needs Assessment

Part III. Community Indicators

4. Maternal and Infant Health Profile


Maternal and infant health indicators are another widely cited category of community health. As shown in Exhibit III4, the study region had 925 pregnancies, 731 total live births and four infant deaths in 2012. Compared to Virginia
as a whole, the study region had a higher rate of births without early prenatal care. Note: Maps 18-21 in Appendix A
show the geographic distribution of births by zip code.
Exhibit III-4
Maternal and Infant Health Profile, 2012
Indicator

Study
Region

Fauquier
County

Rappahannock
County

Virginia

Total Pregnancies

925

844

81

129,787

Induced Terminations of Pregnancy

118

106

12

21,438

Natural Fetal Deaths

76

63

13

5,538

Total Live Births

731

675

56

102,811

Low Weight Births (under 2,500 grams / 5 lb. 8 oz.)

51

48

8,391

Births Without Early Prenatal Care (No Prenatal


Care in First 13 Weeks)

152

138

14

13,368

Non-Marital Births

225

208

17

36,271

Total Teenage (age 10-19) Pregnancies

65

59

8,651

Live Births to Teens Age 10-19

45

41

6,134

Live Births to Teens Age 18-19

34

31

4,504

Live Births to Teens Age 15-17

11

10

1,559

Live Births to Teens Age <15

71

650

Live Birth Rate per 1,000 Population

9.9

10.1

7.5

12.6

Low Weight Births pct. of Total Live Births

7%

7%

5%

8%

Births Without Early Prenatal Care (No Prenatal Care in


First 13 Weeks) pct. of Total Live Births

21%

20%

25%

13%

Non-Marital Births pct. of Total Live Births

31%

31%

30%

35%

Counts

Total Infant Deaths


Rates

Teenage (age 10-19) Pregnancy Rate per 1,000 Teenage


12.6
12.5
14.3
16.7
Female Population
Five-Year Average Infant Mortality Rate per 1,000 Live
5.1
5.5
0.0
6.7
Births) 2008-2012
Source: Community Health Solutions analysis of data from the Virginia Department of Health. See Appendix E. Data Sources for
details.

Page | 23

Community Health Needs Assessment

Part III. Community Indicators

5. Preventable Hospitalization Discharge Profile


The Agency for Healthcare Research and Quality (AHRQ) identifies a defined set of conditions (called Prevention
16
Quality Indicators, or PQIs) for which hospitalization should be avoidable with proper outpatient health care. High
rates of hospitalization for these conditions indicate potential gaps in access to quality outpatient services for
community residents.
17

As shown in Exhibit III-5, residents of the study region had 871 PQI hospital discharges in 2011. The leading
diagnoses for these discharges were chronic obstructive pulmonary disease (COPD) and asthma in older adults
(213), bacterial pneumonia (183), and congestive heart failure (156). The age-adjusted PQI discharge rates for the
study region were generally higher than the Virginia statewide rates for most PQI diagnoses. Note: Map 22 in
Appendix A shows the geographic distribution of PQI discharges by zip code.
Exhibit III-5.
Prevention Quality Indicator (PQI) Hospital Discharge Profile, 2011
Indicator

Study
Region

Fauquier
County

Rappahannock
County

Virginia

Total PQI Discharges by All Diagnoses

871

793

78

88,544

PQI Discharges by Diagnosis


Chronic Obstructive Pulmonary Disease (COPD) and Asthma in
Older Adults PQI Discharges
Bacterial Pneumonia PQI Discharges

213

197

16

16,007

183

170

13

15,720

Congestive Heart Failure PQI Discharges

156

138

18

20,006

Urinary Tract Infection PQI Discharges

108

97

11

10,826

Diabetes PQI Discharges

76

64

12

12,200

Dehydration PQI Discharges

58

54

7,422

Hypertension PQI Discharges

42

40

3,299

Perforated Appendix PQI Discharges

15

14

1,282

Asthma in Younger Adults PQI Discharges

14

13

1,121

661

All Diagnoses
Chronic Obstructive Pulmonary Disease (COPD) and Asthma in
Older Adults
Bacterial Pneumonia

947.5

967.7

828.1

1,068.1

238.2

187.8

--

134.2

236.4

281.3

--

197.4

Congestive Heart Failure

193.8

275.5

--

233.0

Urinary Tract Infection

140.6

150.5

--

131.0

Diabetes

85.1

79.7

--

133.2

Dehydration

70.4

35.7

--

41.4

Hypertension

Total PQI Discharges

Angina PQI Discharges


Age Adjusted PQI Discharge Rates per 100,000 Population

18

47.4

57.7

--

34.8

Perforated Appendix

--

--

--

18.1

Asthma in Younger Adults

--

--

--

75.3

Angina
---8.3
Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information, Inc. and local
demographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

16

The PQI definitions are detailed in their specification of ICD-9 diagnosis codes and procedure codes. Not every hospital admission for
congestive heart failure, bacterial pneumonia, etc. is included in the PQI definition; only those meeting the detailed specifications. Low birth
weight is one of the PQI indicators, but for the purpose of this report, low birth weight is included in the Maternal and Infant Health Profile. Also,
there are four diabetes-related PQI indicators which have been combined into one for the report. For more information, visit the AHRQ website
at www.qualityindicators.ahrq.gov/pqi_overview.htm
17
Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data do
not include discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis.
18
-- Age adjusted rates are not calculated where the number of PQI discharges is less than 30.
Page | 24

Community Health Needs Assessment

Part III. Community Indicators

6. Behavioral Health Hospitalization Discharge Profile


Behavioral health (BH) hospitalizations provide another important indicator of community health status. As shown
in Exhibit III-6, residents of the study region had 260 hospital discharges from Virginia community hospitals for
19
behavioral health conditions in 2012. The leading diagnoses for these discharges were affective psychoses (133),
alcoholic psychoses (21) and schizophrenic disorders (20). The age-adjusted BH discharge rates for the study
region were lower than the statewide rates. Note: Map 23 in Appendix A shows the geographic distribution of BH
discharges by zip code.
Exhibit III-6.
Behavioral Health Hospital Discharge Profile, 2012
Study Region

Fauquier
County

Rappahannock
County

Virginia

260

232

28

55,372

133

123

10

27,038

Alcoholic Psychoses Discharges

21

19

3,623

Schizophrenic Disorders

20

19

8,142

Depressive Disorder, Not Elsewhere Classified

16

14

3,410

Drug Psychoses

15

12

1,532

Adjustment Reaction Discharges

2,346

Neurotic Disorders

1,374

Other Nonorganic Psychoses

2,147

Alcohol Dependence Syndrome Discharges

2,162

Drug Dependence

649

Other Organic Psychotic Conditions-Chronic

773

Non Dependent Abuse of Drugs


Age Adjusted BH Discharge Rates per 100,000
21
Population

626

All Diagnoses

384.8

378.5

--

674.0

Affective Psychoses Discharges

199.4

201.3

--

332.3

Alcoholic Psychoses Discharges

--

--

--

42.2

Schizophrenic Disorders

--

--

--

96.4

Depressive Disorder, Not Elsewhere Classified

--

--

--

42.3

Drug Psychoses

--

--

--

18.5

Adjustment Reaction Discharges

--

--

--

29.0

Neurotic Disorders

--

--

--

16.9

Other Nonorganic Psychoses

--

--

--

26.0

Alcohol Dependence Syndrome Discharges

--

--

--

25.5

Drug Dependence

--

--

--

8.0

Other Organic Psychotic Conditions-Chronic

--

--

--

9.1

Indicator
BH Discharges
Total BH Discharges by All Diagnoses
BH Discharges by Diagnosis
Affective Psychoses Discharges

20

Non Dependent Abuse of Drugs


---7.6
Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information, Inc. and local
demographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

19

Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data do
not include discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis.
20
Includes major depressive, bipolar affective and manic depressive disorders.
21
-- -- Age adjusted rates are not calculated where the number of discharges is less than 30.
Page | 25

Community Health Needs Assessment

Part III. Community Indicators

7. Adult Health Risk Factor Profile


This section examines health risks for adults age 18+. Prevalence estimates of health risks, chronic disease and
health status can be useful in developing prevention and improvement efforts. Exhibit III-7 shows estimates
indicating that substantial numbers of adults in the study region have health risks related to nutrition, weight,
physical inactivity, tobacco and alcohol. In addition, substantial numbers of adults have chronic conditions such as
high cholesterol, high blood pressure, arthritis, diabetes and asthma. Note: Maps 24-27 in Appendix A show the
geographic distribution of selected adult health risks by zip code.
Exhibit III-7.
Adult Health Risk Factor Profile (Estimates), 2013
Study
Region

Fauquier
County

Rappahannock
County

56,590
45,152
33,747
26,597

50,612
40,490
29,861
23,788

5,978
4,663
3,886
2,810

11,645
11,079

10,629
10,122

1,016
956

19,866

17,714

2,152

16,471
13,195
6,165

14,677
11,641
5,567

1,793
1,554
598

10,306

9,110

1,196

9,620

8,604

1,016

Less than Five Servings of Fruits and Vegetables Per Day


Overweight or Obese
Not Meeting Recommendations for Physical Activity in the Past 30
Days
Smoker
At-risk for Binge Drinking (males having five or more drinks on one
occasion, females having four or more drinks on one occasion)
High Cholesterol (was checked, and told by a doctor or other health
professional it was high)
High Blood Pressure (told by a doctor or other health professional)

80%

80%

78%

60%
47%

59%
47%

65%
47%

21%

21%

17%

20%

20%

16%

35%

35%

36%

29%

29%

30%

Arthritis (told by a doctor or other health professional)

23%

23%

26%

Indicator
Estimates-Counts
Estimated Adults age 18+
Less than Five Servings of Fruits and Vegetables Per Day
22
Overweight or Obese
Not Meeting Recommendations for Physical Activity in the Past 30
Risk
Days
Factors
Smoker
At-risk for Binge Drinking (males having five or more drinks on one
occasion, females having four or more drinks on one occasion)
High Cholesterol (was checked, and told by a doctor or other health
professional it was high)
Chronic
High Blood Pressure (told by a doctor or other health professional)
Conditions
Arthritis (told by a doctor or other health professional)
Diabetes (told by a doctor or other health professional)
Limited in any Activities because of Physical, Mental or Emotional
General
Problems
Health
Status
Fair or Poor Health Status
Estimates-Percent of Adults Age 18+

