BusinessWest

Therapy Dogs Make a Difference in the Lives of Children and Adults

Jesse Hagerman says magical things happen when therapy dogs visit Shriners Hospital for Children in Springfield and interact with the patients.
“They light up; it helps them forget why they are here,” said the hospital’s child life supervisor. “These dogs can evoke wonderful responses, and I have seen children really open up around them. “It decreases the anxiety and stress of being hospitalized and enhances self-esteem because the dogs offer non-judgmental, non-threatening attention and give the children unconditional love.”
The canines and trainers that visit the hospital come from K-9 for Kids Pediatric Therapy Unit, a volunteer, nonprofit organization that serves children in Western Mass. and Connecticut. It was established by president/director Melissa Kielbasa of Sandy Hills Farms in Westfield in 1999 at the request of the Melha Shrine Unit, and has expanded to serve other pediatric medical facilities, camp and library programs, school systems, and a youth detention facility.
“The visits are designed to offer emotional support,” Kielbasa said, adding that some handler/dog teams also work with adults in nursing homes and hospitals.
The K-9 program includes dogs who like to cuddle as well as a number who have been trained to do unusual tricks and entertain children. “One dog will hide on command, and the kids think it’s hysterical,” Kielbasa said. Another rolls over on her back and drinks out of a baby bottle which it holds with its front paws. “My dog sneezes on cue. We have dogs that dance, and we have a talking pug that does a yodel that sounds like ‘I love you.’
“And they all love to be petted,” she continued. “Other species might not tolerate it, but dogs are looking for relationships and just want to please people.”
Research shows the interaction between therapy pets and patients is indeed pleasant. The specially trained dogs offer valuable benefits to children as well as adults in settings that include hospitals, hospice units, nursing homes, assisted-living centers, and rehabilitation facilities, to name a few.
Diane Mintz, executive vice president of Spectrum Home Health and Hospice Care, a program of Jewish Geriatric Services in Longmeadow, says its hospice patients and the families it serves find pet therapy extremely beneficial.
The organization works with Bright Spot Therapy Dogs Inc., another all-volunteer, nonprofit group founded by Cynthia Hinckley of Westhampton.
“The dogs are very sensitive to how the person is feeling and are very gentle. When they visit, it makes people smile and brings joy into their day,” Mintz said. “It’s a bright spot for them. Sometimes, when a patient is in a declining state and we gently introduce the dog, they say endearing things to it. It’s comforting for them to have a dog there.”
She noted that the pets are content to simply relax by a person’s side.
Hinckley says dogs from Bright Spot visit hospitals, public and private day and residential schools, psychiatric facilities, senior centers, rehabilitation facilities, and schools with reading programs for children. “Whenever I leave a visit, I know I have made at least one person happier, more comfortable, and less lonely,” she said.
Studies have shown that therapy dogs provide comfort and facilitate learning, and researchers continue to seek empirical evidence to support the theory. The University of California Irvine has begun a four-year, $2.2 million study to learn whether pet therapy can help children with attention deficit hyperactivity disorder improve their social skills and control their symptoms. Meanwhile, other studies in recent years have focused on therapy dogs and people with Alzheimer’s disease.
In addition, last year, a Wall Street Journal article chronicled research that proves a few minutes of stroking a dog reduces the stress hormone cortisol, while a study done at Monmouth Medical Center in New Jersey showed patients waiting to have magnetic resonance imaging (an MRI) found interacting with a therapy dog soothing.

