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Safe at Home

By Mark Morris

Cheryl Moran

Cheryl Moran says she increased staffers’ hours and pay to make sure they worked only at the Atrium during the pandemic.

Beth Cardillo said the arrival of COVID-19 caused a “wildfire effect.”

As executive director of Armbrook Village, a senior-living community in Westfield that offers independent and assisted living, as well as memory care, Cardillo said the first days of the pandemic created huge challenges for healthcare professionals who faced major decisions while working with limited information.

For example, hospitals were only admitting COVID-positive patients if they had a fever and showed respiratory symptoms. Some seniors at Armbrook, however, were testing positive but manifesting different symptoms.

“We had someone who tested COVID-positive, but he didn’t have a fever or a respiratory problem,” she said. “He felt weak, fatigued, and he almost passed out.”

Cardillo’s call for an EMT to transport the positive-testing resident to the hospital was met with disappointment when she was told the hospital would not admit anyone for the coronavirus unless they had a fever or respiratory symptoms.

“At that time, no one knew there were a host of other symptoms,” she said. “It’s nobody’s fault because nobody knew.”

Cardillo informed Baystate Medical Center about residents who showed different symptoms for the coronavirus, and the hospital quickly sent a team of specialists in infectious disease and emergency medicine to Armbrook to further examine these cases.

“Incidents like this were happening all over the country,” Cardillo said. “It’s how we learned that people can manifest other symptoms but still have the coronavirus.”

Similarly, at the beginning of the pandemic, health officials were not encouraging everyone to wear masks; later, with better information, they shifted course. As information on all aspects of COVID-19 improved and safety guidelines were implemented across the U.S., senior-living facilities that already had sanitizing and infection protocols in place increased their efforts to battle the spread of coronavirus.

Emily Tamilio, Corporate Marketing director for Rockridge Retirement Community in Northampton, said her complex revamped its already-strong infection-control policies before the state went into lockdown. “We’ve redoubled our protocols and to make sure all our staff is up to date on proper infection control, hand washing, and strict sanitization procedures.”

Beth Cardillo

“We had someone who tested COVID-positive, but he didn’t have a fever or a respiratory problem. He felt weak, fatigued, and he almost passed out.”

Meanwhile, at Atrium at Cardinal Drive in Agawam — an assisted-living facility exclusively for people with memory loss — Executive Director Cheryl Moran imposed strict screening procedures to keep residents and staff safe, such as requiring all outside agencies to get her approval before they could enter the facility.

In the caregiving community, it’s not unusual for workers at one assisted-living facility to take a second part-time job at a similar site or earn additional income by providing care at a person’s home. Moran knew she had to address this vulnerability to keep the virus away. “I met with all our associates and offered more money, more hours, and different hours to encourage them to work only for the Atrium.”

Tamilio said Rockridge also offered additional pay and hours to keep staff working only at that facility. “Having our people just work for Rockridge was key to preventing transmission.”

Both Moran and Tamilio said encouraging staff to work only at one community is one of the main reasons neither campus has had any COVID-19 cases to date. It’s an example of how senior-living communities across Western Mass. had to be creative and aggressive — and continue to do so — to protect the most vulnerable population from a pandemic that’s far from over.

Visitation Consternation

In mid-March, the state issued guidelines for senior-living facilities to allow visitors only after they’ve had a health screening prior to their entry. When the pandemic first hit, all three communities BusinessWest spoke with said they restricted all outsiders except health providers and other essential personnel. Unfortunately, that meant families were not able to visit their loved ones in assisted living.

“As disappointing as that was, we had a solid communication process in place, and we were transparent about any changes, so it was much easier to get the families, residents, and staff on board,” Tamilio said.

Cardillo also stressed that communication was key, and personally checked in with every family member. “We were honest with people and let them know what was going on, and they appreciated that.”

As a further precaution for those in assisted living, the Executive Office of Elder Affairs mandated that everyone be quarantined in their apartments. No communal dining or walking around the halls was allowed.

Emily Tamilio

Emily Tamilio

“We’ve redoubled our protocols and to make sure all our staff is up to date on proper infection control, hand washing, and strict sanitization procedures.”

Cardillo noted that many residents in assisted living have cognitive impairments that make processing and retaining information difficult, so structure and constant communication are very important. Still, cognitively impaired residents who had been making progress before the quarantine began to backslide.

“They were confused again, depression was setting in, and their anxiety increased,” she recalled. “In some ways, the social isolation was almost worse than the virus.”

Staff dressed in full personal protective equipment (PPE) began meeting one-on-one with each resident in their apartment. Cardillo said reaching out and having conversations with the residents began to make them feel better.

Moran said the configuration of the Atrium made it possible to allow residents out of their apartments and still keep them safe. “Because we have the space, we were able to socially distance our residents while still allowing them to take part in modified programs and activities.”

As late spring arrived and the weather improved, residents in most communities were able to go outside more often and socialize with others. Cardillo said positive changes began to happen the minute residents were able to enjoy some fresh air. “Whether it was having a conversation or taking a walk or simply looking at the birds, we saw their depression and anxiety lessen once they could spend time outside.”

The warmer weather also enabled the facilities to resume family visits. Moran said the Atrium has a designated area for outdoor visits where families can schedule time with their loved ones either after breakfast or after lunch.

“We can only allow two family members at a time, and they have to wear masks,” she explained. “Unfortunately, they can’t hug or kiss their loved ones, so they do air hugs and things like that.”

Videoconferencing through platforms like Zoom, Skype, and FaceTime have been effective ways for families to stay connected — and send air hugs to their loved ones — when a physical visit is not possible. Tamilio said Rockridge staff will often work with families to coordinate a videoconference or even a phone call to help them feel connected during the pandemic.

“There are many times when our staff are the eyes and ears for the families of our residents, so we work very hard to stay in contact with them,” she told BusinessWest.

Using videoconferencing tools is one more way to be reassuring and transparent with families and staff, Moran added. “It’s important for families to know about the place where their mom and dad are living.”

Cardillo talked about a recent Zoom conference conducted like a town-hall meeting that included 80 resident family members, as well as Armbrook department heads. The purpose was to let everyone know what’s been done so far to keep residents healthy and engaged, and their plans going forward.

“Many family members had no idea about everything we’d gone through to keep their loved ones safe,” she said. “They want to do this type of meeting again.”

Meeting with potential new residents and their families is an important part of any senior-living community. The arrival of COVID-19 has moved much of that activity from in-person meetings to videoconferences. For families who want a tour of the facilities, Tamilio said virtual tours have been an effective alternative to an actual visit.

“We can connect them to our community and help them feel engaged,” she said. “Videoconferencing also allows us to bring together multiple family members from different locations to answer all their questions in one meeting.”

Cardillo is still able to meet with families in-person in Armbrook’s private dining area by using social distancing and requiring masks for everyone. Before the meeting, she will have a phone conversation and send information so that, when a family arrives for the meeting, they have some idea about the community.

“I will show them apartments, but we can’t wander around the building anymore,” she noted. “That’s the only thing that’s really changed.”

While Moran is not yet meeting in person, she depends on virtual tours and has identified a number of families willing to serve in an ambassador-type role.

“There are several family members of current and past residents who are willing to speak with new families about their experience here,” she said. “They are able to give their perspective on how things have been going for their loved ones.”

Winter Is Coming

Seven months into the pandemic, and with fall and winter coming, the Executive Office of Elder Affairs is allowing senior-living facilities to permit indoor visitation to specific areas of the building.

Moran said the Atrium will use office space in its main building to screen visitors and supply full PPE. She plans to limit visits to 30 minutes and restrict visitors to meeting in the front areas of the building.

A similar visitor policy will be in effect at Rockridge, which is about to install an air-purification system to use in common areas. The idea is to monitor air quality to make sure those areas are safe, especially as they begin to open the dining area and allow more visitors

“We are trying to find the right balance between mitigating risk and enhancing the quality of life for everyone here,” Tamilio said.

As the weather gets cooler, Cardillo is looking forward to bringing activities such as exercise classes indoors. There will be limits on the number of people who can participate at any one time, but that’s just part of life in these times.

She reflected on the challenges facilities like hers faced with the sudden arrival of the pandemic back in March, and how far they’ve come. “At the beginning, we were all learning together at the same time. With all that we’ve learned since then, we have a much better handle on things now.”

She said residents are in a much better frame of mind these days, with no COVID-19 cases reported in months.

All the administrators we spoke with said a spirit of cooperation — with everyone pitching in and constantly doing more than expected — has been a true highlight of these last six months. To acknowledge that spirit, Cardillo is planning a series of recognition ceremonies for her staff in the coming weeks.

“We had people who got very sick, and our staff did some beautiful things,” she said. “Sometimes it was just sitting with a resident and holding their hand. Their families were really touched by it.”

With the pandemic still a daily reality, Cardillo said she and her colleagues are better prepared if there is another flare-up of the virus.

“We hope it doesn’t happen, but we’re ready if it does.”

Business of Aging

Team Approach

By Mark Morris

the Bioness L200

This device, the Bioness L200, helps patients recovering from a brain injury to re-establish the use of their arms and hands.

In the U.S., 2.5 million adults and children sustain a traumatic brain injury (TBI) every year.

The Brain Injury Assoc. of America (BIAA) reports that more than 2 million of those injuries are treated in emergency departments, while approximately 50,000 result in death. Nearly 280,000 are admitted to hospitals, after which patients transition to inpatient rehabilitation, where the goal is to get back to their maximum level of function and independence.

But what’s involved in that rehabilitation process for brain injuries? It depends on the patient.

“Many people associate traumatic brain injuries with a younger population because they tend to engage in riskier behaviors. Older people who hit their heads from slips, trips, and falls are also susceptible to TBIs,” said Jennifer Blake, an occupational therapist with the inpatient program at Weldon Rehabilitation Hospital, adding, however, that anyone at any age can sustain a brain injury.

The Centers for Disease Control and Prevention (CDC) defines TBI as a “disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury.“

Traumatic brain injuries are evaluated on a spectrum, said Blake, noting that someone who experiences a concussion, also known as ‘mild traumatic brain injury,’ can usually return to normal with just limited therapy. On the other hand, people with moderate to severe brain injuries require medical care and more comprehensive inpatient rehabilitation. Often these patients need some level of supervision after discharge.

On occasion, someone may have a head injury and not immediately recognize it. For example, if a person is in a car accident and has a broken leg, that might get the primary treatment focus, Blake explained. Even after a CT scan, the brain injury may not initially show up. “It’s only after further investigation, when the person is having trouble concentrating or paying attention, that they discover the brain injury.”

“When they see their arm move and their hand open and close, it boosts their confidence and makes them feel more hopeful; you can see it in their faces.”

Because our brains are essential to all our physical and mental functions, therapists have found that taking a multi-disciplinary approach yields the best results in helping people recover from a brain injury. A team of physical therapists, occupational therapists, and speech pathologists, supported by 24/7 care by medical staff such as nurses, doctors, and pharmacists, make sure all the patient’s needs are addressed.

“We meet once a week to make sure we are all on the same page,” said Julie Bugeau, an occupational therapist for Encompass Health Rehabilitation Hospital of Western Massachusetts. “We have an open discussion to determine where the patient is in terms of therapy and function. We also ask questions outside of the therapy, such as, ‘how are they medically?’ ‘Are they eating well?’ We try to look at all the factors that can affect their rehab.”

What’s the Plan?

Blake said most admissions in the inpatient setting last only two weeks, so working as a team helps them determine the patient’s eventual discharge plan.

“By working together in an interdisciplinary team, we can figure out what’s working, what’s not, and make changes along the way.”

Blake said an individualized plan for rehabilitation is developed by therapists who work with patients in three key areas:

• The physical therapist studies a patient’s mobility: for example, how well they can get from one place to another, their balance, and how well their motor skills can function;

• The occupational therapist helps patients with self-care skills, such as eating, getting dressed, bathing, as well as tasks like cooking, cleaning, and managing medications; and

• The speech and language pathologist addresses higher levels of cognition, such as memory, attention, concentration, problem solving, and decision making. Sometimes the pathologist works with patients whose brain injury causes dysfunction in producing or understanding language.

Advancing technology offers therapists tools to aid in rehabilitation that were not available years ago. Bugeau discussed how devices such as the Bioness L300 and H200 help brain-injury patients regain the use of their legs and arms. The L300 attaches to the leg and, through electrical stimulation, can aid a person’s ability to walk.

“The idea is that, with repetition, those leg muscles will be able to move properly without the external stimulus,” she explained.

Meanwhile, the H200 helps re-establish the movement of arms and the grasping action of hands. Bugeau said using these devices results in positive responses from her patients.

help brain-injury patients

The Bioness L300 is used to help brain-injury patients regain their ability to walk through electrical stimulation.

“We’ll have patients who say, ‘my arm doesn’t work — I have a dead arm,’” she noted. “Then, when they see their arm move and their hand open and close, it boosts their confidence and makes them feel more hopeful; you can see it in their faces.”

By employing the different therapies, Bugeau went on, the hope is to maximize the patient’s abilities. But, she added, “while the therapy is important, rest is also an important part of the recovery.”

While many patients transition directly from inpatient to outpatient care, Bugeau said Encompass also offers a home-care component for those who are not yet ready to make the move.

“We will help patients settle into their home and continue training with them and their families to make sure they are safe and getting stronger,” she said. “It’s an option we recommend until the patient is ready to move into outpatient treatment.”

Blake added that the outpatient phase of care at Weldon involves working closely with families during outpatient therapy to help them manage that part of the process.

“Let’s say a patient is receiving all three therapies in an outpatient setting,” she explained. “We will try to schedule all of them on the same day to make it a little less overwhelming for the caretaker.”

Blake said it’s important for the injured person and their support group to understand that, when a person suffers a brain injury, it can be a difficult adjustment for everyone involved.

“You can’t see the residual impairments from a brain injury,” she said. “The person might experience a personality change, or a once-independent person may now need lots of assistance with daily life.”

That’s why Bugeau’s staff involves the patient’s family in training and education early in the process. She said the classes help the family understand how their loved one’s brain injury is progressing and how to properly handle behaviors that are out of the norm.

“We make sure to screen every patient with a brain injury for depression because it is a such a common symptom associated with brain injuries.”

Steady Improvement

While plenty of information and support are available for families, Bugeau said the trick is not to overdo it.

“We create a folder with specific, individualized information that is appropriate to the patient’s injury. We don’t want to overwhelm the family, but we want to make sure they have the information they need.”

Blake and Bugeau encourage families dealing with a brain-injured loved one to take advantage of the support groups available at their respective organizations. Weldon offers a faith-based group as well. Both therapists also cited the Brain Injury Assoc. of Massachusetts as a solid resource for families.

In all cases, the goal is helping patients with a brain injury get back to a maximum level of function and independence.

“It’s hard to say how much time each person needs,” Blake said. “And while things can change quickly or gradually, people do improve and get better.”

Business of Aging

Joint Effort

By Mark Morris

Brianna Butcher

Brianna Butcher says her main priority is to help the patient gain back their range of motion, and “to turn that new joint back into a normal joint.”

In daily life, it’s easy to ignore the important role our knees, hips, and shoulders play in walking, performing simple activities, and helping us get around in the world.

Most people notice these essential joints only when they are in pain. As we age, the onset of arthritis can bring excruciating pain even to the most basic tasks such as climbing stairs and walking.

If medication and physical therapy do not provide relief, then doctors will recommend joint-replacement surgery.

Considered a safe and highly effective surgery, more than 600,000 knee replacements and more than 300,000 total hip replacements are performed each year in the U.S., according to the Agency for Healthcare Research and Quality. The surgery involves replacing an arthritic or damaged joint with a prosthetic made of metal, plastic, or ceramic to replicate the movement of the joint.

Once the surgery is done, then the real work begins, said John Jury, head physical therapist at Weldon Rehabilitation Hospital, noting that “a successful outcome depends on how much effort the patient puts into their rehabilitation.”

The vast majority of patients Jury works with have had total knee or hip replacements, while those with partial knee and shoulder replacements comprise a smaller number. Candidates for joint-replacement surgery tend to be age 50 and up.

“It’s prudent to wait as long as possible to do the surgery so they only have to have it once in their lives,” he said, noting that, if someone in their 40s had a joint replaced, it could wear out in their 90s and when they may not be a good candidate for surgery.

Physical therapy begins on “post-operative day zero,” which means only a few hours after the surgery takes place. Jury said therapy on the same day is especially common for knee replacements. The main goal of this initial session is to initiate moving, standing, and weight bearing, typically with the help of a walker.

“Over the next couple of days in the hospital, we will continue to work with patients on their flexibility with the joint, range of motion, strengthening exercises, and mobility to help get them home,” Jury said.

Some medical centers around the country send knee-replacement-surgery patients home the same day as the procedure. In Western Mass., Jury said, most patients with a total knee replacement are discharged within a day or two, while hip-replacement patients may be hospitalized for up to three days. Both operations are followed up with two weeks of home therapy.

“It’s prudent to wait as long as possible to do the surgery so they only have to have it once in their lives.”

Rehab treatment differs for knees and hips. Jury explained that patients with a hip replacement don’t usually require outpatient therapy after their sessions at home. Knee-replacement patients, however, are almost always scheduled for outpatient therapy.

Moving Experiences

And it’s during outpatient therapy that people like Brianna Butcher, physical therapist and supervisor for Select Physical Therapy, take over joint-replacement rehabilitation.

“Our main priority is to help the person gain back their range of motion and their gait mechanics, which is especially important for knees and hips,” she said. “We’re really trying to turn that new joint back into a normal joint.”

In addition to traditional techniques, therapists are finding new ways to help people get back to day-to-day life with the help of technology. Butcher said one effective tool she has used is called an AlterG. She described it as an anti-gravitational treadmill that uses inflated air to support the body during therapy.

“For people who are tentative about putting weight on their joint, this is a good way to help them get back to normal walking,” she said.

Also finding their way into physical therapy are phone apps. A patient recently asked Jury if there was a way to measure his knee’s range of motion from home.

“We found a couple of apps you can download to your phone that will measure range of motion,” he said. “A family member has to hold the phone next to the patient’s knee, and their movement can be recorded.”

Tele-rehab is another development that is showing promise in several studies here and abroad. Jury said the idea is to share a video of rehab exercises with the patient and follow up by phone, FaceTime, or another video app. The studies compare tele-rehab with the gold standard of care, which is outpatient therapy after a knee replacement.

“They are finding that patients can achieve similar outcomes to outpatient,” he noted, “and they are reporting higher satisfaction scores because they don’t have to get out of the house to drive to a clinic.”

Butcher said her patients are usually driven to physical therapy by someone because they are still taking pain medication and cannot yet drive.

Once the patient arrives, she often observes their sense of fear about starting the therapy.

“For some, this is their first time seeing a physical therapist, and the process can be painful, especially for knees,” she said. “We try to work within that threshold to help the patient make progress while being mindful of the pain, which can be difficult for some.”

On occasion, patients who already have a replacement joint on one side of their body will need a second one, such as the opposite knee or opposite side of the hip.

Butcher said that, in her experience, at least one of those joints proves difficult and painful for the patient during physical therapy.

“The body always responds a little differently from left to right,” she said. “If, for example, therapy on the left hip went great, the right hip just doesn’t want to cooperate.”

In Butcher’s view, therapists often get a bad rap because of a false perception that they somehow enjoy putting people through pain.

“Our ultimate goal is to help patients get back to a better place than before their operation,” she said. “We’re on their side.”

Jury pointed out that therapists are a valuable resource in terms of guiding the patient on what to do, but it’s also up to the patient to follow through. “It’s not an easy rehab, but you’re only going to get out of it what you put into it.”

For those who make the effort, the results can be life-changing. The American Academy of Orthopaedic Surgeons uses the term “second firsts” to describe the experience when patients can once again enjoy things like hiking and other activities that were not possible before their surgery.

For many patients, Jury noted, their biggest revelation is the ability to move around in the world again without a walker or a cane.

“They are happy to be able to return to a certain normalcy of activity,” he said. “Of all the patients I’ve talked to, none of them have said they wished they waited longer for the surgery.”

Bottom Line

Butcher talked about a recent success story in which the patient had undergone a total replacement surgery in his left knee before working with her.

“All he wanted to do was to get back into bowling again, and he’s throwing harder now than before his operation,” she said.

After living with pain for many years, people who have joint-replacement surgery and follow through on their physical-therapy program can often succeed to a point that Butcher describes as almost like having a new life again.

And this new life is the result of successful teamwork — with the patient being a big part of that team.

Business of Aging

Shifting the Balance

Visiting Angels Director Michele Anstett

When Michele Anstett opened a Visiting Angels franchise with her husband in 1999, it was only the ninth branch of a home-care company that now boasts more than 500 locations in the U.S. and overseas. Home care in general had yet to proliferate; maybe a dozen agencies were offering such services in the Pioneer Valley.

The law of supply and demand meant there were more caregivers than jobs, which was great for companies, she noted.

“We had more control, and they were more willing to do what we said. Because there were fewer agencies for these caregivers to go to, they had less choice. They were easier to hire back then — you could find a well-trained one easily because there was a deeper pool, and they were more experienced. The pay was lower — like $7.50 an hour when we started. And more of them were willing to work full-time. They were more likely to take whatever you could give them.”

These days, that balance has shifted, to say the least. Home-care services, both small independents and national chains, now dot the region, and workers are in demand.

“Now, it’s not us with the control,” Anstett said. “They have the control. They can pick where they want to go. They can choose how many hours they want to work. They’re less willing to take whatever you want to give them.”

It helps, she said, that her Visiting Angels franchise, now celebrating its 21st year, is a known name with deep roots in the community.

“You don’t have someone down the hall where you can yell, ‘hey, can you help me?’ This can be a challenge for some nurses, but the nurses we have appreciate meeting with a patient exclusively, being able to develop relationships they often don’t have time for in an acute-care setting.”

“When we first started, there were only a few businesses like this. It was just emerging, and it was something that was really needed,” she told BusinessWest. “Our model was based on what people wanted. We matched the caregiver to the client. We weren’t telling people, ‘we’ll come here at this time.’ We made it all about the client. But we also matched them with a caregiver, and they could meet their caregiver and say, ‘yes, this works,’ or ‘no, this isn’t a good fit.’ There’s a lot of work in matching a personality, skill level, schedule — it’s really challenging.”

That philosophy hasn’t changed over the years, but the challenge has become more intense with increased competition for certified nursing assistants, home health aides, and personal-care assistants.

Also more challenging is the level of care many patients require, in an era when hospital stays are shorter and Americans are living longer than ever before.

“I was a home-care nurse fresh out of nursing school in the early ’90s, and compared to the patients we saw then — even compared to five years ago, really — the patients are much higher acuity, much more complex, and they really need a lot of care coordination and are on so many medications,” said Priscilla Ross, executive director of Cooley Dickinson VNA & Hospice.

“One of the biggest roles of the home-care nurse is reconciling those medications, because medication errors are one of the most common reasons for rehospitalization,” she went on — for example, people often don’t follow instructions, or aren’t aware of certain drug interactions, or are mixing pharmacy prescriptions with mail-order drugs. “Things are so much more complex than years ago, with hospitals focused on shorter stays, and there’s pressure on skilled-nursing and rehab facilities for shorter stays as well, so people are coming home with more needs.”

Michele Anstett (second from left) with some of her team at Visiting Angels, from left, Julie Dewberry, Helen Gobeil, and Natali Pilecki.

For this issue’s focus on the business of aging, BusinessWest spoke with several home-care professionals about what’s appealing about this critical work, what’s challenging, and why those challenges are only increasing as the senior population in the U.S. continues to swell.

Return to Form

The VNA has a sizable clinical staff, as many of its clients have been in and out of hospitals or acute rehab settings. But the focus isn’t on the illness itself, Ross said, but returning people to functional status in the short term. “They want to get back to making dinner, doing the laundry, taking care of grandchildren. With nursing and rehab, that process can happen much more quickly.”

She noted that the national shortage of non-medical home health aides may be more pronounced than the shortage of nurses, but it’s a struggle for organizations to recruit both. For nurses, not only is the pay scale less than in, say, a hospital setting, but some nurses don’t like the autonomy and independence that home care requires; they’d rather work in a team setting. Of course, other nurses desire the opposite, and relish the idea of focusing on one patient instead of several at a time.

“You don’t have someone down the hall where you can yell, ‘hey, can you help me?’ This can be a challenge for some nurses, but the nurses we have appreciate meeting with a patient exclusively, being able to develop relationships they often don’t have time for in an acute-care setting.”

Julie Dewberry, marketing and recruitment specialist for Visiting Angels, agreed. “They like the one on one,” she said. “They don’t have the pressure of one person with five different patients. Some come from nursing homes and say they don’t want to do that.”

Helen Gobeil, staffing supervisor for Visiting Angels, said determining who will be a good care worker is as much art as science.

“It’s a mother’s instinct — you’ve got to feel it,” she said about sitting with prospective staff. “You see they’re caring, they want to work, they really enjoy elders. They don’t call them old people; they respect them. I have to feel it.”

That ‘feel’ can be as simple as whether the interviewee makes eye contact, Anstett said. “What’s their demeanor? Are they a warm and caring person? If they’re warm, caring, and compassionate, that’s the basis, and we can move on to skill.”

That skill can be reflected in many ways — their degree, their experience, perhaps a referral. Sometimes, the agency will bring on someone whose only experience was taking care of their grandmother. “If they have good character, we’ll put them on a companion case, with a mentor, and help them get more education. We didn’t do that before. Now that the pool is lower, we’re trying to find ways to bring in more people.”

One way is to offer more training to staff. In addition, Visiting Angels has done well bringing on nursing students from area colleges, who are able to supplement their income while gaining on-the-job experience. “They’re very good workers,” she said.

The shallower pool of talent is only one growing challenge; a tougher financial climate is another. Wages are higher — Anstett said her goal is to keep what she pays workers above Massachusetts’ minimum wage as it creeps toward $15 over the next few years — as well as higher recruiting costs and expanded paid medical and family leave in the Bay State.

Finally, as noted earlier, workers increasingly eschew full-time work and often make home care one of two jobs, and they increasingly resist set shifts in favor of flexible schedules.

“We are a known name with deep roots, but it is a challenge,” she said. “We do well, though — we’re finding people of quality. Because of our experience, we understand what makes a good caregiver and who wouldn’t make a good caregiver, and how to screen them properly.”

Constant Mission

Roseann Martoccia, executive director of WestMass ElderCare, says her 45-year-old organization’s goal has long been in line with the goals of the home-care industry.

“From the beginning, our mission has been constant: to help people remain at home with the supports they need,” she said, noting that most people, as they age, want to remain in their homes, with some measure of independence.

To help them achieve that goal, WestMass ElderCare offers a broad range of supports, not just home care, aimed at helping seniors live independently. These range from nutrition services — it delivers about 1,400 hot meals daily in seven communities — to adult foster care; from housing support to personal-care management, helping people with chronic conditions or disabilities direct their own care by hiring and supervising personal-care attendants.

In the realm of home care, the goal is similar to other agencies: to help transition people from rehab settings into the home, and to maintain their function there.

“Our goal is to provide compassionate care and guidance so people can live in their homes and communities,” Martoccia said. “When we visit the home, we’re setting up a plan of care. What is your family doing? What do you need help with? What do you want help with? What’s most important?”

“Generally, people have chronic conditions, and their family may be at a distance, or they may not have a lot of family supports,” she continued. “In that case, we might be providing more services to them, helping them with many things they may not be able to accomplish on their own.”

WestMass focuses on the needs of family caregivers as well as patients, she added — people who have to work or raise families, but still want to make sure their parents or grandparents are OK.

“A lot of times, we hear caregiver stories about how what we do helps them and gives them peace of mind,” she said. “They may be checking in daily or weekly, but they know services will be coming.”

Cooley Dickinson VNA & Hospice has a different model than home-care agencies that focus on non-clinical assistance, often over the long term. Instead, it hires nurses and physical, occupational, and speech therapists, among other team members, to help clients transition from an acute or rehab setting to home life over a shorter term. Involving family caregivers in the process is often critical.

“We offer things your average person can’t provide without some training — wound care, IV therapy, or teaching about disease processes and how to manage an illness and manage medications,” Ross explained. “We’re teaching family members how to do wound care, how to provide care at home.”

The other side of the company is hospice care, which can be a longer-term engagement for people who are grappling with terminal illness and the decisions that come with it.

“What matters to you? What are your goals? How do you want your care to play out? It’s really hard to have that conversation, introducing that sense of taking away hope from people,” Ross said.

“But often, when you open those conversations, you’re relieving a burden for the patient and their family, and giving them an opportunity to actually talk about the elephant in the room — and that can lead to earlier access to care,” she went on. “Studies show that the earlier patients get on hospice, the better they do in the course of their terminal illness and the better the family does in the bereavement process.”

Giving Back

There’s a large, framed photograph at Visiting Angels of an aide with Anstett’s mother-in-law, who required home care due to Alzheimer’s disease around the time she and her husband opened the franchise; she passed away a few years ago. It’s a reminder that these services hit close to home for many people, and they’re important.

And not just for the clients, said Natalie Pilecki, the company’s administrative specialist. For workers in this field — at least the good ones — it’s more than a job.

“Spending time with the elderly is always nice,” she told BusinessWest. “The hours are good, the flexibility is always good, and they enjoy socializing with the elderly. Every day is different — it’s different every time you walk into their house.”

A good work experience starts with the employer, though, Anstett said. “I think we all have to value our workforce. We did a survey of our caregivers, about what’s most important to them. They put the highest value on how they’re treated. Pay was second, and benefits third. We listen to our caregivers, and those are the things we work on.”

She noted that one client has been with the company for 13 years, just one of many long-term connections being made.

“You develop a relationship with clients and their families. It’s about giving, and when you give, people respond. The job gives back.”

Joseph Bednar can be reached at [email protected]

Business of Aging

Care Connections

Kathy Burns says Mercy LIFE’s team approach to care has helped seniors maintain and even improve their health.

Celina Conway tells the story of a man who arrived at Mercy LIFE after five years in a nursing home, and was so weak, he couldn’t even hold a cup with both hands. After five years receiving services there, though, he felt stronger than he had in a decade — since before his nursing-home stay, in fact.

“They’re getting stronger,” said Conway, the facility’s director of Enrollment and Marketing. “There are people who came here in wheelchairs and now walk — quite a number, actually. Those are not uncommon stories.”

Mercy LIFE is a PACE (Program of All-inclusive Care for the Elderly) program run by Trinity Health PACE that will celebrate its sixth anniversary on March 1. PACE programs are on the rise in the U.S. because the role they play — providing a range of health programs aimed at keeping seniors out of nursing homes — is becoming more prominent.