Risk
Factors

Chronic
Conditions

11%
11%
10%
Diabetes (told by a doctor or other health professional)
Limited in any Activities because of Physical, Mental or Emotional
18%
18%
20%
General
Problems
Health
17%
17%
17%
Status
Fair or Poor Health Status
Source: Estimates produced by Community Health Solutions using Virginia Behavioral Risk Factor Surveillance System data
and local demographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

22

According to the CDC, for adults 20 years old and older, BMI is interpreted using standard weight status categories that are the same for all
ages and for both men and women. Overweight is defined as a BMI between 25.0 and 29.9. Obesity is defined as a BMI 30.0 and above. For
more information: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Interpreted
Page | 26

Community Health Needs Assessment

Part III. Community Indicators

8. Youth Health Risk Factor Profile


This section examines selected health risks for youth age 14-19. These risks have received increasing attention as
the population of American children have become more sedentary, more prone to unhealthy eating and more likely
to develop unhealthy body weight. The long-term implications of these trends are serious, as these factors place
children at higher risk for chronic disease both now and in adulthood.
Exhibit III-8 shows estimates indicating that substantial numbers of youth in the study region have health risks
related to nutrition, weight, alcohol, mental health, tobacco, and physical activity. Note: Maps 28-29 in Appendix A
shows the geographic distribution of selected youth health risks by zip code.
Exhibit III-8.
Youth Health Risk Factor Profile (Estimates), 2013
Study Region

Fauquier
County

Rappahannock
County

6,150

5,617

533

Less than the Recommended Intake of Vegetables

5,414

4,944

470

Less than the Recommended Intake of Fruit

5,356

4,891

465

23

1,585

1,455

131

883

810

74

1,382

1,258

124

2,008

1,829

179

1,537

1,407

130

Less than the Recommended Intake of Vegetables

88%

88%

88%

Less than the Recommended Intake of Fruit

87%

87%

87%

Indicator
Estimates-Counts
Estimated Youth Age 14-19

Overweight or Obese
Risk
Not Meeting Recommendations for Physical Activity in
Factors
the Past Week
Used Tobacco in the Past 30 Days
Have at least One Drink of Alcohol at least One Day in
the Past 30 Days
General
Feel Sad or Hopeless (almost every day for two or more
Health
weeks in a row so that they stopped doing some usual
Status
activities)
Estimates-Percent of Youth Age 14-19

Overweight or Obese
26%
26%
25%
Not Meeting Recommendations for Physical Activity in
14%
14%
14%
the Past Week
Used Tobacco in the Past 30 Days
22%
22%
23%
Have at least One Drink of Alcohol at least One Day in
33%
33%
34%
the Past 30 Days
General
Feel Sad or Hopeless (almost every day for two or more
Health
weeks in a row so that they stopped doing some usual
25%
25%
24%
Status
activities)
Source: Estimates produced by Community Health Solutions using Virginia Youth Risk Behavioral Surveillance System data and
local demographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.
Risk
Factors

23

For children and adolescents (aged 219 years), the BMI value is plotted on the CDC growth charts to determine the corresponding BMI-forage percentile. Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile. Obesity is defined as a BMI
at or above the 95th percentile for children of the same age and sex. For more information:
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_BMI/about_childrens_BMI.html
Page | 27

Community Health Needs Assessment

Part III. Community Indicators

9. Uninsured Profile
Decades of research show that health coverage matters when it comes to overall health status, access to health
care, quality of life, school and work productivity, and even mortality. Exhibit III-9 shows the estimated number of
24
uninsured individuals, by income as a percent of the federal poverty level (FPL), in the study region as of 2013.
An estimated 8,090 (13%) nonelderly residents of the study region were uninsured at a given point in time in 2013.
This included an estimated 1,188 children and 6,903 adults. Note: Maps 30-31 in Appendix A show the geographic
distribution of the uninsured population by zip code.
Exhibit III-9.
Uninsured Profile (Estimates), 2013
Study
Region

Fauquier
County

Rappahannock
County

Uninsured Nonelderly Age 0-64

8,090

7,094

996

Uninsured Children Age 0-18

1,188

1,044

144

Uninsured Children Age 0-18 <=138% FPL

345

300

45

Uninsured Children Age 0-18 <=200% FPL

578

508

70

Uninsured Children Age 0-18 <=250% FPL

711

624

87

Uninsured Children Age 0-18 <=400% FPL

995

870

125

Uninsured Children Age 0-18 138-400% FPL

649

569

81

6,903

6,050

852

Uninsured Adults Age 19-64 <=138% FPL

2,095

1,801

294

Uninsured Adults Age 19-64 <=200% FPL

3,333

2,899

434

Uninsured Adults Age 19-64 <=250% FPL

4,073

3,544

529

Uninsured Adults Age 19-64 <=400% FPL

5,511

4,802

709

Uninsured Adults Age 19-64 138-400% FPL

3,415

3,001

415

13%

12%

17%

6%

6%

9%

15%

15%

19%

Indicator
Estimated Uninsured Counts*

Uninsured Adults Age 19-64

Estimated Uninsured Percent


Uninsured Nonelderly Percent
Uninsured Children Percent
Uninsured Adults Percent
*FPL Categories are cumulative

Source: Estimates of uninsured are based on Community Health Solutions analysis of U.S. Census Bureau Small Area Health
Insurance Estimates (2012) and demographic data from Alteryx, Inc. (2012).See Appendix E. Data Sources for details.

24

For more information, please see: http://aspe.hhs.gov/poverty/12poverty.shtml

Page | 28

Community Health Needs Assessment

Part III. Community Indicators

10. Medically Underserved Profile


Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) are designated by the U.S.
Health Resources and Services Administration as being at-risk for health care access problems. The designations
are based on several factors including primary care provider supply, infant mortality, prevalence of poverty and the
prevalence of seniors age 65+.
As shown in Exhibit III-10, All of Rappahannock County is designated as medically underserved. Part of Fauquier
County is designated as medically underserved; two county subdivisions (minor civil divisions or MCDs) meet the
designation criteria:

94215 Lee district


94511 Marshall district

For a more detailed description, visit the U.S. Health Resources and Service Administration designation webpage
at http://muafind.hrsa.gov/.

Exhibit III-10.
Medically Underserved Area/Populations Profile
Locality
Fauquier County
Rappahannock County

MUA/MUP Designation
Partial

Census Tracts
2 MCDs of 17 Census Tracts

Full

2 of 2 Census Tracts
Source: Community Health Solutions analysis of U.S. Health Resources and Services Administration data.

Page | 29

Community Health Needs Assessment

Appendix A

APPENDIX A. Zip Code-Level Maps for the Study Region


The maps in this section illustrate the geographic distribution of the zip code-level study region population on key
demographic and health indicators. The results can also be used alongside the Community Interview Results,
Community Survey Results and the Community Indicators to help inform plans for community health initiatives. The
underlying data for these maps are provided in a separate Microsoft Excel file. The maps in this section include the
following:
1. Total Population, 2013

17. Cerebrovascular Disease (Stroke) Deaths, 2012

2. Population Density, 2013

18. Total Live Births, 2012

3. Child Population Age 0-17, 2013

19. Low Weight Births, 2012


20. Births Without Early Prenatal Care (No Prenatal Care
in the First 13 Weeks), 2012
21. Births to Teen Mothers Under Age 18, 2012
22. Prevention Quality Indicator (PQI) Hospital
Discharges, 2011
23. Behavioral Health (BH) Hospital Discharges, 2012
24. Estimated Adults Age 18+ Overweight or Obese,
2013
25. Estimated Adult Age 18+ Smokers, 2013

4. Senior Population Age 65+, 2013


5. Asian Population, 2013
6. Black/African American Population, 2013
7. White Population, 2013
8. Other or Multi-Race Population, 2013
9. Hispanic Ethnicity Population, 2013
10. Per Capita Income, 2013

14. Total Deaths, 2012

26. Estimated Adults Age 18+ with Diabetes, 2013


27. Estimated Adults Age 18+ with High Blood Pressure,
2013
28. Estimated Youth Age 14-19 Overweight or Obese,
2013
29. Estimated Youth Age 14-19 who had No Physical
Activity in the Past Week, 2013
30. Estimated Uninsured Children Age 0-18, 2013

15. Malignant Neoplasm (Cancer) Deaths, 2012

31. Estimated Uninsured Adults Age 19-64, 2013

11. Median Household Income, 2013


12. Low Income Households (Households with Income
<$25,000), 2013
13. Population Age 25+ Without a High School Diploma, 2013

16. Heart Disease Deaths, 2012

**Technical Notes**
1. The maps and data include 26 zip codes, as identified by Fauquier Health and Fauquier Health Foundation,
most of which fall within Fauquier and Rappahannock counties. Because zip code boundaries do not
automatically align with city/county boundaries, there are some zip codes that extend beyond the county
boundaries. Additionally, not all zip codes in each of the two localities were identified by Fauquier Health
and Fauquier Health Foundation as part of the study region. Consequently, the combined zip code-level
totals for population, deaths, births, hospital discharges, etc. differ from the city/county-level study region
totals listed throughout the body of the report.
2. With the exception of population density, per capita income and median household income, the maps show
counts rather than rates. Rates are not mapped at the zip code-level because in some zip codes the
population is too small to support rate-based comparisons.
3. Data are presented in quintiles (categorized in groups of five) where feasible.
4. Gray shading indicates either zip codes not included in the study region, or zero values for zip codes that
are included in the study region. Study region zip codes with zero values are noted.