Intense Training
Bright Spot has 90 dogs and 80 volunteers in its program. There is no fee for its services, but the dogs and their handlers must undergo specialized training before the animals are certified to work in therapeutic settings.
Hinckley has been engaged in pet therapy for 20 years, and founded her program in 2004. She became passionate about the mission when she went into a psychiatric facility with one of her dogs and a patient who hadn’t spoken in 20 years began to talk.
“It changed my life,” she said, adding that she runs classes and certifies dogs and their trainers, and has evaluated and mentored hundreds of therapy-dog teams in Western Mass. and Connecticut.
The first step is a phone interview. “The most important thing is their temperament,” Hinckley said, adding that she asks a series of questions to determine if the dog has ever shown any aggression. She also advises owners to take their dogs everywhere they go because the animals must remain calm in a variety of settings.
During training sessions, they work on obedience and control. Dogs must obey commands at all times, never jump on people, and not bark incessantly for any reason. Surprisingly, although some dogs do well during training, they don’t do well when they encounter unusual situations.
Hinckley said one dog panicked at a nursing home when it saw someone approach who was using a walker. “Therapy dogs have to be able to deal with loud, piercing noises and equipment such as hospital carts, food trays, medical devices, and machinery, Hinckley explained. “And if they are visiting children, they have to be able to deal with the unexpected. Some dogs are better with children, while others are more suited to adults or the elderly.”
When she certifies a dog, she makes a recommendation about the type of facility and population it is suited to work with. However, the owner must also be comfortable with the setting. “I recently evaluated a dog that would be fabulous for hospice work, but the owner said she couldn’t do that,” she told BusinessWest.
Cooley Dickinson Hospital in Northampton and Bright Spot formed a working partnership in 2005. “They do a wonderful job and have dogs that are uniquely suited to a hospital environment,” said Robin Kline, the hospital’s director of volunteer services, adding that CDH is grateful to Hinckley because she worked closely with them for several years to get the program off the ground.
However, before dogs and trainers are allowed into the hospital, Kline conducts an additional screening that includes immunization records and a criminal record check on the handler.
Once that is complete, remarkable things can occur.
Kline says the dogs help patients cope with depression, loneliness, and feelings of isolation, and also stimulate social interaction. She explained that, when the handler introduces himself or herself and the dog, it often sparks conversations about a pet the patient had as a child or a dog they have at home.
“It’s part of the magic that occurs with therapy dogs,” she said. “There are really wonderful moments because the handlers are skilled at creating connections and can help patients who haven’t responded or communicated much. And the dogs have a calming effect on patients. Their presence makes the hospital environment more homelike and brings some relief to the stress of being ill.”
If the dog is small and the patient doesn’t have health issues that prevent it from getting in their bed, they often end up cuddling with the animals. “We have had some beautiful little dogs on beds, and the patients love it; it really cheers them up,” Kline said.
The program operates on the North 3 ward and in the psychiatric unit of the hospital, where the dogs are introduced in a group setting. And if people are having a difficult day, that can change when they interact with the gentle canines.
“A dog can really improve someone’s mood. When patients pet a dog and say, ‘I love animals’ or ‘this is such a good dog,’ they are clearly having a positive experience,” Kline said, adding that staff members really appreciate the volunteers who bring their pets to the hospital.

Creating Relationships
Kielbasa also trains therapy dogs at Sandy Meadow Farms. In addition to a general course, she runs an approved, seven-week pediatric therapy dog unit training class.
But taking the class and passing the certification exam are not enough to qualify for her K-9 program. The dogs and handlers must also pass the K-9s for Kids Performance and Evaluation Test and the American Kennel Club Canine Good Citizen Test. In addition, their handlers undergo background checks.
K-9 teams are used in the Read to Rover program at Franklin Avenue School in Westfield, which was designed to help children who have difficulty with reading.
When the dogs arrive in the classroom, all the students are allowed to pet them before they are sent off with the children in the program.
“It helps with their self-esteem because their classmates think it’s pretty cool. Plus, it provides an opportunity for them to sit and read to a very attentive and loving audience,” said teacher Carly Bannish, explaining that the child sits on a beanbag, the dog sits on a little carpet, and the trainer sits nearby on a chair and is available if the child needs help with a word.
The program has resulted in an increase in reading fluency and comprehension. “The dogs are a non-judgmental audience, so it is a very safe environment for the children to practice something that may be difficult. The dogs give unconditional love, whereas adults correct children or try to help when they make a mistake, which can get pretty frustrating,” Bannish said.
Kielbasa concurs. “The dog doesn’t care if the child reads correctly or mispronounces a word, which can be embarrassing if they are reading aloud in their classroom,” she said.
Children who are hospitalized can suffer from anxiety and stress, and Hagerman said the K-9 dogs also improve life at Shriners. “The environment here can be intimidating as there are so many things that are new to children. The dogs make them feel more at home, and if a child is having a down day, the dogs can really lift their spirits.”
Visits take place in the hospital auditorium because animals are not allowed in the direct-care areas due to stringent infection-control policies, which include a handwashing protocol. However, all children who are medically able to attend are invited.
Peyton Malloy entered Shriners Jan. 9 and was there until the end of the third week in March. “It was so exciting for him every time the dogs came to visit. He looked forward to it,” said his mother, Anne Malloy.
The 6-year-old would hold the small dogs on his lap and pet them and play fetch with the larger breeds and try to make them do tricks. “He would stay for the entire hour. He absolutely loved them, and it made a real difference,” Anne said. “It was something he looked forward to. He would peek out of the door to see if they were coming. And when the talking pug said, ‘I love you,’ he would say it back to the dog.”
Hagerman said the opportunity to play or cuddle with a dog has inspired children to leave their rooms, which can improve mobility and help with their mood. “It provides a diversion from the normal hospital routine, helps them pass the time, and is something to remember that is positive,” she said, adding that staff members take pictures of the children with the dogs, which they are given to bring home.
Kielbasa agrees. “It takes their mind off of things, especially if they are facing surgery or doctor’s appointments. And we do just as much with the parents as the children, as they are also nervous. It doesn’t solve anything, but it helps with what they have to deal with that day,” she said.
Playing with the dogs can also aid in physical therapy, as the interaction involves movement that is fun, rather than repetitive. And in some cases, children who have been hospitalized for months have developed strong bonds with the canines.
That also happens in the hospice setting. Mintz says it’s not unusual for a dog to cuddle in bed with a hospice patient. “It is very therapeutic because relaxation takes place when that occurs. And when our patients pet the dogs or talk to them, it distracts them from their symptoms. It is also a way to help them feel connected. Sometimes there is an opportunity for a patient to be involved with a dog for a few weeks or months, so a relationship develops.”
Kielbasa has also seen dramatic changes during visits a team makes to a youth-detention facility. “When we first started going there, the girls were tough and cold. But after a couple of months, they turned into marshmallows when they saw the dogs walk in. They got excited, wanted them to do tricks, and giggled and talked to each other,” she said.

