A rising number of tuberculosis cases, the opioid epidemic,

A rising number of tuberculosis cases, the opioid epidemic, and an aging population pose a triple challenge to public health nurses in Holbrook, Randolph and Avon.

The three towns have received a $46,000 Community Compact intermunicipal grant from Norfolk County to increase the hours of each town's public health nurse by an additional five hours each week.

In Holbrook, the grant will double the hours of the town's public health nurse from five to 10 hours per week.

"This grant gives more time the public health nurse can spend on local cases," Holbrook Health Agent Arthur P. Boyle Jr. said. "The town will be better off. This grant is a step in the right direction,"

Public health nurses perform duties such as tracking the flu and other diseases, as well as interacting with the state on cases and on states of emergency. In Holbrook, Public Health Nurse Dominique Lounge also conducts blood pressure clinics and wellness clinics.

Boyle netted praise from Holbrook Town Administrator Timothy Gordon for his part in securing the grant.

"Arthur Boyle has worked hard on increasing the hours of our public health nurses," Gordon said Feb. 28 when selectmen voted unanimously, 3-0, to authorize Selectman Chairman Daniel Lee to execute the agreement with Norfolk County.

"We were glad to have the support of the Holbrook Board of Health and Town Administrator Timothy Gordon," Gordon said. "It made things go a lot smoother."

Holbrook has a population 10,791, according to the 2010 census.

Randolph, with a population of more than 40,000, according to the intermunicipal agreement, employs 1 1/2 FTE public health nurses.

"This grant will benefit the town because the Randolph Health Department is a very large and very busy health department," said Randolph Public Health Nurse Jean McGinty, who works 35 hours per week. "This is an important grant. We will use the extra five hours to see our TB patients."

About one-third of Randolph's population are foreign born, according to the 2010 census. One of the town's growing challenges has been the increase in the number of tuberculosis tests and cases. In 2016, 111 cases of tuberculosis were reported and 85 were confirmed.

Tuberculosis disease in the United States is most common among people who travel to or who were born in countries with high rates of TB. In 2016, a total of 68.5 percent of reported TB cases in the United States occurred among non-U.S.-born persons, according to the CDC at www.cdc.gov.

"Randolph's public health nurses have had to respond to this challenge and a diverse and growing range of public health needs presented by the town residents, and it has become a constant challenge for a very limited staff to be able to keep up with the demands," the agreement stated.

In 2015, tuberculosis cases increased in the United States for the first time in 23 years, according the CDC. Two-thirds of the total increase were among people born abroad.

The grant will facilitate caring for Randolph's TB patients.

"The nurses need to go to the patient," McGinty said.

Holbrook, Randolph, and Avon, like all Massachusetts communities, also have been hard hit by the opiate epidemic and remain committed to addressing the substance abuse challenges facing many residents and families, the agreement stated.

In Avon, with a population of 4,356, the public health nurse currently works six hours a month. Avon is serving as the fiscal agent of the grant program.

The effect of the grant will be to expand the hours of the Avon public health nurse from six to 26 each month.

"I am very excited about the grant and hope to expand the services of the public health nurse," Avon Health Agent Kathleen Waldron stated.

The goal of the intermunicipal grant, which expires June 1, 2019, is to provide funding to bring together the boards of health and health departments in Holbrook, Randolph, and Avon to establish a shared services program to help the three towns meet existing public health needs relating to the demands on each of their public health nurses.

"The demand for the nurses' services in each town have consistently outpaced the resources needed to meet their diverse and growing needs," the agreement stated, identifying some of the challenges in each community.

Holbrook and Avon both have aging populations as about 25 percent of their residents are 60 or older.

"Both towns have placed a large emphasis on supporting senior health and wellness initiatives for their growing senior populations, but the current capacities of their public health nurses continues to pose a challenge to these efforts," the agreement states.

After the regional program is established in the first year and proves to be valuable to Holbrook, Randolph, and Avon, the goal of the agreement is for the three towns to pick up the funding, with the cost shared by the three communities.

The agreement includes "the potential for other Norfolk County and/or surrounding communities to join the initiative, allowing the costs of the expanded public health nursing services to be more broadly shared by the participating communities."