Page | 30

Community Health Needs Assessment

Appendix A

Map 1: Total Population, 2013

Map 2: Population Density (population per square mile), 2013

Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

Page | 31

Community Health Needs Assessment

Appendix A

Map 3: Child Population Age 0-17, 2013

Map 4: Senior Population Age 65+, 2013

Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

Page | 32

Community Health Needs Assessment

Appendix A

Map 5: Asian Population, 2013

Map 6: Black/African American Population, 2013

Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

Page | 33

Community Health Needs Assessment

Appendix A

Map 7: White Population, 2013

Map 8: Other or Multi-Race Population, 2013

Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

Page | 34

Community Health Needs Assessment

Appendix A

Map 9: Hispanic Ethnicity Population, 2013

Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

Page | 35

Community Health Needs Assessment

Appendix A

Map 10: Per Capita Income, 2013

Map 11: Median Household Income, 2013

Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

Page | 36

Community Health Needs Assessment

Appendix A

Map 12: Low Income Households (Households with Income<$25,000), 2013

Map 13: Population Age 25+ Without a High School Diploma, 2013

Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

Page | 37

Community Health Needs Assessment

Appendix A

Map 14: Total Deaths, 2012

Map 15: Malignant Neoplasm (Cancer) Deaths, 2012*

* There were no reported cancer deaths for zip codes 22639 and 22643.
Source: Community Health Solutions analysis of data from the Virginia Department of Health. See Appendix E. Data Sources for
details.

Page | 38

Community Health Needs Assessment

Appendix A

Map 16: Heart Disease Deaths, 2012*

Map 17: Cerebrovascular Disease (Stroke) Deaths, 2012*

*There were no reported heart disease deaths for zip codes 20184, 22643, and 22747. There were no reported stroke deaths for
zip codes 22643, 22742, 22639, 22718, 20144, 22713, 22716, 22642, 20137, and 22734.
Source: Community Health Solutions analysis of data from the Virginia Department of Health. See Appendix E. Data Sources for
details.

Page | 39

Community Health Needs Assessment

Appendix A

Map 18: Total Live Births, 2012*

Map 19: Low Weight Births, 2012*

*There were no reported live births for zip code 22643. There were no reported low weight births for zip codes 22643, 22640,
20184, 20144, 22639, 22749, 22627, 22718, 22742, and 22740.
Source: Community Health Solutions analysis of data from the Virginia Department of Health. See Appendix E. Data Sources for
details.

Page | 40

Community Health Needs Assessment

Appendix A

Map 20: Births Without Early Prenatal Care (No Prenatal Care in the First 13 Weeks), 2012*

Map 21: Births to Teen Mothers Under Age 18, 2012*

*There were no reported births without early prenatal care for zip codes 22643, 20144, and 22740.There were no reported births
to teen mothers under age 18 for zip codes 22643, 20144, 22740, 22640, 20184, 22627, 20117, 20137, 22639, 22718, 22713,
22749, 22716, 22720, 22742, 22747, 22642, and 20115.
Source: Community Health Solutions analysis of data from the Virginia Department of Health. See Appendix E. Data Sources for
details.

Page | 41

Community Health Needs Assessment

Appendix A

Map 22: Prevention Quality Indicator (PQI) Hospital Discharges, 2011

Map 23: Behavioral Health Hospital Discharges, 2012*

*There were no reported behavioral health discharges for zip codes 22643, 22640, and 22749.
Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information, Inc.
See Appendix E. Data Sources for details.

Page | 42

Community Health Needs Assessment

Appendix A

Map 24: Estimated Adults Age 18+ Overweight or Obese, 2013

Map 25: Estimated Adult Age 18+ Smokers, 2013

Source: Estimates based on Community Health Solutions analysis of Virginia Behavioral Risk Factor Surveillance System data
and estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

Page | 43

Community Health Needs Assessment

Appendix A

Map 26: Estimated Adults Age 18+ with Diabetes, 2013

Map 27: Estimated Adults Age 18+ with High Blood Pressure, 2013

Source: Estimates based on Community Health Solutions analysis of Virginia Behavioral Risk Factor Surveillance System data
and estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

Page | 44

Community Health Needs Assessment

Appendix A

Map 28: Estimated Youth Age 14-19 Overweight or Obese, 2013

Map 29: Estimated Youth Age 14-19 Not Meeting Recommendations for Physical Activity in the Past Week,
2013

Source: Estimates based on Community Health Solutions analysis of Virginia Youth Risk Behavioral Surveillance System data
and estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

Page | 45

Community Health Needs Assessment

Appendix A

Map 30: Estimated Uninsured Children Age 0-18, 2013

Map 31: Estimated Uninsured Adults Age 19-64, 2013

Source: Estimates of uninsured are based on Community Health Solutions analysis of U.S. Census Bureau Small Area Health
Insurance Estimates (2012) and demographic data from Alteryx, Inc. (2012).See Appendix E. Data Sources for details.

Page | 46

Community Health Needs Assessment

Appendix B

Appendix B. Community Interview Guide and List of Participants


Appendix B-1.
Community Interview Guide
Introduction

Thank you for agreeing to participate in a Community Interview as part of the community
health needs assessment (CHNA) being conducted by Fauquier Health and Fauquier
Health Foundation. This Interview Guide is intended to help you prepare for the interview.
We invite you to review this Interview Guide prior to the interview, so that you can be fully
prepared to share your insights.

The Purpose of the


Interview

The purpose of this interview is to obtain your insights about community health in our
region. Your insights are important because you have a distinctive perspective on the
health of the community and the opportunities and challenges faced by community
residents and service providers. By participating in this interview, you are helping to inform
the work of many community organizations in the coming days.

The Interview
Process and
Product

The process for the interview follows:

The Interview
Questions

The interview will take place at the time and place designated in your invitation letter.
The interview will take place over a two-hour period with short breaks as appropriate.
The interview will be facilitated by staff from Community Health Solutions, our
contractor for the CHNA.
The interview will include between eight and twelve participants who have been invited
to participate by Fauquier Health and Fauquier Health Foundation.
The interview will cover five questions about community health as outlined in the
following section.
During the interview, the facilitator will ask each question and then invite each
participant to share their insights. You will have the option of responding or declining
as you so decide.
During the interview, staff from Community Health Solutions will be manually recording
the responses provided by participants. The objective is to capture the main point of
each response, and some paraphrasing may be used.
After the interview, staff from Community Health Solutions will produce an interview
report outlining the interview participants, the questions asked, the actual or
paraphrased responses to each question, and the source of the response.
A summary of the interview results may be included in the published CHNA report. If
they are included, they will be in summary form and no names will be reported in
association with specific responses.

The interview will include the following questions. Please be assured that there are no
right or wrong answers to these questions. The purpose of the interview is not to judge
or debate peoples responses. We are simply interested in your distinctive perspective on
each question.
1.
2.
3.
4.
5.

Page | 47

In your own words, how would you define the idea of a healthy community?
From your perspective, who are the population segments within the community
that are especially vulnerable or at-risk for health problems?
Still thinking about health problems, are there health issues on the horizon that
few people know about, but could cause serious harm today or in the future?
Think of health assets as people, institutions, programs, built resources (e.g.
parks), or natural resources that promote a culture of health. In your view, what
are the most important health assets within the community?
Thinking of a healthy community as everyones responsibility, please share one
creative way that people could work together to promote better health in the
community.

Community Health Needs Assessment

Appendix B

Appendix B-2.
Community Interview Participants
First Name
Chris
Ray
Tyronne
Jessica
Sam
Shawna
Kathy
Janelle
Andy
Darren
Sandi
Jerry
Rebecca
Sallie
Dennis
John
Donna
Bev
Brian
Cee Ann
Barbara

Page | 48

Last Name
Miller
Knott
Champion
(last name unknown)
Myers
(last name unknown)
Hatter
Downes
Marshall
Stevens
Kelly
Hoke
Wolfrey
Morgan
Rustom
McCarthy
Matthews
Dunford
Duncan
Davis
Downes

Organization
Aging Together
BB&T Bank
Community Touch
Company 1, Warrenton Volunteer Fire and Rescue
Company 1, Warrenton Volunteer Fire and Rescue
Company 1, Warrenton Volunteer Fire and Rescue
Department of Health
Fauquier County Government and Public Schools
Fauquier County Sheriff
Fauquier Fire and Emergency Services
Fauquier Free Clinic
Fauquier Health
Fauquier Health
Mental Health Association of Fauquier County
Piedmont Pediatrics
Rappahannock County Administrator
Rappahannock County Public Schools
Rappahannock Department of Social Services
Rappahannock Rapidan CSB
Rappahannock Rapidan Department of Health
Rappahannock Rapidan Health District

Community Health Needs Assessment

Appendix C

APPENDIX C. Community Survey:


Additional Ideas and Suggestions for Improving Community Health
Survey respondents were given the option to submit additional ideas and suggestions for improving community
health. The open-ended responses are listed below.
Response
#

Responses

A provision of ambulance transport for bedbound patients to access physicians, for routine follow up
appointments, would result in a decrease of costs for emergency services and likely prevent unavoidable
hospitalizations.

Areas that we need to improve, in order to better treat the behavioral health population, are the following:

More psychiatrists in our area

Rapid access for people in need of behavioral health services

There should be no wait time for needed services.

More physicians willing to take Medicaid clients

Consider establishing a Medicaid clinic

Combine Rappahannock-Rapidan Community Services Behavioral Health Clinic with a Health Care Clinic
to ensure comprehensive treatment.

A small inpatient unit at Fauquier hospital to keep residents local and move people out of the Emergency
Room quickly

A holding area for people being assessed for admission to psychiatrist hospitals would save valuable
resources for both the hospital and community law enforcement.

Eldercare services (a coordinator to help families find services)

Health fairs are always a good venue with free screenings and information.

Health self-care information that is engaging enough to get people's attention

Healthy programs and nutrition for youth to make them active and to fight childhood obesity

I appreciate Fauquier Health for their willingness to hear from local stakeholders. The challenge I believe
is to find innovative ways to restore, promote and maintain the health of our community.
A few of the at-risk populations may not fit into the current assistance programs that are available in
Fauquier County but [they] still need assistance. If resource outlets in Fauquier County, who distribute
financial assistance, are stringent and only address a certain section of the community some people may
fall through the cracks. Thank you for listening and I look forward to working with you.