Healing Touch
Laura Coon is a nurse manager at the Linda Manor Extended Care Facility in Leeds, and says Hinckley and her dogs are a welcome sight. “The residents light up when she arrives. So many people had a dog when they were at home, and the visits are calming for them because the animals love unconditionally and people warm up to their warmth. It’s lovely to see.”
It’s also a lovely and love-filled experience for all who take part in these programs.

Rockridge Retirement Community Changes with the Times

For Beth Vettori, success in senior living is all about staying ahead of the trends.
“I think it’s really important that communities such as this one never sit back and rest on their laurels and be satisfied with what they offer,” said the exective director of Rockridge Retirement Community in Northampton.
“We are continually looking at trends and what the stakeholders — meaning the residents, families, the new generations coming up, our employees — are looking for, and where we want to go in 10, 15, 20 years,” she said. “And the only way to stay successful as a community is make sure we’re aware of those things.”
Vettori speaks from experience, having overseen a tidal shift at Rockridge since arriving on the scene less than a decade ago.
Specifically, the facility, which had been a residential-care neighborhood since its inception more than 40 years ago, opened independent- and assisted-living components in 2004 that allow people to age in place, with a continuum of service levels — everything but nursing-home care — available as residents grow older and often frailer.
“One of the things people are constantly seeking is a place where they hopefully have to make just one more move [to nursing care], and we’re able to provide assisted-living services that allow for that aging in place,” Vettori said. “We hope that people are able to stay with us through their remaining days, as we provide a full spectrum of assisted-living services, such as personal care, medication management, meals, housekeeping, maintenance, those types of things.”
And while residents become part of the Rockridge family, Vettori explained, their family members can be exactly that, rather than overburdened caretakers.
“Sometimes, when somebody is living at home, a family member is the primary caregiver,” she said. “Here, they get to become just family again — a son, daughter, granddaughter, niece, or nephew.”
In this issue, Vettori sits down with BusinessWest to share some ways Rockridge is trying to create a true home life for people who, in many cases, can no longer live at home.

Sea Change
Rockridge was founded in 1971 by Elmo Young, who was given land by the Laurel Park Assoc. He partnered with the Deaconess Assoc. of Concord, Mass. to build a 61-suite residential-care neighborhood, and that it remained for more than 30 years.
But the expansion of 2004 added 12 cottages and 30 apartments in the new independent- and assisted-living model, reflecting a quickly growing wave of assisted living across Massachusetts and the U.S.
“When I started in the assisted-living field, there were maybe 20 or so assisted-living communities throughout the Commonwealth,” Vettori said. “Now there are about 200. There’s been an explosion throughout the nation.”
Then, in 2006, Rockridge responded to another industry trend — the growing prevalence of facilities targeted at residents with Alzheimer’s disease and other forms of dementia — by opening the Gardens, an assisted-living memory-care neighborhood with 18 suites.
“With the Gardens structure, it’s a small, close-knit neighborhood, with only private suites available, and that allows for a tight-knit, very family-oriented approach,” she said. “The ratio of staff to residents is such that it creates bonds that enhance the offerings for each resident and helps them maintain their individuality.”
The goal in such a community is to program a routine of meals, cultural events, and other offerings that follow a daily structure. “That helps decrease anxiety, and it helps when residents begin to have that cognitive decline,” she explained. “They have that routine, and they don’t have to worry about what to do next. The staff is right there to keep them at their baseline and provide them with experiences to help them thrive.”
With the Gardens or the standard assisted-living model, the goal is to keep residents satisfied and healthy at Rockridge for as long as possible. Many residents, Vettori said, are surprised at how much more vibrant their lives can be when they’re part of such a community.
“That’s one of the most common quotes we hear — that people felt they weren’t ready, but after they move in, they say, ‘I can’t believe I waited so long. Why did I wait so long? This is amazing.’
“They wouldn’t be able to get that sense of belonging by themselves; here, they start participating and get back into what they enjoy doing. A lot of residents come from rural towns, but even those in bigger towns had so many barriers to participating in external community events,” she explained, such as snow and the inability to drive.
“Here, participating in life is extremely fulfilling,” she went on. “We have an extremely wide range of eclectic, diverse programs and cultural events. We offer trips to Tanglewood and the Symphony, the Bulb Show at Smith College, Gould’s Sugar House in Shelburne, and concerts on the lawn.”
Transportation is available for errands such as shopping, banking, and medical appointments, while in-house activities run the gamut from bell-chime and craft groups to bridge and mah jongg clubs; from historical groups to exercise sessions such as yoga, tai chi, walking, and strength training.
Those tend to be adaptable, Vettori explained, “so that if somebody isn’t fully able to do one of the more intense activities, they’re more than welcome to join in and do it at a modified level. For many, that means yoga in a chair is fine.”
Across the range of activities and programming, she noted, residents have a seat at the decision-making table. “The population is always changing. We have planning sessions where the residents themselves actually have a say in the programs — ‘we’re not interested in this, let’s do something else instead, this is what I want to do.’ We don’t have cookie-cutter activities or programs by any means. That goes for all neighborhoods in the community. All continually change through the years, evolving to be what people are looking for. So they have to have a say; they know what they want.”