“We’re serving people who could be in nursing homes. The model was designed as a place for folks who need some care and need some eyes on them on a more regular basis than an elder living independently,” said Kathy Burns, the center’s executive director. “In fact, everybody who joins us has to be, in the eyes of the state of Massachusetts, clinically nursing-home eligible. And they tend to thrive here because of the intensive care management we do with this big, multi-disciplinary team.”

Indeed, that team includes primary-care doctors, home-care nurses, physical and occupational therapists, dietitians, social workers, among others, all working as a team on each enrollee’s individualized care plan. And it’s not just healthcare; it’s also a place for seniors to socialize, participate in activities, and be generally engaged in life.

“Everything is under one roof, kind of like a nursing home, but nobody lives here; they go home at the end of the day,” Conway said. “When people enroll in the PACE program, they agree to have all their services provided by the staff here, including primary care.”

It’s a managed-care model not far removed from accountable care, the model that has crept into hospitals nationwide, which involves teams of providers being paid by insurers to keep patients well over a period of time, rather than being paid for each treatment, test, and hospital stay.

“It’s actually the precursor to accountable care,” Burns said, noting that, about 40 years ago in San Francisco’s Chinatown neighborhood, families wanted a place for their elders to go instead of a nursing home — a central location where they could bring in health services. Medicare funded a trial run, and the model worked. A second PACE site followed in Boston, and today, 131 PACE programs provide services at 263 centers nationwide, serving about 51,000 participants.

Why? Because the model works, Burns said, giving one example of how such programs keep people healthier while saving money.

“We get a good idea how this person functions, what’s important to them, what their goals are, how we think we can meet their needs. They have the ability to say, ‘I don’t want to do this,’ but typically, once they walk in the door, they’re sold and they do want to enroll.”

“Everybody on the team is equally important in their observations of what’s going on with the elder. Let’s say a driver who’s driven Mrs. Smith here every week for a long time notices, ‘boy she’s really out of sorts today.’ He’s supposed to come in and tell his boss, who will come to the morning meeting and say, ‘Mrs. Smith isn’t right today.’

“So Mrs. Smith is sent right down to the clinic, and we’re going to look at her,” she continued. “And if she’s got, say, a UTI brewing, we’re going to get her on some antibiotics and take care of her right here instead of her going home, where the infection gets worse, and she ends up in the ER with delirium because the infection makes her delirious, and all of a sudden she’s in a psych ward spending Medicare or Medicaid’s money unnecessarily because what she needed was antibiotics, which we can take care of right here.”

Safe Haven

Mercy LIFE currently enrolls more than 300 seniors, about 100 of whom are on site on a typical day.

“We explain to people this is a different way to have your healthcare delivered, and we have conversations to make sure they want care delivered this way,” Conway said. “We want to help them live safely at home.”

If, after being assessed by a nurse, they meet the criteria of needing nursing-home-level care, team members speak further with them and their family members, she went on.

“We get a good idea how this person functions, what’s important to them, what their goals are, how we think we can meet their needs. They have the ability to say, ‘I don’t want to do this,’ but typically, once they walk in the door, they’re sold and they do want to enroll.”

Conway said Mercy LIFE enrollees are assessed and placed into one of four different activity levels, from totally independent to needing more help to memory care, and it’s not uncommon for people to move from one level to another over time. “If people are concerned they won’t find people like them, they will.”

The rehab gym is a popular spot where participants can get stronger, she added. Some sign up for time with a personal trainer, while others might work in small groups or one on one to deal with specific issues, such as balance.

“They always think they’ll get weaker and less mobile as they age, but we’re lifers; we’re planning to be with them for life. So we’re trying to do preventive care, which is less expensive than dealing with a crisis after an episode where somebody falls.”

Occupational therapists on the team also spend time in the home, and are always scoping out issues that could be dangerous, Conway noted.

“We are responsible for everything. So if someone needs a grab bar, or someone needs a toilet set, we are going to order it and deliver it ourselves, which is better than getting a script and going to the medical equipment store. It’s very personalized service. When we work as a team, we prevent so many hospitalizations, emergency-room trips, that sort of thing.”

Burns added that the attention and engagement seniors get at Mercy LIFE brings a richness and measure of security they might not find on their own. “It’s an intensive model of oversight that really keeps them safe at home, happy at home. A lot of folks who come here had spent years at a time just sitting at home watching television. Now they’re doing all kinds of interesting things in our day room, while they’re seen by doctors and therapists.”

And the care plan is different for everybody, Conway said as she walked with BusinessWest past a conference room where an interdisciplinary team was meeting, as they do multiple times each day, to discuss whatever issues may have arisen with some of the people in their charge.

“We’ve helped 550 people over the past six years,” she added. “We don’t discharge people to hospice. We serve people until the end of their life. It’s a beautiful model. To see people when they enrolled and then see the progress and the support they get is very rewarding.”

Burns agreed. “A lot of families have been incredibly grateful for that gift.”

Effective Model

Burns and Conway both came back repeatedly to the financial benefits of preventive care and the value of preventing incidents before they arise. “If you don’t have an ambulance ride, an ER visit, a hospitalization, and a rehab visit, you’re saving a ton of money right there,” Conway said. “I know our interdisciplinary team members work hard to prevent those four key things. Everybody’s happy as a result of that.”

There is no cost to the vast majority of the seniors or their families (there is a private-pay option for a small percentage of participants). Medicare grants the program a flat monthly premium, while MassHealth provides funding as well. However, this year, MassHealth reduced its rate by 2.1%.

“We’re advocating for some of that to be brought back,” Burns said. “The problem for small but effective programs like ours is they’re easy targets for things like that. And we’re really hoping MassHealth will consider pulling back that decrease.”

Those who work at the West Springfield site see that effectiveness every day, Conway said. “This is mission work. I don’t think you’ll find anyone working at Mercy LIFE for the money. They stay here because they enjoy it so much.”

She told BusinessWest she appreciates the chance to tell the Mercy LIFE story because many people still have misconceptions.

“People think it’s home care, they think it’s adult day health, they think it’s a doctor’s office … but it’s all of those things,” she said.

“It sounds too good to be true,” Burns added. “But it just works.”

Joseph Bednar can be reached at [email protected]

Business of Aging

Sound Judgment

By Kayla Ebner

The girl sits in her classroom and turns up the volume wheel on her hearing aid loud enough to hear her teacher. Suddenly, the classmate sitting next to her drops his book. She tries to turn her hearing aid down, but it’s already too late. A loud ‘bang’ echoes through her head, then ringing, and more ringing.

Decades later, Jen Sowards remembers exactly how moments like those — and hearing loss in general — felt.

She’s struggled with hearing loss for her whole life, although it wasn’t identified until she was 6 years old. Fortunately, technology in hearing aids continues to get better and better, and Sowards gets to be a part of the evolution. 

Her life experience with hearing loss inspired her to become an audiologist, a career she has thrived in for more than 18 years. After spending more than a decade practicing across the country in Portland, Ore., she returned to the East Coast, where she worked at Clarke Hearing Center in Northampton for about a year. She has since opened her own practice at Florence Hearing Health Care and continues to help people who face the same daily struggles as she does.

“My own experience helped shape my philosophy for clinical practice now. I remember the audiologist just not necessarily taking a lot of time to explain things to me.”

“My own experience helped shape my philosophy for clinical practice now,” said Sowards, adding that her interactions with audiologists as a young child weren’t always positive. “I remember the audiologist just not necessarily taking a lot of time to explain things to me.”

Now, years later in her own practice, she takes ample time to explain to patients what she’s doing, why she recommends one type of hearing aid over another, and much more.

Dr. Deborah Reed, doctor of Audiology at Ascent Audiology & Hearing in Hadley, compares the human auditory system to a piano. The sensory nerve cells in the ear are like the keyboard, and their job is to stimulate the auditory nerve fibers. 

Jen Sowards uses her personal experience with hearing loss to help her patients who face the same daily struggles she does.

“If we unroll that auditory nerve, each fiber would be tuned to a particular pitch just like each string of a piano would be tuned to a particular note, and the job of the keyboard is to play the piano strings,” Reed said. “What we look for during the hearing test is, how well is your keyboard working, and how tuned are your piano strings?”

To continue with this analogy, hearing aids are tuned to respond wherever the keyboard dysfunction is occurring. 

“The bottom-line job of the hearing aid is to restore speech sounds and to improve our communication,” Reed continued. “We’re not necessarily looking to just give you a bunch of volume, we’re looking to give you clarity of speech, and we can do that by fine-tuning the digital processor of the hearing aids today.” 

That’s a long way from the earliest hearing aids, which were hollowed-out animal horns in the 1800s. As technology continues to improve, more people than ever are able to receive custom treatment for their hearing loss — and more lives are being changed.

Beat of a Different (Ear) Drum

Now, Sowards no longer hears the ringing, and loud noises are no longer painful.

That’s because the hearing aids themselves automatically adjust the volume of sounds coming into them. If a sound is very soft, the hearing aid recognizes that and turns it up, and vice versa.

“They really came a long way to where, by digitizing that signal, they were able to have an automatic volume control,” she said, adding that a hearing aid is a lot like a mini-computer. “Being able to automate the volume control on those really made a big difference.”

This is just one way in which modern-day hearing aids have improved. From those initial hollowed-out animal horns, hearing aids evolved to giant battery packs strapped to a person’s chest. A lot of variations have followed — with the past decade in particular seeing a notable burst of progress.

“We’re not necessarily looking to just give you a bunch of volume, we’re looking to give you clarity of speech, and we can do that by fine-tuning the digital processor of the hearing aids today.”

Sowards was fit with just one hearing aid when she was identified with hearing loss as a child. Since then, research has shown that the brain processes sound a lot better when hearing clearly through both ears.

“The prevailing thought at the time was, ‘well, if you can hear with one ear, that’s probably good enough,’” she said. “But if you can hear well out of both ears, you tend to have much better processing for speech when there’s competing background noise, and you also have much better localization skills, or the ability to tell what direction the sound is coming from.”

To achieve this, the patient must first be fit with the right hearing aid. They come in myriad types and sizes, but the ideal match depends on their ear anatomy and severity of hearing loss.

“In a perfect world, we would want to fit the best technology with everybody, but we can’t always do that,” said Reed, adding that fitting hearing aids to people is very much a case-to-case basis. “Then, we have to make judgment calls around quality of life and need.”

For example, someone who is a manager working full-time attending events and interacting with people on a daily basis will want a hearing aid that can process noise much better. On the other hand, someone who works in assisted living might not need all the fancy features.

One of the more recent developments is fall detection. If a person falls, Reed said, some hearing aids now have the ability to detect that fall and issue an alert. If the person does not respond and cancel the alert, a message is sent out to an emergency contact list.

“What we know about people with hearing loss is they tend to be older and might be more isolated,” she explained. “We’re trying to keep them safe and independent.”

Another feature is the ability to Bluetooth hearing aids to a smartphone. Apps allow a person to adjust the settings of their hearing aid and pin that location, so the next time they go there, the hearing aid will adjust to those saved settings automatically.

Hearing aids are also rechargeable, whereas years ago, batteries needed to be replaced. Sowards says most hearing aids now last 20 to 21 hours before needing to be charged again.

Not every person with hearing loss needs hearing aids, but for those that do, plenty of technology is available to support their needs.

“We’re really fortunate today in that technology is amazing,” Reed said. “The digital processing available in hearing aids has never been faster or more accurate.”

Don’t Ignore the Signs

The effects of untreated hearing loss can be startling. An estimated 36 million Americans have some sort of hearing loss — that’s 17% of the adult population.

Unsurprisingly, the incidence of hearing loss grows with age; however, hearing loss is growing in teens as well. According to the Hearing Loss Assoc. of America, an estimated one in five American teens experiences some degree of hearing deficit. Meanwhile, 12.5% of kids between the ages of 6 and 19 have hearing loss as a result of listening to loud music, particularly through earbuds at high volumes.

And the effects go beyond the ears. Studies show that those with hearing loss show significantly higher rates of depression, anxiety, and other psychosocial disorders. Hearing loss has also been associated with decreased social and emotional communication and cognitive function.

Dr. Deborah Reed

“What we know about people with hearing loss is they tend to be older and might be more isolated. We’re trying to keep them safe and independent.”

 

When it comes to teens with hearing loss due to loud music, Sowards says two factors are hugely important: the volume of the music and the time the ears are exposed to the sound.

She compares the fine hair cells in the ears to a green lawn. “If you walk across it a couple times, those blades of grass spring right back up, and it’s no big deal. But if you and 20 of your friends walk that same path eight hours a day, you’re going to get a bare patch.”

The simple solution: be careful with how loud and how often you listen to music. “If it’s loud and constant, that’s when you start to see the damage,” Sowards said.

Reed gave another analogy: exposure to sunlight. Limiting the duration of loud sounds is similar to putting on sunblock or avoiding long stretches of exposure to harmful UV rays.

“It’s okay to listen to music a little louder when you’re working out or something, but make sure you’re turning it down when you’re hanging out reading or doing homework,” she said.

Signs a person may be experiencing hearing loss may include muffled speech and other sounds and difficulty understanding words, especially with competing background noise.

When experiencing symptoms like this, Reed said it’s important to visit an audiologist to get a baseline hearing test sooner rather than later. “What we know now that we didn’t know seven or eight years ago is that the sooner we start treating hearing loss, the better we do.”

Business of Aging

And the Road to Recovery Program Needs More of Them

Ray Bishop, left, with cancer patient Norman Clarke, says volunteers helped him overcome illiteracy, and this inspired him to be part of the Road to Recovery program.

When asked how he came to participate in the American Cancer Society’s Road to Recovery program, which recruits volunteers to drive cancer patients to medical appointments, Ray Bishop was more than ready to answer that question.

He grabbed a book he had with him and quickly pointed to a passage within it while explaining that, 20 years ago, he couldn’t have read it — because he was essentially illiterate.

With help from literacy volunteers, he was able to put that embarrassing problem — one that he somehow managed to hide from others — behind him. Those volunteers gave him a precious gift, he said, but also something more, the firm desire to pay that kindness forward.

“If volunteers can help me, then I can volunteer to help others — that was my thinking,” said Bishop, as he talked with BusinessWest in the waiting room at the Sister Caritas Cancer Center at Mercy Medical Center. He was there with Norman Clarke, a West Springfield resident he has driven to that facility several times over the past year or so.

Now battling stage-4 cancer that has spread from his gallbladder to his liver, Clarke says he will go on fighting the disease, through aggressive chemotherapy treatments “that won’t stop until I tell them I can’t take it anymore.”

To fight this fight, he relies heavily on the Road to Recovery program and people like Bishop, many of whom have what amount to backstories when it come to their volunteerism and, specifically, this particular program. Indeed, many have loved ones who have battled the disease, and some have fought it themselves.

But others, like Becky Mason, simply have some flexibility in their schedules and found an intriguing and quite rewarding way to take full advantage of it.

“I was looking for a volunteer opportunity,” said Mason, who has been driving for just a few months now. “They had a table for the Road to Recovery program at a breast-cancer event I attended recently with a friend. I knew there was a large need because I’ve had a few friends who have had different types of cancer, and in talking to them, one of their biggest concerns, beyond getting well, was all their appointments and how they had to go here and there. And they can’t drive, obviously.

“I never really thought about it, because I never had to go through it myself,” she went on. “But it is definitely a stressor in their lives to make sure they have the rides to and from.”

Kelly Woods says there is a strong need for new drivers for the Road to Recovery program to meet demand for the service.

There are more than 75 volunteers (50 who would be considered active) working to help relieve this stress by donating time and energy to the Road to Recovery program for the American Cancer Society’s Northwest Region, headquartered in Holyoke, said Kelly Woods, senior manager for Mission Delivery at that office, adding that each one has a different story, a different motivation for getting involved.

“Sometimes they’re cancer survivors or they have someone in their life who’s a survivor and they want to give back, or there’s someone they lost and that they want to honor,” she said, adding that, through November, volunteers provided roughly 1,000 rides in the four western counties. “But there are also individuals who are just looking for something meaningful to do; each story is different.”

Behind all their stories, though, is an even bigger one, said Woods, who told BusinessWest there is now a critical need for more drivers to meet the number of requests for assistance pouring into the agency. Among all the statistics she has regarding this program — and there are many — perhaps the most eye-opening, and easily the most concerning, involves how many requests the agency is not able to honor.

“Last year, in Hampden County alone, there were a little more than 300 rides that we could not meet,” she said, adding that, over the past few years, the program has lost some drivers due to what she called “natural attrition,” a situation that has actually led to fewer requests for rides.

This has left the local chapter in what she termed a rebuilding mode, meaning it is actively recruiting new drivers, with the goal of being able to meet more requests, thus generating more referrals down the road, as they say.

For this issue, BusinessWest takes an in-depth look at the Road to Recovery program, the drivers who are its life blood, and the critical need for more volunteers to step forward.

Driving Force

Mason works as a project manager for a company called Test America, which tests water and soil. Her duties fall largely within the realm of customer service, she explained, adding that she’s often on the phone with clients discussing scheduling or test results.

While there’s always plenty to do, there is room for flexibility with her schedule, she went on, adding that she had this flexibility firmly in mind when she learned about the Road to Recovery program and started considering whether she could become a part of it.

The more she learned, the more intrigued she became. She learned, for instance, that drivers can essentially choose their assignments and how many they take on — at least a few times a month is requested. She was intrigued by the mission, impressed by the level of training that drivers must undertake (more on that later), and motivated by the obvious need for more volunteers.

Becky Mason has been driving just a few months, but she already finds her participation in the Road to Recovery program very rewarding.

And just a few months in, she can say it’s been an extremely rewarding experience.

“It gives me warm fuzzies when I do it,” she explained. “I like to help people, and I feel that when I do this I’m making a good impact on the world, I’m doing a good deed that is making a bright spot in someone’s life. I can’t change the world, but I can at least help one person with one small thing that they couldn’t get done.”

With that, she pretty much spoke for everyone who has been part of this program, said Woods, adding that Road to Recovery has been a big part of the landscape at the cancer society for decades now.

At the heart of the program lies a very basic need. Indeed, cancer care has improved exponentially over the past several decades, but it is a simple fact that, in most cases, people need to travel to receive treatments — often several times a week and even daily, as with radiation treatments.

And a good many of them, even those with family and a strong core of friends, need help getting ‘to and from,’ as Mason put it.

“These treatments can last several months, and then there’s follow-up appointments,” she explained. “Even for people with a good family network and friends, that gets tapped after a while. It may be that at the beginning they don’t need any help, but as time goes on, they do.

“And sometimes, we just serve as that ‘in-between,’” she went on. “Radiation treatment is six weeks — that’s 30 rides. They may be able to parcel 20 together, but they may need us for 10. And sometimes, we do all 30 because people don’t have a support network.”

To become a volunteer, one must obviously have a vehicle, a valid driver’s license, and a good driving record, said Woods. But they must also undergo a screening process and some training, the former involving a criminal background check and the latter including everything from using something called a service match portal computer to pick and schedule assignments to understanding the many rigid privacy laws now on the books.

“It’s great for the drivers, because there’s flexibility,” Woods said of the match portal. “They can log in as often as they want, and the system communicates with them and sends them e-mails if there are requested rides in their area.”

But there are some things that cannot really be taught, she told BusinessWest, noting that drivers essentially have to learn how to share time — and a front seat — with someone going through perhaps the most difficult time of their life.

Elaborating, she said they have to get a feel for what to talk about and when, knowing that cancer patients have both good and bad days.

Bishop, who drives two or three times a week, a schedule he’s maintained since he retired five years ago, said he learned this early on. He also learned that many patients do like to open up about their condition, their treatments, and life in general.
“They talk to me more about their stuff than I think they do with their own families,” he said. “I’m kind of like a second doctor sometimes; they’re not afraid to talk about it.”

Clarke said that individuals like Bishop are more than drivers; they’re companions and good listeners who help take some of the stress out of an already very stressful and difficult time.

“A lot of the people who drive me have been through cancer or have seen a family member affected by it, and that’s why they’re doing it,” he said. “I can’t thank them enough — they take a lot of stress off my wife; I do this to break it up so that she can have a life without running me back and forth all the time.”

The Ride Stuff

Moving forward, the biggest challenge is to recruit more drivers and thus reduce the number of requests that could not be met, said Woods, adding that, while there are many retirees within the current roster of drivers, one doesn’t have to wait until they’re done working to be a part of this program.

Indeed, she said a number of college students drive, as well as those who work second or third shift, like police officers and firefighters, and those like Mason — and Woods herself — who have some flexibility in their schedules.

The only real requirement is to be able to drive between 8 a.m. and 5 p.m., when most all appointments are scheduled, she said, adding that those interested in volunteering can call (800) 227-2345 or log onto cancer.org for more information.

If they do call that number and become part of this special volunteer force, they will find a way to give back that is rewarding on a number of levels, said all those we spoke with.

They’ll discover, as Mason did, that while they can’t change the world, they can help one person in a very meaningful way.

George O’Brien can be reached at [email protected]

Business of Aging

A Warm Handoff

Jim Carroll says one of the most rewarding parts of his job is seeing people turn their lives around.

Addiction knows no boundaries.

This is the main message Jim Carroll, medical director at OnCall Healthy Living Program, tries to instill in everyone he comes in contact with.

By this, he means addiction can affect people in all walks of life, and is not specific to one group of individuals like the stereotype may depict.

“What many people don’t realize is, addiction is in your neighborhood, in your workplace,” he said. “It doesn’t have any boundaries.”

This is what he and other staff members at OnCall keep in mind at all times when treating patients who are recovering from a substance-abuse disorder. What first started as a mixed-treatment facility with urgent care and addiction switched over to strictly addiction services in early 2018.

The facility pulls patients all the way from the Berkshires to Worcester, and Carroll says between 550 to 600 patients visit the main office in Northampton and a satellite office in Indian Orchard.

Carroll began at OnCall in 2008 as an attending doctor before moving up to medical director in 2013, but has been on staff in the Emergency Department at Mercy Medical Center for 13 years, giving him plenty of experience with addition services and showing him how much need exists for this kind of care.

“It became clear over several years that we wanted our focus to be on the addiction side of things,” he said. “Being in the Emergency Department, we were always very well aware of the opioid crisis and what it was doing to each individual and society as a whole, so we wanted to be a part of the solution.”

And there certainly is a need.

“We’re all about getting people on the path to becoming a better version of themselves.”

The opioid epidemic in Massachusetts has skyrocketed over the last decade. The Massachusetts Department of Public Health reported 1,091 confirmed opioid-related overdose deaths in the state during the first nine months of 2019, with an additional 332 to 407 deaths expected by year’s end.

This makes the services OnCall provides even more imperative. In recent years, OnCall has been putting a new two-part model to the test to make its services even more effective, working toward trying to bring the number of opioid-related deaths much closer to zero.

Beyond the Medicine

Carroll said the mission for every medical provider and behavioral-health professional at OnCall is to help patients recover and lead healthy lives, providing a comfortable environment free of judgment.

“We’re all about getting people on the path to becoming a better version of themselves,” he explained. “The more people we have in treatment, the less people we have at risk for death from overdose that we see in the Emergency Department on an almost daily basis.”

In order to accomplish its goal of helping people get on a healthier and safer path, OnCall uses a two-part model and what it calls ‘a warm handoff’ to get patients back on track. This includes the use of medication along with therapy and other supportive services to help address issues related to alcohol and opioid dependence.

“I really couldn’t say that one would be okay without the other, which is why we utilize both,” said Carroll, adding that frequency of visits for therapy and medication checkups vary based on how patients are doing.

He added that one of the hardest parts is getting people to take that first step through the door. “One of our biggest challenges is getting people in for the first follow-up visit. When we actually get people to show up, they usually have a positive experience, and then they’re off and running on their recovery.”

He also noted that, according to the limited studies OnCall has conducted, somewhere between 70% and 90% of people who have an opioid-use disorder are not in treatment — yet another reason for the facility to eliminate its urgent-care services and move to addiction services full-time.

“We know a lot of people need help, and with a rise of more and more urgent cares, that became less of a need,” he said.

Another big challenge is the stigma surrounding addiction and treatment, and Carroll said people sometimes worry about how they are going to be treated. This has prompted OnCall to focus on cultivating a comfortable environment for patients from the time they walk in the door to the moment they walk out.

“One of the things we’ve been very cognisant of is what kind of environment we present for patients who present to our clinic,” he told BusinessWest. “Our philosophy and our feeling here is that, once someone actually presents here, they should feel very comfortable being here.”

Rewarding Challenge

“A no-judgment zone” is another way Carroll describes OnCall.

Unfortunately, stigma still does get in the way of people seeking treatment, and labels are often assigned to people who have substance-abuse disorders. He stressed that it’s important for people to realize addiction is a disease — one that can happen to anyone.

“Addiction doesn’t have any special predilection toward any race, gender, age, or profession,” he said. “When people actually understand the disease process and understand that addiction is a brain disease and that it’s not a moral failing, they’ll understand that this isn’t someone trying to proactively ruin their lives or the lives of the people around them.”

He drove this point home by asking a perspective-shifting question: “if someone had type-2 diabetes, would you hold that against them?”

Despite the various challenges that come with the job, for Carroll, the rewards are innumerable.

“Seeing the turnarounds that happen in people’s lives is amazing,” he said. “We see people at some of their lowest moments, and when we can be part of the support team that turns things around for them and you see people get their self-esteem back, their jobs back, their families back, that’s very gratifying as a provider. Seeing people literally turn their lives around in front of you is one of the most rewarding things of my professional career.”

And although the 600 patients OnCall currently serves might seem like a huge number, Carroll says the practice has the capacity for double that amount, and encouraged anyone who is suffering from a substance-abuse disorder, or knows someone who is, to seek help immediately.

“The busier we are, the more people we’re helping, and that’s a good feeling,” he said. “Until we aren’t seeing any overdoses anymore, we just keep moving forward and trying to be part of the solution.”

Kayla Ebner can be reached at [email protected]

Business of Aging

Man UP

Joy Brock

Joy Brock says organizations like the CONCERN Employee Assistance Program can bring mental-health resources to men — if they’re willing to ask.

Behavioral health is not a male issue or a female issue — it’s a human issue. Yet, the imbalance between the problems facing men and their willingness to seek help has raised alarm bells in the field over the years.

Suicide rates provide one of the starker contrasts, with men making up more than 75% of all suicide victims in the U.S., with one man killing himself every 20 minutes on average. Substance abuse — sometimes referred to as ‘slow-motion suicide’ — follows a similar track, ensnaring three men for every woman.

And, yet, men don’t want to bring up these issues, said Sara Kendall, vice president of Clinical Operations at MHA in Springfield.

“In our society, we have expressions like ‘man up.’ So many things in our culture are geared toward men being strong, and therefore, seeking any help — especially anything behavioral-health-related — been viewed as weakness,” she told BusinessWest. “It’s often difficult for men to feel comfortable talking to someone, so there’s a disconnect with how to help. We encounter that a lot.”

Joy Brock, director of the CONCERN Employee Assistance Program, which is affiliated with River Valley Counseling Center, has battled the same tendencies in her counseling and referral work.

“Oftentimes, men have this tendency to pull back and not discuss any mental-health stuff that’s going on with them,” she said. “They might be struggling with anxiety or depression or even social anxiety, but they’ll hide it.”

“Not all families sit down and say, ‘all right, as a guy, here’s how you handle this.’ They just tell you, ‘stop crying’ or ‘you’re being weak right now’ or ‘be a man.’”

Many times, the reluctance of men to seek help begins in their youth, with stereotypes that eventually harden into personality traits.

“We’re not all taught how to deal with situations growing up,” she noted. “We all come from different families, and not all families sit down and say, ‘all right, as a guy, here’s how you handle this.’ They just tell you, ‘stop crying’ or ‘you’re being weak right now’ or ‘be a man’ — all these social norms and stereotypes, which make it even harder when something’s happening to you.”

It’s a situation that’s exacerbated when one’s peers hold the same stereotypes, Brock added.

“Where do you go for help when you can’t go to your family and friends because they’re like, ‘oh, it’s not that big of a deal’? So some guys don’t talk about it, which is tough because it’s isolating. And if we hide it or pretend it doesn’t exist, it just keeps growing and gets to a place where you’re having breakdowns or meltdowns, or you’re getting suspended from work, and part of you doesn’t understand what’s going on.”

While difficult emotions — and clinical depression and anxiety — don’t always have a specific cause, there are some common stressors, she said, noting that divorce and unemployment can strike at the identity of men by altering their traditional roles and leaving them adrift, without pride or purpose.

It’s notable that men in small towns and rural areas have particularly high rates of suicide, and flyover states such as Wyoming, Montana, New Mexico, and Utah, as well as Alaska, have the highest rates of suicide in the country — a trend that has been linked to the decline in traditional male industries such as manufacturing, forestry, and fisheries, leaving large swaths of men in certain regions jobless or underemployed.

High rates have also been observed in veterans, young Native Americans, and gay men, with one possible common thread being perceived rejection by mainstream society, leading to strong feelings of alienation and isolation.

If there is an obvious trigger to feelings of depression or anxiety, Kendall said, it’s often easier to get men in the door to talk about it.

“The referral may come from a spouse. Oftentimes, a gentleman will come in and say, ‘I have to do this or lose my marriage, or lose my family, or lose my job.’ It’s tied to the fear of losing something. But once they’re here, they’re just as inclined to stay in treatment as females. There’s so much potential to help, if we can make it more comfortable for men to talk.”

Breaking Barriers

Besides cultural factors, Mental Health America notes three elements that may feed into the reluctance of men to seek help for mental-health issues.

The first is that awareness strategies are not targeted effectively to men. Research indicates that men respond more strongly to humor (especially dark humor) and, at least initially, to softer mental-health language. But, as Kendall noted, once men are engaged enough to learn more, there is often much less resistance to continuing the conversation.

The second factor is that men ask for help differently. Men are much more likely to accept help when there is a chance for reciprocity — that is, when they perceive an opportunity to help the other person in return, which wards off the feeling of weakness that is often associated with asking for help. Men also prefer to either fix or at least try to fix issues themselves when possible, before reaching out for help.

Sara Kendall says men tend to stay with needed mental-health programs once they begin, but getting the conversation started can be difficult.

Sara Kendall says men tend to stay with needed mental-health programs once they begin, but getting the conversation started can be difficult.

For this reason, Brock suggested that acceptance and commitment therapy (ACT) is an effective option for many men. Instead of putting the emphasis on talking about feelings, ACT stresses accepting the reality of one’s situation, choosing a direction, and taking specific action toward those goals.

