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Silver Linings: North Country hospital a model for dementia care

New Hampshire Union Leader

October 11. 2018 9:29PM
Cassie Tucker, R.N., program director of Ray of Hope, the gero-psychiatric unit at Cottage Hospital in Woodsville, reviews records with Debbie Shepple, a nursing assistant in the unit. (ROBERTA BAKER/UNION LEADER)

WOODSVILLE — Around the corner from the Harmony Acres Trailer Park and across the bridge from Wells River, Vt., 35-bed Cottage Hospital has become nationally known for delivering high-quality health care in a remote part of the state.

Ray of Hope, its 10-bed gero-psychiatric unit, may become a model for treating the urgent mental health needs of rural elders — as well as those referred by urban and regional hospitals where demand for in-patient care exceeds beds.

“We wanted to provide services to fill a gap of care in the state,” said Cottage CEO Dr. Maria Ryan, a health care administrator and former family nurse practitioner. “And we wanted to provide resources to keep the hospital solvent for years to come.”

Since it opened in 2016, the wing named after the late Woodsville native Executive Councilor Raymond Burton has treated the oldest residents from 26 North Country communities on both sides of the Connecticut River, in addition to others regularly referred from hospitals in southern New Hampshire, the Seacoast, southern Massachusetts and across Vermont.

The target population is adults 65 and older suffering from chronic and critical mental health conditions including dementia and depression. Many have co-occurring medical conditions, such as diabetes, which further compromise psychological and emotional wellbeing.

“We can’t necessarily cure them, but we can make their lives more enjoyable,” said Holly McCormack, chief nursing officer at Cottage Hospital.

“We realize we’re caring for our neighbors. Everyone here feels empowered,” said Maryanne Aldrich, director of development and community relations.

Treatment at Ray of Hope during an average 20-day stay includes cognitive and dialectical behavioral therapies that strive to alter negative thinking patterns and offer calming strategies, as well as music, art and reminiscence therapy.

“Some medications cause more symptoms and cloud judgment,” said Dr. Ryan, adding that one elderly patient was able to live years independently after counterproductive medicines were stripped off. “It’s amazing to see them come alive.”

According to staff, return visits to Ray of Hope are infrequent because patients aren’t released until they’re able to live independently with regular outpatient treatment and ongoing community support, or move to long-term care as needed.

So far, hospitals in Florida, Maine and Arizona have approached Cottage for advice on how to create similar units, which cost Cottage approximately $2 million to furnish, equip and convert a wing previously used for rehabilitation.

Cottage Hospital is noteworthy for its lack of reliance on state funding; it’s one of the first hospitals to sell tax credits to New Hampshire-based banks and businesses in exchange for funding.

Woodsville, a tiny village in the town of Haverhill, sits at the intersection of the Connecticut and Ammonoosuc Rivers, at the northern tip of Grafton County, where average income is skewed by wealthy Hanover and surrounding communities — reducing Cottage’s eligibility for government aid. Ray of Hope was built through a combination of hospital investments, fundraisers and private financing from banks.

A working model

“It’s tough nowadays to run a hospital. Reimbursement is cut, and we don’t have enough workers,” Ryan said. “Most small hospitals are affiliating with larger institutions. Cottage is doing it on its own.”

“We’ve got a working model here,” said James Potter, executive director of the New Hampshire Medical Society. “As health care systems see the ability to sustain the practice, it’s something they’ll look at doing. The demand is there, and it’s only going to increase.”

Residents age 65 will likely comprise 20 percent of the state’s population by 2020, according to estimates by The New Hampshire Center for Policy Studies. At present, cases of memory- and cognition-robbing Alzheimer’s disease, one of 10 to 12 forms of dementia, number over 24,000 statewide and are expected to climb 33 percent by 2025, according to the Alzheimer’s Association.

Depression and anxiety are nearly universal among elders who live alone, having lost spouses and longtime friends, and struggling with eroding physical and mental abilities and waning independence. Depression is also extremely common in those with chronic illness — roughly 80 percent of seniors, according to the National Alliance on Mental Illness.

The state’s existing psychiatric units don’t meet current and projected demand. According to hospital statistics, up to 60 people wait daily in hospital emergency rooms statewide for psychiatric treatment or a bed in a psychiatric unit — and that wait can last two weeks or longer; there are no estimates of how many are 65 and older. “You can’t mix a 25-year-old mental health patient in with a 65-year-old psychiatric patient,” said Holly McCormack, Cottage’s chief nursing officer. “It just wouldn’t be safe. Geriatric patients’ bodies process medications differently. Their bodies and brains function differently.”

Ray of Hope is one of the state’s four voluntary-only gero-psychiatric units. A fifth option may be on the horizon: Sun Behavioral Health, which currently operates psychiatric treatment facilities in Texas, Ohio, Delaware and Kentucky, is evaluating a site in southern New Hampshire for a 100-bed psychiatric hospital that will include geriatric treatment, according to the medical society.

The Ray of Hope’s third annual fundraiser, “Don’t Stop Believing in Hope” will be held today (Friday) from 6 to 10 p.m, at the Common Man restaurant in Plymouth. Tickets are $100 and available at (603) 747-9707.

Silver Linings is a continuing Union Leader/Sunday News report focusing on the issues of New Hampshire’s aging population and seeking out solutions. Union Leader reporter Roberta Baker would like to hear from readers about issues related to aging. She can be reached at or (603) 206-1514. See more at This series is funded through a grant from the Endowment for Health.

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