Touches of Home
Vettori kept coming back to that concept of family, of giving residents as close to a home life as possible when the arrive.
“There’s a feeling, when people come in, of a warm embrace, like a family,” she told BusinessWest. “People know each other’s names — not just staff knowing residents’ names, but residents know each others’ names — and the atmosphere here is truly welcoming. A gentleman who came two weeks ago said he was truly thankful to all the staff members and residents who came by; he said he was surprised at that kind of support. He had heard us talk about it, but when he came here, he said, ‘this is great.’”
Vettori said she’s personally gratified at some of the conversations she has with residents and family members — not just about their living arrangements, but about each other’s lives.
“This morning I was able to sit down and talk with a resident who had been here many years, chatting about my Great Dane and dog training,” she said. “She and her husband had trained dogs — they had a dog in the top 9 in the country — and being able to share those experiences from so long ago made her light up.
“Residents say they feel that heartfelt connection, and it’s truly amazing; it’s an endorphin rush that really keeps me young, and helps keep them young as well.”
Vettori added that she tries to encourage that kind of fulfillment among her staff, who eventually become a kind of second family to residents.
“My team — not just the management team but also the frontline employees — have a true heart for this community,” she said. “Knowing that they’re happy and fulfilled in their roles gives me satisfaction. I have a hard time if I know employees are not happy in their roles.”
Meanwhile, Vettori continues to think ahead, to the needs of the Silent Generation who populate the units at Rockridge and the Baby Boomers who are increasingly joining their ranks.
“We need to be very aware of what their needs are,” she said, “by working on that advanced planning — we call them strategic advancements — if we want to continue to offer what people are looking for in the next decade, and on and on.”

Joseph Bednar can be reached at bednar@businesswest.com

Unique Partnership Strives to Reduce Rehospitalizations

Avoidable rehospitalization, when a patient returns to acute care within 30 days of having been released, has always been an issue facing those professionals on the front lines of quality patient care.
Dr. Cynthia Jacelon is the director of the UMass Amherst School of Nursing’s Ph.D. program, as well as the scholar-in-residence at Jewish Geriatric Services in Longmeadow. Her particular field of research in health care centers on dignity of care in older adults. She told BusinessWest that the issue of rehospitalization has received renewed scrutiny in recent years due to federal health care reform.
Specifically, it is the Patient Protection and Affordable Care Act, which has numerous provisions. But one which hits the bottom line is a change in insurance reimbursements for patients who have been subject to what is called ‘avoidable readmission.’
“Rehospitalization has become a problem, in part, because hospitals are squeezed to discharge people at the moment they are ready,” Jacelon said. “Every time a hospital discharges someone at the first second that they are able to be in a different care setting, they are taking a risk that they misjudged that second. If they judge the moment correctly, they get paid for the hospital stay, and it’s all good. But if they misjudge the second, they now face financial penalties.”
However, a partnership comprised of employers, education providers, workforce-development leaders, and philanthropists, which has been in existence since 2006, is in the beginning stages of a program designed to target that concern. Among the many partners in the Healthcare Workforce Partnership of Western Mass. is the Regional Employment Board of Hampden County, where Kelly Aiken is the director of Healthcare Initiatives. She said this partnership is “invested in the future of nursing.”
As she explained, “the whole premise of the project itself is that partners have come together to solve a problem that no one organization can solve on their own. Care transitions are such a critical component of achieving all the industry’s goals around improving access, increasing quality, and reducing costs.”
Since September of last year, the program known as the Care Transitions Education Project (CTEP) has been in the first of three stages in three years to develop what those involved say is a means to directly address the issue of rehospitalization, from both a financial perspective and also that of providing the best in patient care.
And while one primary goal is to reduce financial strain due to rehospitalization, and both Jacelon and Aiken stressed that this is indeed an outcome, they said the implications for health care are nothing short of groundbreaking.
“Yes, it is a strategy to reduce readmission rates,” Aiken said. “But the genesis of our partnership has been about collaboration. It has been a perfect match for trying to advance the type of collaboration that is required amongst these settings, in education and in health care.”