I feel that if Fauquier Health could establish an ambulance transport section of the hospital, in conjunction with
County Fire and Rescue, [then] a long standing partnership along with another source of revenue could be the
outcome. Right now, the nursing home residents and our elderly population are waiting for these outside
transportation services to arrive. [They] sometimes have an hour or longer wait time. If this idea were to be
investigated a few of the outcomes could be:

Ambulances at the hospital for transports to and from the nursing homes (revenue both ways),

In the advent [that] inter-hospital transport and helicopters are grounded due to weather, this unit could
transport them to nearest appropriate facility,

The crew could be used as Emergency Room technicians in the Emergency Room when they are on a
transport. A partnership between the county Fire and Rescue and the hospital could be started and we
could place new Emergency Medical Technicians and Paramedics on this unit in order to gain experience
all the while working with and getting to know the hospital staff.

I wish you would work more collaboratively with outside organizations. I realize you have a full continuum of
services within Fauquier Health but there is still room for working more with healthcare and community
services outside the system. Building partnerships and community capacity would improve your work as well.

Page | 49

Community Health Needs Assessment

APPENDIX C. Community Survey: Additional Ideas and Suggestions for Improving


Community Health (continued)

Appendix C

10

I would like to see more community activities and outreach programs such as diabetes clinics, cholesterol
screening and mobile flu shot clinics. I also believe more community activities such as a 5K, bike rides and
"lets get active" events would put Fauquier on the map as a healthy community. The Richmond area has
done a great job of this with their partners Anthem and HCA.

11

I would like to see us work on bringing more physicians and services to this area such as: cardiac catheter
labs, vascular labs, neurology on-site, cancer service line, open MRI and other state of [the] art technologies
as well as expert physicians.

12

I would love to see some sort of community service where a nutritionist comes in and talks to the kids about
nutrition [with] one for each level: lower, middle, and upper. Also possibly a trainer who can talk to them about
safe exercise for their ages.

13

I would strongly encourage a satellite operation within or near the town of Washington to serve county needs.

14

[There is a need for] increased health awareness, health screening and physical activity improvement for
children and teens. I have seen a large rise of children and teens living sedentary lifestyles, with limited
physical activity, resulting in a rise of child and teen obesity.

15

Like I mentioned at the round table discussion 3 days ago, I think a health fair would be a great idea! This
could be done, with different stations representing the different health needs (cardiovascular, mental, etc.). If
successful, this could be an annual or (as [fellow community member] suggested) a seasonal event.

16

[There is a need for] more community follow-up by health care professionals (e.g., regular home visits by
doctors and community nurses). Studies indicate that taking responsibility for one's health and taking
appropriate steps to manage chronic conditions does not occur on a level the health care industry would like
[to see]. And it is frequently those in most need who have the least resources.

17

My experience with Fauquier Health, which I assume owns Fauquier Hospital, is that they have been very
quick to pull the trigger regarding sending due bills to collections. I have had at least two experiences where
my insurance has paid the bulk of my bill and I have made partial payments and communicated only to find a
collections letter in my mailbox. If this happens to me, someone who has a good health insurance plan and
who has an upper middle class income, I cannot imagine what happens to those who have no insurance and
little income. I feel, strongly, that Fauquier Health should re-examine its policies regarding turning accounts
over to collections agencies. I realize that the hospital must maintain some cash flow and make a profit per se,
but I do not think their bottom line would be hurt if this policy were changed. Given that a collections agency
probably takes 30% or more as its fee, I would expect that in the long run the hospital may find they bring in
more money if they turned fewer accounts over to collections. And I assure you they would have far more
satisfied customers.

18

My interactions with the staff at the hospital and foundation exemplify the mission.

19

[There is a] need to promote healthy eating and exercise in the schools.

20

Offer partnerships with other nonprofit organizations in your area [that are] established to assist and meet the
needs of the elderly, however, with additional funding [they] could expand their service lines to include and
serve more people in the Fauquier area.

21

Page | 50

Our community could really use a federally qualified health center to provide maternity, mental health
services and elder care.
Our community needs good access to psychiatric hospitalization for adults and children and rapidly
available outpatient assessment and support.
We need counselling and shelter support for victims of domestic violence or good coordination with
another nearby community that has these services and [we need] to involve emergency room, women's
services, and police in assuring safe access to these havens.
We need financial support for services that provide reliable long-acting contraceptives to patients,
regardless of income, as the health department has to bear the cost of these expensive units for indigent
patients without the old levels of state funding.

Community Health Needs Assessment

Appendix C

APPENDIX C. Community Survey: Additional Ideas and Suggestions for Improving


Community Health (continued)

22

Our CTC community needs mental health options and transportation services. Logisticare does not have
enough drivers to work reliably and Lifecare only provides stretchers.

23

Palliative Care services open the door to partnership and extend the reach of the care provider.

24

Participation by Fauquier Health in helping to either expand existing physician services or start its own
physician office would dramatically improve access to health care.

25

Partnering with the schools and after-school programs, such as FCCC and Boys and Girls Clubs, we could
begin to develop healthy lifestyles through promotion of exercise, food choices and mental and social wellness.
Starting in the schools will continue to benefit the entire community by providing services for the children that
will carry lessons forward.

26

27

Promote healthy eating and exercise options in the schools.

28

Promoting integrated all inclusive care

29

Recognizing that mental health is fundamental to overall health, promote services that address mental health
needs and integrate mental health with physical health care. [A need for] increased support for mental health
emergencies coming through the emergency department is a particular concern.

30

Please continue to actively support the free clinic.


Enhance offerings to those in need of mental health professionals or substance abuse counselors.

Strengthen transportation services to medical and rehabilitation appointments


If possible, require those with diabetes, using free clinic services, to attend diabetes education services
offered to this population (for free) at the Fauquier Health Wellness Center.
Offer, at least yearly, a health fair for the community.

31

Suggest a grant program encouraging front line health organizations to work together to help alleviate the types
of health problems identified above [in the stakeholder survey]. The types of organizations are Social Services,
Emergency Medical Services, Fauquier Free Clinic, etc.

32

Support for the Fauquier Free Clinic

33

Support walking, jogging, biking and community connectivity


I think mental health services are the most desperate need we have. We are far too short of experts to
help folks with depression; especially young people.

34

Tap into the richness of the local nonprofits. We have our pulse on all facets of the community. Partnerships
with the nonprofits will greatly enhance both the mission of Fauquier Health and the residents of this
extraordinary county.

35

Thank you for allowing me to participate. I am sure you will agree that there is more to health than just the
physical absence of disease.

36

There are many services available to our community. More linkage to these services could be beneficial.

37

This would turn into a dissertation. Start with cultural competency and work from here.

38

To possibly form a partnership with additional mental health facilities for a less time consuming process

39

Page | 51

To restore, we must target the uninsured and keep the insured healthy.
Education is so vital.
Go back to go bedside manners when seeing patients is good but not when they're in the hospital thinking
about what is going on with them that someone comes to their room [to] talk about a bill. This becomes
discouraging to the mental wellness of people.

Community Health Needs Assessment

Appendix C

APPENDIX C. Community Survey: Additional Ideas and Suggestions for


Improving Community Health (continued)

40

We are your local fire, rescue, and Emergency Medical Service organization that protects the Fauquier Hospital
and most of Fauquier Health's facilities. We serve the largest population in the county along with providing
service to the Town of Warrenton and County of Fauquier for over 4,600 incidents annually on average. We do
have current equipment and apparatus needs to keep our mission surviving so we can ensure the highest level
of capability to the residents and visitors in our community. Our current lifesaving equipment is aging and
needs to be replaced, along with upgrades to several other items. Our link in the chain of survival is critical and
without the proper tools, equipment and training, the post portion of an incident (getting the patient to definitive
care) will be hampered. I would like to meet with the foundation and discuss and review some of our current
needs and thoughts on ways to enhance our capacity.

41

We need social services to help people navigate available resources and set them up with elder care help,
psychiatric help, substance abuse help, and establishing a medical home instead of using the emergency room
services or urgent care.

42

You could do a great service by establishing a satellite primary care clinic and pharmacy in the central area of
Rappahannock County, somewhere along Route 211.

43

You have been a wonderful partner with the schools aiding us in promoting the health and welfare of our
students. We especially appreciated the help with the IMPACT program.

Page | 52

Community Health Needs Assessment

Appendix D

Appendix D. Defining a Healthy Community


On May 7, 2014, Community Health Solutions (CHS) facilitated a town hall meeting of community stakeholders on
behalf of Fauquier Health and Fauquier Health Foundation. As part of the meeting, participants were invited to
share their vision of a healthy community. Twenty-four responses were submitted. These responses are listed
below.
Response #
1.

Every person, family, organization, business and government values wellness and actively
pursues it.

2.

Children have safe places to grow and play, community resources for physical fitness, facilities
that support safe travel, up-to-date schools that grow the mind and body, and schools that offer
clean air, regulated heat, nutritious foods, and foster community learning spaces.

3.

All citizens' needs are valued, and if possible, addressed.

4.

Everyone has access to affordable healthcare.

5.

[Everyone has] time for an afternoon walk; [this] requires jobs close to (or at) home.

6.

Comprehensive health services available to all; including health promotion, healthy environments
healthy food.

7.

Members are encouraged, supported and model good health. Health needs to be broad and
include mental health, physical health, and education regarding health.

8.

A well-educated, healthy, mentally fit, [and] emotionally well-balanced population are allowed [to]
and capable of working out a world view; a life plan. This would be a place where each citizen is
satisfied with his or her situation, and there is help available for those who are under physical,
emotional, financial, spiritual, or mental stress or threat.

9.

Every faith community has an active, engaged health ministry to provide health information and
direct access to services.

10.

There is an awareness at all age levels to improve health status, and one that focuses on the
family unit as a way to engage all age levels. I envision schools and community centers being an
active change agent in this awareness.

11.

Community supports the individual, to achieve his or her personal goal, by a support structure in
place to assist each objective for an overall goal of physical and mental health.

12.

13.