“What is it you’re fighting for? What gives you meaning in your life? Let’s focus on that, while also acknowledging you don’t feel great about the situation you’re in,” she said. “It’s a different, more action-oriented approach, and works especially well for veterans.”

The third factor is the fact that men often express mental-health problems differently than women, leading to misdiagnosis.

Although both genders experience similar symptoms of some mental-health concerns, how they manifest and present those symptoms can vary. For example, women often respond to symptoms of depression by appearing disheartened, sad, or talking about feelings of worthlessness. Men, however, often respond with anger, frustration, impulsive behavior, or other manifestations that are often dismissed as normal male, acting-out behaviors.

“It’ll end up presenting like anger or sometimes irritability,” Brock said. “Sometimes they just get tired, they don’t want to do anything, they’re not motivated, or they’re pulling away from work or the things that normally interest them. Sometimes it’s physical — stomachaches or chest tightening, that kind of thing. Or they do a lot of risk taking or avoiding or trying to escape a situation. And they might use substances, like alcohol or drugs, to try to hide things.

“If you’re no longer enjoying activities, if it creates disruption in your life, let’s talk about that. It’s no different than a pulled back keeping you from baseball games.”

“Sometimes we don’t recognize what depression is,” she went on, “because when you think depression, you think sadness, and for guys it looks way different. If you’re finding you’re more angry or irritable, that may be depression. And if you’re pulling away and isolating from other people, that’s depression as well.”

Because depression, anxiety, and related issues can wreak as much havoc on daily life as physical problems, if not more, it makes sense to seek help, Kendall said.

“If you’re no longer enjoying activities, if it creates disruption in your life, let’s talk about that. It’s no different than a pulled back keeping you from baseball games,” she explained. “We’re all in the same boat, and it’s OK to talk about it. Asking for help is not a sign of weakness.”

Dispelling the Myths

Joshua Beharry, a survivor of suicide, has become a mental-health advocate and the project coordinator of HeadsUpGuys, which provides men with advice and resources to identify, manage, and prevent depression.

“Fighting depression is difficult. Not only do you have to fight the illness, but you also fight the stigma attached to it,” he recently wrote for the National Alliance on Mental Illness website. “For men, the fear of looking weak or unmanly adds to this strain. Anger, shame, and other defenses can kick in as a means of self-protection, but may ultimately prevent men from seeking treatment.”

He outlined several common myths that stand between men and recovery from depression, including ‘depression equals weakness,’ ‘a man should be able to control his feelings,’ ‘real men don’t ask for help,’ ‘talking about depression won’t help,’ and ‘depression will make you a burden to others.” Understanding the falsehood behind all of these is the first step toward a healthier life, he added.

“Being unhealthy and refusing to seek treatment can put pressure and stress on those that care about you, but asking for help does not make you a burden. It makes people feel good to help a loved one, so don’t try to hide what you’re going through from them. What’s most frustrating is when someone needs help, but they refuse to ask for it.”

An employee-assistance program like CONCERN, which contracts with numerous area employers, is a good place to start, Brock said. It’s intended to be a non-confrontational environment where someone can admit they’re struggling and learn about resources — such as outpatient therapy, anger-management and substance-use support groups, and perhaps more intensive treatments — that can help.

“Sometimes it’s easy to hide things under drugs and alcohol, so that men don’t even know they have a problem,” she added. “Sometimes men have trouble being assertive and communicating their needs. But when they drink, out come the feelings.”

Primary-care physicians are also a good place to bring up issues of concern, Kendall noted.

“Most of us have one — it’s someone we know and feel comfortable with, who doesn’t feel as foreign or off-putting to call,” she said. “I feel like that’s the safest place to start. They know you physically, and mental health is just as important as your physical health.”

The doctor might provide a number of options, she added, such as an outpatient behavioral-health clinic like the BestLife Emotional Health & Wellness Center that MHA recently opened in Springfield. The important thing is to get the conversation started.

“How can we make it OK for men to talk openly about this part of themselves, which is just as important as their physical health?” Kendall said. “Men need to hear that it’s OK to talk about feeling anxious or depressed, just as they’d be concerned about having a back problem or a knee injury.”

Taking the First Step

The bottom line is that mental health is a critical part of life, both Kendall and Brock said. Not only do men attempt suicide far more often than women, they tend to use more lethal means, and are successful — if that’s the right word — about two-thirds of the time.

“I think it’s just hard to talk about what’s going on with us,” Brock told BusinessWest. “We’ve been trained that we have a life to live, we have to get on with it, and we’re supposed to be productive members of society. The reality is, life is not perfect, and it’s not smooth.

“With mental health, in order to get through it, you actually have to go straight through it,” she went on, “and it takes an extraordinary amount of courage and willingness to face something that is terrifying and extremely painful. Most of us would prefer to go out the back door and say, ‘yeah, I’m not dealing with that today.’”

Those who choose to take action — to man up, if you will — are typically glad they did. But the first step, facing the truth, is often the hardest.

Joseph Bednar can be reached at [email protected]

Business of Aging

Education Anywhere

Marjorie Bessette says online nursing programs are opening doors to higher degrees at a time when the industry is demanding them.

Marjorie Bessette says online nursing programs are opening doors to higher degrees at a time when the industry is demanding them.

Back in 2010, the Institute of Medicine put out a call for 80% of all registered nurses to have a bachelor’s degree in nursing (BSN) by 2020. National nurse organizations picked up the goal as well — 85% is the current goal — while hospitals with ‘magnet’ status, such as Baystate Medical Center, maintain even stricter staffing goals.

One problem, though: RNs work full-time jobs, and many go home to a full slate of family and parenting obligations. And that leaves little opportunity to go back to school to take classes toward a BSN.

Enter the online model.

“The reason for the increase in online RN-to-BSN programs is the need to increase the number of BSN-prepared nurses in the workplace,” said Marjorie Bessette, academic director of Health and Nursing at Bay Path University.

“There’s a national initiative to have 85% of RNs be minimally at the BSN level by 2020, which is right around the corner,” she went on. “Nurses have full-time jobs and full-time lives. With area hospitals and work sites demanding BSNs, we’re trying to help that workforce shortage by creating accelerated programs online that nurses can take on their own schedule. They don’t have to be in class at a certain time.”

Bay Path, through its American Women’s College, launched its online RN-to-BSN program in 2015 and graduated its first class in 2017. It also offers online tracks toward master of science in nursing (MSN) and doctor of nursing practice degrees.

“Many students come in with an RN already, and they’re usually able to transfer most of their associate-degree credits toward a bachelor’s degree,” Bessette noted.

American International College (AIC) offers online programs for an RN-to-BSN degree, as well as its MSN track, which offers three concentrations: nurse educator, nurse administrator, and family nurse practitioner.

“Ultimately, both RNs and graduate-program students are already working nurses, and it can be challenging to go back to school while working on their chosen career, but the online format gives them the opportunity to do that,” said Ellen Furman, interim director for Graduate Nursing and assistant professor of Nursing at AIC.

“The reason for the increase in online RN-to-BSN programs is the need to increase the number of BSN-prepared nurses in the workplace.”

“They have to be online weekly, but when, exactly, to be online is up to them,” she went on. “So, a nurse might be working nights, or might be on days, and this gives them the flexibility to arrange their schedule to get their work done at a time that’s convenient for them.”

And convenience is paramount for young medical professionals who don’t need much more added stress on their plates.

“Many have families, and trying to balance that can be really difficult,” Furman said. “With the online forum, they can work when they want to work, or when they have time to work, rather than being at a specific place at a specific time on a weekly basis.”

And that, industry leaders believe, will lead to many more nurses seeking the higher degrees so in demand.

“There is currently an RN shortage, which seems to be cyclical. Some years, graduates are looking for jobs, and some years, there are multiple jobs per graduate,” Furman said. “Right now, there seems to be a real shortage. If you look at any healthcare institution in the region, they’re all looking to recruit nurses, and at higher levels of education, especially if they’re a magnet institution like Baystate, which is looking to increase their number of nurses with higher degrees.”

Setting the Pace

Cindy Dakin, professor and director of Graduate Nursing Studies at Elms College School of Nursing, said Elms offers all three tracks of its MSN program — one in nursing education, one in nursing and health services management, and the third in school nursing — online.

“You don’t have to be sitting in front of the computer at a specific time. Classes are not live. You can access the materials through the system,” she noted. “The faculty will load the syllabus and load all the assignments for the entire semester, so students know when each deadline is. That allows them to plan ahead if they want to get ahead. If somebody moves quicker, or if a vacation is coming up, you can get it done ahead of time if you want to. It allows flexibility when you can access the whole course and know what the requirements and deadlines are.”

Elms launched its first MSN program — a totally in-person classroom model — in 2008, then moved to a hybrid format, recogizing that nurses have busy lives, and the requirements of the job — with often-unexpected overtime shifts arising — made it difficult to come to class at times.

School nurses in particular were having a tough time making it to class for 3 or 3:30 p.m., Dakin noted. “They always had to be late, and we always made allowances for them, but they were still missing something in the first half-hour of class.”

The best option, department leaders decided, was a totally online program.

“It has helped to broaden our market,” she said. “Normally, students — even in hybrid programs — have lived within close proximity to Elms, and come on campus for classes. Being online, I have students from the North Shore, on Nantucket, and these people definitely would not have enrolled in our program if we still required face-to-face classes. Our base is much wider now.”

Bessette added that students face the same academic rigors as they would in a physical classroom, but they can complete the program on an accelerated basis to meet the requirements.

“It’s more convenient because, whatever shift you’re working as a nurse, you’re able to fit that in. When I went back for my bachelor’s degree, I did it the traditional way; we didn’t have an online program at the time. I went in the evening after work, one course, three nights a week, for 15 weeks. But I did my master’s online, and that made a huge difference.”

Most online nursing courses do require a clinical component, depending on the track. Also, “we have a few on-campus days, but those are minimal,” Furman said. “In the RN-to-BSN program, there’s no on-campus requirement.”

Breaking Through

Dakin was quick to note that, if students need to talk to faculty, the professor will schedule a session, or perhaps arrange to meet several students at once through a videoconferencing session.

In fact, technology has made the online model feel less isolating in recent years, she added. “When they load the course information, they may use PowerPoint, or they might tape themselves lecturing. Most of us, at the very least, do voiceovers, which lends a more personal aspect to it.

“Some students aren’t sure if they’ll like it,” she added. “They like the extra time, not having to travel to a specific place. But they’re also afraid of losing contact. But that doesn’t happen, and at the same time, it really broadens our base to recruit students.”

Furman agreed.

“There will be people who say, ‘I don’t think I can learn online.’ I’ve been that student who has been both online and in the classroom, and I’ll say that online education is not like it used to be,” she told BusinessWest. “Today, with technology as it is, there are so many more options to deliver content and more effectively teach students in that online room. I believe if a student says they can’t learn online, they just haven’t been engaged in the right program in the right way.”

Joseph Bednar can be reached at [email protected]

Business of Aging

On the Path of Discovery

Skip Matthews says Louis & Clark

Skip Matthews says Louis & Clark is continuing a process of evolution and response to changes in the marketplace that began in 1965.

By now, a good number of people in this region know the story of how the second-generation, 55-year-old company known to most as Louis & Clark came to take that name.

The sign over the pharmacy on Memorial Drive in Chicopee in the mid-’60s read ‘Airline Drug,’ an obvious nod to what was then known as Westover Air Force Base, just a few hundred yards away. But before long, many customers had unofficially renamed it, using the first names of the partners — and pharmacists — who had acquired the business, Louis Demosthenous and Clark Matthews, who just happened to share names with those famous explorers (sort of).

“There weren’t really marketing companies back then,” Skip Matthews, Clark’s son, explained with a laugh. “It was just … we were Airline Drug, the customers started calling it Louis & Clark, and they kept calling it that, so they changed the name. I imagine that feeds your ego pretty well, too.”

Perhaps a less-known story (although the company is investing considerable time and energy in telling it, as we’ll see later) is how this company continues to evolve and respond to change — within the industry, in societal needs, in demographics, and even in the way companies are operated.

We’ll start with the much longer name over the door. Under the ‘Louis & Clark’ in large type (with a stick figure in a wheelchair taking the place of a traditional ampersand) are the words ‘Pharmacy & Home Medical Supplies,’ and they go a long way toward telling this story.

“Our employees possess a world of knowledge. Our emphasis is on unlocking all that knowledge instead of having people place an order, come in and pick it up, and leave.”

Indeed, a company that once had several pharmacies scattered across this region has seen that division of the company remain vibrant while also taking on a different look and feel. There are fewer locations — in fact, just one — but also a greater focus on convenience and delivery.

It’s all on display at the company’s recently opened pharmacy on Brookdale Drive in Springfield.

Formerly located on Page Boulevard in the same city, the company calls this a ‘long-term-care-facility’ pharmacy, one that focuses on delivery, packaging, and medication management, especially through a relatively new service called the MediBubble, its new medication-management system delivered to those in assisted-living facilities, group homes, nursing homes, and independent-living situations within the community.

The MediBubble is a medication package that helps individuals safely manage what prescription medications they take, and when, he explained, adding that each package contains all of one’s medications for a specific time of day, this reducing confusion when taking multiple medications.

Diane Cordeiro says one of the main focal points for Louis & Clark

Diane Cordeiro says one of the main focal points for Louis & Clark is to build relationships and boost awareness of its many products and services.

“Sometimes it’s hard for people to remember if they’ve taken their pills,” he went on. “With MediBubble, they simply have to look at the sheet. If that bubble has been opened, they’ve probably taken their pills.”

Meanwhile, the medical-supplies side of the operation, which itself dates back to 1978, has grown considerably and also evolved to meet new and different needs and bring a higher level of service to customers. Matthews explained this by stressing that the company doesn’t simply supply medical equipment. It also provides education and advice, something that isn’t available to those who might be tempted to merely order something online.

“The big point of emphasis now is becoming more and more knowledge providers as opposed to order takers,” he explained. “That’s a challenge for us and a challenge for our industry; people have options — they can go to a pharmacy, or they can try to find something online. For people to come into our location, there has to be a reason — it’s too easy to buy things anywhere else.

“Our employees possess a world of knowledge,” he went on, adding that some have been in the business for three decades or more. “Our emphasis is on unlocking all that knowledge instead of having people place an order, come in and pick it up, and leave.”

Over the years, the company has developed a number of specialty services, including the Pink Mermaid Mastectomy Boutique, located in the medical-supplies location in Groton, Conn., and a focus on foot care in all its medical-supplies locations — in Springfield, Easthampton, and East Longmeadow.

And it continues to find new ways to bring quality service and convenience to customers, a pattern that has continued for 55 years. For this issue, BusinessWest looks at how this ability to respond, adapt, and evolve has positioned Louis & Clark for continued growth in an always-changing healthcare landscape.

Blazing New Trails

Before talking about the present and especially the future, Matthews first stepped into the way-back machine and returned to 1965 — and actually a few years before that, when his father and Louis Demosthenous were classmates at the Hampden College of Pharmacy in Chicopee, long since merged into the Massachusetts College of Pharmacy and Health Sciences in Boston.

After graduation, they went in different directions — mostly work at pharmaceutical chains — before deciding to go into business for themselves. They acquired Airline Drug, and as you now know (if you didn’t know before), the partners’ first names, not their last, as is so often the case, became a brand.

And a brand that quickly expanded its presence across the region as the partners opened additional pharmacy locations.

Indeed, just a few years after acquiring the Chicopee facility, they opened a second on Breckwood Boulevard in Springfield, across from Western New England University. Additional pharmacy locations were opened in the center of Wilbraham (1970), Ludlow (1971), Page Boulevard (1972), Baystate Medical Center (1988), Mercy Medical Center (1992), and Holyoke Health Center, among others. The first medical-supplies facility was located in one of the company’s pharmacies in West Springfield.

Kim Vigliotte, seen here in the fitting area

Kim Vigliotte, seen here in the fitting area in the East Street, Springfield location, is a compression specialist and pedorthist who consults with 25-30 customers a day.

As the landscape changed and pharmacy became much more of a volume business, the company consolidated those operations and focused its attention on the types of business that the large chains dominating that landscape were not interested in — specifically delivery and packaging, like the MediBubble, said Matthews, who has been involved with the business since graduating from college in 1987 and assumed full ownership a few years ago.

The recently opened facility on Brookdale Drive will deliver to individuals and facilities within a wide geographic radius, from Greenfield to the north to Westfield and beyond to the west, to Monson and Palmer to the east.

As noted, the service specializes in bringing packaged medications to those who take anywhere from five to 15 medications a day, and it is becoming increasingly popular, said Matthews, adding that the pharmacy side of the business remains vibrant — but different than it was decades ago.

And the same can be said of the medical-supplies division, which has seen more dramatic growth over the years.

Indeed, there are now four locations — what Matthews calls the ‘hub,’ a large showroom and warehouse on East Street in Springfield; a satellite location in Easthampton; a recently opened retail location in the Heritage Plaza in East Longmeadow; and the location in Groton, which was an acquisition of an existing facility.

As was noted earlier, Matthews said the focus is on not merely supplying or resupplying a wide range of items — from catheters to compression socks; from incontinence products to wheelchairs — but also supplying information, education, and guidance.

“People need help, and sometimes they don’t even know what’s out there to help them — like a different product or a different size of a given product,” he said, again stressing that the company strives to move well beyond merely taking and filling orders and dispensing more knowledge.

This is especially true when it comes to foot care, said Kim Vigliotte, a compression specialist and pedorthist, who spends much of her time at the East Street location, but rotates to all of the company’s medical-supply locations.

She told BusinessWest she assists individuals with a range of foot problems, including diabetes, vascular disease, and non-healing wounds, and sees, on average, 25 to 30 people a day at the Springfield location.

“A patient comes in with a prescription from their podiatrist or primary-care doctor, and we do a foot evaluation or evaluation of their legs, and determine which product would be most appropriate for them to address whatever issues they’re having, be it pain, swelling, or ulceration,” she said, adding that there are a number of products on the market now that can improve quality of life for such patients. Her work is focused on matching them with the right ones, and she acknowledged it’s very rewarding work.

Charting a New Course

While working to improve service to customers, Louis & Clark has also been working to improve efficiency and develop and then follow a roadmap for continued growth, and it has been helped in this regard by adaptation of what’s known as the entrepreneurial operating system (EOS).

In simple terms, EOS is a system by which companies large and small can manage and strengthen six key components of business operation: vision, data, process, traction, issues, and people.

Rachel Duda says Louis & Clark has been very proactive

Rachel Duda says Louis & Clark has been very proactive in its outreach to a number of constituencies.

The company now has separate leadership teams for its two divisions — pharmacy and medical supplies — thus enabling Matthews to focus more on the vision side of the equation and long-term strategic planning.

This new structure has allowed for better, sharper focus within each division, said Diane Cordeiro, the company’s marketing manager and also the integrator, or chief operating officer, for the medical-supplies division, adding that it also enables them to work better together toward the same goals.

“The integrator is the individual who is responsible for keeping all the different business units working together — finance, HR, operations, marketing — and just make sure that each unit is working to the best of their ability and that their leader is having them maximize everything they do on a day-to-day basis,” said Cordeiro, who joined the company in 1990 as a cashier and moved steadily up the ladder. “We want to have everyone working toward the same goals and being enthusiastic about their day-to-day, helping customers, working with referral groups, and enabling us to stand out from every other standard medical-supply location.”

Elaborating, she said one of the emerging priorities for the company is to make the public fully aware of all it does — and all the knowledge its employees possess, work that dovetails nicely with the main title on her business card: ‘marketing manager.’

“I want to see that part of the business grow,” she said, referring specifically to medical supply. “And, obviously, this involves making new relationships with new referral groups, maximizing outreach for relationship building, and just letting people know who we are and what we do.”

Rachel Duda, a marketing assistant for the company, said Louis & Clark has been very proactive in its outreach to a number of constituencies, including physicians’ offices, assisted-living facilities, nursing homes, and group homes, in both Massachusetts and Connecticut, in an effort to build awareness of the company as a resource.

“It’s all about education — individuals don’t know what they don’t know,” she explained, adding that the company has taken things to a higher level in recent years with a program called ‘lunch and learn.’

As the name implies, it involves lunch and learning — about Louis & Clark and its various services, said Cordeiro, adding that lunch is very often the only time to get the full attention of a staff at a physician’s office or residential facility.

“We offer these to any new opportunity or referral group,” she explained, “including doctor’s offices, home-care agencies, physical-therapy offices, rehab facilities, anyone who would be prescribing products that we dispense.”

The lunches are definitely having an impact, Cordeiro went on, adding that company is receiving prescriptions from a number of new sources. And they are just one example of more aggressive outreach that benefits both parties.

Another is a relatively new initiative involving on-site visits to senior centers and senior-living facilities for everything from ice-cream socials to hot lunches to what are known as ‘tune-up clinics.’

“Our in-house technician will go on site on a scheduled day, and any individual who is from that community can bring down their walker, their wheelchair, anything that might need some sort of adjustment, new wheels, new brakes, whatever,” she told BusinessWest, adding that for parts under $5 there is no charge, and for parts over that amount, the individual pays just the retail cost.

That explains why these tune-ups have become hugely popular and also a huge part of the company’s efforts to tell its story and build new relationships, something it’s been doing since Lyndon Johnson was in the White House.

Making More History

After Louis Demosthenous retired more than a dozen years ago and Skip Matthews took on a leadership role, there was brief — as in very brief, apparently — discussion about changing the company’s name again to Skip & Clark.

Those talks were brief because it was decided this name didn’t roll off the tongue as well and didn’t have the historical connection. Besides, Louis & Clark had become a regional brand, one that had become synonymous with service and innovation.

So, while the name hasn’t changed, the company remains, in a word, fluid as it continues to discover — pun intended — ways to better educate and better serve its customers.

George O’Brien can be reached at [email protected]

Business of Aging

Back in the Swing

Jared Bean

Jared Bean says he’s giving people the injury-prevention education he didn’t receive as a young athlete.

Jared Bean grew up in Hampshire County and played youth sports in Easthampton. He recalls learning about how to improve his performance and conditioning — but not how to avoid getting hurt.

“I didn’t have that education, and neither did my coaches, and I ended up with injuries,” he told BusinessWest. “Now, I want to prevent that and give some more resources to this area.”

He does that as program coordinator and certified strength and conditioning specialist at the Cooley Dickinson Wellness and Sports Performance Center in West Hatfield.

Bean, who is credentialed through the National Strength and Conditioning Assoc. (NSCA), recognized early in his career how important it was for clients to achieve pain-free movement.

“I worked in the community for a while and found my way into what I call a corrective-based training system. I came across people, both athletes and non-athletes, who had discomfort or pain in a joint while moving, so I got into the process of helping alleviate that.”

“We wanted to have a place where we can focus on keeping our community healthy, and maybe prevent a visit to the doctor or the surgeon or rehab.”

On one hand, the center — the only one of its kind in Western Mass. — helps patients in Cooley Dickinson’s rehabilitation programs by serving as a connector between post-injury rehab and real-world activity. Trainers have on-site access to Cooley Dickinson’s orthopedic providers and rehabilitation therapists to collaborate on program development, striving to create a seamless transition from rehab therapy to resumed athletic training or other activity.

Andrea Noel-Doubleday, assistant director of Rehabilitation Services, noted that Cooley Dickinson supports two trainers in Northampton High School and Smith Vocational and Agricultural High School, maintains seven rehabilitation locations, and launched a walk-in orthopedic-injury clinic last year.

“We felt like, wow, we’re really supporting athletes and people in the community from the time they get injured on the field to finding their way to a doctor to finding their way to rehab, and this seemed like the next logical step,” she told BusinessWest.

“After rehab, where’s the best place to go to get that continuing work to get back to top performance?” she continued. “Then we thought, who better to do it than us? Jared knows the surgeons, he knows the therapists, he knows what we’ve been doing, so it’s a seamless recovery. That’s really what we were going for.”

But, because of its emphasis on injury prevention, it’s also a place where non-patients are welcome to work out, as they would be at any gym, while also learning proper technique. The center’s classes and programs emphasize injury prevention for athletes of all ages, as well as optimizing performance for serious athletes.

“We really wanted to offer wellness programs, and that’s why we called it the Wellness and Sports Performance Center,” Noel-Doubleday said. “We wanted to have a place where we can focus on keeping our community healthy, and maybe prevent a visit to the doctor or the surgeon or rehab. I think that’s a need in the community.”

Broad Spectrum

Bean, who earned a degree in applied exercise science at Springfield College, saw friends go into athletic strength and conditioning, often working solely with athletes on one team.

“I always had an interest in trying to help a bigger variety of people,” he went on. “I’ve seen older couples that came to me because they wanted to move well enough to hang out with their grandchildren. I had a gentleman who lost a lot of neuromuscular control through disease and wanted to go to Greece for two weeks — that was the sole reason he came to see me.”

Other clients include a 63-year-old power lifter and a ju jitsu fighter in her late 30s who just signed her first professional contract. “Definitely, being here, I’m going to see a lot of variety.”

Noel-Doubleday agreed. “It depends on what the person’s goal is. Sometimes they just want to lift their grandchild up, and sometimes they want to go out and try kayaking, and their shoulder’s been bothering them. They do a little PT, and I say the next step is to see the strength and conditioning specialist. Once I’ve gotten you to feel better and move well, he’s going to really tweak it and move you to the next level. It really is the next step, and more people are looking for that.”

Andrea Noel-Doubleday

Andrea Noel-Doubleday says CDH wanted a place that focuses on keeping the community healthy.

She noted one patient who had some cervical issues, but from a physical-therapy standpoint, there wasn’t much more she could do. “He said, ‘I’d like to start lifting weights, but I don’t want to get hurt.’” So the Wellness and Sports Performance Center was ideal for that — because improper technique is common to all athletic endeavors.

“A lot of times, it’s really just faulty movement,” Bean said. “That creates imbalances in the musculature, which creates discomfort and irritation. Unless it’s addressed, it’s just going to be continued discomfort, and might progress into a larger injury.”

And when someone’s technique is poor, Noel-Doubleday said, they have to be retaught. The center will film clients engaging in certain movements — jumping, for example — and the playback clearly demonstrates what’s wrong.

“When you see it, it makes sense. I can tell someone all day they’re not landing properly, but when they visualize it, especially in slow motion, they’re like, ‘oh.’”

Jumping, in fact, is something the trainers focus on, as it’s a common mechanism for non-contact ACL injuries.

“No one wants those. That’s one of those injuries that’s really devastating to an athlete. That could be the end of their career,” she said. “And there’s no reason we should have them, ever. It’s about weakness and neuromuscular control. And we know what we need to do to prevent it. So we need to really teach that.”

That education should start young, she said, which is why the center offers an injury-prevention class for athletes ages 11-14. Attendees learn positional awareness and how to move safely throughout space, and, by increasing their balance and stability, they learn how to safety build strength, endurance, speed, and agility.

“We want to prevent those non-contact ACL injuries before they happen. We know why they happen and how to prevent it, and we want to offer people a place to learn that,” she explained. “But we also offer advanced performance for the older athletes — the high-school varsity and college player who really wants to take it to the next level, and is asking, ‘how do I condition better and build strength so I don’t get injured?’ We wanted to offer a place where it’s safe to do that.”

Other classes include adult fitness, a blend of strength, endurance, cardiovascular development, and other components of physical activity; a class designed to help those who have undergone ACL reconstruction or other hip or knee surgeries return to their sport safely by focusing on restoring strength, endurance, and mobility; and a total joint class, for individuals who have undergone total joint replacement and want to maintain joint health and function through structured training.

A Vision for the Valley

Noel-Doubleday said the center has so far seen a healthy blend of CDH rehab patients and people coming from outside the system. In either case, they benefit from the expertise available to Bean, as the center is housed in the same building as Cooley Dickinson’s Orthopedic & Sports Medicine practice, the walk-in injury clinic, and the physical- and occupational-therapy suite.

“We have rehab specialists across the hall and orthopedic surgeons and sports medicine physicians downstairs,” she said. “If he needs to touch base with somebody, he’s got a whole group of resources at his fingertips.”

As it is not a physical-therapy facility, per se, the Wellness and Sports Performance Center does not take insurance, she noted. However, clients may submit their receipts to their health-insurance company to try to get reimbursed for fitness classes and services.

“It’s exciting for our organization to embrace this vision. Nobody else is doing this,” she told BusinessWest. “We’re in the business of recovering from injury, but we’re shifting the focus to say, ‘let’s not get injured in the first place.’ We want to get our rehab patients to where they want to be, but I would love to prevent non-contact ACL injuries. I would love to not see them in the Valley at all. If we can be a part of that, to me, that’s really exciting.”

Joseph Bednar can be reached at [email protected]

Business of Aging

In Search of Heroes

In the spring of 2017, BusinessWest and its sister publication, HCN, created a new and exciting recognition program called Healthcare Heroes.

It was launched with the theory that there are heroes working all across this region’s wide, deep, and all-important healthcare sector, and that there was no shortage of fascinating stories to tell and individuals and groups to honor.

Two years later, that theory has been validated, and stories that needed to be told have been told.

Some of them have involved individuals known to many across this region, such as Sr. Mary Caritas, SP, former president of Mercy Hospital and an inspirational leader for more than 60 years. And Bob Fazzi, the first leader of the nonprofit that became known as the Center for Human Development, and later the founder of Fazzi Associates, a company that provides a variety of products and services to home-care, hospice, and community-based programs.

But many have involved lesser-known individuals and groups, many of them working on the front lines of healthcare, saving lives and improving quality of life for those they touch every day.

There are hundreds, perhaps thousands of heroes whose stories we still need to tell. And that’s where you come in.

Indeed, BusinessWest and HCN are now actively seeking nominations for the Healthcare Heroes class of 2019. Nominations are due July 12, and we encourage you to get involved and help recognize someone you consider to be a hero in the community we call Western Mass. in one (or more) of these seven categories:

• Patient/Resident/Client Care Provider;

• Health/Wellness Administrator/Administration;

• Emerging Leader;

• Community Health;

• Innovation in Health/Wellness;

• Collaboration in Health/Wellness; and

• Lifetime Achievement.

Since we launched this initiative, many people have asked, ‘how do you define hero?’ We generally reply by saying, ‘what’s more important is how you define hero.’

A hero is someone you have come to recognize as a difference maker, a game changer — someone, or some group, that has stepped forward and changed the equation in a very positive way through what they do day in and day out.

People and groups like these — the Healthcare Heroes for 2017 and 2018:

Patient/Resident/Client Care Provider

• 2017: Dr. Michael Willers, owner of the Children’s Heart Center of Western Massachusetts;

• 2018: Mary Paquette, director of Health Services and nurse practitioner, American International College.