Team Work
Aiken said the CTEP program would never have happened “if the broader partnership of the Healthcare Workforce Partnership of Western Mass. were not in existence.” That group is comprised of three groups:
In health care, the players are Baystate Health, Berkshire Healthcare Systems, Cooley Dickinson Hospital, Commonwealth Care Alliance, Genesis Healthcare/Heritage Hall, Holyoke Health Center, Holyoke Medical Center, Jewish Geriatric Services, Noble Hospital, Holyoke VNA & Hospice Lifecare, Sisters of Providence Health System, Mass Senior Care Assoc., Home Care Alliance of Mass., Mass. Coalition for the Prevention of Medical Errors, and VNA and Hospice of Cooley Dickinson.

In education, the stakeholders are American International College, Elms College, UMass Amherst, Westfield State University, and Greenfield, Holyoke, and Springfield Technical community colleges.
Finally, the workforce-development group includes the Regional Employment Board of Hampden County and its programs.
The HWPWM has many broad initiatives under its banner, Aiken said, but one of crucial importance is the CTEP. According to the State Action on Avoidable Rehospitalizations Initiative, avoidable readmission rates for patients returning into acute care are as high as 28% of all hospitalizations.
Of course, that rate has long been addressed by a health care industry seeking to offer the best in care to its clients, but the insurance reform puts readmission into high relief.
“Readmissions have long been an issue,” Aiken explained, “but never one that has been tied to reimbursement rates. Now, what is coming down the line … if a patient is going from one setting to another, and it is deemed avoidable, there are going to be changes to the reimbursement rates for Medicaid and Medicare patients. That insurance will no longer reimburse facilities if there is an avoidable readmission that takes place within 30 days of discharge.”
The CTEP timeline approaches its goals in three parts. Currently, the project is in phase one — creation of curriculum for nursing students and incumbent professionals. Subsequent stages are pilot projects to put that information into the field, and the final stage of the process is to disseminate the curriculum, findings, and information statewide. Aiken explained the steps.
“Right now, we’re developing the curriculum which will be packaged as training for our target audience — staff nurses, nurse managers, and nursing students — those health care professionals who are the point of care,” she explained.
“You take that big-picture environment where health care reform is changing,” she continued, “and then you take it down further to an individual organizational level where they understand they are not going to be reimbursed if they don’t change their process and improve their care. And then you take it down even to the unit level, where you say, ‘my workforce needs to understand how to improve care transitions so that ultimately the quality of patient care improves, and I’m going to be reimbursed in an adequate manner for the services that I’ve provided.’”
The second phase of CTEP involves pilot testing and evaluation of the curriculum, rigorously evaluated. “We will be determining if the curriculum itself can help us achieve the learning objectives that we’ve set forth,” Aiken said.
The third phase is about dissemination statewide. Aiken said the lead grantee for CTEP is the Mass. Senior Care Foundation, which is associated with the Mass. Senior Care Assoc., the trade association for long-term-care facilities.
“The fact of the matter is that we’re operating here regionally because of our history of collaboration,” she explained. “But we are working directly with a state-level organization because we believe that what we can develop here has implications across the state.”

Collaborative Effort
The curriculum is designed not for the purpose of reinvention of nursing standards, but rather to offer a new perspective on collaboration between acute and long-term care.
Jacelon said this is nothing short of revolutionary.
“Across agencies, from acute care and long-term care, there can be a lack of what I will call respect,” she said. “For instance, it’s easy for me, as a nursing-home nurse, to say, ‘well, that acute-care nurse didn’t do their job because this patient came here clearly not ready to be discharged from the hospital.’ And it’s easy for the acute-care nurse to say, ‘they were OK when they left here, so the nursing-home nurse must not have known what they were doing.’
“So one of the goals of this CTEP curriculum is to build teams of nurses across settings,” she continued, “so the nursing-home nurse can say, ‘oh my goodness, something bad must have happened on the way here, because I know Joan at the hospital would not have sent me this patient in this condition.’ And for the hospital nurse to be able to say, ‘I know those people at the nursing home do a really good job, so it’s not their care that caused this person to come back; it’s something about the patient’s condition.’”
Summing up that hypothetical scenario, she added, “if we can build that respect, then you have much better communication across the changes of settings. And once you have better communication, then you have better transfers.”