14.
15.
16.
17.
Page | 53

Responses

People in the community are educated on health related topics that are important to the
individual's family. Community folks should know where to go for information and resources that
are available to them in regards to their personal needs. Service providers should be well-versed
in the services they offer, as well as be willing to offer referrals to other agencies for help. If we
create an educated community based around the cooperation of service providers, we would be
able to tackle anything that comes our way!
Citizens feel connected one to another and all citizens are acknowledged as important to the
community. This includes positive behavioral interventions and supports for those populations
who might otherwise be marginalized, such as returning offenders (from prison), minority
populations, and victims of crime. [A healthy community is a place where] providers dialogue to
address and resolve community issues, before they reach a crisis.
The community provides services which meet the residents needs; physical and emotional,
educational and social.
The ethic of the community is that health is permanent, and an asset to be engaged defensively
and prophylactically, and that pathology and infirmity [are] prevented/avoided, to the extent
practical, is the real hallmark of health.
There is physical, emotional/mental and spiritual balance; [an] emphasis on the prevention, acute
and post-acute care; and an environment [that] supports a healthy culture which starts [with] the
youth through the end of life.
All resources are utilized to create a culture that is promoting and expecting good health, and the
practices to accomplish good health.
Community Health Needs Assessment

Appendix D

Response #

Responses

18.

[The] community gives access to all citizens. It also incorporates preventive care by advocating,
through medical facilities and schools, choices that will help them on a daily basis.

19.

People have access to great services and opportunities regardless of economic status. Health
care and dental care services, in particular.

20.

21.

Available health and mental health services, as well as services for those with developmental
disabilities and intellectual disability are transparent. Parents and caregivers have enough on
their plates without having to also search for [a] 'needle in the haystack' to find out where/how to
access transition services; get assistance with applying for Medicaid, DD/ID waivers; find
housing; get rent assistance; etc.
The community encourages a collaborative approach to addressing issues; input from all
perspectives, focus on physical and mental health, shift from curing disease to maintaining and
improving heath, celebration of differences, recognition that people of all abilities are equal
members, open forums encourage input with program development or improvements. Supports
that allow all members of community to stay actively engaged and meaningfully connected
regardless of abilities. Stagnation, isolation, lack of meaningful connection all lead quickly to
impaired mental and physical health.

22.

[The community is] informative with ease of access, supported by adequate personnel and
resources.

23.

People are able to live lives secure in the knowledge that if they have a need for services to help
them thrive, those services are available and easily accessed.
An entire community is focused on health. Highway posters, schools, and businesses that have a
constant thrust towards health; a true interest in the health of its' community. Primary focus is
health then the business of service they provide is next to this. [This includes:]

24.

People in the community who care and assist others to meet needs
Removal of items - sale of items such as cigarettes, alcohol, etc.
Physicians who aren't over burdened with patients
Daily community activities that are promoted as a community activity physical, mental, social
Transportation to and from needed services
Education - free, on healthy living in rotated areas in the community
Healthy foods and community gardens.
Places to help parents get together to share ideas, connections and go out
to understand under-privileged families and join with them

Too big a scope to really say it all.

Page | 54

Community Health Needs Assessment

Appendix E

Appendix E: Data Sources


Section

Source
Qualitative Data

Part I. Community Interview Results


1)

Community Interview Results

Community Health Solutions analysis of three community interviews


conducted with a total of 21 community stakeholders in March 2014.

Part I. Community Insight Profile


2)
3)
4)
5)

Survey Respondents
Community Health Concerns
Community Service Gaps
Vulnerable/At-Risk Populations
in the Community
Community Health Solutions analysis of Community Insight survey
6) Vulnerable/At-Risk Regions in
responses submitted by community stakeholders.
the Community
7) APPENDIX D. Community
Insight Profile-Additional Ideas
and Suggestions for Improving
Community Health
Appendix D: Defining a Healthy Community
1) Defining a Healthy Community Community Health Solutions analysis of each town hall meeting
participants definition of a healthy community.
Quantitative Data
Part II. Community Indicator Profile
1) Health Demographic Trend
Profile
2) Health Demographic Snapshot
(also Appendix A. Maps 1-13)

Page | 55

3)

Mortality Profile
(also Appendix A. Maps 14-17)

4)

Maternal and Infant Health


Profile (also Appendix A. Maps
18-21)

Community Health Solutions analysis of U.S. Census data and local


demographic estimates from Alteryx, Inc. (2013 and 2018). Alteryx,
Inc., is a commercial vendor of demographic data. Note that
demographic estimates may vary from other sources of local
demographic indicators.
Community Health Solutions analysis of Virginia Department of Health
death record data (2012). Locality level counts and rates were obtained
from the Virginia Department of Health. The combined study region
counts and rates, plus zip code-level counts were produced by
Community Health Solutions.
Community Health Solutions analysis of Virginia Department of Health
death record data (2012). Locality level counts and rates were obtained
from the Virginia Department of Health. The combined study region
counts and rates, plus zip code-level counts were produced by
Community Health Solutions.

Community Health Needs Assessment

Appendix E

5)

Preventable Hospitalization
Profile (also Appendix A. Map
22)

6)

Behavioral Health
Hospitalization Profile (also
Appendix A. Map 23)

Community Health Solutions analysis of hospital discharge data from


the Virginia Health Information (VHI) 2011 and 2012 datasets and
demographic estimates from Alteryx, Inc. (2011 and 2012). Data
include discharges for Virginia residents from Virginia hospitals
reporting to Virginia Health Information, Inc. These data do not include
discharges from state behavioral health facilities or federal (military)
facilities. Data reported are based on the patients primary diagnosis.
NOTE: Virginia Health Information (VHI) requires the following
statement to be included in all reports utilizing its data: VHI has
provided non-confidential patient level information used in this report
which was compiled in accordance with Virginia law. VHI has no
authority to independently verify this data. By accepting this report the
requester agrees to assume all risks that may be associated with or
arise from the use of inaccurately submitted data. VHI edits data
received and is responsible for the accuracy of assembling this
information, but does not represent that the subsequent use of this data
was appropriate or endorse or support any conclusions or inferences
that may be drawn from the use of this data.
Estimates of chronic disease and risk behaviors for adults 18+ were
produced by Community Health Solutions using:

7)

Adult Health Risk Factor


Profile
(also Appendix A. Maps 24-27)

A multi-year dataset (2006-2010)from the Virginia Behavioral


Risk Factor Surveillance System (BRFSS).For more
information on BRFSS visit:
http://www.cdc.gov/brfss/about/index.htm
Local demographic estimates from Alteryx, Inc. (2013)

Estimates are used when there are no primary sources of data


available at the local level. The statistical model to produce the
estimates was developed by Community Health Solutions. The
estimates are for planning purposes only and are not guaranteed for
accuracy. The table does not include a comparison to Virginia statewide
rates because the local estimates were derived from state-level data.
Differences between local rates and state rates may reflect estimation
error rather than valid differences.
Estimates of risk behaviors for children age 14-19 were produced by
Community Health Solutions using:

8)

Page | 56

Youth Health Risk Factor


Profile (also Appendix A. Maps
28)

Data from the Virginia Youth Risk Behavioral Surveillance


System from the Centers for Disease Control (2011). For more
information on YRBSS visit:
http://www.cdc.gov/HealthyYouth/yrbs/index.htm
Local demographic estimates from Alteryx, Inc. (2013).

Estimates are used when there are no primary sources of data


available at the local level. The statistical model to produce the
estimates was developed by Community Health Solutions. The
estimates are for planning purposes only and are not guaranteed for
accuracy. The table does not include a comparison to Virginia statewide
rates because the local estimates were derived from state-level data.
Differences between local rates and state rates may reflect estimation
error rather than valid differences.

Community Health Needs Assessment

Appendix E

Estimates of uninsured nonelderly age 0-64 were produced by


Community Health Solutions using:

9)

Uninsured Profile
(also Appendix A. Maps 30-31)

10) Medically Underserved Profile

Page | 57

U.S. Census Bureau Small Area Health Insurance Estimates


(2012). For more information visit:
http://www.census.gov/did/www/sahie/data/index.html
Local demographic estimates from Alteryx, Inc. (2013)

Estimates are used when there are no primary sources of data


available at the local level. The statistical model to produce the
estimates was developed by Community Health Solutions. The
estimates are for planning purposes only and are not guaranteed for
accuracy. The table does not include a comparison to Virginia statewide
rates because the local estimates were derived from state-level data.
Differences between local rates and state rates may reflect estimation
error rather than valid differences.
Community Health Solutions analysis of U.S. Health Resources and
Services Administration data. For more information visit:
http://muafind.hrsa.gov/.

Community Health Needs Assessment

10461 Mill Run Circle - Suite 215


Owings Mills, MD 21117
410 998 9310 fax 410 998 9320
www.thevincagroup.com

Cost Effective Strategies for Quality Health Care

June 11, 2015

Mr. Neal Gumbin


Beckham Gumbin Ventures, LLC
10611 N. Hayden Road
Suite D-105
Scottsdale, AZ 85260
Dear Mr. Gumbin,
The Vinca Group L.L.C. is pleased to present the demand estimate for a routine assisted living and
Alzheimers disease/dementia assisted living facility to be located on Legion Drive in Warrenton,
VA. The demand calculations indicate that the market could support up to 48 routine assisted
living beds and 24 dementia assisted living beds for Phase I of the project. A possible Phase II
could include an additional 46 dementia assisted living beds.
We defined the primary market area based on resident origin data from The Villa at Suffield
Meadows, which is an assisted living facility located in Warrenton, VA. The data showed that
46% of the facilitys residents came from the following zip codes:
20137 Broad Run
20169 Haymarket
20187 Warrenton

20155 Gainesville
20186 Warrenton

We tested the market demand using $4,450 monthly rent for routine assisted living and $6,640
monthly rent for dementia assisted living based on another facility in the market area.