Health/Wellness Administrator/Administration

• 2017: Holly Chaffee, RN, BSN, MSN, president and CEO of Porchlight VNA/Home Care;

•2018: Celeste Surreira, assistant director of Nursing, the Soldiers Home in Holyoke.

Emerging Leader

• 2017: Erin Daley, RN, BSN, manager of the Emergency Department at Mercy Medical Center;

• 2018: Peter DePergola II, director of Clinical Ethics, Baystate Health.

Community Health

• 2017: Dr. Molly Senn-McNally, Continuity Clinic director for the Baystate Pediatric Residency Program;

•2018: Dr. Matthew Sadof, pediatrician, Baystate Children’s Hospital.

Innovation in Health/Wellness

• 2017: Dr. Andrew Dobin, director of the Surgical Intensive Care Unit at Baystate Medical Center; and Genevieve Chandler, associate professor of Nursing at UMass Amherst;

• 2018: TechSpring.

Collaboration in Health/Wellness

• 2017: The Healthy Hill Initiative;

• 2018: The Consortium and the Opioid Task Force.

Lifetime Achievement

• 2017: Sr. Mary Caritas, SP;

•2018: Robert Fazzi, founder and managing partner, Fazzi Associates.

As we said, there are many more heroes to be recognized. To nominate one, visit HERE and click on ‘Our Events’ and then ‘Healthcare Heroes.’

Business of Aging

One Step at a Time

Scenes like this one — from the 20th Rays of Hope Walk five years ago — are played out each October in Forest Park.

Scenes like this one — from the 20th Rays of Hope Walk five years ago — are played out each October in Forest Park.

Lucy Giuggio Carvalho is a tough person to say no to, as Kathy Tobin found out one afternoon 25 years ago.

“I was a health reporter for WGGB, and I was in the lobby of Baystate Medical Center to do a story,” Tobin told BusinessWest. “And this little petite thing comes walking across the lobby, points at me, and says, ‘I had a dream about you, and you’re going to help me.’ And that’s how I met Lucy.”

Carvalho — then a nurse at Baystate — had been diagnosed with breast cancer some time earlier, and, inspired by an AIDS fund-raising walk she had recently participated in, had a vision to bring something like that to Western Mass. to raise money and awareness around the cause of breast-cancer research and treatment.

A quarter-century later, it’s safe to say that Carvalho’s creation — known as the Rays of Hope Walk & Run Toward the Cure of Breast Cancer — has done just that, and a whole lot more.

As it turned out, Tobin did help her; WGGB became the media sponsor of the first Rays of Hope walk in 1994, and Tobin spearheaded a half-hour documentary special to bring attention to the cause.

“She had this overwhelming desire, not just to do this walk, but to change the way we treat breast cancer,” said Tobin, who has come full circle since then, now serving as director of Annual Giving and Events for Baystate Health, which has long overseen the Rays of Hope organization.

The first Rays of Hope event attracted some 500 walkers and raised $50,000. Today, it has raised more than $14.2 million and attracts about 24,000 walkers and runners each October. This year’s annual fundraiser, slated for Oct. 21, will once again step off from Temple Beth El on Dickinson Street in Springfield and wind through and around Forest Park.

As usual, all money raised remains local, administered by the Baystate Health Foundation to assist patients and their families affected by breast cancer. Funds support research, treatment, breast-health programs, outreach and education, and the purchase of state-of-the art equipment, as well as providing grants to various community programs throughout Western Mass. 

“Sometimes I can’t believe all that’s been accomplished,” Carvalho said. “I never would have believed we could raise the amount of money we raised; $14.2 million over the last 25 years is a lot of money, and we can do a lot of things with it — and we have. I’m really proud of Rays of Hope and all we’ve accomplished.”

It wouldn’t have happened, she added, without the continuing, loyal support from the community. “We’ve mostly accomplished what we have through individual walkers and local organizations that have supported Rays of Hope from the beginning. Most of the agencies that got involved in the early years are still involved, as well as the walkers; they come back year after year.”

Carvalho said she created Rays of Hope with a very specific vision.

“I wanted to help people that were going through breast-cancer treatment, to help them navigate the healthcare system,” she explained. “I’d found it difficult, and it was my motivation to make it easier for other people, seeing that I had such a hard time. And I wanted the money to stay local, too. That was really important for me.”

Beyond the critical funding, however, she has long recognized the importance of Rays of Hope as a bonding agent for individuals facing one of life’s most daunting challenges, and the people who love them.

Lucy Carvalho (left) and Kathy Tobin at the first Rays of Hope walk in 1994.

Lucy Carvalho (left) and Kathy Tobin at the first Rays of Hope walk in 1994.

“I think the event is very unique in that, when you’re there, it feels like there’s a big hug all around you, and that people really care about you. It’s just uplifting to be involved, and it’s something to look forward to, something that has become a tradition.”

Tobin also compared the event to a massive hug — one with a great deal of feeling behind it. “We have such a support system in place. It’s like a sorority — but I shouldn’t say sorority, because men are diagnosed, too. It’s just a network of people who care.”

Changing Times

Dr. Grace Makari-Judson has witnessed the evolution of Rays of Hope from a clinical standpoint; she was appointed medical director of Baystate’s breast program at the same time Carvalho was organizing her first walk.

“Lucy’s initial mission for Rays of Hope was not only helping breast-cancer research, but trying to provide coordinated care … a holistic approach,” Makari-Judson said — in other words, to make the journey easier for others than it was for her.

“Thinking back, it’s amazing how much we’ve been able to do with addressing those goals,” Makari-Judson went on. “Twenty-five years ago, women were having mammograms in the hospital, sharing the same waiting room with people who needed X-rays or had pneumonia. Biopsies were done in the operating room, and women got unnecessary scars.

“Today,” she went on, “we have a dedicated breast center where women go for mammograms and other breast imaging. We have needle core biopsy, which is done at the breast center and is a less invasive approach, so women go home with a Band-Aid instead of a scar. That’s the minimally invasive approach started in the mid-’90s and has since become the standard of care. It’s the whole philosophy of less is more.”

Other examples are sentinel node biopsy, introduced at Baystate in 1996, and radiactive seed localization, started in 2010. Both are minimally invasive procedures that Baystate pioneered in the region that have since become national standards of care, Makari-Judson said — and both benefited from Rays of Hope funding.

Meanwhile, Carvalho’s vision of more coordinated care has become reality as well, the doctor said.

Dr. Grace Makari-Judson

Dr. Grace Makari-Judson

“Twenty-five years ago, physicians were seeing patients all in a row — the surgeon, then the medical oncologist, then a radiation oncologist,” she explained. “And sometimes that would leave women with conflicting information. In today’s approach, we have something called a multi-disciplinary breast conference, where we get all the experts together to review radiology images and pathologist slides and come to a consensus recommendation. That has had a positive impact on care and really enhances our mission.”

It’s a model, she said, that started to coalesce around the time Rays of Hope was being launched, and it eventually spread to all Baystate hospitals and eventually became the model of care regionally and nationally.

“Everything about cancer has come such a long way,” Tobin agreed. “Women don’t have to wait days for biopsy results; they don’t necessarily have to have drastic surgeries. Everything about treatment has changed.”

“Twenty-five years ago, women were having mammograms in the hospital, sharing the same waiting room with people who needed X-rays or had pneumonia. Biopsies were done in the operating room, and women got unnecessary scars.”

Then there’s the Rays of Hope Center for Breast Cancer Research, launched in 2011 with the help of a $1.5 million Rays of Hope grant. The center brings together a group of scientists with diverse areas of expertise who work toward reducing the impact of breast cancer — for instance, understanding how obesity, diabetes, and environmental exposures interact to alter breast-cancer risk and prognosis.

It’s important work, and not something to be taken for granted, Tobin said, adding that many events like Rays of Hope eventually peter out — Avon’s national fundraiser for breast cancer isn’t continuing this year, for example — and such events require a lot of work and diligence to thrive and grow.

“Sometimes the fundraising becomes secondary,” she added. “After a while, people want to be a part of it, but they don’t remember the fundraising piece, and that’s critical to our survival. We’re trying to drive home the point that, yes, we need your involvement, but we also need your fundraising, because that’s what makes the programs happen.”

And it’s not just Baystate programs that benefit, Tobin added. Other local organizations, like Cancer House of Hope, also rely on support from Rays of Hope.

“We’re always getting new people involved,” Carvalho said. “Unfortunately, it’s often because they have breast cancer or someone close to them has breast cancer — but that passion keeps us going, and keeps us a vibrant organization. I think we’re always going to walk until there’s a cure, and we don’t need to walk anymore.”

Personal Impact

Denise Jordan was first introduced to Rays of Hope by her late friend, Tracy Whitley, and she joined its advisory board in 2008. A decade later, she’s chairing the 25th interation of the event, dedicating her service to Whitley, who succumbed to the disease last year.

Jordan calls herself an ambassador for Rays of Hope, making public and media appearances and encouraging people to take part in the Oct. 21 walk. She hasn’t found it to be a hard sell.

“I think, as long as people are affected by breast cancer, there will always be a willingness to participate in an initiative whose main focus is finding a cure,” she told BusinessWest. “Also, unlike a lot of organizations, when you give money to Rays of Hope, you can actually say, ‘the money I gave went to this person or that person; I know that because all the money stays right here in the region.’”

During her time as chief of staff for the city of Springfield, Jordan helped establish Pink & Denim Days, when city employees took up that dress code in exchange for donations to Rays of Hope. “It was really an easy ask,” she said. “Folks were very enthusiastic.”

Rays of Hope has proven to be a meaningful event for both survivors and supporters, as well as an educational experience for all ages.

Rays of Hope has proven to be a meaningful event for both survivors and supporters, as well as an educational experience for all ages.

So was Jordan, when she was asked to chair the event this year, even though she had some reservations about the time commitment. But when she thought about her Whitley, and the way she not only battled cancer but became a strong advocate for survivors, it wasn’t a hard decision.

“There’s going to be some special things happening that day,” she said of this year’s walk. “I’m pushing to get more people involved. We’ve had participants in the past who have missed a couple walks, but, this being the 25th anniversary, we’re hoping to bring a lot of folks back to the walk.”

Tobin agreed. “We’re adding some exciting elements. We’re going to tell the story of the progress we’ve made and celebrate some joyous stories of beating the disease — and remember those we’ve lost. I think there will be some special moments.”

Having been active in the walk for 25 years, Tobin has lots of stories, but likes to recount one from the event’s first year. Her 4-year-old son attended and took in the speeches, and as he settled into his car seat for the ride home, he said, ‘I’m so glad I’m not a girl.’

“My feminist self practically slammed on the brakes,” she laughed. But when she asked why, “he said, ‘because I can never get breast cancer.’

“The earnestness of this little boy took my breath away,” she continued. “I realized in that moment the impact this walk was having, and could have, if someone that young understood the seriousness of breast cancer.”

The fact that he assumed it was a girl’s disease isn’t odd; many adults think the same thing, and Rays of Hope has created plenty of teaching moments around that misconception as well.

In short, it’s hard to overestimate the impact this 25-year tradition has had on breast-cancer treatment, research, awareness, education — not to mention the giant hug of support that so many women (and men) need.

“Lucy had certainly given us a gift,” Tobin said. “She had done something incredible in that parking lot that day, and $14.2 million later, we’ve seen a lot of profound moments.”

Added Carvalho, “there’s a spirit at Rays of Hope, and I don’t know exactly how it came to be, but it’s real, and it’s powerful, and it’s heartwarming. That’s what I’m proud of — how the community has come together to make a difference.”

Joseph Bednar can be reached at [email protected]

Business of Aging

The Power of Movement

Chad Moir turned his resentment against Parkinson’s disease into a chance to help others fighting the disease that took his mother.

Chad Moir turned his resentment against Parkinson’s disease into a chance to help others fighting the disease that took his mother.

As they don boxing gloves and pound away, with various levels of force, at punching bags suspended from the ceiling, the late-morning crowd at this Southampton gym looks a lot like a group exercise class at a typical fitness center.

Except that most of them are older than the usual gym crowd. Oh, and all of them are battling Parkinson’s disease.

“A lot of them have never boxed before in their lives, and now they get to put on gloves and punch something,” said Chad Moir, owner of DopaFit Parkinson’s Wellness Center in Southampton. “Some are hesitant at first, but usually the hesitant ones are the ones who get into it the most.”

Tricia Enright started volunteering at DopaFit before joining Moir’s team as a fitness trainer.

“I just fell in love with the people,” she told BusinessWest. “I absolutely love my job, and I don’t think many people can say that. But you come here, and they inspire you in so many different ways — they walk in here with all these things they’re dealing with and get in front of these bags, and they’re pushing it and fighting. It’s so amazing to see. It makes me want to come to work every day, which is not something I’ve experienced before.”

Tricia Enright says she’s inspired not only by members’ physical progress, but by the support they give each other as well.

Tricia Enright says she’s inspired not only by members’ physical progress, but by the support they give each other as well.

It’s not just boxing. Members at DopaFit, all of whom are at various stages of Parkinson’s, engage in numerous forms of exercise, from cardio work to yoga to spinning, and more. On one level, activities are designed to help Parkinson’s patients live a more active life by improving their mobility, gait, balance, and motor skills.

But research has shown, Moir said, that it does more than that: Exercise releases the neurotransmitter dopamine into the brain, slowing the progress of Parkinson’s symptoms.

Moir has seen those symptoms first-hand, by watching his mother, stricken with an aggressive form of Parkinson’s, decline quickly and pass away five years after her diagnosis.

“She went through a hard diagnostic process,” he said. “There were probably about three to four years where we knew something was wrong; she was going to the doctor, but they couldn’t figure out what it was. There are symptoms of apathy and depression and anxiety that come along with Parkinson’s, and those manifested first. So they were trying to treat it as a mental-health issue, but Parkinson’s was underlying everything the whole time. Eventually she got her diagnosis, and from there she deteriorated pretty quickly.”

Moir said he took his mother’s death hard. “I fell into a bit of a depression. I hated Parkinson’s disease and everything to do with it. I didn’t even want to hear the word Parkinson’s. But one day, something clicked, and I decided I was going to use my resentment toward Parkinson’s in a positive way and start to fight back.”

He used a half-marathon in New York City to raise some money for the Parkinson’s Disease Foundation, and ended up collecting about $6,000 — an exciting tally, as it was the first time he’d ever raised money for a cause. And he started to think about what else he could do for the Parkinson’s community.

“At that point, I was a personal trainer, and the more I looked into it, the more I found out that exercise is the best thing someone with Parkinson’s can do. All the research shows that it can slow the progress of some of the symptoms of Parkinson’s, so I started researching what people with Parkinson’s could do through exercise.”

He started working with individuals in their homes, but a visit to a support-group meeting in Southwick was the real game changer. “I asked the people there if they wanted a group exercise class, and they said ‘yes,’ so I started one. I think we had four people at first.”

These days, a visitor to DopaFit will typically see around 25 people working out. “Really, it’s set up like a regular gym would be — aerobic training, running, dumbbells,” Moir said.

“At that point, I was a personal trainer, and the more I looked into it, the more I found out that exercise is the best thing someone with Parkinson’s can do. All the research shows that it can slow the progress of some of the symptoms of Parkinson’s, so I started researching what people with Parkinson’s could do through exercise.”

The difference is the clientele — and the progress they’re making toward maintaining as active a life as they can.

Small Steps

The first DopaFit gym was launched in Feeding Hills in 2015, but moved to the Eastworks building in Easthampton a year later. This year’s move to the Red Rock Plaza in Southampton was a bid for more space; ample parking right outside the door and a handicapped-accessible entrance are pluses as well.

Meanwhile, a second DopaFit location in West Boylston — Moir lives in Worcester — boasts about 20 members.

When the business was starting out, Moir was studying occupational therapy at American International College. “That’s a grueling program, so I had to make a choice — and I don’t love school as much as I love this. The deal with my wife was that I could leave the OT program, but I’ve got to finish my degree.”

Today, he’s back at AIC, working toward a degree in public health. “They’ve been instrumental and supportive of what I’m doing here, creating a business and working with this population,” he said. “Any time you’re helping the public with a healthcare need, it becomes public health.”

The Southampton gym runs classes four days a week — exercise groups on Monday, Tuesday, and Thursday, and a yoga session on Wednesday. “Most people come two or three times a week, but some come every day,” Moir said, adding that members with jobs often make time for exercise before or after their work schedule.

Individuals are referred to DopaFit by their therapists, neurologists, movement-disorder specialists, and family members as well.

“Some go to their neurologist, who says, ‘you need to exercise,’ and they find out about us, exercise here for six months, go back to the neurologist, and their scores are better than they’ve been. When the neurologist finds out they’re going to DopaFit, they reach out and start referring more people. The proof is in the pudding.

“Exercise is the best medicine,” he added. “Your pills are great because they help with the symptoms of Parkinson’s, but when the medicine wears off, the symptoms come back right away. The exercise helps prolong some of that, so you’re less symptomatic for a longer period of time.”

When they first arrive at DopaFit, members undergo an assessment of where they are physically and where they would like to be in six months. Then they’re assigned to one of two exercise groups. No Limits is made up of people who don’t need assistance getting in and out of chairs and can move about freely with no assistive equipment, like canes, walkers, or wheelchairs. The second group, Southpaw, requires a little more assistance.

“The exciting thing is, some of those people come to that class with canes and eventually come in with no canes, and eventually they’re in the next class, running and jumping around,” Moir said. “Especially for someone who’s been sedentary for a while, it really makes a huge improvement.”

He said studies have shown that Parkinson’s patients who have been sedentary can show improvement in their symptoms simply by getting up and doing the dishes or another minor task each day, just because they’re up and moving. “If you take someone sedentary and get them moving in a training facility, sometimes the outcomes are almost immeasurable.”

Not to mention that exercise can be fun, Enright said.

“You get these people on the floor with a hockey stick and a ball, it brings them back to when they were 8,” she said. “They’re spinning and jogging, and it’s just so neat to see what it brings out in them. It’s such a testament for what this does for them. They’re pretty inspiring.”

Special Connections

Between the business and his studies, Moir doesn’t have a lot of time to stand still, but he said he occasionally allows himself to step back and let the potential of DopaFit sink in.

“I’ve been so deeply involved in it that I forget how special this really is,” he told BusinessWest, and not just because of members’ physical progress, but their growing confidence.

“A lot of times, they’re leery of going out to eat because they can’t eat a bowl of soup, or their food’s going to be shaking off the fork. When they come here, they don’t have to worry about that, or they talk about that with each other and tell each other, ‘oh this is how I get around that.’ Or, ‘when I go to this restaurant, I order this because it’s easier to eat.’”

Those conversations and the social support they gain at DopaFit hopefully translate to greater confidence in other areas of their lives, Moir said. “That support system is huge, and it’s special.”

Enright agreed. “They’re such a close group, and the support they receive is as important as the exercise, and they come for that too. But the physical piece really is amazing, to watch them slow the progression of the disease because of what they’re doing here.”

She said members are excited when they visit their neurologist, and the doctor is pleasantly surprised with how they’re managing their symptoms. “Exercising gives you a lot of confidence in your physical ability anyway, so that’s really cool to watch. They’re amazing.”

In addition to the exercise and yoga, DopaFit also hosts the Smile Through Art Workshop once a month, an art program for individuals with Parkinson’s disease that’s run by Moir’s wife, Saba Shahid.

“It’s even more gratifying knowing that, every day, I get to honor my mother. What’s happening here is a living testament to the values she instilled in me.”

“It’s the only art program in the country designed specifically for people with Parkinson’s,” he explained. “We do different art projects that work on different symptoms of Parkinson’s disease, like tremors. Or we’ll do a workshop on handwriting.”

One goal of that particular class is, simply, the increased independence someone gets by being able to sign a check or do any number of other tasks that most others take for granted. “When you give that back to someone, it’s another barrier they feel they can successfully navigate in society.”

Moir has certainly navigated his own path since those days when he was so angry about his mother’s death that he couldn’t even think about Parkinson’s disease.

“It’s even more gratifying knowing that, every day, I get to honor my mother,” he said. “What’s happening here is a living testament to the values she instilled in me.”

Joseph Bednar can be reached at [email protected]

Business of Aging

The Dream and the Journey

Officials take up ceremonial shovels during the groundbreaking for Hillside Residence on May 18.

Officials take up ceremonial shovels during the groundbreaking for Hillside Residence on May 18.

During their long and sometimes frustrating quest to secure funding for what would eventually be Hillside Residence, the Sisters of Providence never stopped believing the project’s model — blending healthcare and affordable senior housing — was worth fighting for. Now that the development is under way, they are even firmer in that conviction.

As she talked about the long and persistently frustrating quest to secure funding for the project that would come to be called Hillside Residence, Sister Kathleen Popko summed things up by recalling sentiments she expressed at the time — words that blended diplomacy, poignancy, and even a little sarcasm.

“I would tell people, ‘though our progress is slow … I’m making a lot of friends locally, regionally, and nationally,’” she recalled, with a phrase that hinted broadly at how many doors, in a proverbial sense, were knocked on by the Sisters of Providence, which Popko leads as president, as they sought to take a dream off the drawing board.

And also at how important it was to be making those friends.

Indeed, while making all those introductions, Sr. Popko and the other Sisters of Providence were gaining even more resolve as well. And it stemmed from the firm conviction that their unique model for Hillside Residence — the intersection of healthcare and affordable elder housing, if you will — was worth fighting for.

And fight they did, for the better part of eight years, a struggle that was ultimately successful and celebrated, as much as the project itself was, at an elabotate groundbreaking ceremony on May 18.

Fittingly, Sr. Popko, during her turn at the podium that morning, borrowed from St. Francis of Assisi to convey what it took to make that moment a reality.

“The journey is essential to the dream,” she said, invoking St. Francis’s famous quote. “With hindsight, I can see the truth and wisdom in that statement. Our eight-year journey to this moment expanded and sharpened our vision, tested our determination, enlarged our circle of friends, and committed supporters to this initiative. Let us work now to realize the dream.”

That dream, as noted, is to bring innovative, health-integrated, affordable elder housing to a region, and a city (West Springfield) where there is an acknowledged need for it, said Popko.

Elaborating, she said Hillside Residence, a demonstration project, will create 36 affordable rental units to frail elders, who will receive healthcare services from the Mercy LIFE PACE program (program for all-inclusive care for the elderly). Both programs are situated on the same 27-acre campus that was formerly home to Brightside for Families and Children.

And the expectation is that this $10 million project will demonstrate that this is an effective model for bringing needed services to what has historically been an underserved segment of the population, she told BusinessWest, adding that there have attempts to create affordable senior housing, but not in the same, holistic environment that Hillside Residence will create.

“This is innovative in that it will keep frail elders independent,” she explained. “They’ll live in an independent-living facility, but they’ll be supported in a way, on the same campus, that they can access a tremendous array of services and at the same time go home and live independently.”

For this issue, BusinessWest looks at both the dream and the journey that made Hillside Residence a reality — and why both are worth celebrating.

The Big Picture

When Brightside’s closing was announced in 2009, it left the Sisters of Providence with what amounted to a 27-acre canvas that could be filled in any number of ways, said Sr. Popko.

An architect’s rendering of Hillside Residence.

An architect’s rendering of Hillside Residence.

What made the most sense, she said, was to use the land and existing buildings, part of what’s known collectively as the Hillside at Providence, to help create a broad array of senior-living and senior-care facilities that would complement each other and meet recognized needs within the community.

This was a process that actually started with the conversion of the former Sisters of Providence Mother House into an independent-living and retirement community known as Providence Place in 1999, and it continued with the creation of Mary’s Meadow at Providence, a complex on the Providence Place campus comprised of 10-person houses designed to give elders a place to live in comfort equal to that of a private home. This was the first ‘small-home’ facility, as they have come to be called, in the Bay State.

The process of filling in the canvas at Brightside was accelerated with the creation of Mercy LIFE, a PACE program operated by Mercy Medical Center that provides tightly coordinated care and support designed to help seniors continue to live safely at home and avoid moving into a nursing home, she said.

The 25,000-square-foot facility, located within what was the main administration building for Brightside, includes everything from a medical clinic to a rehab gym to gathering places.

Meanwhile, the remainder of that 78,000-square-foot administration building has been devoted to reuses ranging from hospice care to a home for elder-focused programs administered by the Center for Human Development.

What emerged as a missing piece in the puzzle — and the next dream for the Sisters of Providence — was an affordable senior-living facility, one where the residents could take full advantage of the many programs and services at Mercy LIFE.

Talks for such a facility — and thus that ‘journey’ Sr. Popko described — began in 2011, she said, adding that it took the better of eight years (and work with four different mayors of West Springfield) to secure everything from the proper zoning to the needed funding.

And the latter part of the equation became more difficult when, in 2012, HUD, the U.S. Department of Housing and Urban Development, ceased funding for so-called ‘Section 202’ projects, those aimed at expanding the supply of affordable housing with supportive services for the elderly.

“So we had to take a step back and try to look for alternative sources of funding,” said Sr. Popko. “That included private sources and looking at federal grants and so forth.

“And they really weren’t forthcoming at the time,” she went on. “We visited many legislators and congressmen, and we brought in experts to come in and talk about some other concepts we were thinking about. We had people come out here, we visited state offices … we talked to so many people.”

State Elder Affairs Secretary Alice Bonner

State Elder Affairs Secretary Alice Bonner addresses those assembled at the May 18 groundbreaking for Hillside Residence.

Like she said, progress was slow, but she and others were making acquaintances.

“Everybody was very encouraging — they kept saying, ‘go ahead, yes, do this,’” she recalled, adding that the words of encouragement were not backed up with checks.

But the sisters pressed on. They succeeded in getting the property rezoned, and eventually started making progress on funding, thanks in part to a timely visit to Mary’s Meadow by state Elder Affairs Secretary Alice Bonner in April 2016.

“I said, ‘I just need minutes of your time,’” Sr. Popko recalled, adding that she used it to give the secretary a brief overview of the Hillside Residence project and hand her a concept paper of the proposal.

Bonner put the paper in her backpack, but eventually took it out, read it, and became sufficiently intrigued to call Sr. Popko and arrange a meeting to discuss the matter.

“We brainstormed about what could happen,” she recalled, “and also about how we could remove the silos between housing and health services and bring the two closer together.”

Eventually, the sisters were able to cobble funds together for a number of state and federal sources, including the Housing Stabilization Fund, the National Housing Trust Fund, the Housing Innovation Fund program, and the Mass. Rental Voucher Program. Also, private funding was provided by the Sisters of Providence and the Harry and Jeanette Weinberg Foundation, and the West Springfield Community Preservation Committee also chipped in toward the price tag, currently pegged at $9.65 million.

The project will focus on serving individuals who are 62 and older, with incomes at 50% of the area median income (AMI) or lower, and whose healthcare needs and housing instability can be optimally addressed by the program, said Sr. Popko, adding that, because the project has secured commitment of state rental subsidies, Hillside Residence participants’ housing costs will be capped at 30% of their income.

And while meeting an immediate need for those twin services — housing and healthcare — the project will be adding to the base of research on the efficiency and effectiveness of the integration of PACE and affordable elder housing.

“This data will assist policy makers, housing developers and managers, and healthcare providers better understand the benefits and operational challenges of an integrated PACE housing model,” said Sr. Popko.

The Next Chapter

As she talked about Hillside Residence, Sr. Popko noted that there is still more of the former Brightside canvas to be filled in.

Indeed, there are several cottages on the property that are roughly 9,000 square feet in size and could be transformed into more housing for the elderly.

“We could have another 50 units on this site, but it will be even more difficult to attain funding for that,” she said, adding that those cottages comprise what would be phase 3 of the work at the Hillside at Providence and the proverbial ‘next dream.’

As for the one currently coming to fruition, she said, again, that St. Francis of Assisi was right.

“Our journey of eight years was probably essential for realizing this dream,” she said in conclusion. “Because we’ve brought together people from the state level, we’ve brought together funders, legislators, and people within the community of West Springfield, to a point where they all want this to happen. That’s what has brought us to this moment.”

That, and a firm determination never to let the dream die.

George O’Brien can be reached at [email protected]

Business of Aging

Changing the Landscape

By George O’Brien

Erasmo Ruiz says he has found a profession that offers stability, flexibility, and a wide range of options.

Erasmo Ruiz says he has found a profession that offers stability, flexibility, and a wide range of options.

To say that Erasmo Ruiz took a circuitous route to the nurse-pinning ceremony at Springfield Technical Community College late last month would be an understatement. A huge understatement.

Now 34, the father of two teenagers — and the first one in his family to attend college — studied engineering at UMass. But things “didn’t go as expected,” he told BusinessWest, noting that he was into partying and girls far more than he was into his studies and eventually had to drop out.

From there, he went into the Navy, specializing in electronics. But he didn’t finish his enlistment because his father got into trouble with the law and was incarcerated; Ruiz needed to get home and help support his family.

He would join the workforce, trying his hand at everything from manufacturing to time as a clerk in the Post Office. Then, by chance, he got a job as a medical assistant working with a group of neurosurgeons at Baystate Medical Center.

“It just made sense at the time to take things to the next level,” he said of his decision to pursue a nursing degree. “With the guidance of nurses and other medical professionals, I chose this career.”

A circuitous route to be sure, but Ruiz found himself at that pinning ceremony, persevering through a two-course of study that challenged him on many levels. And many men are doing the same thing.

Well, let’s say many more men, and even a phrase like that needs to be put into perspective.

Yes, there are more men getting into nursing these days, at least compared to 40 or even 20 years ago, but the numbers still don’t approach that of women, said Karen Aiken, a Nursing professor at Holyoke Community College for the past 17 years, eight as chairman of the department.

“The labor bureau will tell you, and make it sound really great, that since 1970, the number has tripled,” she said of men in the profession. “But the numbers are so small, that doesn’t mean much; overall, I think the percentage [of all nurses who are male) has risen from 2.9% to just over 9%, so those are still small numbers.”

We’ll get into the numbers and the reasons they’re higher than they were, but not as high they as perhaps they should be, later. First, let’s look at some of the men who are getting into nursing.

Most are not taking what would be called the traditional route, right out of high school, but then again, many women don’t take that path either.

Andy Bean, 38, who graduated from Westfield State University this spring, worked in sales for a trucking company, sitting in front of a computer all day ordering parts for clients. He was laid off once when the economy took a turn for the worse and decided that he wasn’t going to let that happen to him again.

So he segued into healthcare and eventually a nursing program. Actually, several of them. He’s been working toward a degree in healthcare for seven years, by his estimate, and he’s looking to make a home in the emergency room at Baystate Noble Hospital in Westfield, where he’s already spent considerable time as a technician and student nurse.