Dollars and Sense
The financial incentives behind CTEP lie first and foremost with the acute-care facilities. But Jacelon and Aiken stressed that dollars and cents are important considerations for their organizations as well. Both stressed that readmission is first and foremost a problem under the purview of quality patient care, but there are fiscal ramifications for their organizations.
“The business point comes in for us because that acute-care facility is highly invested in not having their patients come back within 30 days,” Jacelon said, “and they’re going to be shopping, if you will, for the most effective post-acute-care setting for that patient.
“If the Jewish Nursing Home’s re-hospitalization rate is less than 10%, which I’m pleased to say ours is,” she added, “and the XYZ nursing home elsewhere is 25%, where are you going to send your patients? Therein lies the incentive for us; it makes us more desirable.”
Aiken said that, from the very start of the CTEP’s existence, the REB has seen this program as a means to address new-worker and incumbent-worker training and education needs.
“One, we have staff that our employers say are not prepared to face the future of health care,” she said, “and to help them in the success of their evolving business model. So in that way, it’s an incumbent-worker training need.
“From a new-worker perspective,” she continued, “we want to make sure that we are educating our new nurses so that they are prepared to take the jobs in the region that are here. And frankly, in the work that we had been doing before, we identified that new graduates weren’t interested in taking jobs outside the hospital setting. And in some cases, the employers weren’t prepared to take new graduates.
“There’s been this model for years that your first job is in the hospital, then you get some training, and then you can go into different care settings,” she added. “Well, it’s not necessarily the way it’s going to work in the future. Fewer and fewer jobs are going to be in the hospitals, so nurses have to be prepared and willing and excited to take the jobs that are going to exist in all these other care settings.”

Goal Standard
Because CTEP is funded through a Partners Investing in Nursing’s Future (PIN) grant, a collaborative effort of the Robert Wood Johnson Foundation and the Northwest Health Foundation, both Aiken and Jacelon are eager to see the regional impact of this curriculum and its outcomes. When asked about the national implications of CTEP, Aiken smiled.
“We would love to say that we can ultimately head in that direction, but I think that we start small and see where we can go,” she explained. “But PIN is involved in 37 states. That’s an incredible network that is in the future on our stage for dissemination.
“There is a great expectations of where we could go,” she added, “but first we have to get it right. And we feel that Western Mass. is a good place to test the waters.”
As an educator who has been actively building curricula for years, Jacelon said this is a fundamental building block in how nursing will be taught. “CTEP will be part of the curriculum of nursing school,” she explained, “and it’s designed for practicing nurses and for student nurses. It’s going to fill a hole in the curriculum, in that, to date, not a lot has been taught about these issues.”
Time will tell how CTEP will help to reduce rehospitalization rates, but like their other partner organizations, Aiken and Jacelon are both proud and confident in the partnership designing the curriculum and its subsequent programs.
“But it’s very hard to say whether a project like this will globally reduce rehospitalization,” Jacelon added. “Although, if the rates in the area decline over the next three years, it’s going to be because someone has done some intervention. That is our goal.”

WNEU Prepares to Launch Pharmaceutical Business Major

Even as businesses of most kinds have struggled during the Great Recession, health care has continued to be a growth industry.
The pharmaceutical sector is no different, with growth projected at more than 6% over the next several years by the U.S. Bureau of Labor Statistics.
But that growth is not only expected on the clinical side. Opportunities in pharmaceutical administration, finance, and sales and marketing, to name a few niches, promise similar growth.
For that reason, Western New England University will launch a new major in Pharmaceutical Business this fall. The multidisciplinary track integrates elements from the school’s pharmacy, health care, and business programs, preparing business students for careers in the growth industry of pharmaceuticals.
And, make no mistake, the major is targeted at business majors, not those seeking clinical health careers.
“It’s definitely students interested in business programs,” said Julie Siciliano, dean of the WNEU College of Business. “I think some business students see the advantage of a little specialization, of how an understanding of a specific industry can provide them with a nice entry into the job market. And jobs are what everyone is paying attention to these days.
“This program,” she added, “will help them better understand the fundamental areas of pharmacy, aside from the clinical aspects of evaluating the patient, patient management, and health care delivery.”
The major also prepares students for work on the business side of biotechnology and medical diagnostic devices, she added.
“We’re focusing on where the jobs are,” Siciliano told BusinessWest. “In this area, in the Northeast, we’ve got quite a few medical device manufacturers. We’re seeing that this major would also be good preparation for those who might want to go into the distribution or wholesaler aspect of the business, as well as the sales and marketing positions. Again, we’re providing extra expertise in addition to the basic business degree.”