Mr. Neil Gumbin


June 11, 2015
Page 2
We use two projections to evaluate the market areas ability to support the project at stabilized
occupancy. The Market Penetration Rate helps to determine a markets depth and assess the degree
of difficulty for a single facility to achieve and maintain occupancy. We use 5% as the threshold
for Market Penetration Rates. Saturation occurs when the markets total capacity of units exceed
market demand. The Saturation Rate compares the markets total inventory of units to the qualified
market. We use Saturation Rates that are less than 25% for assisted living.
We use the following assumptions when projecting demand:
We assumed 93% stabilized occupancy for the project.
We assumed that 75% of the projects residents will come from the market area.
The market for people entering routine assisted living is limited to people ages 75 and
older.
The market for people entering Alzheimers disease/dementia assisted living is limited to
people ages 65 and older.
Income qualifications assume routine assisted living and Alzheimers disease/dementia
assisted living residents use 92% of available income and $20,000 of their assets annually
to help to pay for assisted living care.
The demand for routine assisted living uses age specific rates for people who require
assistance with activities of daily living reported in U.S. Census, Americans with
Disabilities, Household Economic Studies, July 2012.
Age
75-79
80 and Older

Routine AL Utilization
15.40%
30.20%

The incidence rate for dementia is from Alzheimer Disease in the United States using
2010 Census, published February 2013 by the American Academy of Neurology.
Age
65-74
75-84
85 and Older

Dementia AL Utilization
2.90%
17.30%
32.10%

Mr. Neil Gumbin


June 11, 2015
Page 3
The Market Penetration Rate for the projects 40 routine assisted living units calculates to 7.7% in
2015 and 5.2% in 2020. The Saturation Rate for the market area calculates to 27.0% in 2015 and
20.0% in 2020.
The Market Penetration Rate for the projects 24 dementia assisted living beds calculates to 3.0%
in 2015 and 2.2%. We project one property could support up to 56 dementia assisted living beds
using 2020 demographic data.
Following this letter are the following documents:
A map of the market area showing the locations of retirement facilities
A list of the retirement facilities in the market area with addresses and bed complements
Exhibits 1 through 8 showing the demand calculations
A Claritas Senior Life Report presenting 2015 and 2020 demographic projections for the
market area.
This report is intended for use in the planning of this project. Conclusions are based on a desk
review of published data. Site visits were not conducted. The report is based on estimates,
assumptions and other information available to us when we conducted the study or developed in
connection to the study. Sources of the information and the basis of the estimates and assumptions
are stated in the appropriate places within this report. However, some assumptions may not
materialize and unanticipated events and circumstances may occur. Therefore, actual results
achieved may vary from those reported. We have not evaluated the effectiveness of the projects
management and we are not responsible for future marketing efforts and other management actions
upon which results will depend.
If we can answer any questions, or if you require additional information please do not hesitate to
contact us at 410-998-9310. Thank you for this engagement.
Very truly yours,
Alice Katz
President

Produced by: The Vinca Group L.L.C.

Blue Circle-Independent Living

RETIREMENT FACILITIES
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA

Purple Triangle-Assisted Living

6/9/2015

NAME
239 ALEXANDRIA PK
305 OAK SPRINGS DR
6735 SUFFIELD LN
13650 HEATHCOTE BLVD

ADDRESS

WARRENTON
WARRENTON
WARRENTON
GAINSVILLE

CITY

VA
VA
VA
VA

ST

20186
20186
20187
20155

ZIP

540-347-6000
540-349-9725
540-316-3800
703-468-1895

PHONE

FACILITY LIST
RETIREMENT FACILITIES
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA

AMERISIST OF WARRENTON
THE OAKS
THE VILLA AT SUFFIELD MEADOWS
THE TRIBUTE AT HERRITAGE VILLAGE (Planned)
TOTAL

Source: The Vinca Group L.L.C. Analysis

BEDS

IL
AL ALZ SNF
0
41
0
0
111
0
0
0
0
60
12
0
0
60
30
0
111 161
42
0

Page 1 of 1

6/11/2015 - 12:07 PM

Source: The Vinca Group L.L.C. Analysis

EXHIBIT 1
ROUTINE ASSISTED LIVING AND DEMENTIA ASSISTED LIVING
REQUIRED INCOME
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
2015 AND 2020 PROJECTED

$434,191
$334,327
$26,746
$307,581
$15,379

17.53%
$4,450
$53,400
$58,043
$10,175

$434,191
$334,327
$26,746
$307,581
$15,379

87.27%
$6,640
$79,680
$86,609
$15,379
$71,230
$62,162

12.73%
$6,640
$79,680
$86,609
$11,025

$434,191
$334,327
$26,746
$307,581
$15,379

2015

$73,187
$20,000

87.27%
$6,640
$79,680
$86,609
$15,379
$71,230
$62,162

12.73%
$6,640
$79,680
$86,609
$11,025

$434,191
$334,327
$26,746
$307,581
$15,379

2020

Dementia Assisted Living

17.53%
$4,450
$53,400
$58,043
$10,175

82.47%
$4,450
$53,400
$58,043
$15,379
$42,664
$35,185

$73,187
$20,000

$53,187

2020

REQUIRED INCOME
Renter Occupied Units:
Market area rent
Annualized
Available income used per year - 92% AL; 92% ALZ
Weighted average renter income

82.47%
$4,450
$53,400
$58,043
$15,379
$42,664
$35,185

$45,360
$20,000

$53,187

2015

Owner Occupied Units:


Market area base rent
Annualized
Available income used per year - 92% AL; 92% ALZ
Less: income from home sale
Net income qualification for owners
Weighted average owner income

$45,360
$20,000

$25,360

Routine Assisted Living

Weighted average required income


Less: Asset spend down

$25,360

HOUSING VALUE CALCULATION


Median housing value
Elderly Housing Valued at 77% of Median
Less: 8% transaction costs
Net Proceeds
Income invested at 5% per year

Net Income Qualification

6/11/2015 12:07 PM

EXHIBIT 2
ROUTINE ASSISTED LIVING
INCOME QUALIFIED MARKET
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
2015 AND 2020 PROJECTED

MONTHLY RENT

$4,450
2015

Age Cohorts

2020

75 - 84

85 +

75 - 84

85 +

Population

3,562

1,108

4,765

1,300

Total Households

2,049

547

2,628

633

Income Qualified Households

1,675

380

2,229

463

81.75%

69.47%

84.82%

73.14%

2,912

770

4,042

951

2,912

770

4,042

951

50.22%

50.22%

50.22%

50.22%

1,462

387

2,030

478

21.91%

30.20%

21.91%

30.20%

320

117

445

144

Percent Income Qualified Households


Income Qualified People
Less: CCRC IL Households
Net Income Qualified People
Single %
Income Qualified Singles
Needing Assistance %
Income Qualified Singles Needing Assistance
Total Assisted Living Income Qualified Singles
Adjustment for married/significant other
Total Assisted Living Income Qualified PMA Residents

437

589

72

97

509

686

Assumptions:
1. Monthly rent is
.
2. Potential assisted living residents are aged 75 years and older.
3. ASHA reports 16.5% of assisted living residents are married or have a significant other.
4. Utilization percentages are taken from the U.S. Census Bureau, Americans with Disabilities, Household Economic
Studies, July 2012. Ages 75-84 incidence rate is calculated weighted average using 2010 U.S. Census population.

Source: The Vinca Group L.L.C. Analysis

6/11/2015 12:07 PM

EXHIBIT 3
ROUTINE ASSISTED LIVING
MARKET PENETRATION RATE
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
2015 AND 2020 PROJECTED

MONTHLY RENT

$4,450
2015

Assisted Living Qualified PMA Residents


Competitor Licensed Beds PMA (Existing and Planned)
Occupancy @ 93%
Net Available AL Qualified PMA Residents
Subject Facility Licensed Beds
Subject Facility Licensed Beds @ 93% Occupancy
PMA Origin @ 75%
Market Penetration Rate Licensed Beds
Assisted Living Qualified PMA Residents
Competitor Operating Units PMA (Existing and Planned)
Occupancy @ 93%
Net Available PMA Residents
Subject Facility Operating Units
Subject Facility Operating Units @ 93% Occupancy
PMA Origin @ 75%
Market Penetration Rate Operating Units

2020
509
161
150
360

686
161
150
536

48
45
33
9.3%

48
45
33
6.2%

509
157
146
363

686
157
146
540

40
37
28
7.7%

40
37
28
5.2%

Assumptions:
1. The Market Penetration Rate is used to measure a market's depth and assess the difficulty in achieving
and maintaining stabilized occupancy. Penetration Rates under 5% are viewed favorably for assisted living.
The higher the Penetration Rate, the greater the potential level of risk.
2. Please refer to Exhibit 8 for a schedule of units in the market area.

Source: The Vinca Group L.L.C. Analysis

6/11/2015 12:07 PM

EXHIBIT 4
ROUTINE ASSISTED LIVING
SATURATION RATE
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
2015 AND 2020 PROJECTED

MONTHLY RENT

$4,450
2015

Total Assisted Living Qualified PMA Residents


Saturation Rate @ 25%
Market Area PMA Residents Seeking Assisted Living

2020
509

686

25%

25%

127

172

Total Licensed Assisted Living Beds Including Subject Facility

209

209

Assumed Occupancy @ 93%

93%

93%

Occupancy Adjusted Beds


PMA Origin @ 75%
Occupancy and PMA Adjusted Licensed Beds

194

194

75%

75%

146

146

Market Area Residents Using AL

127

172

Less: Occupancy and PMA Adjusted Licensed Beds

146

146

Net Need

-18

26

28.6%

21.2%

Saturation Rate Licensed Beds


2015 = 146 beds /

509

AL qualified PMA residents

2020 = 146 beds /

686

AL qualified PMA residents

Total Operating Assisted Living Units Including Subject Facility

197

197

Assumed Occupancy @ 93%

93%

93%

Occupancy Adjusted Units

183

183

PMA Origin @ 75%

75%

75%

Occupancy and PMA Origin Adjusted Operating Units

137

137

Market Area Residents Using AL

127

172

Less: Occupancy and PMA Origin Adjusted Operating Units

137

137

Net Need

-10

34

27.0%

20.0%

Saturation Rate Operating Units


2015 = 137 beds /

509

AL qualified PMA residents

2020 = 137 beds /

686

AL qualified PMA residents

Assumptions:
1. The Saturation Rate is used to compare the inventory of units (or capacity) in the market to the qualified market.
The Saturation Rate equals the total occupancy and PMA adjusted units including the proposed project divided by the
AL qualified market. Saturation Rates under 25% are viewed favorably for assisted living.