Andy Bean, seen here in the ER at Baystate Noble Hospital in Westfield

Andy Bean, seen here in the ER at Baystate Noble Hospital in Westfield, likes the fast pace of that setting and wants to start his career in nursing there.

Meanwhile, Nick Labelle, another member of STCC’s class of 2018, now 36, worked in everything from food preparation to sheet-metal fabrication to real estate before getting a job as a counselor in a substance-abuse clinic. It was that last stop that convinced him that he liked helping people and working in a healthcare setting.

But some have taken more of a direct route. People like Brendan McKee from North Attleboro, another recent graduate of WSU. He said that, unfortunately, he spent a lot of time in hospitals in his youth visiting sick family members, and quickly realized he wanted to be part of that environment. Nursing, he said, was his first choice.

Overall, there are many reasons why nursing has become the first choice, or the second, or the fifth, for men, said Lisa Fugiel, director of the Nursing program at STCC, listing everything from solid pay to the availability of jobs as Baby Boomers retire, to the flexibility within the profession and the wide variety of options available to those who choose it.

But for many, it comes down to those same ingredients that bring women into nursing, she said — compassion, caring, and a desire to help others.

For this issue and its focus on nursing education, BusinessWest interviewed several men on their way to joining the profession (the licensing exam is their next challenge). Collectively, their stories help explain why the landscape within nursing — gender-wise, anyway — is changing.

Course Change

Bean told BusinessWest that he likes the pace of work in the ER and the fact that he’s always moving in that setting.

“That’s a big change from when I was just sitting in front of that computer all day,” he said. “That’s one of the things I hated the most about my old job. It just didn’t feel like a good fit for me anymore.”

But pace of work — and fit — are just two of many reasons why there are more men hearing their names called at those nurse-pinning ceremonies, said both Aiken and Fugiel as they discussed the changing demographics in their classrooms.

They both spoke of greater acceptance of male nurses in general and among women receiving care, and, on the flip side of the equation, more acceptance of the profession as a career option among men. And both halves of the equation are important.

“Women are more comfortable with women, and in some areas especially,” Fugiel noted. “But overall, there is more acceptance of men now.

“And we’re seeing a steady increase when it comes to men getting into the profession,” she went on, noting that this is reflected in the numbers of men in the STCC program; there were nine in this year’s class of 74, roughly double the total from when she started 15 years ago.

There are many reasons for this, said Fugiel and Aiken, listing solid pay and benefits, stability (an important consideration given anxiety about many professions in an age of ever-advancing technology), a host of opportunities, and a wide array of specific areas to get into, from critical care to medical-surgical nursing to behavioral health.

“All the students talk about how there are so many options in nursing, which is one of the things that’s so enticing about the profession, whether it’s male or female,” said Fugiel. “Just look at all the options in an acute-care setting — pediatrics, maternity, ER, ICU, med-surg, and mental health — but there’s also community nursing, nursing infomatics, and managed care.

“And there’s stability,” she went on. “A lot of our nurses are getting older, and that translates into opportunities and stability.”

While it’s good for men to be getting into the profession, given its many rewards, it is also good for the profession, the healthcare community, and society in general, to have men as nurses, said Aiken.

“As an instructor and as a seasoned nurse, I believe that that the more men we can get into nursing, the better,” she explained. “It makes it a rounded profession, and it makes the care more rounded.”

Elaborating, she said men can and often do bring a different perspective to the work of caring for people in need.

“Nurses that are female think one way, and our society doesn’t give men a lot of credit for compassion and caring,” she told BusinessWest. “When these men come into nursing, they come in for a reason — they have that compassion and want to care for people.

“A large number of men who enter our program have been out in the workforce and are either changing professions or are looking to be caring professionals,” she went on. “And they bring so much with them when they come in.”

Getting into the profession is difficult for many, she said, and perhaps more difficult than for many women because men are still traditionally the breadwinners in many families, and, therefore, it is difficult to quit work completely or go to school part-time to earn a nursing degree.

Lisa Fugiel says society is becoming more accepting of male nurses

Lisa Fugiel says society is becoming more accepting of male nurses, and, likewise, men are becoming more accepting of careers in the nursing field.

“The commitment, the education, is more than a full-time job,” said Aiken, adding that men often enter a program not fully understanding what they’re getting into and how they’re going to manage that commitment given their other responsibilities, and that’s why many struggle to get to the finish line or never get there.

Labor of Love

As for those that do, well, interviews with several men graduating this year provide solid evidence that men are more open to a career in nursing — and for all those reasons listed above, from the stability to the flexibility; from the nature and pace of the work to the ability to work with people.

“A big factor for me was all the options we have — you can do anything with this,” Ruiz said of that diploma he’s earned. “Also, in terms of looking out for my family, that was also part of it. The demand is there; there’s a nursing shortage.”

Stability was also a big consideration for Bean, who, as noted, had been laid off once and was looking for firmer ground career-wise. He was also looking for something more rewarding and with opportunities to do some ladder-climbing.

He had taken a few EMT courses, and, after returning to his job with the trucking company after being laid off, found it lacking in many ways,

“So I quit my job, and with the support of my wife, I went back to school to get my nursing degree,” he explained. “I found that, with nursing, there were so many avenues to go down; if one didn’t fit, you could find another one that did fit.”

As noted, he’s been going to school, part-time or full-time, for seven years now. It’s been a struggle at times, but he kept his eyes on the prize awaiting him.

“I was taking classes while working, then quitting and going back to full-time, then working again quite a bit in the emergency room while going to school full-time,” he said. “It’s been a long road, and I’m happy to be done with it.”

Job satisfaction was also a mostly missing ingredient for Labelle, who tried to find it, without much success, in fields ranging from hospitality to selling houses. He found much more of it working in that substance-abuse clinic, but desired an even higher level.

“I wanted a career that would directly impact patient or client care,” he explained. “I did a variety of career assessments, and found that nursing was something that seemed to suit me with regard to compassionate care of client needs, and also something that would be challenging.

“I needed a job that would really challenge me, and I was looking for stability as well,” he went on. “And nursing really fit that criteria. It was a very careful decision.”

As it was for Brendan McKee, who, as noted, didn’t segue into nursing; it was his first choice.

“I did spend a lot of time in hospitals with sick family members,” he recalled. “And I got to see how the nurses worked and took care of my family. It left a really good impression on me.”

He entered Westfield State out of high school, and, like all nursing students, was exposed to a number of different and intriguing paths within the profession. One of them was work in the ICU, and that’s where he is slated to work, at Baystate Medical Center, this fall.

“I like the acuity of it — I enjoy being in that demanding of an environment,” he explained. “I’m the kind of person who runs well when there’s a lot to do and there’s a faster-paced environment.”

A second reason for choosing the ICU, said McKee, is that he eventually wants to work in anesthesia, and the ICU is the “gateway,” as he called it, to that specialty, just as the nursing degree itself is the gateway to a seemingly endless range of career paths within healthcare.

Making a Difference

Ruiz, like all those we spoke with, said he’s taking things one step at a time right now. That means his focus is on passing the licensing exam, which he’ll tackle in the next few months.

After that? He has a comfort level on the “neuro side,” as he called it, but he’s also willing to explore.

“I grew up in Springfield, and I would love to work with the community,” he told BusinessWest, adding that one of his rotations while at STCC was at the High Street Clinic, located in one of the city’s poorer neighborhoods. “I think I could make a difference in a center like that, but I’m not really sure that’s what I want — there are lots of options.”

With that, he summed up why more men are getting into a profession long dominated by women. They want to make a difference, and they’re becoming more accepting of a profession that allows them to do just that.

The numbers of men are not rising quickly or dramatically, but the arrow is definitely pointing up. And as Aiken and others noted, that’s good not just for the men taking this career path, but for those they will serve when they reach their destination.

George O’Brien can be reached at [email protected]

Business of Aging Sections

Support System

hcncover1217Group classes — whether spinning or dancing or core workouts — are all the rage in the fitness world, and it’s easy to see why. Working out in a group provides not only socialization and support, but accountability and motivation to maintain one’s progress. Often, area gym owners say, the biggest challenge is just taking that first step — and learning that fitness classes are, quite simply, a lot of fun.

Maggie Bergin is certified to teach spinning, TRX, and Group X classes, and has, in fact, been teaching fitness in the Valley for the past seven years. As the communications director at Open Square, she thought it would be a natural move to open a fitness facility in that complex overlooking Holyoke’s canals.

So, last month, she launched the Reset, which specializes in group classes, hoping to draw some of the 200 people who work at Open Square, as well as employees of nearby businesses, to take part in ‘nooner’ sessions at lunchtime and classes after work.

“I love leading people through workouts,” she told BusinessWest. “I designed the Reset to accomplish the medical things we are supposed to get done in the most efficient way possible. And what are we supposed to do? Getting our heart rate up on a regular basis, using our muscles so muscle mass doesn’t decrease over time, and stretching, so we’re not tighter than bark on a tree in our 40s and 50s.”

But there’s a difference between understanding the need to work out and actually doing it, she went on.

“I see that people have less and less time; we’re drawn in 20 different directions in the morning and exhausted at night. So things have to be comprehensive and quick. People think, ‘if I can’t get a full-body workout in an hour, I’m not going to do it.’ I created this place to hit those three goals so people can keep moving and stay healthy into their 90s.”

The Reset is equipped with TRX suspension trainers hanging from the ceiling, a popular fitness device designed by a Navy Seal to have intense core workouts with a minimum of equipment. But it’s not equipment that will draw members to Bergin’s new gym, she said; it’s the appeal of working out as a group.

In fact, group training classes have become the most popular element of today’s fitness facilities. Gym owners say people who might initially be reserved about working out around others are quickly taken by the sense of community, mutual support, and socialization these classes offer.

Maggie Bergin

Maggie Bergin says exercise classes are an investment of money and time, and people want to know they’re getting results — and having fun, too.

“Some people, particularly women, feel they have to be perfect immediately, and do it exactly like the instructor immediately. That is a lie,” Bergin said. “You don’t have to do it like anyone else; you can make it your own, within safety precautions, which I’m going to take care of. You have to embrace that you’re on a journey, and in a different place than someone else in the room.”

Marie Ball, owner and group personal-training specialist at the Anytime Fitness franchise in Agawam, agrees.

“The biggest trend we’re responding to is the need for small-group personal training,” she said. “People are more focused today on socialization in fitness, which allows for accountability and motivation. They like to work out in a group.”

However, the smaller groups that Anytime runs typically max out at five to seven participants, so there’s more individualized attention from the trainer, while maintaining that social aspect people desire.

“Some of the participants may not have the same ability, so the trainer is constantly checking and instructing and making sure they’re exercising with proper form, technique, and posture,” she said. “In a large class, the trainer might not have the ability to make sure everyone is doing things properly, so there’s greater potential for injury.”

Justin Killeen, owner of 50/50 Fitness/Nutrition in Hadley, said the trend has been away from commercial, big-box gym environments filled with Nautilus and circuit equipment, and toward a more supportive, community environment. He noted that the technology on today’s group workout equipment gives instant feedback for calories burned and other data, while allowing participants to compete against each other for extra motivation.

Mostly, though, what fitness enthusiasts — especially the younger crowds — are looking for is a fun experience.

“If we have a regular spin class but don’t make it fun and interesting, it’s not as engaging, and people won’t want to come back to it,” he said, adding that people also want a progressive experience, tracking their goals with each workout. “We want to build on each workout and tie it in to your overall health and wellness.”

For this issue’s focus on fitness and nutrition, BusinessWest examines why group fitness classes are growing in popularity and how they motivate people to get — and stay — healthy.

Time and Energy

When she considers where people find that motivation, Bergin agrees with Killeen that it starts with having fun.

“I keep things light. We’re not saving babies here; we’re trying to get stronger and stay healthy,” she explained. “I take my training seriously, but I’m not a yeller. I’m going to encourage, not berate. Some people want to be berated; they respond to that. At places with multiple instructors, you can find one that works best for you.”

Finding time can also be an issue, especially for people with jobs and kids. The 24/7 model at Anytime Fitness is geared toward this issue, Ball said. “In today’s busy world, people have crazy schedules, and it’s hard to fit time in for themselves and make that investment. That’s one of the benefits of our facility. You can do this on your own time.”

She said the overnight hours are beneficial not only for those with those so-called crazy schedules, but first-timers who might be nervous about working out in front of lots of people. Many of them, however, eventually move on to daytime classes and experience the social benefits of exercising as a group.

“Every fitness club or gym has a certain demographic,” she said. “Our club is kind of mixed; some members want to come in the when the gym is quiet, and our 24/7 model lends itself to that. People can work out on their own terms and don’t have to worry about being in an overwhelmingly busy place. Many are just beginning their journey, and they’re not comfortable exercising in front of people.”

Others strictly crave the one-on-one interaction with a personal trainer, which Anytime also offers, but the most popular option continues to be those small-group classes. “People like the socialization aspect. I think some people really need that in their lives to get motivated; they like that engaging atmosphere.”

Besides its popular group classes, 50/50, as its name suggests, helps members with their nutrition plans as well, as a way to bring total wellness under one roof — and save time in the process.

Marie Ball

Marie Ball says small-group classes provide both a sense of community and more individualized attention from the trainer than a larger class.

“We try to integrate a lot of the health and wellness spectrum,” Killeen said. “People might end up going to one place for a gym, then go to nutritionist, then a massage therapist. Our goal here is to pull as many of these together as possible.”

That said, “we try to create a network of people that come together here as part of a community. We bring the whole experience full-circle for them. The nutrition piece is certainly a big part of it. The underlying concept is a balanced approach, thinking more holistically, instead of jumping in on one thing at a time — diet for a while, gym for a while, and so on.”

It helps, he said, that people today are more educated about health and wellness and have options for improving their own.

“For the first time, the younger generation has grown up with it, and they consider it a fun and social thing to do,” he said of group exercise. “If you go out with some friends and go to a spin class and head out afterward, you form friendships. It’s the best of both worlds — the social piece and the feeling that you’re progressing toward something important.”

First Steps

Still, Ball said, it can be difficult for some people to get started.

“I always say, when people walk in our door, that might be the hardest thing they’re going to do this month. That first step is so hard for people,” she told BusinessWest, adding that the sheer variety of fitness modes can be intimidating.

“It’s a good thing there’s a lot of options, but that can also be a bad thing, when they don’t even know what they need. The first step should be to check out a lot of places and find out where you’re comfortable.”

That’s why Anytime offers a seven-day all-access pass so people can get a feel for the center without a long-term, high-cost commitment.

“If people don’t feel comfortable, they’re not going to come back, and they’re not going to progress along their journey,” Ball said. “But it starts with stepping out of your comfort zone and finding like-minded people who support you. A lot of people out there though they couldn’t do it, and then they found they could. Everyone can have a success story.”

And, as Bergin said, success often starts by finding an activity that’s fun, because without that element, people don’t want to invest their money and time.

“It’s not food or shelter. You have to be interested and find joy and be willing to spend money on this thing,” she said, adding that there are always more people to reach with the message that fitness matters. “If we’d figured out how to get people motivated, we wouldn’t have an obesity epidemic and a pre-diabetes epidemic. We all know what we need to be doing.”

And she’s eager to help people find their fitness joy.

“I was always the second-to-last picked in gym. I don’t come by this naturally,” she said. “I have a deep empathy for people who haven’t found their thing yet. So, if you don’t like swimming, don’t swim. If you don’t like running, don’t run. If you want to dance in your underwear to Depeche Mode, then do that. And do it again and again and again. If I can find a thing, you can find a thing. And once you’ve found that thing, keep doing it.”

Joseph Bednar can be reached at [email protected]

Business of Aging

Fresh Ideas

Pat Roach

Pat Roach says the plan to improve culinary service in Springfield’s schools could eventually be a model replicated nationwide.

Pat Roach likes to share an anecdote that speaks to the occasional absurdity of school lunch. It involves the community gardens that dozens of Springfield schools have planted and maintain.

“Take Kennedy Middle School, which has a beautiful garden, where kids grow their own vegetables,” said Roach, chief financial officer of Springfield Public Schools. “If they want to serve them in the cafeteria, we have to ship the vegetables to Rhode Island, where they’re washed, cut, processed, and shipped back to Kennedy.”

But what if the city didn’t have to rely on an out-of-state partner to prepare its meals? What if everything served in the schools was cooked fresh, from scratch, on site?

That’s the goal of the Culinary and Nutrition Center, a 62,000-square-foot facility to be built on Cadwell Drive in Springfield, just two addresses from the school system’s current, 18,000-square-foot, food-storage warehouse.

The new facility will be much more than a warehouse, however. It will include all the resources necessary to prepare fresh ingredients for breakfast and lunch at every public, parochial, and charter school in Springfield, and to train staff to prepare meals from scratch right in the school kitchens.

“We’re renting space in Chicopee for cold storage. Our bakery is based in Rhode Island,” Roach said. “Here, we’ll cook all the food fresh on site — egg sandwiches, fresh muffins, local blueberries, as opposed to getting stuff packaged out in California and shipped to us. And it will bring down the cost of using local produce.”

The city broke ground on the center on Dec. 13, and the facility should be fully operational before the start of the 2019-20 school year, Roach said, and will include several components:

• A production and catering kitchen aimed at increasing product quality and consistency and reducing the use of processed foods;

• A produce cutting and processing room where fresh fruit and vegetables sourced from local farms will be washed, cut, and packaged for use by the schools, and waste will be composted;

• A bakery to prepare fresh muffins and breads, which will also incorporate local produce;

• Cold and dry food storage, which will centralize product purchasing and receiving and inventory control; and

• A training and test kitchen, where culinary staff from the city’s schools, and their ‘chef managers,’ will be trained in preparing from-scratch meals in their own cafeterias. The potential also exists to use the facility to train students interested in the culinary arts as a career.

“They want to serve much higher-quality food to students, with more locally sourced products and fresh-baked goods,” said Jessica Collins, executive director of Partners for a Healthier Community, one of the school system’s foundation partners on the project. “For the schools, it means quality food, and for some students, it’s a career path.”

Speaking of careers, the district plans to add 50 to 60 jobs for cooks, bakers, vegetable cutters, warehouse personnel, and other roles. It will take that many, Roach said, to bring food production and preparation in house for the second-largest school food program in New England, one that serves 43,000 meals served daily.

Considering the nutrition needs of those students, many of whom live in poverty, the stakes could hardly be higher.

Dawn of a New Day

The Culinary and Nutrition Center is hardly a standalone project. Instead, its the culmination of several years of efforts to improve food quality in the schools. Among those programs was an initiative, now in its third year, to move breakfast service — a requirement for districts that serve high numbers of children from poor families — from a strictly before-school program to one that creeps into actual class time.

As a result, Roach said, the schools are serving more than 2 million more breakfasts per year than they were several years ago.

“By law, because of the poverty level, breakfast in school is mandated, but logistically it causes all sorts of problems. If the kids don’t get to school early enough, they don’t get breakfast, or they get to class late.”

It has been an adjustment for teachers in that first period, who have fine-tuned how they craft the first few minutes of class while students are eating. But the impact of fewer kids taking on the day hungry more than makes up for that challenge, he argued. Much fewer, actually, as participation in breakfast has risen from 20%, district-wide, to almost 80%, with much of the remainder likely students who ate something at home.

“It’s been a huge success. Nurse visits for hunger pains are down 30%, and more students are getting to class on time and having breakfast.”

But putting breakfast — and lunch, for that matter — in front of students is one thing; serving healthy food is another. And that concern was the germ of an idea that will soon become the Culinary and Nutrition Center.

“One of the biggest challenges is getting healthy produce, real egg sandwiches, freesh muffins,” Roach said, noting that pre-packaged egg sandwiches, the kind that convenience stores sell, and heavily processed muffins aren’t ideal.

bowles

“We want to be feeding the kids — this is better than nothing — but we want to give them something fresh,” he said. “Instead of buying crappy egg sandwiches that cost a lot of money, we know we can do things in-house cheaper and better. They want real eggs, better muffins — not fake, microwaved stuff.”

Instead of a central kitchen that prepares all the meals and sends them to schools for reheating, the vision is for the school kitchens to actually prepare the meals from scratch using fresh ingredients sent from Cadwell Drive. For instance, “they’ll be making their own sauces using fresh tomatoes and fresh basil,” he noted. “We want to have the best food around. We want kids to want to eat breakfast and lunch at school.”

He also wants students to learn about nutrition and food delivery through their own experiences. “Kids are starting to get it. There’s a whole educational component, and kids understand this stuff is being sourced locally from local farms.”

That gives them a sense of ownership of the nutritional changes. For instance, when Michelle Obama led a change in school lunches, emphasizing whole grains, lower sodium, lower sugar, and other improvements, Roach noted, many schools made the shift all at once, and students rejected what suddenly started appearing on their plates.

“But we had already started increasing whole grains in food, reducing sodium levels — it was a huge success with us,” he said. “We think we’re training kids in lifelong dietary habits. If they get accustomed to eating this way, three meals a day, they’ll continue to do so for the rest of their lives.”

Back to School

Roach said the $21 million project, funded through government and private sources, is being supported by several partners with an interest in food policy, such as Trinity Health, Partners for a Healthier Community, EOS Foundation, and Kendall Foundation.

“Everyone knows how big and important this is, and a lot of people see this as potentially a model for Boston or Worcester, even across the whole country,” he told BusinessWest. “They do see us as pioneers on this project, and a lot of people are excited for us to get this project off the ground. Whether it’s improving student nutrition, decreasing obesity, or reducing hunger, all these organizations share our mission in this center.”

Collins said the city’s support — the project was part of a recent $14.3 million bond approval — is encouraging to those, like her, with a keen interest in community health.

“That’s really exciting, because here you have policymakers investing in what we have been pushing for years, which is higher-quality food for kids,” she said. “When you think about nutrition and higher-quality food and food insecurity, the schools are critical, because that’s where they are every day.”

Roach said the potential exists to broaden the center’s reach to serve other districts, but that’s not in the plans right now. “We don’t want to expand it beyond Springfield until we’re sure we’re serving 100% of our kids.”

That begins with a better egg sandwich, a better muffin — and a better school day.

Joseph Bednar can be reached at [email protected]

Business of Aging Sections

Re-connecting the Dots of Life

By Alta J. Stark

From left, Beth Cardillo, Terry Hodur, and Susan O’Donnell.

From left, Beth Cardillo, Terry Hodur, and Susan O’Donnell.

Helen S. is in her 80s. She’s lived at Armbrook Village Senior Living Residence in the northwest corner of Westfield since June 2016.

A resident of the community’s assisted-living homes, she receives help with many activities of daily living. When Helen moved here, she exhibited many of the cognitive challenges of aging, which can range from basic memory loss to Alzheimer’s disease. She would stay in her room and watch TV. Aides would guide her to and from meals and visit with her, but Helen didn’t socialize or make friends with other residents.

A long-time friend of hers, Terry Hodur, says she was getting discouraged. “There was a care meeting about a year ago when we discussed how quiet and reserved Helen had become. She would never step out, and she would always say ‘that isn’t my business,’ and she would turn away from people. It seemed like there was no way to help her, and we were told we needed to prepare ourselves for a possible move into the memory care unit.”

Then, Beth Cardillo, the residence’s executive director, mentioned a new program that was getting underway at Armbrook called ConnectedLIFE. The program is designed to meet the unique needs of those beginning to show signs of dementia.

“They might not process as quickly as they used to, or maybe they don’t remember things like how to play a card game, or people’s names, so they tend to isolate themselves in their room; they don’t engage in social activities and they tend to become depressed, frustrated and angry,” she explained. “This program helps them maintain connectedness, independence, and confidence.”

A few weeks after Cardillo mentioned the program, Helen started participating, and soon, Hodur saw a transformation she says is nothing short of amazing.

Helen S., Terry Hodur’s formerly shy, reserved friend, enthusiastically took part in a tea party for Queen Elizabeth’s 90th birthday at Armbrook Village.

Helen S., Terry Hodur’s formerly shy, reserved friend, enthusiastically took part in a tea party for Queen Elizabeth’s 90th birthday at Armbrook Village.

“She’s doing well and she’s so happy,” said Hodur. “The ‘aha’ moment for me, came one night after dinner when Helen left her walker by me and walked over to a woman in a wheel chair who could really benefit from someone helping her, and Helen just started to push her into the room where residents gather. When she came back to me, I said ‘Helen, that was phenomenal,’ and she said ‘what do you mean? Of course I was going to do that!’

“To me, that was just a giant step,” Hodur went on. “This very quiet, reserved person is now someone who jumps in to help her friends. She wasn’t going to breakfast, now she is; she was losing weight early on, and now she’s starting to gain it back. ConnectedLIFE is providing a significant service, helping people like my friend Helen.”

Life’s Work

Susan O’Donnell, a certified dementia practitioner, is the director of the ConnectedLIFE program at Armbrook, and she explained how it came to be.

“We noticed that many of our assisted living residents were wandering around the building and not going to their preferred activities. They didn’t really have anything to do, and wouldn’t get up til noon, or one o’clock in the afternoon. So we designed a specific program that not only jumpstarts their days but also meets their therapeutic goals. It’s a set of failure-free activities that provides just the right challenge for them to be successful.” O’Donnell says the program is an intimate peer group of people who have a lot in common.

“We try to foster fun and laughter, because laughter is a good medicine. It’s one of the brain chemicals that get released and when you laugh, it makes you feel good,” she told BusinessWest. “We also talk a lot about relationships and reminisce, because these women (the group is presently all women) have a lot of things in common, and they don’t realize it. But the program helps them start to help each other and they empathize with each other.

“It’s kind of amazing,” she added.  “Take Helen for example. She’s playful now, and everybody knows about Helen at Armbrook.”

The ConnectedLIFE program starts after breakfast each morning. All of the a.m. programming is done in the same place to help people remember where they need to be, an important consideration.

“We had one woman living with dementia who was living independently with her husband. When he died, she moved into assisted living, but kept going back to her old apartment, because she didn’t remember where the new one was,” said Cardillo. “I remembered she and her husband sailed a lot, and I had a nice photo of a sailboat, so I hung it by her new apartment, so that whenever she got off the elevators, she’d follow the sailboat.”

The first activity is really a coffee klatch — a time to look at the daily paper, see what’s going on, what the weather’s going to be, and what happened in history that day. “I want them to realize, ‘yup, it’s August; yup, it’s hot,’ and that it’s normal. That’s what we’re trying to do, normalization,” said O’Donnell.

After coffee hour, there’s usually a cognitive game that gets the women remembering and sharing things like what they fed their kids, or what they did with them in the car on long road trips. “Everything flows from one activity to the next,” said O’Donnell. “The activities are usually about 45 minutes in total, because that’s the attention span we have,” she added. A snack is served midmorning. After the snack, residents take part in a physical game to get them revved up for lunch.

“At this point, their minds are alert,” O’Donnell noted, “and now I want their bodies to be as well. We really focus on whole-brain fitness. It’s the whole package of body, mind and spirit.”

After lunch, there’s another physical game to keep the residents active. When the weather’s good these activities tend to be outside, including games like golf or corn toss.

In the fall, they’ll move inside and into the kitchen for the wonderful aromatherapy of baking. After the physical game, they may move into the den and play bingo or other games.

“We work a lot with reminiscing. We have a lot of books that are … ‘finish the phrase; finish the line; finish the lyrics.’ We do a lot with music. Thanks to YouTube, we can find pretty much anything they want, including Sinatra and Perry Como. They also love cute baby pictures and puppies,” said O’Donnell.

The last half hour before dinner is all about chilling out and cooling down. “These people are tired. They’ve been going since 8 in the morning, so by 4:30, they’re spent, and if they want to take a little snooze before dinner, that’s o.k.,” says O’Donnell.

The final program of the day is after dinner, at 6:15 p.m. While it’s geared to ConnectedLIFE, it’s open to the whole community, which gives residents a chance to see what the program is all about.

Still Growing

Recently, ConnectedLIFE expanded programming to include weekends. “We were hearing from families that when they came to visit loved ones on Saturdays, they didn’t have much to do. We listened to that feedback and added weekend programming,” said Cardillo. “This is way more than a day program.”

Presently, there are 14 people participating in ConnectedLIFE, and Cardillo hopes there will be more.

“We started last September with a small group and have seen about 20 come through the program,” she said. “We don’t know where this is going to take us, maybe a second tract, but for now we know it works.

With ConnectedLIFE, seniors get as many chances as they need to get the bean bag into the hole.

With ConnectedLIFE, seniors get as many chances as they need to get the bean bag into the hole.

Hodur agreed. “When Helen came here, I was hoping she’d have a friend, someone to get coffee with; well now, she’s got a baker’s dozen friends. It’s so fabulous.”

Families are kept up to speed with quarterly assessments and a bi-annual care plan meeting where they go over goals for each resident. Cardillo also e-mails or texts families weekly to keep them updated and aware of what’s going on.

ConnectedLIFE is another example of how Armbrook Village, one of 14 senior living residences owned, operated and managed by Senior Living Residences (SLR), continues to innovate and create new programs to meet residents’ needs.

Twelve of the SLR communities are in the Boston area, with Armbrook Village the only community in Western Mass. The first ConnectedLIFE program started in SLR’s Canton, Mass. community, and once Cardillo heard about it, she said “we have to do this.”

Cardillo praises SLR for being innovative.

“They’re incredibly progressive, and proactive; every month all of the executive directors meet with the company president,” she explained. “At one meeting, I brought up how we were seeing people walking around, and we weren’t serving their needs, and everyone said ‘that’s a problem for us, too.’ ConnectedLIVING is the end result.”

Canton was a start-up community at the time, she went on, and it was decided to pilot the program there as an opening-up venture.

Cardillo is also proud of another first-of-its-kind educational program that started at Armbrook.

“We have the distinction of being the first Dementia Friendly Community on the east coast,” she noted. “It’s part of a drive to make towns friendlier and safer to those experiencing dementia. We wanted to create an environment where, if an individual with memory loss went into a restaurant or other establishment, staff would know the right steps to handle the situation.”

Every EMT in Westfield has been trained in the program, along with Baystate Noble Hospital, Baystate Noble VNA, Councils on Aging, schools, chambers of commerce, family members, and the community at large.

“My job is really to educate people,” she explained. “We feel it’s really important to prepare people for interactions with someone whose memory may be a little topsy-turvy. We started this campaign here, then all Senior Living Residences decided to do that in their community, and now there’s a whole movement called Dementia Friendly Massachusetts.”

Community Resource

Armbrook Village also provides support groups once a month for people in the community. Presently there are about 15-20 people who attend each month, sharing experiences, advice, and sympathy.

“Our role is to make sure everybody gets a chance to talk, and get their questions answered,” said Cardillo. “It’s meaningful for them, and us. We’ve gotten really close with these people.”