Good Medicine
The demand for pharmacy professionals begins with a shortage of pharmacists, and growing opportunity in that field, which WNEU addressed when it opened its School of Pharmacy in 2010.
According to the American Assoc. for Colleges of Pharmacy, a variety of changing demographics and social and health issues will pose new challenges and opportunities in the pharmaceutical world. These factors include:
• Increases in average life span and the increased incidence of chronic diseases;
• The increased complexity, number, and sophistication of medications and related products and devices;
• The increased emphasis on primary and preventive health services, home health care, and long-term care; and
• Concerns about improving patients’ access to health care, controlling its cost, and assuring its quality.
In fact, according to a report by the Pharmacy Manpower Project Inc., a shortfall of 157,000 pharmacists is expected by 2020. “While the overall supply of pharmacists has increased in the past decade, there has been an unprecedented demand for pharmacists and for pharmaceutical care services, which has not been met by the currently available supply,” the report says.
Those opportunities are expected to be reflected on the non-clinical side of the sector as well, with job growth in pharmaceutical sales and marketing alone expected to approach 30% over just the next three years, according to government forecasts, Siciliano said.
“This major allows for interdisciplinary opportunities,” she noted. “Given our structure here at the university and our small size, the faculty were able to collaborate to create this major. We thought this was something students would want.
“So, on one hand, students are still getting the full-blown business degree, but this has courses specializing in the pharmaceutical industry, drawing upon some of the expertise out of our pharmacy school. There’s a nice course, where professors come over and provide a survey of various aspects of pharmacy. There are a variety of pieces.”
The new business/pharmacy track also requires more science courses than business students are normally required to tackle.
“All college business students take two science cources, but this program has four course requirements in science, areas like biology and chemistry,” Siciliano said. “The faculty are developing some extra courses, things like human organ systems, diseases and therapies, cancer and the immune system, and human reproduction. This really allows for collaboration between the two schools.”

Come Together
This isn’t the first time WNEC has combined a business degree with a health-related field, however. The college’s general business major previously added a health care administration concentration for students interested in a career in the business side of the medical field, such as the administration of a hospital or other health care provider.
“They get to pick a few more options and gain a basic understanding of the business components of any administrative area of a hospital or another provider environment, anything involving the business aspect,” Siciliano said. “They pick from a variety of courses, whether it’s psychology, social work, or another area, providing them with a little more industry-specific knowledge and, of course, an internship.”
The College of Business has also partnered with the College of Pharmacy to offer a joint degree program, where students can earn their doctor of Pharmacy and their MBA at the same time. Candidates can apply for the program following the completion of their first semester in the College of Pharmacy.
“We offer a PharmD/MBA combination without any additional time on campus,” she told BusinessWest. “Just as the JD/MBA has become popular [for those interested in business law], the PharmD/MBA is becoming more popular across the country.”
Those types of programs, Siciliano re-emphasized are important particularly in a tough economy, because they give students a leg up on generalists when competing for particular career opportunities.
“It’s the kind of thing students are interested in, and their parents are interested in, of course,” she noted. “It works out really nicely because our structure is so unique. The thing with us is, our size is small, so our faculty are able to collaborate in such a way. The more of that we do, the better off we are. It provides students with a great opportunity that sometimes you miss at larger universities.”

Joseph Bednar can be reached at bednar@businesswest.com

A chart of acute-care hospitals in the region

Click here to download the PDF

A Health Care Proxy Ensures That Wishes Will Be Honored

No one likes to think about what might happen if they were in a serious accident or had a disease that left them unable to speak and make their wishes known.
But, unfortunately, such situations occur every day. And although people may have expressed opinions about medical measures that could prolong their life if they became ill or injured, loved ones may disagree on what is best.
Fortunately, there is an easy solution to the problem that costs $100 or less. People can create a document that declares someone their health care proxy, granting them the power to make medical decisions if a doctor declares the patient mentally incapacitated. This can result from a wide variety of circumstances, ranging from a stroke or advanced dementia to an auto accident. The document can include specific instructions, such as whether the person wants to be an organ donor or be cremated.
“Everyone who is at least 18 should complete a health care proxy after giving simple consideration to their intentions and the people they plan to appoint as future decision makers,” said Hyman Darling, an attorney with Springfield-based Bacon and Wilson, P.C., noting that it’s important to discuss decisions with the person named as agent/decision maker and provide them with a copy of the document.
Designating someone as a health care agent/proxy can reduce arguments among family members in difficult situations.
“Everyone wants to be in charge, but if a health care proxy hasn’t been appointed, no one is in charge, including the spouse,” Darling explained. And although doctors might perform surgery or proceed with treatments for a patient if everyone in the family agrees on a proposed course of action, if they disagree, the matter may end up in court and take weeks to resolve, especially if it is contested.
“It’s much better to have a health care proxy than not have one, even though there may still be family differences and a lot of emotion,” said attorney Jeffrey Roberts of Robinson Donovan, P.C. in Springfield.
If the document is prepared by an attorney, that individual can also defend it if a family member disagrees on anything. “The power to make life-and-death decisions only goes into effect if a physician declares a person mentally incapacitated. And if that occurs, the person designated as their agent is required to speak for them and act as they would act, which is not necessarily the way the agent would normally act,” Roberts said, adding that the more information a document contains, the easier it is to know exactly what someone wants and carry out those wishes.