Source: The Vinca Group L.L.C. Analysis

6/11/2015 12:07 PM

EXHIBIT 5
DEMENTIA ASSISTED LIVING
INCOME QUALIFIED MARKET
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
2015 AND 2020 PROJECTED

MONTHLY RENT

$6,640
2015

2020

Age 65-74
Income Qualified Households 65-74

3,557

4,665

68.04%

68.04%

Married Couples

2,420

3,174

Married Individuals

4,840

6,348

Single Individuals

1,137

1,491

Income Qualified Residents

5,977

7,839

2.90%

2.90%

173

227

1,206

1,660

Married Couples %

Incidence Factor
Dementia AL Income Qualified Ages 65-74
Age 75-84
Income Qualified Households 75-84
Less CCRC Households
Available Income Qualified Households
Married Couples %
Married Couples
Married Individuals
Single Individuals
Income Qualified Residents
Incidence Factor
Dementia AL Income Qualified Ages 75-84

1,206

1,660

49.78%

49.78%

600

826

1,201

1,653

606

834

1,806

2,486

17.30%
312

17.30%
430

243

301

Age 85+
Income Qualified Households 85+
Less CCRC Households
Available Income Qualified Households
Married Couples %

243

301

49.78%

49.78%

Married Couples

121

150

Married Individuals

242

300

Single Individuals

122

151

Income Qualified Residents

364

451

32.10%

32.10%

117

145

603

802

Incidence Factor
Dementia AL Income Qualified Ages 85+
Total Dementia Assisted Living
Income Qualified PMA Residents

Assumption:
1. The incidence rates are from Alzheimer Disease in the United States using 2010 Census,
published February 2013 by the American Academy of Neurology.

Source: The Vinca Group L.L.C. Analysis

6/11/2015 12:07 PM

EXHIBIT 6
DEMENTIA ASSISTED LIVING
MARKET PENETRATION RATE
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
2015 AND 2020 PROJECTED

MONTHLY RENT

$6,640

2015
Dementia Assisted Living Qualified PMA Residents

2020
603

802

Competitor Licensed Beds PMA

42

42

Occupancy @ 93%

39

39

564

763

24

24

22

22

17

17

3.0%

2.2%

Net Available Dementia AL Qualified PMA Residents


Subject Facility Licensed Beds
Subject Facility Licensed Beds @ 93%

Occupancy

PMA Origin @ 75%


Market Penetration Rate Licensed Beds

Assumptions:
1. The Market Penetration Rate is used to measure a market's depth and assess the difficulty in achieving and
maintaining stabilized occupancy. Penetration Rates under 5% are viewed favorably for assisted living. The
higher the Penetration Rate, the greater the potential level of risk.
2. Please refer to Exhibit 8 for a schedule of units in the market area.

Source: The Vinca Group L.L.C. Analysis

6/11/2015 12:07 PM

EXHIBIT 7
DEMENTIA ASSISTED LIVING
SATURATION RATE
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
2015 AND 2020 PROJECTED

MONTHLY RENT

$6,640

2015

2020

Total AL Dementia Qualified PMA Residents

603

802

Saturation Rate @ 25%

25%

25%

Market Area Residents Seeking AL Dementia Care

151

201

Licensed AL Dementia Beds Including Subject Facility


Assumed Occupancy @ 93%
Occupancy Adjusted Beds
PMA Origin @75%
Occupancy and PMA Origin Adjusted Licensed Beds
Market Area Residents Seeking AL Dementia Care
Less: Occupancy and PMA Origin Adjusted Licensed Beds
Net Need
Saturation Rate Licensed Beds
2015 = 46

beds / 603 AL qualified PMA residents

2020 = 46

beds / 802 AL qualified PMA residents

66

66

93%

93%

61

61

75%

75%

46

46

151

201

46

46

105

155

7.6%

5.7%

Assumptions:
1. The Saturation Rate is used to compare the inventory of units (or capacity) in the market to the qualified market.
The Saturation Rate equals the total occupancy and PMA adjusted units including the proposed project divided by the
dementia AL qualified market. Saturation Rates under 25% are viewed favorably for dementia assisted living.

Source: The Vinca Group L.L.C. Analysis

6/11/2015 12:07 PM

EXHIBIT 8
SCHEDULE OF UNITS
AMERICAN LEGION
WARRENTON, VA
DEFINED MARKET AREA
JUNE 2015

FACILITY
Existing
Ameristist of Warrenton
The Villa at Suffield Meadows
Existing Beds Subtotal
Proposed Facilities
The Tribute at Heritage Village
Proposed Facilities Subtotal

TOTAL LICENSED TOTAL OPERATING


UNITS
BEDS
Routine Dementia Routine Dementia
Assisted Assisted
Assisted Assisted
41
60
101

0
12
12

41
56
97

0
12
12

60
60

30
30

60
60

30
30

Subject Facility Beds Total

161
48

42
24

157
40

42
20

TOTAL

209

66

197

62

Existing and Proposed Total

Source: The Vinca Group L.L.C. Analysis

6/11/2015 12:07 PM

Prepared on: Wed Jun 10, 2015


Project Code: #417 - Warrenton, VA
Prepared For: #417 - Warrenton, VA

Page 1 of

Area Map

Nielsen Solution Center 1 800 866 6511

Zip Code
See Appendix for Geographies

2015 The Nielsen Company. All rights reserved. 2006-2014 TomTom


Prepared By:

Senior Life 2015


Warrenton, VA - defined market area
Area ZIP Codes (see appendix for geographies), Total
Totals

Population
2020 Projection
2015 Estimate
2010 Census
2000 Census

102,609
92,925
81,019
40,072

Growth 2000 - 2010


Growth 2010 - 2015
Growth 2015 - 2020

102.18%
14.70%
10.42%

2010
Census

Population by Age

2015
Estimate

2020
Projection

Total Population
Age 45 - 54
Age 55 - 64
Age 65 - 74
Age 75 - 84
Age 85 and over

81,019
13,117
9,309
5,934
2,722
835

16.19%
11.49%
7.32%
3.36%
1.03%

92,925
15,000
11,421
8,394
3,562
1,108

16.14%
12.29%
9.03%
3.83%
1.19%

102,609
15,332
14,287
10,863
4,765
1,300

14.94%
13.92%
10.59%
4.64%
1.27%

Age 65 and over

9,491

11.71%

13,064

14.06%

16,928

16.50%

39,845
6,604
4,475
2,789
1,220
264

16.57%
11.23%
7.00%
3.06%
0.66%

45,686
7,452
5,502
3,966
1,603
390

16.31%
12.04%
8.68%
3.51%
0.85%

50,380
7,464
6,938
5,141
2,126
459

14.82%
13.77%
10.20%
4.22%
0.91%

Age 65 and over

4,273

10.72%

5,959

13.04%

7,726

15.34%

Total Population, Female


Age 45 - 54
Age 55 - 64
Age 65 - 74
Age 75 - 84
Age 85 and over

41,174
6,513
4,834
3,145
1,502
571

15.82%
11.74%
7.64%
3.65%
1.39%

47,239
7,548
5,919
4,428
1,959
718

15.98%
12.53%
9.37%
4.15%
1.52%

52,229
7,868
7,349
5,722
2,639
841

15.06%
14.07%
10.96%
5.05%
1.61%

Age 65 and over

5,218

12.67%

7,105

15.04%

9,202

17.62%

Total Population, Male


Age 45 - 54
Age 55 - 64
Age 65 - 74
Age 75 - 84
Age 85 and over

Prepared On: Wed Jun 10, 2015

Page

Of 7

Prepared By:

Project Code: #417 - Warrenton, VA

Nielsen Solution Center 1 800 866 6511

Prepared For: #417 - Warrenton, VA

2015 The Nielsen Company. All rights reserved.

Senior Life 2015


Warrenton, VA - defined market area
Area ZIP Codes (see appendix for geographies), Total

2010
Census

Population by Single-Classification Race


White Alone
Age 65 and over
Black or African American Alone
Age 65 and over
American Indian and Alaska Native Alone
Age 65 and over
Asian Alone
Age 65 and over
Native Hawaiian and Other Pacific Islander Alone
Age 65 and over
Some Other Race Alone
Age 65 and over
Two or More Races
Age 65 and over

63,277
8,215
7,052
642
241
18
6,103
496
63
7
1,614
40
2,669
69

2010
Census

Population by Hispanic or Latino


Hispanic or Latino
Age 65 and over
Not Hispanic or Latino

5,862
217
75,157

2000
Census

Households by HH Income by Age of Householder


Householder Age 45 - 54
Income less than $15,000
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
Income $200,000 or more
Median Household Income

Prepared On: Wed Jun 10, 2015

3,577
104
109
159
280
761
721
607
373
286
177
$88,020

Page

Of 7

%
12.98%
9.10%
7.47%
8.13%
11.11%
2.48%
2.59%

%
3.70%

%
2.91%
3.05%
4.45%
7.83%
21.27%
20.16%
16.97%
10.43%
8.00%
4.95%

2015
Estimate
69,539
11,080
8,739
877
279
17
8,619
879
73
8
1,985
57
3,691
132

%
15.93%
10.04%
6.09%
10.20%
10.96%
2.87%
3.58%

2015
Estimate

7,505
343
85,420

4.57%

2015
Estimate
7,870
144
133
170
310
587
1,059
1,054
898
1,675
1,840
$138,307

%
1.83%
1.69%
2.16%
3.94%
7.46%
13.46%
13.39%
11.41%
21.28%
23.38%

Prepared By:

Project Code: #417 - Warrenton, VA

Nielsen Solution Center 1 800 866 6511

Prepared For: #417 - Warrenton, VA

2015 The Nielsen Company. All rights reserved.

2020
Projection
73,606
13,997
10,413
1,189
304
29
11,110
1,351
87
14
2,345
118
4,744
215
2020
Projection
9,088
567
93,521
2020
Projection
7,963
112
98
123
253
465
900
980
831
1,715
2,486
$156,399