Cardillo said she sees Armbrook Village as an educational resource in the community. “We see a need, and we figure out what to do to meet the need,” she says.

Armbrook offers a variety of options along the continuum of aging, its 122 units encompassing independent living, assisted living, and what’s known as Compass Memory Support Neighborhood, a secure setting where residents receive constant treatment and supervision.

Research-based memory support programs, including Reconnections lifelong learning, and specialized art and music classes, contribute to increased social engagement and greater cognition.

“Four or five women are of Italian descent, so we started to learn Italian,” said O’Donnell. Every day she puts up a vocabulary word for the day and the women practice. “It brings them back to their childhood, and their roots.”

A year ago, Armbrook started a Memory Café for people in the community newly diagnosed with Alzheimer’s disease or other dementias. “We offer a place for folks to go monthly with their caregivers to meet other people like them. It’s not a support group; it’s a chance for them to meet people who have the same stuff going on, and share an activity from yoga and painting to art and ice cream sundae socials,” said Cardillo.

Her next venture, which is still in the research phase, involves a new movement of music therapy called the ‘Giving Voice Chorus.’

“All the current research points to the importance of music in people’s lives,” said Cardillo. “And we’re seeing amazing success stories of people living with dementia coming together and forming a chorus.”

Stay tuned.

“We’ve learned to be flexible,” Cardillo said in conclusion. “We want to give our residents the best quality of life possible, and we keep raising the bar. We work until we get it right.”

Business of Aging Sections

Passing Interest

It’s hardly news that America’s Internet and smartphone culture has transformed the way people live.

But not everyone knows they’re also changing the way people die — or, more specifically, how they plan for death and the often-difficult process of transferring key information, end-of-life wishes, and even treasured memories to their loved ones.

cakeTake Cake, for instance. This free online platform helps people determine and share their end-of-life wishes. Similar to the popular dating app Tinder, Cake outlines and organizes these wishes by presenting users with a number of questions on which they can swipe yes or no. Based on the answers, the app creates a profile divided into four categories — legacy, health, legal/financial, and funeral — each of them accompanied by action steps one could take to carry out those wishes.

“Each and every one of us should have a say in how we live our lives, from beginning to end (and even beyond),” the Boston-based Cake creators note. “Gift your loved ones with the information of what you would want, and how you want to be remembered.”

For many people, they note, thinking about the end of life isn’t a morbid activity, but can be a motivating factor to live life to the fullest. “It can put things in perspective and give you and your loved ones more peace of mind. It is a very considerate act to let your loved ones know what you would want. You can go at your own pace, and plan as much as feels right to you.”

Even folks with a will can benefit from such a service, the company notes, because many aspects of end-of-life planning — right down to the food one would want served at one’s funeral — are typically not be covered in that document.

“Additionally, medical preferences can be difficult to think through,” they go on. “Cake helps uncover your values so you can be clearer on your preferences, and so that your loved ones can be clear on them too.”

Plenty of Options

But Cake is far from the only player on this unique scene, which mixes some time-honored concepts with a decidedly 21st-century twist. Here are some of the others.

everplansEverplans, in some ways similar to Cake, is a digital vault for a person’s end-of-life plans, described as “a complete archive of everything your loved ones will need should something happen to you.” The app allows users to securely store wills, passwords, funeral wishes, and more in a shareable vault. Documents may include anything from wills, trusts, and insurance policies to bill-payment schedules, advance directives and do-not-rescuscitate orders, as well as final wishes and funeral preferences.

Users begin by taking a short assessment survey to see how much planning they’ve already done, how much else they need to do. Based on that information, the service, which costs $75 per year, creates a to-do checklist and helps prioritize that list. The user then assigns specific ‘deputies’ for the plan, so loved ones can find everything neatly in one place.

mydirectivesMore of an emergency-care tool than an strictly an end-of-life plan, MyDirectives allows people to speak for themselves — digitally. Users populate their ‘medical ID’ with date such as their health information and end-of-life plans. This allows doctors to have access to this information right from a patient’s iPhone lock screen.

The four basic parts to this free service are ‘My Decisions,’ which outlines care preferences, values, and treatment goals; ‘My Thoughts,’ which uses messages, video posts, music, and photos to help caregivers know more about the patient; ‘My Healthcare Agents,’ which outlines who represents the patient during a health crisis when he or she can’t communicate; and ‘My Circle,’ which keeps key contact information in one place.

principled-heartThe creator of Principled Heart, a certified financial planner, said his goal was to help answer a common question: where do we keep all our planning documents and information — and how will my loved ones know what to do? His site encourages people to keep only what is necessary, including passwords (or instructions on where to find them) for financial accounts, social media, and other accounts. Other features include instructions for pet care, key contacts, and space to upload up to 60 documents.

Three specified people are required to validate the account owner’s death, and then the site, which costs $45 a year for up to one gigabyte of storage, will provide access to all the information stored inside.

afterstepsAfterSteps, created by a Harvard Business School student, also requires the names of three verifiers, who will be notified in the event of the user’s death and will get access to all information stored on the site, which includes wills and other legal forms, passwords and instructions for digital accounts, funeral-arrangement wishes, and other data. It costs $60 a year or $299 for life.

Most services of this sort are recent developments, but a few have a longer history. DocuBank was created in 1993 as a registry to give members 24-hour access to their advance directives. More than 200,000 members have used the service ($55 per year) since then, and DocuBank has added new features, including an online vault called SAFE that provides a place for members to store files. The site’s latest ‘Digital Executor’ feature allows members to designate one person who will be able to access all of their online files once they’ve presented proof of the member’s death or permanent incapacity.

Celebrating Life After Death

Many end-of-life planning apps are about more than financial and funeral arrangements; however, crossing over into the realm of preserving history and sharing memories.

safebeyondFor example, SafeBeyond ($48 to $96 per year) defines itself as a ‘legacy-management service.’ As such, this app allows users to keep record of their life story in the form of meaningful digital content. SafeBeyond’s distribution capabilities then allow for the future delivery of this content in the form of personalized messages accessible by specific loved ones – almost like emotional life insurance through which one can be remembered.

“Everyone’s life story is unique and constantly affected by change,” the creators write. “Our platform provides an innovative online and mobile-app solution for the easy and secure management of your life story and your meaningful digital content, with enhanced distribution capabilities for the future delivery of personalized messages and digital assets. You decide when, where, and with whom your messages and other digital assets will be shared.”

The app allows people to record text, audio, and video messages throughout their life and store them in a heavily encrypted ‘digital vault.’ Then, SafeBeyond will send messages on behalf of its clients for up to 25 years after they die. Many users choose to schedule those messages on birthdays or on the anniversary of their passing. After the user dies, their recipients are e-mailed a notification telling them to download the app so that they can, one day, receive a message from the grave.

eterniamMeanwhile, Eterniam provides a free, secure online locker for one’s personal digital assets, including photos, videos, and other documents, and then releases them after the user’s death to whomever he or she specifies. Rather than focus on death, the app encourages users to ‘celebrate life,’ and to capture moments and upload them to the cloud.

Bcelebrated ($20 yer year, $100 for a lifetime membership) enables members to create a multi-media website that will become their autobiographical memorial site when the time comes. They may share their story in words, images, and audio; write password-protected private messages for loved ones; and essentially leave a permanent site where friends and family can celebrate a life.

Members create password-protected private pages for loved ones, record their last wishes, and assign a charity to receive donations on their behalf. The service also sends automated notification e-mails at the time of a member’s death and provides a list of numbers for those who need to be called.

Finally, on a different, slightly more downbeat note, Life Countdown is a free app that asks users to pick the date they think they’ll live to, then sends notifications at random intervals about how much time they theoretically have left. The app, its creators say, has a philosophical bent: “to cultivate the contemplation of death.”

Some might feel that’s a worthy-enough goal. For those who want to do more than contemplate, but instead do some real planning about what they’ll leave behind, today’s online culture offers plenty of options.

Business of Aging Sections

Aging in Place

Suzanne McElroy

Suzanne McElroy says it’s important to match a family with the right caregiver to ensure there’s a comfort level on both sides.

As the Baby Boom generation continues to advance into the golden years, the demand for home care continues to rise, as families embrace a model that keeps seniors stay in their homes while helping them with everyday needs. That means the need for qualified caregivers is rising, too — and it’s not always easy to find them.

Home care is a far cry from, say, plumbing, Suzanne McElroy says. Sure, both careers require specialized skills, but not a lot of plumbers are turned away because they just don’t … feel right.

“I’ve often tried to compare this to other industries, and you can’t,” said McElroy, owner of Home Instead Senior Care in Springfield. “A plumber can come in and fix your pipes, and you don’t have to worry about what they look like or smell like, or how they talk; they just come in and fix your pipes. But I’ve had caregivers rejected for silly things, like a tattoo in the wrong place, or things I’m not legally able to consider, like age, race, or religion.”

Paul Hillsburg, owner and president of Amada Senior Care in West Springfield — who left financial services for a career in this fast-growing field — has observed similar difficulties matching caregivers to families, starting with his own life.

“I saw the challenges we had with my mom in finding qualified caregivers,” he said, noting that she utilized home care in the early stages of her dementia. “My dad fired the first seven. I realized that was an important part of providing care in the home — the personalities need to match. So we take a personalized care approach.”

After all, McElroy said, she has to consider things from the family’s perspective, and why they need a certain comfort level with someone who will be spending lots of time in the home. “It’s not like fixing pipes and leaving; they’re going to be staying and sitting with your mom.”

SEE: List of Home Care Options

The problem, both she and Hillsburg, noted, is that the challenge of making those matches, plus the surge of Baby Boomers into their senior years — around 10,000 are turning 65 every day, on average — are ratcheting up the pressure on home-care agencies to find and retain talent.

“More and more people want to stay at home, and hospitals are actually suggesting home care during discharge,” Hillsburg said. “People want to age in place, to be at home, where their family can come and visit, and where they feel more comfortable.”

Home-care services run the gamut from companionship and household help to assistance with ambulation and medical needs, and the popularity of this option continues to grow, creating worries that demand will eventually outstrip the number of qualified caregivers. That means competition among agencies, which are bringing myriad tools to bear with the goal of helping seniors live as independently as possible.

The Right Choice?

McElroy, who has lectured many times on the topic of choosing a senior housing plan, outlined several considerations that families must discuss, including:

• Physical needs, including activities of daily living — from shopping, cleaning, cooking, and pet care to more intensive help with bathing, ambulating, and eating — and medical needs, which could arise from a sudden condition, such as a heart attack or stroke, or a more gradual condition that slowly needs more care, such as Alzheimer’s disease.

• Home maintenance. “If you’re living alone, your current home may become too difficult or too expensive to maintain,” she noted. “You may have health problems that make it hard to manage tasks such as housework and yard maintenance that you once took for granted.”

• Social and emotional needs. As people age, their social networks may change, with family and long-time friends no longer close by, and neighbors moving away or passing on. At the same time, they may no longer be able to drive and have no access to public transportation. The desire to be around a community of friends and take part in social activities may be paramount.

• Financial needs. “Modifying your home and long-term care can both be expensive, so balancing the care you need with where you want to live requires careful evaluation of your budget.”

The answers to these questions may very well point to assisted living as a better option than home care, but others may be able to age in place, accessing home-care services to better manage activities of daily living, while still enjoying the comfort and security of a residence they have lived in for years or decades.

Aging in place is a less effective senior-housing option once your mobility is limited. Being unable to leave your home frequently and socialize with others can lead to isolation, loneliness, and depression. So, even if you select to age in place today, it’s important to have a plan for the future when your needs may change and staying at home may no longer be the best option.”

“You may also be able to make home repairs or modifications to make your life easier and safer, such as installing a wheelchair ramp, bathtub railings, or emergency response system,” McElroy said.

Home care is a good option, then, for people who can access transportation; live in a safe neighborhood and in a home that can be modified to reflect changing physical needs; don’t have an overwhelming burden of home or yard maintenance; have physical or medical needs that don’t require a high or specialized level of care; and, perhaps most important, have a network of nearby family, friends, or neighbors.

“Aging in place is a less effective senior-housing option once your mobility is limited,” she added. “Being unable to leave your home frequently and socialize with others can lead to isolation, loneliness, and depression. So, even if you select to age in place today, it’s important to have a plan for the future when your needs may change and staying at home may no longer be the best option.”

Individuals and families who do choose home care, Hillsburg said, still have to overcome that initial reluctance to invite a stranger into their home.

“When I meet clients, I do my own personal assessment, trying to link their personalities with the personality of the caregiver,” he explained. “And when the caregiver goes to the family’s home for the first time, I meet them there and introduce them to the family, make sure there’s a comfort level there.”

Hillsburg said his company, part of a national network of Amada franchises, also performs extensive background screening — credit history, DMV records, criminal records, sex-offender registries — to ensure client safety, and also assists people trying to figure out how to pay for care, whether that’s a long-term care policy, veterans’ benefits, reverse mortgages, even life-insurance policies that can be sold back, swapping death benefits for current care.

Paul Hillsburg

Paul Hillsburg says the biggest challenge for home-care companies is finding and retaining quality caregivers in an increasingly competitive arena.

But to build a team of reliable caregivers at a time when the competition for talent is becoming fiercer by the month, a company has to make sure they’re paid well and happy in their jobs, he told BusinessWest.

“It’s a very, very competitive field. The biggest challenge going forward is going to be finding and retaining good, quality caregivers. That’s why we provide 20 hours of free training, or more, if they want it, to all our caregivers, and we pay them while they’re in that training,” he explained. “They want to be treated like a person and respected.”

Cost is still a major consideration for families, McElroy said, especially when agencies have to pay their caregivers competitively. While lower-income services are available through Medicaid and MassHealth, home care still isn’t within reach of everyone who needs it. “That’s only going to change in importance when enough people feel this pain, or the right people feel this pain.”

High-tech, High-touch

At the same time, Hillsburg said, home care continues to absorb technological advances that make it easier for families and companies to assess results, from an online portal Amada offers called Transparent — which allows families to see which duties a caregiver has performed — to a GPS system that lets the company know whether caregivers show up at the right place and time.

Meanwhile, the company’s Discharge Admissions Reduction Team (DART) works with care managers to negotiate transitions between hospital and home care with the goal of reducing hospital readmissions.

“The need for care is going to continue to increase for the next 30 years before we hit the end of the Baby Boom generation,” Hillsburg said by way of explaining the ways companies are honing their services to meet the needs of this population.

Still, at the end of the day, McElroy said, families are most concerned with whether the caregiver increased their loved one’s quality of life. She recalled one client who requested someone versed in quilting, to help her thread needles and otherwise allow her to continue enjoying her favorite pastime.

“That’s the heart of what we’re doing. Yes, we’re helping them out of bed and into the shower, but if we can help someone live the live they want, that’s what’s driving the spirit of our business,” she explained. “It’s hospitality; it’s customer service. You have to love what you’re doing. You have to love the mission and love the work.”

After all, “whenever I have someone raving about a caregiver, it’s not because they came in for a few hours and got the job done; it’s because they made a difference in someone’s life,” McElroy said. “They can be doing the grossest thing ever, but when they leave, if the person takes their hand and says, ‘I don’t know what I would do without you,’ they’re flying. They can’t wait to go back.”

Joseph Bednar can be reached at [email protected]

Business of Aging Sections

A Matter of Time

Dr. Rajiv Padmanabhan

Dr. Rajiv Padmanabhan says the initial 911 call triggers a chain of events at the hospital that ensures everyone is in place to treat a stroke quickly when the patient arrives.

Everyone knows women who are fiercely independent and used to doing everything for themselves. Getting to the hospital after a stroke — or, more likely, getting a friend or loved one there — shouldn’t fall into that category.

“We stress to stroke patients that we want them to come to the hospital quickly,” said Patti Henault, coordinator of Stroke Programs at Mercy Medical Center. “Every minute someone is having a large stroke is a minute that is wasted, and a little part of your brain is going to be damaged. Basically, the quicker you get treatment, the better the outcome usually is. But to arrive as fast as possible, you should call EMS. People think an ambulance takes longer, but the thing is, EMS lets us know they’re coming, so we can get everything in place. That helps a lot.”

Once the patient calls 911, she explained, the ambulance crew is in contact with the hospital, so doctors and CT-scan technicians are in place the moment of arrival. “The first diagnostic test for stroke is do a CT scan, so we know what’s going on inside the brain,” Henault said. “It’s a quick test, but the faster we can do it, the faster we can know whether it’s something we can treat.”

Dr. Rajiv Padmanabhan, a neurologist with Baystate Health, said the system has an algorithm — a chain of command, if you will — for stroke response, and it begins with the EMS team.

“When they call into the hospital, we are on standby, with the CT scan and neurology team and the emergency room; we’re all aware that a patient with a stroke is coming on the ambulance,” he told BusinessWest. “The 911 call triggers the whole thing. They go straight to the CT scan, and we also look at pictures of the arteries.

“The most important lesson is to get them treated fast,” he went on. “Every minute, 1.9 million neurons are lost in the brain. The sooner we treat them, the better chance we have of getting blood supplied back to the brain, which is what we aim for. Once the patient calls 911, the likelihood of a good outcome increases. It sets up a chain of command, which notifies techs, the lab, pharmacy, and the ER. It triggers a chain of events that leads to faster delivery of care. 911 makes a difference.”

According to the American Stroke Assoc., stroke is the third-leading cause of death for women and the fifth-leading cause of death for men; each year, 55,000 more women have a stroke than men. And because women live longer on average than men, strokes often have a more negative impact on their lives. In fact, women are more likely than men to live alone when they have a stroke; require the services of a long-term healthcare facility after a stroke; and have a worse recovery overall.

But with proper management of risk factors, and a quick response when an event occurs, women, as well as men, have a better chance of decreasing mortality rates from stroke and boosting quality of life.

On the Clock

Once a stroke patient arrives at Mercy, Henault said, a consultation is conducted with a neurologist from Massachusetts General Hospital in Boston through that institution’s stroke telemedicine program. “They can see the patient, give directions, answer patient questions, they can even zoom close up on eyes and check the pupils. It’s pretty amazing. They can give us advice on how to treat the patient.”

Patti Henault

Patti Henault says many risk factors for stroke — like high blood pressure, obesity, and smoking — are manageable with lifestyle choices.

Mercy began using the Mass General service in January 2016 because they are always ready to consult. “The neurologists in our area are often with patients, and it’s difficult to stop what they’re doing. We decided we’d get quicker service with telemedicine. And it really has made an impact.”

About 85% of all strokes are ischemic, caused by a clot, while the rest are hemorrhagic strokes, which are treated differently. In the case of an ischemic stroke, the first line line of defense is the blood-thinning agent tPA (tissue plasminogen activator), known colloquially as a ‘clot buster.’

“If there is a problem like a clot blocking an artery or arteries are very narrowed because of artherosclerosis, we might be able to resume blood flow to the brain,” Henault said. “The idea is, if we can resume blood flow to the brain, the brain cells stop dying because they’re getting the nutrients and oxygen they need.”

For patients that require a more dramatic intervention than a clot buster, a cutting-edge device in use at Baystate known as the ‘stentriever’ can actually be inserted into the artery to remove the clot.

“We’ve incorporated that as part of the protocol,” Padmanabhan said. “We want to make sure we have the right tools, state-of-the-art tools, to respond 24/7/365 and get all patients to the right treatment immediately.”

He added that doctors are waiting on trials and studies examining whether such interventions may be employed more than seven hours after a stroke, which is considered the current limit. (Clot busters like tPA are typically administered no more than four and a half hours out). “Expanding the window might capture more big strokes before disability and death. We won’t get them all, but we can decrease mortality.”

The best medicine, of course, is not to have a stroke at all, and fortunately, most risk factors are lifestyle-related and can be managed in most people.

“High blood pressure is huge one,” Henault said. “A lot of people think high blood pressure is kind of harmless, but it’s insidious because it does damage to blood vessels every day, and if you have high blood pressure, it’s constantly wearing down the side of the blood vessel, and one crack can develop a blood clot because the body is trying to fix it.”

Other risk factors, she went on, include being overweight, lack of physical activity, and behaviors like smoking, excessive drinking, and drug abuse. “Our younger stroke victims, especially, tend to have some high-risk behavior such as that.”

Some stroke risks require medical intervention, such as atrial fibrillation, or irregular heartbeat, which increases an individual’s chance of developing blood clots. Many with this condition take blood thinners on a regular basis.

“The most important risk factors are hypertension, diabetes, high cholesterol, and obviously smoking,” Padmanabhan said. “Quitting smoking and controlling sugars are important for treating blood pressure. Sleep apnea also has a correlation, so if you feel foggy and tired all the time, check it out and make sure it’s treated. You don’t have to be obese or have a metabolic syndrome to have sleep apnea.”

Although it sounds simple, he added, regular doctor visits can go a long way toward preventing strokes, as will following the American Heart Assoc. guidelines to engage in 20 minutes of moderate exercise five times a week. “The important thing is knowing your numbers. You won’t get to your goals in a day.”

For recovering stroke patients without these risk factors, Padmanabhan said, Baystate’s stroke clinics in Springfield and Greenfield conduct diagnostic cardiac testing to try to determine a cause. But there’s no one way to rehab from a stroke, Henault added.

“No two people are the same. Every section of the brain controls different things, so everyone’s treatment after a stroke is different. Younger brains tend to recover more quickly.”

Different for Women

Each year, according to the American Stroke Assoc., stroke kills twice as many women as breast cancer. But the public tends to be less knowledgeable about the risk factors and don’t perceive themselves at risk for stroke.

In addition to the general risk factors like family history, high blood pressure, high cholesterol, diabetes, smoking, lack of exercise, and being overweight, women face some unique risk factors, including:

• Taking birth control pills. The greatest concern about using oral contraceptives is for women with additional risk factors, such as age, cigarette smoking, high blood pressure, or diabetes;

• Being pregnant. Stroke risk increases during a normal pregnancy due to natural changes in the body such as increased blood pressure and stress on the heart;

• Using hormone-replacement therapy, a combined hormone therapy of progestin and estrogen, to relieve menopausal symptoms; and

• Suffering from migraine headaches with aura. Migraines can increase a woman’s stroke risk two and a half times, and most people in the U.S. who suffer migraines are women.

Women may also report symptoms that are different from common stroke symptoms. These can include loss of consciousness or fainting; general weakness; difficulty or shortness of breath; confusion, unresponsiveness, or disorientation; sudden behavioral change; agitation; hallucinations; nausea or vomiting; pain; seizures; and hiccups. Because these are not typically recognized as stroke symptoms, treatment is often delayed.

Henault said men and women should at least know the FAST symptoms. That’s an acronym stroke-care professionals use to help people recognize the signs of a stroke. The letters stand for facial drooping, arm weakness, speech difficulties, and time — which is of the essence, so call 911 immediately.

“It sounds silly,” she said, “but little kids understand that, and sometimes they end up calling 911.”

It could be the most critical call they ever make, because it launches a chain of events at the hospital designed to save lives — and, more often than ever, does just that.

Joseph Bednar can be reached at [email protected]

Business of Aging Sections

Sight Restoration

Dr. John Papale says most patients who undergo cataract-removal surgery see a more than 95% restoration of vision.

Dr. John Papale says most patients who undergo cataract-removal surgery see a more than 95% restoration of vision.

As the population ages, eye problems will become an increasingly large healthcare issue for society. Fortunately, modern science and new surgical techniques are bringing improved vision — and better quality of life — to those suffering from a number of common ailments.

Several months ago during a routine eye exam, Louise Pugliano was told that she had cataracts in both eyes. The 84-year-old doesn’t drive at night and had no symptoms, but had worn glasses or contact lenses for more than 20 years, and agreed to have cataract-removal surgery.

The first procedure took place Jan. 8, and the second was done Jan. 23, and they were not only painless, but the Springfield woman was thrilled to find she no longer needs prescription eyewear.

“I’m so glad I did this; I had a great experience and wonderful results: I don’t need glasses anymore and can read the small print in the newspaper,” Pugliano said, adding that she had complete faith in her surgeon, Dr. John Papale of Papale Eye Center in Springfield.

Her diagnosed condition, treatment, and response to it are all typical of what’s happening within the broad realm of eye care today — as the population ages, more people are being diagnosed with problems, but modern science has created solutions, many of which are truly life-altering.

Papale told BusinessWest that cataract removal is the most commonly performed surgery in the U.S., and more than 3 million people have the procedure done every year. The 20-minute outpatient operation corrects vision and eliminates troublesome symptoms that affect many seniors, such as seeing halos or being bothered by the glare of oncoming headlights when driving at night.

“Most people have more than a 95% restoration of vision, assuming there are no other problems such as glaucoma and macular degeneration,” Papale said, as he spoke about conditions that affect aging eyes.

Indeed, they are common. The Mayo Clinic reports that about half of all 65-year-old Americans have some degree of cataract formation, and more than 30 million Americans are expected to develop them by 2020. In addition, more than 6.5 million Americans age 65 and older have a severe visual impairment, and rates of severe vision loss are expected to double by 2030.

Dr. Camille Guzek-Latka, an optometrist at Chicopee Eyecare, P.C., says many people use over-the-counter glasses to avoid getting an eye exam. “But the exam is important; we not only evaluate the need for glasses, we look for evidence of eye disease because, as people age, their risk of developing a problem increases.”

Annual eye exams are critical for people over the age of 60 because eye disease can cause irreversible blindness and there may be no symptoms until it reaches an advanced stage.

Dr. Andrew Jusko says an eye exam is needed to detect glaucoma, as there are no symptoms in the early or middle stages.

Dr. Andrew Jusko says an eye exam is needed to detect glaucoma, as there are no symptoms in the early or middle stages.

Although some people don’t have vision coverage on their insurance plan, Eye Care America has provided free exams to almost 2 million eligible seniors (visit www.aao.org), and health-insurance plans cover the cost if a minor medical problem is uncovered, which usually happens as people get older.

“It’s important to protect against damaging eye diseases; people are living longer today and want to maintain full visual functionality through the end of their lives,” said surgeon Dr. Andrew Jusko of Eyesight and Surgery Associates in Springfield and East Longmeadow.

Papale agrees. “The eye is our most important sense: 25% of all input to the brain comes from the eye and nerve endings,” he noted.

For this issue and its focus on the business of aging, BusinessWest examines problems that affect aging eyes and what can be done to prevent and correct them.

Cause, Effect, and Treatment

The lens of the eye consists of a flexible jelly that begins to stiffen as people enter their 30s and 40s. The condition is called presbyopia, and most people need reading glasses to compensate for the fact that their eyes can no longer shift focus easily.

“Many people in their 40s and 50s get by with over-the-counter reading glasses, but by the time they reach their 50s or 60s they usually don’t work well,” Jusko said, adding that early stages of other diseases such as diabetes or hypertension can be seen in the eyes during an exam.

Cataracts cause the lens to change from crystal clear to cloudy, and typically develop as people age. They don’t harm the eye but do affect vision, and surgery to correct the problem involves replacing the aging lens with an artificial one.

In the past, eye drops were always needed for a few weeks following the procedure, but Guzek-Latka said a newer approach is often used today called ‘dropless cataract surgery,’ which occurs when the surgeon injects a combination of antibiotics and steroids into the eye at the time of the procedure to reduce the need for drops after it.

“The surgery is safe and wonderful; it can restore sight, reduce the risk of falling, and people are thrilled with the results,” she noted, adding that, although cataracts are related to aging, prolonged use of steroids for conditions such as asthma can cause them to develop earlier.

Cataracts are a change that occurs as the eye ages, but glaucoma is an age-related disease that causes blindness as the peripheral or side vision is lost.

“It’s called the silent thief of sight because the vision loss occurs slowly and painlessly,” Guzek-Latka said, adding that the condition is linked to a buildup of pressure inside the eye, but it can take many years for the vision loss to occur.

The disease can start in the 40s, but risk increases with age. “People cannot tell if the pressure inside their eye is normal, so they can be going blind and not know it,” Papale told BusinessWest, noting that, since glaucoma frequently only affects one eye, the other eye compensates for it so the person doesn’t realize what is happening.

As a result, it’s critical to catch the disease before irreversible damage is done. “An eye exam will show whether the pressure is normal and if the optic nerves appear abnormal,” Jusko said.

Some forms of glaucoma can be cured, and treatment ranges from surgical procedures to prescription eye drops that control pressure inside the eye.

Jusko often uses eye stents during surgery, which are small devices implanted in the drainage area of the eye to help reduce the need for future medication.

“The average age for glaucoma is the 70s, which is about the same age that people need cataract surgery,” he said, noting that stents can also be used during that procedure.

Age-related macular degeneration, or AMD, is one of the most serious eye diseases and the leading cause of blindness in seniors. “The macula is the part of the retina that gives you the sharp vision you need to read, drive, and recognize faces,” Papale said.

More than 2 million Americans are afflicted with some form of the disease, and that number is expected to more than double to 5.4 million by 2050 due to the aging population.

“It’s the leading cause of irreversible vision loss in people age 50 and older, and treatment for it is limited,” Guzek-Latka said.

“There are usually no symptoms in the early stages, but the disease can be seen when the pupil is dilated during an eye exam,” she continued, adding that, as the disease progresses, it causes distortion in the central vision. “People can still see things on the side, but they can’t read, and faces often appear as dark gray areas. Most people think blindness means total blackness, but it’s very rare not to be able to see any light.”

The cause of AMD is unknown, but it’s important for people to be aware of risk factors. Smoking doubles the risk of macular degeneration, it tends to run in families, women are more likely to develop it than men, and it is more common among Caucasians than African-Americans, Hispanics, and other races.

“People might be able to reduce their risk of macular degeneration or slow the progression by making healthy choices such as regular exercise, maintaining normal blood pressure, quitting smoking, and eating a healthy diet rich in green, leafy vegetables and fish,” Guzek-Latka said.

The disease is divided into two categories — wet macular degeneration and dry macular degeneration. Although there are no symptoms associated with early dry macular degeneration, the vision becomes distorted over time, and once function is lost, it cannot be restored.

However, further damage may be prevented with special vitamins formulated for the eye. “But we don’t recommend taking them unless the person has been diagnosed with macular degeneration,” Jusko said, noting that studies show no definitive or preventive benefits for people without the disease.

Wet macular degeneration is caused by the growth of abnormal blood vessels under the macula that are fragile and prone to bleeding.

“The bleeding is not visible because the macula is in the back of the eye,” Papale said, adding that the dry form of the disease can progress to the wet type.

Treatment includes injections of medicine that block the growth of abnormal blood vessels and can lead to some improvement.

“It won’t cure the disease, but it’s definitely an advance; 10 years ago, there was less hope for people with wet macular degeneration then there is today,” Guzek-Latka said.