Historical Perspective
The issue began receiving national attention several decades ago when high-profile cases, such as one involving a woman named Karen Ann Quinlan, came to light. After the 21-year-old suffered irreversible brain damage, her parents discovered they were legally barred from turning off the artificial life-support systems that were keeping her alive, even though her condition was deteriorating and doctors felt there was no hope of recovery.
Darling said this case, which ended up in the Supreme Court, and others like it cost hundreds of thousands of dollars to resolve and exact a heavy emotional toll on the families involved.
Prior to these cases, people typically assigned someone to take care of their affairs if they were unable to do so; this was often the case for soldiers who went to war. “But there was never anything legal where states allowed people to designate someone as their agent to make health care decisions for them if they became incapacitated,” Roberts said.
“This in a relatively modern concept,” he told BusinessWest. “In the past, the health care provider had the choice of relying on the nearest relative to make decisions or having a guardian appointed by the court if family members couldn’t agree or there were no relatives.
“The system called out for order because health care providers wanted some protection,” he continued. “It’s a very cumbersome procedure to have a guardian appointed, and if two people disagree, they have to go court and fight it out. The health care proxy law created a safe haven for Massachusetts residents that resolves 98% of these issues.”
In recent years, many states have enacted laws that allow people to sign a document which names someone to stand in their stead if anything extreme happens. “In Connecticut it’s called an advance-care directive, in Florida it’s a health-care surrogate, in Massachusetts it’s a health care proxy, while in other states it’s a living will,” Roberts said.
Documents that are legal in one state are honored by the others, and in Massachusetts the language typically found in a living will can be included in the proxy document. This language can include whether heroic measures should be taken to keep the person alive.
“Someone may only want to be given pain medication if it reaches that point,” Darling said. “And it’s a lot more stressful on the family if someone hasn’t named a health care proxy.”
He added that, if family members disagree with the person appointed as the proxy, the attorney who drew up the document can hold a family meeting.

Transfer of Power
Darling said physicians should have a copy of a person’s health care proxy form so they can release information needed to make medical decisions. He also advises clients to talk about their wishes with the person they plan to name as their agent.
One of his clients was a soldier being deployed to Afghanistan who did not want artificial measures taken to keep him alive if he was injured in the line of duty. He had planned to name his parents as his health care agents, but they told him it would be too difficult for them to carry out his directives.
Darling cited other cases where family members told a loved one they would not be comfortable doing what was asked. “The person who is appointed should be responsible, trustworthy, and able to carry out the wishes that have been expressed,” Darling said, adding that Internet tools such as Skype and e-mail make it easy for physicians to communicate with people who are geographically distant.
However, despite advance directives, decisions can still be difficult. “There is no bright line, but at least this gets rid of vagaries,” Roberts said.
Some people elect to name several individuals as agents on their health care proxy document, but Roberts advises against this. “The statue states that a person can name a proxy and an alternative,” he said, adding that listing more than one person has never been challenged in court. “But if you name three children, you may be creating arguments that the system was designed to avoid.”
Darling said a proxy document can include what is known as the ‘five wishes,’ which are included in a national advance directive created by the nonprofit organization Aging with Dignity. They are:
• Who you want to make health care decisions for you when you can’t make them;
• The kind of medical treatment you want or don’t want;
• How comfortable you want to be;
• How you want people to treat you; and
• What you want loved ones to know.
Although health care proxy documents can be obtained via the Internet, they do not usually include such provisions or language that specifies anything other than who the proxy will be. An attorney can provide that language or the person can do research and add it to the document. But the person named as proxy will need to have a copy of the document in the event of an emergency.
“Living-will language makes sure there are no arguments about issues as whether to put someone on a ventilator if doctors say there is no chance of recovery,” Roberts said.
Other things people need to know are that signing a new document revokes previous ones, and that Massachusetts law prohibits an ex-spouse from making decisions if the document was written while the couple was still married. In addition, people cannot list the administrator, operator, or employee of a health care facility such as a hospital or nursing home where they are a patient or resident as their proxy or resident unless the person is related by blood, marriage, or adoption.

Keeping the Peace
Roberts says that if people want to get their affairs organized, they should appoint a durable power of attorney as well as a health care proxy, so both their financial and health care wishes can be handled in the event that help is required.
“It’s the flip side of the coin and you can name different people,” he explained. “But in the end, you need a decider, even though the person may consult with other family members. And the more you do in advance, the more it reduces risks.”
It also gives people power over what might happen to them today and in the future if their ability to make and voice decisions is compromised. “It’s simple, but complicated,” Roberts said. But it’s a powerful measure that can provide people and their families with peace of mind, which is a priceless gift.