%
19.02%
11.42%
9.54%
12.16%
16.09%
5.03%
4.53%

%
6.24%

%
1.41%
1.23%
1.54%
3.18%
5.84%
11.30%
12.31%
10.44%
21.54%
31.22%

Senior Life 2015


Warrenton, VA - defined market area
Area ZIP Codes (see appendix for geographies), Total

2000
Census

Households by HH Income by Age of Householder


Householder Age 55 - 64
Income less than $15,000
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
Income $200,000 or more
Median Household Income

2,308
87
91
164
226
431
498
232
185
222
172
$82,781

Householder Age 65 - 74
Income less than $15,000
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
Income $200,000 or more
Median Household Income
Householder Age 75 - 84
Income less than $15,000
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
Income $200,000 or more
Median Household Income

Prepared On: Wed Jun 10, 2015

Page

Of 7

2015
Estimate

3.77%
3.94%
7.11%
9.79%
18.67%
21.58%
10.05%
8.02%
9.62%
7.45%

6,138
181
165
177
293
501
860
762
649
1,201
1,349
$130,008

1,304
114
145
135
210
286
164
122
41
53
34
$54,196

8.74%
11.12%
10.35%
16.10%
21.93%
12.58%
9.36%
3.14%
4.06%
2.61%

681
135
90
87
116
108
69
23
14
28
11
$38,685

19.82%
13.22%
12.78%
17.03%
15.86%
10.13%
3.38%
2.06%
4.11%
1.62%

2020
Projection

2.95%
2.69%
2.88%
4.77%
8.16%
14.01%
12.41%
10.57%
19.57%
21.98%

7,512
173
155
159
295
507
907
870
759
1,501
2,186
$147,727

2.30%
2.06%
2.12%
3.93%
6.75%
12.07%
11.58%
10.10%
19.98%
29.10%

4,632
157
198
192
413
905
618
563
434
616
536
$93,244

3.39%
4.27%
4.15%
8.92%
19.54%
13.34%
12.15%
9.37%
13.30%
11.57%

5,838
170
196
215
466
992
717
710
564
852
956
$105,739

2.91%
3.36%
3.68%
7.98%
16.99%
12.28%
12.16%
9.66%
14.59%
16.38%

2,049
157
212
150
272
406
225
160
132
178
157
$64,378

7.66%
10.35%
7.32%
13.27%
19.81%
10.98%
7.81%
6.44%
8.69%
7.66%

2,628
169
223
191
324
482
284
220
182
258
295
$71,110

6.43%
8.49%
7.27%
12.33%
18.34%
10.81%
8.37%
6.93%
9.82%
11.23%

Prepared By:

Project Code: #417 - Warrenton, VA

Nielsen Solution Center 1 800 866 6511

Prepared For: #417 - Warrenton, VA

2015 The Nielsen Company. All rights reserved.

Senior Life 2015


Warrenton, VA - defined market area
Area ZIP Codes (see appendix for geographies), Total

2000
Census

Households by HH Income by Age of Householder


Householder Age 85 and over
Income less than $15,000
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
Income $200,000 or more
Median Household Income

171
47
27
23
23
22
13
4
3
8
1
$30,000

2000
Census

Households by Household Income


Total Households
Income Less than $15,000
Income $15,000 - $24,999
Income $25,000 - $34,999
Income $35,000 - $49,999
Income $50,000 - $74,999
Income $75,000 - $99,999
Income $100,000 - $124,999
Income $125,000 - $149,999
Income $150,000 - $199,999
Income $200,000 - $249,999
Income $250,000 - $499,999
Income $500,000 or more

14,266
705
704
943
1,610
3,329
2,649
1,838
942
943
313
216
74

%
27.49%
15.79%
13.45%
13.45%
12.87%
7.60%
2.34%
1.75%
4.68%
0.58%

%
4.94%
4.93%
6.61%
11.29%
23.34%
18.57%
12.88%
6.60%
6.61%
2.19%
1.51%
0.52%

2015
Estimate
547
87
78
47
81
90
48
44
31
23
18
$46,389

%
15.90%
14.26%
8.59%
14.81%
16.45%
8.78%
8.04%
5.67%
4.20%
3.29%

2015
Estimate
31,167
997
984
1,117
1,944
3,679
4,132
3,917
3,524
5,297
2,148
2,410
1,018

%
3.20%
3.16%
3.58%
6.24%
11.80%
13.26%
12.57%
11.31%
17.00%
6.89%
7.73%
3.27%

2020
Projection
633
88
80
58
93
100
60
59
35
31
29
$49,597

2020
Projection
34,140
953
921
1,063
1,966
3,573
4,012
4,045
3,680
5,878
3,304
3,186
1,559

Average Household Income

$87,474

$140,853

$155,377

Median Household Income

$73,813

$117,427

$128,648

Prepared On: Wed Jun 10, 2015

Page

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Prepared By:

Project Code: #417 - Warrenton, VA

Nielsen Solution Center 1 800 866 6511

Prepared For: #417 - Warrenton, VA

2015 The Nielsen Company. All rights reserved.

%
13.90%
12.64%
9.16%
14.69%
15.80%
9.48%
9.32%
5.53%
4.90%
4.58%

%
2.79%
2.70%
3.11%
5.76%
10.47%
11.75%
11.85%
10.78%
17.22%
9.68%
9.33%
4.57%

Senior Life 2015


Warrenton, VA - defined market area
Area ZIP Codes (see appendix for geographies), Total

2000
Census

Owner-Occupied Housing Units by Value


Total Owner-Occupied Housing Units
Value Less than $20,000
Value $20,000 - $39,999
Value $40,000 - $59,999
Value $60,000 - $79,999
Value $80,000 - $99,999
Value $100,000 - $149,999
Value $150,000 - $199,999
Value $200,000 - $299,999
Value $300,000 - $399,999
Value $400,000 - $499,999
Value $500,000 - $749,999
Value $750,000 - $999,999
Value $1,000,000 or more

11,840
150
35
56
197
552
2,108
3,309
3,262
1,095
673
280
78
45

Median All Owner-Occupied Housing Unit Value

%
1.27%
0.30%
0.47%
1.66%
4.66%
17.80%
27.95%
27.55%
9.25%
5.68%
2.36%
0.66%
0.38%

$192,641

2010
Census

Group Quarters by Population Type


Group Quarters Population
Correctional Institutions
Nursing Homes
Other Institutions
College Dormitories
Military Quarters
Other Noninstitutional Quarters

464
96
337
0
0
0
31

Owner-Occupied
Renter-Occupied

%
20.69%
72.63%
0.00%
0.00%
0.00%
6.68%

23,437
4,483

Prepared On: Wed Jun 10, 2015

Page

Of 7

26,264
79
129
73
45
14
243
752
3,926
5,984
5,519
6,382
2,414
704

%
0.30%
0.49%
0.28%
0.17%
0.05%
0.93%
2.86%
14.95%
22.78%
21.01%
24.30%
9.19%
2.68%

$434,191

2010
Census

Occupied Housing Units by Tenure

2015
Estimate

28,830
72
119
96
31
16
197
593
3,402
5,643
5,597
7,833
3,792
1,439

%
0.25%
0.41%
0.33%
0.11%
0.06%
0.68%
2.06%
11.80%
19.57%
19.41%
27.17%
13.15%
4.99%

$475,862

2015
Estimate
466
96
339
0
0
0
31

2020
Projection

%
20.60%
72.75%
0.00%
0.00%
0.00%
6.65%

2015
Estimate
26,264
4,903

Prepared By:

Project Code: #417 - Warrenton, VA

Nielsen Solution Center 1 800 866 6511

Prepared For: #417 - Warrenton, VA

2015 The Nielsen Company. All rights reserved.

2020
Projection
470
96
342
0
0
0
32
2020
Projection
28,830
5,310

%
20.43%
72.77%
0.00%
0.00%
0.00%
6.81%

Senior Life 2015


Warrenton, VA - defined market area
Area ZIP Codes (see appendix for geographies), Total
Totals

Households by Tenure by Age of Householder


Total Households
Owner-Occupied
Householder 55 to 64 Years
Householder 65 to 74 Years
Householder 75 to 84 Years
Householder 85 and over

27,920
23,437
4,612
3,089
1,406
302

Renter-Occupied
Householder 55 to 64 Years
Householder 65 to 74 Years
Householder 75 to 84 Years
Householder 85 and over

4,483
559
338
239
109

19.68%
13.18%
6.00%
1.29%

31,167
26,264
5,481
4,167
1,759
382

12.47%
7.54%
5.33%
2.43%

4,903
657
465
290
165

20.87%
15.87%
6.70%
1.45%

34,140
28,830
6,711
5,258
2,273
452

23.28%
18.24%
7.88%
1.57%

13.40%
9.48%
5.91%
3.37%

5,310
801
580
355
181

15.08%
10.92%
6.69%
3.41%

Some median values are assigned pre-determined amounts rather than calculated amounts. Med HH Inc by Age values more than
$200,000 are displayed as $200,001. Med HH Inc values less than $15,000 are displayed as $14,999. Med HH Inc values more than
$500,000 are displayed as $500,001. Med Housing Values more than $1,000,000 are displayed as $1,000,001.

Prepared On: Wed Jun 10, 2015

Page

Of 7

Prepared By:

Project Code: #417 - Warrenton, VA

Nielsen Solution Center 1 800 866 6511

Prepared For: #417 - Warrenton, VA

2015 The Nielsen Company. All rights reserved.

Senior Life 2015


Warrenton, VA - defined market area

Appendix: Area Listing


Area Name:
Type: List - Area ZIP Codes

Reporting Detail: Aggregate

Reporting Level: Area ZIP Codes

Geography Code

Geography Name

Geography Code

Geography Name

20137

Broad Run

20155

Gainesville

20169

Haymarket

20186

Warrenton

20187

Warrenton

Project Information:
Site:

Order Number: 975036043

Prepared On: Wed Jun 10, 2015

Page

Of 7

Prepared By:

Project Code: #417 - Warrenton, VA

Nielsen Solution Center 1 800 866 6511

Prepared For: #417 - Warrenton, VA

2015 The Nielsen Company. All rights reserved.