She added that FDA approval was granted for an implantable device in 2010 that is used at the end stages of the disease. It’s the size of a pea and magnifies images onto the retina.

“But it’s only used as a last resort. It will not restore vision, but might allow someone to identify faces, even if they are not clear,” she said.

Diabetes is another disease that affects the eyes. According to the National Eye Institute, 40% of Americans over age 40 have some degree of diabetic retinopathy, and one of every 12 people with diabetes in this age group has advanced, vision-threatening retinopathy.

That’s a condition that results when small blood vessels in the retina leak blood or other fluids that cause progressive damage to the retina, which is the light-sensitive lining at the back of the eye.

“Once someone is diagnosed with diabetes, they need yearly eye exams to detect it,” Jusko said.

Treatment ranges from the use of lasers to injections and surgical procedures, and primary-care physicians usually work closely with the person to ensure their blood-sugar levels and blood pressure are under control.

Hope for the Future

Dry eye is another condition that can affect people of any age, but is more prevalent in elders and post-menopausal women. It results from inadequate tear production and causes burning, stinging, itching, or the feeling that sand is in the eyes.

It can be alleviated with over-the-counter lubricating drops, fish-oil supplements, and vitamin C. But dry eye that is moderate or severe can cause damage, so people whose symptoms aren’t helped with over-the-counter remedies should see their eye doctor.

There is no doubt that eyesight is affected as people age, but there are things everyone can do to help to prevent disease. Eyes need good blood circulation and oxygen intake, and since both are stimulated by regular exercise, it ranks high on the list.

People should also do their best to maintain normal blood pressure and cholesterol levels, and wear sunglasses that block ultraviolet light.

But getting an annual eye exam is the most important measure anyone can take to preserve vision.

“Eyesight is our most important sense,” said Guzek-Latka. “We rely on it for so many things, and having good vision is a driving factor in people’s well-being as they age.”

Business of Aging Sections

The Write Stuff

By Gina Barry, Esq.

Gina Barry

By Gina M. Barry, Esq.

It should come as no surprise that the general population of the U.S. is aging. According to the Administration for Community Living, which was created by the U.S. Department of Health and Human Services, people who were age 65 or older represented 14.5% of the population in 2014, and that number is expected to grow to 21.7% of the population by 2040.

When aging, most people would prefer to have a plan in place to ensure that their needs and goals will be met, even if they are incapacitated or pass away. While many people believe they do not have enough money to need an estate plan, the need for an estate plan is not solely related to the amount of one’s wealth.

As explained below, a basic estate plan is comprised of four legal documents and is quite simple to establish.

Last Will and Testament

A will directs the disposition of the probate estate. The probate estate consists of assets held in the decedent’s name alone that do not have a beneficiary designated. When a person passes away without a will, their estate will be distributed as directed by the Commonwealth’s intestacy law, which may not be as they would have desired.

A common misconception is that a will is not needed if every asset is jointly owned or has a designated beneficiary. Of course, there must be a surviving joint owner for this plan to work. If both owners pass away simultaneously in a common accident, the estate will need to be probated, as there will be no surviving joint owner.

A will is also necessary in order to designate a personal representative, who will carry out the estate. The personal representative will gather the probate assets, pay valid debts, and make distribution of the estate to the beneficiaries as set forth in the will. Further, if the decedent leaves behind minor children, a guardian can be designated in the will to take custody of these children.

Likewise, a trust can be established in a will that would provide ongoing protection for minor children — or possibly for other beneficiaries who should not receive their inheritance outright, usually due to spendthrift concerns. When there is no will in place, the power and ability to make these designations and to direct the disposition of property is forfeited.

Healthcare Proxy

A healthcare proxy is a document that designates a healthcare agent, who would make healthcare decisions in the event of incapacity of the principal (person signing the proxy). The healthcare agent would step into the shoes of the principal and make decisions as they would if they were able. For example, they may decide whether a certain medication should be taken, whether a certain medical procedure should be done, or whether there should be an admission or discharge from a medical facility.

 

While many people believe they do not have enough money to need an estate plan, the need for an estate plan is not solely related to the amount of one’s wealth.”

 

‘Living will’ language is normally included within the healthcare proxy. The living-will language addresses end-of-life decisions and generally sets forth that the principal does not want extraordinary medical procedures used to keep them alive when there is no likelihood of recovery. This can be a difficult decision to carry out; therefore, care should be taken to name someone who would be able to honor that decision. Individuals who have an advanced illness may choose to establish medical orders for life-sustaining treatment (MOLST) in addition to a healthcare proxy.

A MOLST is a medical order form completed by a patient and their physician that relays instructions about a patient’s care, including stating which treatment should be given or otherwise withheld. A MOLST would eliminate the need for living-will language in a proxy, but the best practice would be to reference it in the proxy.

Durable Power of Attorney

A durable power of attorney is a document that designates someone to make financial decisions. This document is usually in full force and effect when it is signed, but it is expected that it will not be used unless you are unable to handle your own financial affairs. It is also possible to grant a springing power that does not take effect until incapacity arises.


Rehabilitation Facilities in Western Mass.


The power of attorney is a very powerful document that is as broad as the powers granted within it. It gives authority to the designated person to handle all financial decisions, not just pay bills. In most cases, the person named will be authorized to handle real estate, life insurance, retirement accounts, other investment accounts, bank accounts, and any other matters involving money.  As such, the person chosen to serve in this capacity should be someone with financial savvy who can be trusted without reservation.

Homestead Declaration

The homestead declaration, once properly recorded in the Registry of Deeds, declares a principal residence to be a homestead. The homestead declaration protects the equity in the primary residence up to $500,000 from attachment, seizure, execution on judgment, levy, or sale for the payment of debts.

In some cases, such as advanced age or disability, the equity protection can be up to $1 million. If a homestead declaration is not recorded, there is an automatic $125,000 of equity protection.  In addition to some other specific exceptions, a homestead declaration will not protect the real estate from nursing-home costs or tax liens.

Conclusion

With these four documents, most people can help their family members or trusted companions avoid expensive and painful legal hassles related to their ongoing care and their estate.

Individuals with more complicated estates may require different or additional documents to fully protect their interests and their beneficiaries, but for the majority of people, an estate plan is only four documents away.

Gina M. Barry is a partner with the law firm Bacon Wilson, P.C. She is a member of the National Assoc. of Elder Law Attorneys, the Estate Planning Council, and the Western Mass. Elder Care Professionals Assoc. She concentrates her practice in the areas of estate and asset protection planning, probate administration and litigation, guardianships, conservatorships, and residential real estate; (413) 781-0560; [email protected]

Business of Aging Sections

A Transformation in Care

The living room at the Sosin Center for Rehabilitation

The living room at the Sosin Center for Rehabilitation, like other areas of the facility, are meant to
evoke a home-like feel for residents preparing to return to their own homes.

When JGS Lifecare launched the strategic plan five years ago that would become Project Transformation, the goal was to, well, transform the organization’s entire range of senior services to reflect 21st-century ideas about delivering care in a resident-centric way. The Sosin Center for Rehabilitation, the highlight of the project’s first phase, is a good example, employing the burgeoning Green House philosophy, a model aimed at making residents feel at home while achieving the independence they need to return to their own homes.

The hallways in the Sosin Center for Rehabilitation are wide, allowing for freedom of movement for multiple individuals going about the business of regaining their independence.

The bedrooms, as BusinessWest observed on a recent tour, are simple but elegant, with mounted flat-screen TVs and adorned with paintings created by local artists. The bathrooms are large, well-appointed, and completely accessible to people with ambulatory challenges, and the spacious common living room is bathed in natural light.

Martin Baicker

Martin Baicker says the Green House model has been proven to improve rehab outcomes and reduce rehospitalization rates.

“When we show people the Sosin Center, it speaks for itself,” said Susan Halpern, vice president of Philanthropy for JGS Lifecare, which opened the Sosin Center to short-term residents this month. “It’s the kind of environment where you’d want your loved ones to be cared for.”

The facility is named after George Sosin, a JGS volunteer, family member, former resident, and supporter who left $3 million dollars to JGS Lifecare in support of the center, the largest contribution received in JGS’s 104-year history. It contains two households, each designed to accommodate 12 short-stay residents. All 24 rooms are private, with full baths, and each home has a shared living room, dining room, den, kitchen, and porch, which provides seasonal access to the outdoors.

JGS unveiled the Sosin Center and the neighboring Michael’s Café — which connects the short-term rehab facility with the Leavitt Family Jewish Home, the organization’s nursing home — as part of phase 1 of Project Transformation, a multi-pronged endeavor to, well, transform JGS’ many senior-care elements into facilities that truly reflect 21-st century healthcare.

Notably, JGS Lifecare partnered with the Green House Project to implement a small-house model of care at the Sosin Center that is slowly becoming recognized throughout the industry for its success in reducing medication use and rehospitalizations, while affording greater socialization and interaction with caregivers.

Martin Baicker, president and CEO of JGS Lifecare, noted that more than 64% of all short-stay residents at JGS are successfully discharged to the community, which is more than 10% above the national average, but he expects the percentage to rise further at the Sosin Center.

The Green House model extends well beyond aesthetics, Baicker said, encompassing a three-pronged philosophy — real home, meaningful life, and empowered staff.

The first element is an effort to make short-term residents feel at home, not on some institutionalized schedule. “You wake when you want, go to sleep when you want — and it also looks like your home, architecturally,” he said.

Meaningful life means giving people choices in their day, and the small number of units allows residents to build strong relationships with the staff, he went on. “They feel a real sense of engagement.”

As for empowered staff, this might be the most important element of all, Baicker noted. Typically, he noted, an organizational chart extends from the top down, but here, it’s a series of concentric circles with the resident at the center, and the certified nursing assistants representing the second circle. “They provide personal care, cooking, laundry, light housekeeping, activities — and this is given by the same person spending an awful lot of time with the resident, getting to know them.”

Susan Kline and Stephen Krevalin

Susan Kline and Stephen Krevalin are co-chairing the $11 million capital campaign for Project Transformation.

The CNAs are supported by nurses; physical, speech, and occupational therapists; and perhaps a doctor, but still essentially make the day-to-day decisions about how the house is run, he explained. “That is totally, radically different than running a traditional nursing home.”

Person-centered Care

Of course, the Sosin Center isn’t a nursing home, which is why Halpern is happy that short-term rehab residents at JGS are no longer sharing space at Leavitt. “It’s not beneficial for someone to come in for rehabilitation and cohabitate with people in long-term care. They’re here short-term, getting ready to go home.”

Baicker agreed. “People in short-term rehab don’t want to feel like they’re in a nursing home.”

The Green House philosophy represents a stark change in the way the healthcare industry traditionally frames short-term rehab, Halpern added. “It’s person-centered care. You empower the residents to make decisions about how to model their daily lives and routines — when they get up, what food they eat. They have more say in their actual caregiving.”

Baicker said the outcomes of the Green House model have been impressive at other facilities that utilize it. Patients tend to need less medication, eat more food — because the scents of meals being prepared where they live activates their appetite — and engage in life in a more dynamic way, since they’re constantly engaged with the staff. “All those things combine to improve outcomes.”

Much of the rehabilitation incorporates activities residents will conduct once they’re back at home, from reaching shelves and preparing food to washing and bathing, said Susan Kline, who is co-chairing the $11 million capital campaign for Project Transformation with Stephen Krevalin. Both are longtime volunteers with the JGS Lifecare organization and former chairs of its board of directors.

Most Sosin residents will come from hospitals, but some from other settings, and while a small number may wind up in nursing homes, that’s rare; the idea is to prepare individuals to return to their homes and independence.

“The outcomes have proven to be much more successful in this setting than what occurs in other areas,” Kline added.

When Baicker came on board in 2012, JGS was already busy strategizing for the series of changes that would eventually become Project Transformation, including planned improvements to short-term rehabilitation and assisted living, as well as a revamp of the adult day health program to better serve a growing population of seniors in the early stages of dementia.

JGS Lifecare building committee members Frank Colaccino and Jeff Grodsky

JGS Lifecare building committee members Frank Colaccino and Jeff Grodsky unveil the Sosin Center for Rehabilitation at the facility’s recent ribbon-cutting ceremony.

But he was one of the first in the organization to promote the Green House model, and when the board responded positively, team members started paying visits to other facilities that had incorporated it, from Mary’s Meadow in Holyoke to the Leonard Florence Center for Living in Chelsea.

“The board did their due diligence and decided this is the way we’re going to move,” he said. “And, ultimately, we want to expand this model to the long-term portion of the nursing home.” Indeed phase 2 of Project Transformation will turn to modernizing two 40-bed wings of the Leavitt Family Jewish Home in the Green House model.

Construction of the 24,000-square-foot Sosin Center and the adjoining kosher café began in June 2015, and both were dedicated at a ceremony last month shortly before their official opening.

The café is dedicated to the memory of the late Michael Frankel, who was an outspoken advocate for Project Transformation, Halpern said. “Naming the café in his honor is a permanent tribute not only to Frankel’s extraordinary commitment to the care of our elders at the highest standards, but also his vision for JGS Lifecare for generations to come.”

Krevalin hopes the café serves as a “beacon for the community,” noting that it connects the nursing home and the Sosin Center and is not only an ideal meal spot for residents, families, and staff, but for the public as well. “We’re hoping the community supports it.”

Ahead of the Curve

Project Transformation is far from the first time JGS leadership has moved away from traditional, stale facility design, Halpern said. As far back as the 1990s, the organization was renovating the nursing home and designing the Ruth’s House assisted-living facility to be more homelike and less institutional. “It’s all about making people feel comfortable in the environment where they’re living. The nursing home was built at a time when nursing homes were like hospitals, with nurses’ stations.”

Twenty years ago, a shift to a more home-like setting was still an innovative idea in healthcare, Baicker said. “You can’t underestimate the forward thinking of the leaders of this organization, making the common areas and dining areas less institutional. This [Project Transformation] is the continued evolution of that.”

“And believe me,” Kline added, “we’re already thinking about what’s next.”

Ruth’s House underwent some improvements as part of phase 1 as well, and phase 2, in addition to modernizing the nursing home according to the Green House model, will relocate and expand Wernick Adult Day Health Care to include a specialized Alzheimer’s program.

All this takes money — both phases were initially budgeted at $20 million but could eventually approach $23 million, Krevalin said — and more than 150 supporters have already contributed some $8.5 million to the capital campaign, which had an initial goal of $9 million but will be extended to $11 million.

“The initial response is heartening. It shows that many donors already understand the impact that our new facilities will have on the quality of life of our elders and others we serve,” Krevalin said. “Once people see Project Transformation, they will understand its impact, and they will want to be part of it.”

Joseph Bednar can be reached at [email protected]

Business of Aging Sections

Finders, Keepers

pileofjunkhoardingartWhen Bec Belofsky married Lee Shuer, she had no idea he had hoarding disorder.

When they met, he was living in an apartment with roommates, and she didn’t know most of the items in it, which included a ‘museum room’ filled with a seemingly endless number of things, belonged to him.

But within a short period of time, every surface in the married couple’s apartment was covered. In fact, although they could barely get through the apartment — and she had bruises from bumping into things — he continued to bring home ‘treasures’ on a daily basis. “I had a feeling of dread every time I heard the sound of his key in the lock,” she recalled.

Shuer told BusinessWest he also had a storage unit that was full and a collectibles booth in South Deerfield, but never sold much.  “I couldn’t let go of anything, so I had everything priced for more than it was worth,” he said.

Anyone has who watched TV shows depicting people who hoard might think there was little hope for Shuer or the marriage, but today much of the couple’s Easthampton home is immaculate, he has been in recovery for 11 years, and they have made it their mission to help other people with what they refer to as “excessive finding and keeping,” because the word ‘hoarder’ leads to feelings of shame and guilt.

They have appeared on many national and international TV and radio shows, including CBS Sunday Morning and Voice of America, and travel the world educating therapists, government officials, relatives of people who hoard, as well as hoarders themselves about what it takes to successfully overcome the disorder.

They want the public to know that television shows that portray interventions with people who hoard are extreme and not representative of the majority of people with the problem. In addition, tactics that include forcing the person to make quick decisions about untold numbers of items, accompanied by threats from family members, can be devastating and lead to a return of the behavior after their space is free of clutter.

“There are kinder, gentler, more effective approaches to the problem,” Shuer said. “Telling someone to stop collecting things is like putting a warning on cigarettes. You have to have the motivation to stop, but once it becomes internalized, people find the strength of purpose they need.”

home-office-before-fix

Lee Shuer

Top: before Lee Shuer overcame hoarding disorder, his home office was unusable. At left: today, his home office is well-organized and contains only items that are truly important to him.

He has worked with individuals, groups, and institutions ranging from Stanford University and Smith College to the Institute for Challenging Disorganization through the couple’s business, Mutual Support Consulting, and has created a program called WRAP for Reducing Clutter, which is a wellness and recovery plan.

Shuer also works with researcher Randy Frost, who co-authored the book Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding, to create The Facilitator’s Manual for the Buried in Treasures Workshop, as well as another workbook designed to help people with the problem.

Frost says the reason it is so difficult for people with hoarding disorder to relinquish possessions is that everything they save has real significance to them. In some cases, such as a journalist who collects newspapers, the collection is a concrete embodiment of their professional identification.

“So getting rid of them makes the person feel as if they are losing that piece of themselves,” said Frost, professor of Psychology at Smith College. “We don’t really know what the underlying cause is, although it is clearly an attachment issue, and there is some indication it is related to early life experiences.”

Jane Laskey, a psychotherapist from Holyoke Medical Center’s Behavioral Health Outpatient Center, has had clients with hoarding disorder, and each one of their situations has been unique. “In many cases, hoarding is a symptom; it’s something people do to protect themselves from feelings that are very scary or painful, including sadness, anger, or hopelessness that often originated in childhood,” she explained.

For this issue’s focus on health, BusinessWest explores the type of thinking connected with hoarding and offers advice from these experts to help people with an overabundance of possessions regain control of their lives.

Making Progress

Shuer’s love for tangible items began when he was about 4 years old and began asking neighbors if they had anything old they didn’t need. His parents allowed him to keep many of the things he was given, including old tools he really liked.

“I was socially awkward as I was growing up, and these things gave me comfort and something to talk about with other people,” he said, adding that, although he had a wonderful family, he often felt lonely because he was a social outcast at school. “I was looking for myself in the stuff I collected.”

For example, he’d always wanted to learn to play a musical instrument, and by the time he was married, he had collected far too many of them.

Today, Shuer tells people who hoard that “letting go doesn’t mean giving up a dream. You can come back to it, but you need to keep your eyes on the real prize.”

His own recovery began 11 years ago when Belofsky-Shuer heard of a study on hoarding that was being conducted by Dr. David Tolin, co-author of Buried in Treasures.

“We have developed treatments for the disorder that work fairly well, but they don’t work for everyone,” Frost said, noting that research continues to help people with hoarding disorder.

At the time, Shuer was working as a mental-health counselor for ServiceNet in Northampton and had served on the Western Mass. Hoarding Task Force for about a year. No one at work knew he had the problem, but in time he admitted to it publicly.

“I had to help others overcome the stigma,” he said, adding that he also received a grant to lead a peer-support group based on Frost’s book. After using principles outlined in the tome himself, Shuer began leading the group and meeting with Frost weekly, and they developed the facilitator guide to help others.

“By that time, I had learned enough to help myself and share what works,” he said. “What takes place in the Buried in Treasures groups is not therapy; it’s an action-oriented plan that helps people take concrete steps to alleviate clutter.”

Still, his wife struggled for years with her own issues caused by his problem. Although Belofsky Shuer has a degree in psychology from Smith and had some academic knowledge gleaned from one of Frost’s classes, she felt isolated and alone.

“The stuff Lee collected was so important to him that it put a real strain on our marriage,” she said. “I felt helpless in our home and insignificant; the things that made up my identity were buried under all of his things.”

Lee Shuer and Bec Belofsky-Shuer

Lee Shuer and Bec Belofsky-Shuer want others to know that TV shows about people with hoarding disorder do not present realistic ways to overcome the problem.

She added that most people don’t know there is help available that works. “Research only began in the ’90s, and TV shows that show forced cleanouts don’t work. But finding the motivation to change and learning why people become so attached to things and challenging their beliefs can make a real difference.”

However, the couple stressed that it’s not an all-or-nothing proposition; getting support from others online, through counseling, or in a support group with peers, which offers the best chance at success, can slowly lead to change.

Shuer said the disorder reflects an abnormal attachment to items that can stem from positive qualities that spiral out of control. For example, a person may feel they are archiving family treasures, don’t want to get rid of printed information they believe may prove valuable in the future, or be overly concerned about recycling things in a proper manner.

“There are emotional and cognitive aspects to decision making when it comes to letting go of things,” Belofsky Shuer explained, adding that the workbook outlines steps for decision making and is available free through their website, www.mutual-support.com.

“We encourage people to start small and focus on clearing one square foot at a time,” Shuer said.

Anyone whose problem hasn’t reached an extreme level can also begin by focusing on sorting through one type of item at a time: they could gather all the books in their home, put them in one place, then begin going through them.

“They need to remember they can get many of them at the library if they want to read them again,” Shuer told BusinessWest.

It’s critically important, Belofsky Shuer added, for family members to take care of themselves during the process. “I completely lost my identity and had a lot of anger and resentment when our home was filled with his possessions,” she said, noting that counseling allowed her to be supportive and restored her sense of self while her husband slowly worked toward their shared goals.

Course of Treatment

Studies have shown that people who hoard have suffered more trauma than the normal population, but only half have undergone a very difficult trauma.

“Trauma is not the underlying issue, but there is a lot of co-morbidity, and the biggest one is depression. More than half of hoarders suffer from it,” Frost said. “It isn’t clear that depression causes the problem, but it can make it worse.”

Laskey added that accumulating things can give people a feeling of control or enhanced self-esteem. She treated one woman with a very poor self-image that stemmed from her childhood who kept buying new clothing, even though she had never worn most of what she already owned.

“Buying gave her hope and a momentary feeling that included excitement and anticipation,” Laskey said, adding that the woman envisioned feeling attractive and confident wearing the new clothing, and lacked the confidence to think of other behaviors that could improve her self-esteem.

She suggests using stalling techniques before bringing anything new home, which can be something as simple as taking a walk.

“The problem is that the brain gets stuck like a record in a groove, and the need to have something becomes an automatic way of thinking,” Laskey said, explaining that, in some cases, the person can learn to be an “impartial spectator” by detaching from their feelings and trying to judge an item the way a friend might view it.

Indeed, asking a close friend for support can be beneficial, but it’s critical for that person to respect boundaries.

“If the person with the problem says they only want to spend 10 minutes going through things, don’t push them to do another five minutes,” Laskey said. “Let them set the ground rules and praise any progress they make. Hoarding is like an addiction which becomes a habit, and habits are really hard to break.”

Frost says three elements are critical to attaining lasting success. The first is controlling acquisition, and addressing the reasons why the person feels compelled to collect things.

“People see something they want, seek things out at yard sales, or find something while they are driving on trash day. Acquiring it is an impulsive behavior. When they find something they like, they get a high that is almost like an addiction; many people have told us it gives them joy in life when they find a new object to bring home,” he explained. “Their attention becomes so narrowly focused that they don’t think about whether they have the money to buy it, room to keep it in, or whether they already have a dozen of the same items at home.”

Treatment involves bringing conscious control into the decision-making process, but won’t work unless something else is substituted that gives the person an equal sense of pleasure.

Frost’s book Buried in Treasures contains a tear-out page with questions people can ask themselves to help them decide whether they should acquire a new item, and includes room for questions appropriate for individual situations that can be generated during therapy sessions or with a peer-support group.

The second key element in successful treatment is treating the overpowering urge and belief the person has that they must have something they see and desire.

“The urge is overpowering, but they have to learn to tolerate it, which is done by creating a hierarchy of situations in which they practice walking away from an item without buying it,” Frost said.

After acquisition and impulsive behavior are under control, the person then needs to pare down their existing trove of belongings.

“We work on changing the nature of the person’s attachments to things so it’s easier to get rid of them,” Frost noted, explaining that people often fear they will become depressed and unable to stop thinking about an item they get rid of, will never be able to find the same type of thing again, will lose an important connection to someone in their life, or will be responsible for harm coming to the object.

“So, we turn them into scientists whose goal is to discover whether their beliefs are true,” Frost said, noting that some clients get rid of one item, then keep track of what their life is like afterward.

“Some feel they will be anxious forever and won’t be able to stand it,” he told BusinessWest, explaining that putting long-held beliefs to the test is difficult for anyone to do.

Shuer said it was an epiphany to realize he could get rid of something and not miss it. “I thought, ‘If I can let go of one thing, maybe I can let go of others.’ The idea brought me a sense of joy and relief that I thought I could only get from acquiring things,” he said, cautioning that, when people begin weeding through their belongings, they should start with items that don’t have strong emotional meaning.

The third key element in successful treatment is learning organizational skills. People who hoard are taught how to create filing systems as well as ways to organize items that are important, as many lack knowledge in this area.

New Outlook

Today, whenever Shuer is tempted to bring home anything new, he asks himself whether he has a place for it, whether he can afford it, and what his wife will think.

“These questions are reality checks that have become automatic for me. I am less impulsive and have moved towards a long-term vision for acquiring things that fits in with my physical space,” he said.

His success has resulted in a new life mission and a better marriage.

“We are happy now,” Shuer said. “When you are living with too much stuff, you can never relax; you feel you should always be working to reduce it. But now that we are liberated from clutter mentally and physically, we have the time and freedom to have fun and help others.”

Indeed, the hope of finding peace of mind, improving relationships, and having time to enjoy life are real treasures that can motivate ‘finders and keepers’ to seek — and work toward — lasting change.

Business of Aging Sections

Difficult Decisions

Dr. Richard Alexander says screening for prostate cancer has become controversial

Dr. Richard Alexander says screening for prostate cancer has become controversial, but at least one study shows it extends longevity in people with the disease.

While much of what is known about prostate cancer is fact — including the fact that 99% of the men diagnosed with the most common forms of the disease will survive more than five years after diagnosis — there is still a good deal of conjecture. That’s especially true when it comes to screening for the malady.

One in seven men will be diagnosed with prostate cancer at some point in their lifetime.

“It’s a complicated disease, and a lot of issues surround it; doctors have devoted their entire careers to one subset of prostate cancer,” said Dr. Adam Tyson, a urologist at Urology Group of Western New England in Springfield.

Although it’s the second-most-common cancer in men and the second-leading cause of cancer deaths (skin and lung cancer, respectively, are number one), routine testing for the disease, which typically has no symptoms until it advances to the lymph nodes and bones, has become very controversial.

Screening involves a digital rectal exam and a simple blood test that measures the level of prostate-specific antigen, or PSA, which is a protein shed into the blood by the prostate gland that becomes elevated when cancer is present.

But in 2012, the U.S. Preventive Services Task Force declared that PSA testing should be abandoned. The reason is twofold: many men with elevated levels of PSA and an abnormal digital rectal exam have had biopsies that turned out to be negative, which caused unnecessary stress and did more harm than good; and arguments have been presented about whether routine testing increases survival rates.

Dr. Richard Alexander, a urologist at Baystate Medical Practices – Greenfield Urology, says a randomized study that followed a group of American men for 10 years found no difference in survival rates in men that were screened versus those not screened for the disease. But the problem with the study was that 70% of the men assigned not to be screened did indeed get screened outside of the study.

Dr. Adam Tyson says most prostate cancers are non-aggressive

Dr. Adam Tyson says most prostate cancers are non-aggressive, so the doctor and patient have to work together to figure out the best way to treat the disease, which depends on a number of factors.

In contrast, a very large European study conducted in many countries showed routine screening did lead to an increase in overall survival.

“It is not an easy thing to determine, and the results were astonishing,” Alexander said, noting that prostate cancer is found most commonly in men age and 60 older who often have two or more other diseases as well due to their advancing age, among other factors.

It can only be diagnosed by a biopsy of the prostate, which is done in a doctor’s office through the rectum using ultrasound guidance.

Alexander noted that an elevated PSA level increases the chance that cancer could be present, but it can be elevated by other factors that range from an enlarged prostate to inflammation of the prostate gland.

Neither the digital rectal exam or PSA level is a perfect test, but the American Urological Assoc. feels screening can be valuable for men between the ages of 55 and 70, especially if they are at high risk for the disease due to a family history, as it has a strong genetic component.

“I don’t think all men should be tested. But at age 50, they should have a conversation with their doctor about it, and if they ask for my recommendation, I tell them to get it done,” Tyson said, explaining that, since it is often a slow-growing cancer, it doesn’t make sense to test men over the age of 75.

“A lot of the cancers are non-aggressive and may or may not catch up with people, so the question is how to find men with aggressive cancer and treat them. Many men get biopsies who don’t need them, but if they don’t, the only other time the cancer will be found is in the late stages. And although most men with prostate cancer are more likely to die with it, rather than from the disease, there are still 26,000 men who die every year from it, and if it doesn’t kill you, it can keep you from being able to urinate, or spread to the bones and lead to fractures.”

He noted that a biopsy can be recommended with an abnormal PSA or abnormal exam.

“Often, the PSA will be repeated to confirm accuracy if it is elevated. But depending on many factors, a urologist may recommend a biopsy with a single abnormal PSA or an abnormal digital rectal exam,” he continued, explaining that, although prostate cancer is rarely found in men under the age of 40, he has seen it in men in their 50s with some degree of frequency.

Personal Decisions

The American Cancer Society says about 180,890 new cases of prostate cancer will be detected this year, and about 26,120 deaths will result from it. However, if it is caught in the early stages, it is treatable, and 2 million men who are alive today are prostate-cancer survivors. In fact, 99% of men with the most common types of prostate cancer will survive more than five years after diagnosis, and when the disease is localized to the prostate or just nearby, which occurs 90% of the time, the prognosis is even better; almost 100% will live at least five years.

But there is a great deal of fear surrounding the disease as well as myths associated with it, including the perception that prostate-cancer surgery means an end to a man’s sex life.

“When I tell someone they have cancer, that word is almost always the only thing they hear during our first conversation,” Tyson said. “It’s a life-changing event, so people with the disease need to work closely with their doctors.”

Alexander says men have choices about what will happen to them, but they need to have a clear understanding of the issue before making any decisions.

“People are terrified of the word ‘cancer,’” he said. “But many men can live with prostate cancer their entire life, while in others it progresses, and although there is no way to accurately predict the future, predictions have become more accurate than they were in the past.

“I encourage men to be aware of their options and make informed decisions,” he continued, adding he frequently hears horror stories from men who had a relative with the disease. Their initial instinct is to base their decisions on anecdotal evidence about what happened to that person, but decisions need to be made carefully, and both he and Tyson believe in seeking second and even third opinions after a cancer diagnosis.

“There is a risk in doing anything, but there is also a risk in doing nothing,” Alexander noted.

Symptoms that occur when the disease has advanced include problems with urination, loss of appetite, weight loss, and metastatic disease, which is the name given to a cancer when it has spread to the lymph nodes or bones.

But the disease has different stages as well as grades, which refers to how the cells in the biopsy look under the microscope and can indicate whether the cancer is likely to progress.

There are four treatment options available today: radical surgery, radiation therapy, hormone therapy, and active surveillance, which can include additional biopsies every year or several years. The age of the patient and their overall health and willingness to be treated help determine what choice is best. But they all have their own risks.

“A radical prostatectomy removes the entire prostate and attached glands, and the main risk is urinary incontinence and erectile dysfunction,” Alexander said, adding that the surgery is done if the cancer is still confined to the prostate, and the success rate is high. As to side effects, although most men have some incontinence following surgery, few are left with a permanent problem.

Radiation therapy can be done with machines over a period of weeks, and side effects include more frequent urination, burns to the bladder or rectum, and erectile dysfunction. The therapy can also be delivered by implanting radioactive seeds into the prostate. The radioactivity is gone within a year, but the metal seeds remain. The procedure requires anesthesia and takes about an hour.

“But not everyone is a good candidate for the seeds,” Alexander said, adding that whether someone is a candidate depends on the stage of the disease and how likely it is that the cancer will spread.

Hormonal therapy is reserved for more advanced cases, but this treatment has come a long way: decades ago, it involved removing the testicles, while today it is administered through injections. Possible side effects include hot flashes, muscle loss, fatigue, and loss of bone density.

“In some cases, hormonal therapy is combined with radiation,” Tyson said, noting that is usually done only in the case of advanced disease.

And although some treatments do cause erectile dysfunction, the problem has been mitigated by drugs such as Viagra and Cialis, which can improve the quality of a man’s life.

“The way a man urinates after any treatment will shift, and since the nerves and blood vessels involved in an erection are attached to the back of the prostate, any treatment will affect it. Sometimes there is only an occasional weakening, but most men will need medications to regain potency,” Tyson explained.

The final option for men with cancer is to do nothing other than be followed closely, and this choice is becoming more popular in cases where the disease is considered low-risk. “We are finding that prostate cancer can often be watched for years and never progress,” Alexander said, adding that hundreds of thousands of men who have the disease may never know about it.

Final Recommendations

Despite conflicting opinions, Alexander believes men with abnormal PSA levels should have biopsies. “I would rather know I had the disease and make a decision not to have any treatment than not know I have it,” he said, adding that the decision is an individual one, and although in most cases prostate cancer is slow-growing, that’s not always the case, as evidenced by the number of deaths from it each year.

Advances in the field have been made, such as robotic surgery, which is less invasive, involves less blood loss, and allows men to recover more quickly than they did before it was invented.

“When people hear the word ‘cancer,’ they go into panic mode, but it’s important to understand the nature of the cancer because every cancer has its own way of behaving,” Tyson said. “Most prostate cancers do not spread rapidly and are non-aggressive, so the doctor and patient have to work together to figure out what is right for the patient. There is no single right answer; some people absolutely need treatment, and in others, it is less clear.”

Indeed, there is a lot of choice involved in the matter, but the first step — which is to get tested — is something every man should consider and talk to his doctor about.

Business of Aging Sections

Lighting a Path

 

pathlightSPRINGFIELD — In a time of change for what, until recently, was known as the Assoc. for Community Living, the organization’s passion and innovative spirit will remain constants, its executive director says.

But it needed a name change, Ruth Banta went on, one that underscores the scope of the services it has provided to people with intellectual disabilities in the community — from youth through the senior years — since 1952.

That new name is Pathlight.

“What we’re hoping with the new name is that people will associate it with the breadth of the services that we offer,” she said. “When people hear that a service is a Pathlight program, we want them to know that means it is a caring, high-quality service backed by high-level expertise.”

Banta also announced that, in continuing the organization’s innovative spirit, Pathlight has partnered with Valley Venture Mentors (VVM) to offer the Pathlight Challenge. The two organizations have put out a national call to startup entrepreneurs to develop technology aimed at increasing independence for people with intellectual disabilities.

It’s expected that at least two proposals from startups will be accepted by Pathlight. Those entrepreneurs will be enrolled in Valley Venture Mentors’ four-month, intensive Accelerator Program in January.

“It’s a great partnership,” Banta said. “We’re tying our history of innovation and our passion for the people that we serve to entrepreneurs’ passion for innovation and breaking barriers.”

Paul Silva, chief innovation officer at Valley Venture Mentors, said what’s key in the Pathlight Challenge is that startups will have access to people in the populations they are hoping to serve as they produce their innovations.

“Interfacing with stakeholders is normally hard to do,” he said. “We have created a way in which companies that are worthy can get the access they need. If they want to develop something for parents, Pathlight can connect them to parents. If they want to gain access to staff, we can connect them to staff. This will allow them to troubleshoot problems as early as possible and allow their ideas to evolve more quickly. Pathlight is giving these startups a chance to be more competitive and, thus, more likely to survive.”

New Era

Formerly vice president of administration and chief financial officer at the organization that serves people with disabilities across Western Mass. from infancy through end of life, Banta said the name change to Pathlight was part of a rebranding that began last fall as a means of solidifying the agency’s persona and outlining its key values.

“Our mission is to help people on their own unique journey to experience the life they want to live,” she noted. “We weren’t being literal when we chose the new name, but we hope that it conveys that we shine a light on those journeys.”

Banta is excited about the partnership with Valley Venture Mentors, as it highlights the organization’s long-standing history of innovation. She noted that Pathlight’s history of advances dates back to its roots. “We were the first to open a community residence for people with disabilities and the first to create a shared living model for families.”

Now, she added, “we’re looking at how we serve the Millennial population of people with developmental disabilities and autism and looking at how technology can give these young adults the independence that they and their families want for them.”

The Pathlight Challenge is especially seeking solutions to issues regarding health, safety, and transportation.

“Transportation is often a big hindrance to the people we serve in terms of getting to jobs and recreational opportunities,” Banta said. “We’re looking to see how technology can offer assistance there.”

Silva said he is excited about the national call for proposals that will now be launched via both organizations’ databases and online connections. The selection process will continue through October.

The Accelerator Program is a four-month, intensive program held over one long weekend a month, offering startups connections to subject-matter experts, investors, and highly engaged and collaborative peers. Those competing in the program can win up to $50,000 in grants to develop their business or product.

The Pathlight fellows will graduate from the Accelerator Program in May, when they will also unveil their new technology, Silva said.

“To our knowledge, this challenge is the first of its kind,” he added. “There are hundreds of accelerator programs in this country running every year, but I haven’t run across any that are focused on assistive technology. Assistive technology is a new focus.”

One he and Banta — and plenty of clients — hope will continue to light a path to greater independence.

Business of Aging Sections

Shock to the System

DBS treatment

From left, Dr. Octavian Adam, Dr. Mohamad Khaled, and Paul and Kathie Schafer discuss the results of Paul’s recent DBS treatment at a recent press conference.

Paul Schafer’s wife likens it to “something out of Star Wars,” but it’s firmly in the realm of real-world science, and it holds the potential to change countless lives. It’s called deep brain stimulation, and for Schafer, who suffers from essential tremor, as well as many Parkinson’s disease patients, this treatment — now available at Baystate Medical Center — has opened a door to enjoying the activities of daily life most people take for granted.

Paul Schafer pressed a button on a small, handheld device, and started to shake.

The tremors were subtle at first, but within seconds his hands were shaking uncontrollably. When he picked up a plastic cup, the doctors sitting with him were grateful it was empty. When they handed him a pen to write his name, the scrawl couldn’t even be recognized as letters, let alone anything intelligible.

That was his life before his recent brain surgery, one of the first of its kind in the region. But when he pressed that button again — not without difficulty — the shaking stopped, and he was able, once again, to perform those simple activities.

That’s his life now.

“It changed my whole life,” said Schafer, 74, while sitting with his wife, Kathie, and the Baystate Medical Center doctors who facilitated that change. “All the mundane things you do every day, I wasn’t able to do without help — drink coffee out of a mug, brush my teeth, comb my hair, button my shirt … all the stuff everyone takes for granted. It was too challenging to do those things before the surgery.”

The procedure is known as deep brain stimulation, and it helps people like Schafer — who suffers from a common neurological movement disorder called essential tremor — as well as patients with Parkinson’s disease, dystonia, and obsessive-compulsive disorder, a chance at a normal life.

It changed my whole life. All the mundane things you do every day, I wasn’t able to do without help — drink coffee out of a mug, brush my teeth, comb my hair, button my shirt … all the stuff everyone takes for granted. It was too challenging to do those things before the surgery.”

The tremors caused by such conditions can be debilitating. But DBS, performed successfully — as Baystate neurosurgeon Dr. Mohamad Khaled did for Schafer — is opening up a dramatic new door to quality of life for potentially millions of sufferers.

The surgery — which involves drilling a small hole into the skull, under local sedation, and inserting electrical wires into the area of the brain where circuit errors are causing the tremors — may also hold potential in areas ranging from Alzheimer’s disease to severe depression, but those frontiers are still being studied.


Go HERE for a list of Skilled Nursing/PT Facilities in Western Mass.


The U.S. Food and Drug Administration approved the treatment for essential tremors and Parkinson’s in 1997, and it’s now recommended for patients with severe symptoms that don’t respond to medication anymore, or when the response isn’t sufficient, said Baystate neurologist Dr. Octavian Adam.

“Paul had symptoms for 15 years, and took a number of medications with some response; then the symptoms progressed and really affected his life in a negative way,” he went on. “He had difficulty using his hands — writing, holding a cup of coffee without spilling it, using a fork and knife to eat, brushing his teeth.”

Because the medications weren’t working anymore, the Schafers saw DBS as, well, a no-brainer.

“Dr. Adam was suggested by Paul’s previous neurologist, who said there may be something else we could look into,” said Kathie Schafer. “When we walked out of the building, we sat in the car, looked at each other, gave a big sigh, smiled, and said, ‘it looks like there’s a way — a better way of life.’ I think that was how we thought about the entire procedure.”

Finding the Sweet Spot

According to the National Parkinson Foundation, deep brain stimulation has proven to be an effective treatment for that disease’s symptoms, such as tremor, rigidity, stiffness, slowed movement, and walking problems, as well as similar symptoms present in essential tremor.

DBS does not damage healthy brain tissue by destroying nerve cells, the foundation noted. Instead, it uses a surgically implanted, battery-operated medical device called a neurostimulator to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremors.

Dr. Octavian Adam, left, and Dr. Mohamad Khaled

Dr. Octavian Adam, left, and Dr. Mohamad Khaled say not everyone with tremors is a candidate for DBS, but those who are typically find the results dramatic.

The DBS system consists of three components: the ‘lead,’ an electrode — a thin, insulated wire — inserted through a small opening in the skull and implanted in the brain; another insulated wire passed under the skin of the head, neck, and shoulder, connecting the lead to the neurostimulator; and the neurostimulator itself, a sort of battery pack implanted under the skin, usually near the collarbone.

In the first phase of the procedure — called phase zero, because it doesn’t involve surgery — the neurosurgeon uses MRI or CT scanning to identify the area of the brain where the electrical nerve signals generate the tremors.

Phase one, as the next step is known, involves implanting the electrodes in the brain while the patient is under sedation. When the patient wakes up, Khaled asks him to point a laser at a target on the wall. As the doctor adjusts the electrical wires to target the appropriate circuit in the brain, the patient’s shaking hand slowly begins to stop shaking so that the laser is directly pointed in one location. That’s when Khaled knows he’s found the ‘sweet spot’ for the electrodes, and the patient suddenly is nearly cured of the tremors.

“The circuitry is in disarray, so you sort of shut that circuit down,” he explained. “Sometimes it’s like a radio dial — you need to dial it up or tune it down.”

After a few weeks of healing, a second surgical procedure is completed to make the changes permanent.  The wires are attached to a device implanted in the chest, which is programmed to send electrical impulses to the brain, which block the signals causing the tremors.

Not everyone with essential tremor or Parkinson’s is a candidate for deep brain stimulation, Adam explained. The best candidates have suffered from tremors for a long time and failed to find relief through medications, and the tremors have to be severe enough to impact their daily life in a significant way. “If those conditions are met, we consider surgery to treat them.”

That said, only about 10% of patients with essential tremor are good candidates, and 20% of those with Parkinson’s, though the calculation with Parkinson’s is a bit more complex, requiring at least some positive response to medications and a lack of other conditions, such as dementia, cognitive issues, and severe depression.

About 100,000 patients worldwide have undergone DBS since 1997. Previously, the closest hospitals in the Northeast that offered it are in Boston to the east, Albany, N.Y. to the west, Burlington, Vt. to the north, and New Haven, Conn. to the south. “So we had a big hole in the middle,” Khaled said.

That’s important, Adam noted, because patients with essential tremor or Parkinson’s are often unable to drive and may not have access to transportation, and the procedure is more than the surgical visits; many appointments are necessary in advance of the actual surgery. “Having it here makes it available to a lot of patients who would not have access to it otherwise.”

In Schafer’s case, he had hit the wall with medications; there was nothing else he could try. Despite the risks possible with any surgery, “I was very positive about the whole procedure.”

Still, the risks were minimal, Adam explained. In any brain surgery, the risk of bleeding or stroke is about 2%, and the risk of infection between 3% and 5%. “That’s pretty low. Ninety-five percent of the time, nothing happens. And this does not carry any extra risk compared to other brain surgeries; in fact, there’s less. The level of invasiveness is less. The electrodes are thinner than a spaghetti noodle.”

Science, Not Fiction

Schafer was also, naturally, curious about how long DBS would prove effective. Khaled and Adam explained that early response is always the strongest, and over time — perhaps a decade or more — some of the effect may start wearing off. But the device settings can be fine-tuned to provide better coverage and more control.

Paul Schafer

Paul Schafer speaks to the media about how DBS has allowed him to perform routine tasks that had become impossible.

In a Parkinson’s patient, the surgery’s effectiveness lasts between six and 10 years on average, but that disease’s symptoms are not limited to tremors, and those other symptoms progress regardless of the surgery. “So the management changes a bit,” Khaled said, “but studies show that quality of life with surgery is better than for those without surgery — that is, for the right candidates.”

Schafer knew he was one of those success stories when, right after the electrode began delivering signals to his brain, doctors handed him a flashlight, which he slowly — and accurately — lifted up to his mouth like a glass.

“We had tears in our eyes,” he said. “I wouldn’t have been able to do that with one hand.”

He shuts the system down to sleep — “when I turn it off, it’s a whole different world,” he noted — but restarts it in the morning and feels the tremors subside. He compares the feeling, when the neurostimulator switches on, to the tingle of a Novocaine shot, only throughout his whole body.

Today, he and Kathie say they understood both the potential and the risks — and there was really never any question.

“Of course, it does get a little scary, the idea that Dr. Khaled would drill into my husband’s head, but it needed to be done,” she said. “If there was a chance Paul could have a better quality of life going forward, then we were both very willing to give this a try.”

She’s glad they did, saying they’ve felt “nothing but happiness and wonderful excitement” as Paul rediscovered the ability to perform the tasks of everyday life with no difficulty. “We just keep smiling. It’s not without its risks or challenges, but to us, it was like something out of Star Wars. It was a miracle.”

Paul, now able to live a relatively normal life, plans to start a support group for people with essential tremor. “There are a lot of people out there with what I have,” he said, knowing that he can both share his experiences with those who might qualify for the surgery and at least bring together those who don’t. But he hopes more people fall into the former category than the latter.

“This has changed my life,” he said. “I strongly advocate getting the surgery done if you qualify for it. It makes so much difference.”

Kathie agrees. “He has a wonderful sense of humor, and he’s always been able to accept what happened with him and take it humorously and have everyone relax around him. But I knew it bothered him,” she said.

After letting Khaled, as she put it, drill into her husband’s head, “it’s made him 10 to 15 years younger in his attitude because now he goes out fully, completely aware of the fact that he can do whatever he wants to do, whenever he wants to do it.”

Joseph Bednar can be reached at [email protected]

Business of Aging Sections

Parental Guidance Suggested

Natalie, a Springfield mother

Natalie, a Springfield mother, is one of two women featured on murals for the “You’re the Mom” campaign.

Here’s a whopper of a statistic: according to the Centers for Disease Control and Prevention, about one-third of U.S. kids eat fast food every day.

But they’re not, for the most part, buying it for themselves; parents are making those choices.

That’s the issue that “You’re the Mom,” a new public-health campaign launched by ChildObesity180 at Tufts University, seeks to address. The campaign offers an array of messaging through various media, with one goal: get mothers thinking about the nutritional choices they’re making for their kids, and hopefully make better ones.

“We’re looking to increase the supply of healthier menu options for kids and create more consumer demand for those options,” said Linda Harelick, director of operations and communications at ChildObesity180. “We have engaged the restaurant industry and restaurant brands, and we’ve learned that there have been changes to menu options. Things have gotten healthier in the fast-food setting.”

However, she went on, “parents aren’t always aware of it. They get into the habit of ordering the number 7, or have their kids order a couple items off the dollar menu. Nobody’s studying the menu. We want to make them aware there are healthier options to choose from.”

In short, she explained, “we want to celebrate moms for the people they are and the role they play in families and communities — and give them simple tips.”

Harelick knows the issue is a complicated one, especially in a city with many low-income families living in neighborhoods underserved by stores selling fresh produce and other healthy options — a problem echoed by Kristine Allard, vice president of development for Springfield-based early-education provider Square One.

We want to celebrate moms for the people they are and the role they play in families and communities — and give them simple tips.”

“Particularly here in Springfield, where so many neighborhoods struggle with being part of a food desert, we know it’s not always easy to access good, healthy choices, and some families make fast foods their only option,” Allard told BusinessWest.

For families on a budget — often living near the poverty line — a visit to a fast-food drive-thru is often an exercise in filling up their children quickly at little expense, she went on. “But if we can make changes to what they order — swapping water for soda, ordering apple slices instead of fries, downsizing, not supersizing — that can make a big difference.”

She’s under no illusion that fast food is the best option for kids, “but if we can make small changes — and, in the long term, they make smarter choices — we can help reduce childhood obesity. It just makes sense.”

Square One is among a number of local organizations, including Partners for a Healthier Community and Springfield Food Policy Council, that are partnering with ChildObesity180 on the campaign, which is being piloted in the City of Homes, with plans to roll it out nationally in 2017.

Harelick recognizes that too few parents are immune to the combined pressures of packed schedules and picky kids bombarded with marketing for less-healthy options. But she believes the “You’re the Mom” campaign can make a difference, one choice at a time.

The campaign includes billboards, radio spots, bus advertisements, a heavy social-media presence (its hub is yourethemom.org), and murals by artist Marka27 — at 1072 State St. and 461 Main St. — featuring real Springfield mothers and promoting the message, “you’re the mom; you make decisions about what your kids eat,” Harelick explained.

The issue is nothing new to Partners for a Healthier Community (PHC), which joined several other community organizations eight years ago to launch Live Well Springfield, a movement to promote physical activity in area youth and increase access to healthy foods, a two-pronged approach to slowing a trend that has seen childhood-obesity rates triple nationwide and locally over the past few decades.

“What Tufts is doing is implementing a communications campaign that is very specific to low-income families with children who frequently eat at fast-food restaurants,” said Jessica Collins, PHC president. “If you have to eat at McDonald’s, make a healthier choice for your kid. Don’t buy soda; get water or milk. Give up the fries and choose apple slices. It’s another strategy to educate parents.”

Menu of Programs

Since its inception, Harelick explained, Child Obesity180 has brought in public-health advocates, industry and government leaders, and other nonprofits to design, pilot, evaluate, and scale initiatives intended to reverse the trend of childhood obesity — a full 180 degrees, in other words — within one generation’s time.

“We have very aggressive goals,” she admitted.

To get there, the organization has taken a multi-pronged approach. Among its initiatives:

• Its Active Schools Acceleration Project aims to increase physical activity in U.S. schools by identifying innovative solutions and giving schools the tools and resources needed to replicate proven models. For example, the New Balance Foundation Billion Mile Race has challenged students to walk and run 1 billion miles. “Five thousand-plus schools are participating in the campaign, driving excitement and interest in walking and running programs,” Harelick said.

• The Healthy Kids Out of School initiative works with afterschool enrichment organizations, like Boy Scouts, Girl Scouts, 4H, and youth sports leagues, to promote three principles: drink right, move more, and snack smart.

“Kids are eating more junk food than they need and not moving as much as they should, even in youth sports,” she noted. “We found if we communicated these three simple principles, we could have an impact. It’s been very well-received by the CEOs of these organizations.

“What we have learned is, we have to tie into the organizations’ values and practices,” she went on. “Scouts are looking to develop future leaders, and to be a future leader, you have to develop a healthy lifestyle. We developed a special healthy-habits patch for Boy Scouts and Girl Scouts, and developed a short online training for sports coaches.”

• The Restaurant Initiative, which is where “You’re the Mom” fits in, takes a three-pronged approach to reduce excess calorie consumption when children eat at restaurants: Increase consumer demand for healthier children’s meals, inform restaurant-industry leaders of the positive outcomes of increasing healthy menu offerings, and continue to conduct and disseminate original research.

• Another effort, the Breakfast Initiative — which promoted a healthy school breakfast and evaluated its impact on several key measures for children, including obesity prevention — completed its work in 2014.

That’s an area Square One knows something about, said Allard, who noted that many of ChildObesity180’s programs fit well into Square One’s mission of promoting well-being in children — not just academically, but physically and emotionally as well.

Linda Harelick

Linda Harelick says restaurant menus have gotten healthier and nutrition labeling has improved, but parents aren’t always aware of these changes.

“We know that kids who are well-nourished do well in school, so helping in a campaign like this, helping moms make healthy choices for their kids, is very much in alignment with our mission,” she explained. “Teaching kids to read, write, and be ready for kindergarten and academic success are very important, but we know there are so many more pieces than simply handing them a book.

“For many kids in our program,” she went on, “we provide two meals a day — breakfast, lunch, and two snacks — so we know they’re getting those meals with us, and we make sure they’re balanced and nutritious. But when they go home, they don’t always have those types of options. Access is the issue here, and budget is a challenge.”

Likewise, Partners for a Healthier Community, through the Live Well Springfield collective, has been trying to enhance school nutrition, from the preschool sector on up; make higher-quality foods, especially fruits and vegetables, more available in the city’s neighborhoods; and enhance urban agriculture and community gardens.

Live Well Springfield has also partnered with the city and the Pioneer Valley Planning Commission on improving area riverwalks, and has a hand in the city’s Complete Streets program, which is putting more sidewalks and bike lanes on streets. “People have to move around, basically,” Collins said. “That’s a national best practice cities are trying to do.”

Food for Thought

Harelick welcomes the partnerships with organizations like PHC and Square One. “We call ourselves a multi-sector organization,” she told BusinessWest. “We believe childhood obesity is an issue that can only be solved if everyone participates.”

In the case of “You’re the Mom,” which admittedly takes a narrow focus, “we saw an opportunity to address the issue of kids consuming excess calories in restaurants and at the same time improve the nutritional quality of selected meals,” said Christina Economos, director of ChildObesity180. “Moms have an enormous amount of influence on their kids, but sometimes they don’t feel that way. We want to support them and remind them that making small changes can add up to a meaningful difference in their children’s health.”

Harelick has significant experience in several sectors that are part of ChildObesity180. After an early career as a registered dietitian, practicing in clinical and research settings at Massachusetts General Hospital and Brigham & Women’s Hospital, she spent 17 years at Kraft Foods, overseeing strategic planning and marketing for iconic brands such as Maxwell House coffee and Post cereal. Upon leaving Kraft in 2008, she returned to academia to earn a doctorate in public health policy and management.

Having taken so many different views of the nutrition issue, Harelick is optimistic that her current organization’s goal — a full ‘180’ on childhood obesity — is within reach.

“We really believe that,” she said. “When we look at the problem of obesity, it seems very complex, but very interconnected. If you can influence one aspect of a child’s life, it has a wave effect on other aspects. And the more kids hear these messages, the greater the influence — it’s an echo effect.”

Beyond that, she said, “if we can impact culture in terms of the restaurant industry, convince them to offer lower-calorie foods, more nutritional quality, they’ll become societal norms for kids. It will become the norm to drink water on the basketball court, baseball field, or restaurant.”

Leaders at Square One — which, beyond its emphasis on healthy meals, offers an after-school physical fitness program called LAUNCH — say the work of ChildObesity180, and its new campaign, are effective complements to what’s already happening locally. “Our LAUNCH program is a health and wellness program for kids,” Allard said, “teaching them that fitness is fun, and that healthy eating can be fun and delicious.”

Just as Square One moves beyond talking about nutrition and fitness and actually provides opportunities for both, so Partners for a Healthier Community continues working toward greater access to healthy foods in the so-called ‘food deserts’ that tend to plague cities.

“The campaign bolsters work we’ve been doing locally, which is create access for families,” Collins said. “We have to start somewhere. It has to be both educating families to make the right decisions and also providing them access; if you just educate people, they’ll turn around and say, ‘but there’s no place to buy something healthy.’ That’s why the other strategies are so critical.”

Still, Harelick said, change begins with education, and she’s confident “You’re the Mom” will prove impactful enough to become a nationwide call.

“By delivering these messages and then reinforcing these practices at home,” she said, “we can really have a snowball effect.”

Joseph Bednar can be reached at [email protected]

Business of Aging Sections

A Sense of Motion

Dr. M. Zubair Kareem

Dr. M. Zubair Kareem says BPPV can be managed, but it is a permanent condition, and symptoms can reoccur at any time.

Some 90 million Americans will experience a sudden onset of dizziness at least once, and about 50% of those may have a condition called benign paroxysmal positional vertigo. While it’s a permanent malfunction, symptoms can be treated and managed, which is why doctors say it’s important to educate patients about the condition.

About four years ago, Jeanne Tardit got up one night and suddenly became so dizzy, she couldn’t make it to the bathroom.

“It was really scary. Everything was spinning, and I felt as if I had no control over my body,” the 86-year-old recalled. “It was something I couldn’t live with.”

Tardit numbers among an estimated 90 million Americans who will experience dizziness at least once in their lifetime. It can be frightening, and the causes can vary, so it’s important to get an accurate diagnosis.

About 50% of people, including Tardit, who experience a sudden onset of dizziness have a condition called benign paroxysmal positional vertigo, referred to as BPPV or BPV.

Dr. M. Zubair Kareem, vascular neurologist and medical director of Holyoke Medical Center’s award-winning stroke program, said the symptoms can be treated and managed, but once BPPV occurs, it can return, because it is a permanent mechanical malfunction of a part of the internal ear.

It is diagnosed by taking a good history and examining the patient; tests including a CT scan or MRI of the brain are not required. BVVP is not life-threatening or something that can be resolved with surgery or medication. However, many patients get quite nervous when an attack occurs, and sometimes require an anti-anxiety medicine at least for a short period of time.

“It’s important to educate people about what BPPV is and how it can be managed,” said Kareem, adding that, although most people associate only hearing with the ear, the organ also serves as sensor for the coordination system of the body. Since the head weighs 10 to15 pounds, people could fall forward due to the change in the center of gravity when the head bends forward, and the brain makes appropriate adjustments, which include causing the back of the neck muscles to stiffen. The inner ear is part of the body’s balance system and helps with that adjustment.

BPPV results in a false sense of motion, or vertigo, due to inaccurate signals sent to the brain, which result in dizziness or spinning that can be accompanied by nausea, loss of balance, and blurry vision due to rapid jerking movement of the eyes.

It does not make a person confused or cause any paralysis, disorientation, pain, or speech or language problem, but some patients experience significant anxiety, which can be disabling. Symptoms may vary in each person, and they are typically brought on by changing the position of the body or head position, and often occur when a person looks up, bends down, rolls over, or gets out of bed.

About 2% to 4% of people experience BPPV in their lifetime, and the Mayo Clinic reports it is the cause of approximately 50% of dizziness in the elderly population.

Caitlin Eckhoff

Caitlin Eckhoff demonstrates one of four sequential head positions used in the Epley maneuver, which was designed to reduce vertigo.

Although it can be extremely uncomfortable and disrupt a person’s work and social life, the problem is usually treatable and can be helped with specific, easy-to-learn exercises that patients do whenever a dizzy spell begins. Kareem, along with other doctors and physical therapists trained in vestibular rehabilation therapy, often teach their patients to do these exercises.

In addition, Kareem employs something called the Epley maneuver, which was developed by and named after Dr. John Epley in 1980 and consists of a series of carefully orchestrated head movements. However, for the Epley maneuver to be successful, it is important to have a precise diagnosis and know the exact location of the malfunction.

Kareem does not recommend this maneuver to patients of advanced age or with neck arthritis. Patients unable to do the day-to-day exercises themselves may benefit from sessions with a therapist trained to administer vestibular therapy and the Epley maneuver, which can help keep vertigo from reoccurring or at least minimize the symptoms.

Mechanical Problem

Kareem says understanding BPPV involves a brief lesson in physics, and he frequently provides one to his patients using a detailed diagram.

“Basically, we have sensors in each ear that can detect our head’s movement or position,” he explained. “It’s important for the brain to know where the head is in space.”

Each ear has three sensors in the shape of tiny, semicircular canals that are filled with a jelly-like substance. One end of each tube is dilated, and its floor is lined with tiny hair cells topped by thousands of minuscule calcium carbonate crystals that are suspended in the gel, like a cloud hovering over them. When a person moves his head to the side, the weight of the crystals creates a ripple in the jelly, which causes the hair cells to move and initiates nerve impulses that are passed along the vestibular nerve to the brain to tell it the head is moving. When the brain receives this signal, it sends commands to the eyes, muscles, and the rest of the body that allow the person to maintain balance.

The system works well when people are young, unless there is a trauma to the head, but once people reach age 50, a significant number develop a problem because some of the tiny crystals break off, become loose, and settle on the floor of one of the ear canals. If that happens and the person moves their head in a certain way, the floating crystals send a false signal to the brain, which it reads as motion even though there is none. Normal signals transmitted by the moving hair follicles are subtle, but Kareem says signals from loose crystals are very strong, and the result can be a sudden onset of severe dizziness.

“It usually happens when a person gets up in the middle of the night or upon waking,” he noted, adding that BPPV typically occurs in one canal of either ear, although in some cases it can occur in both ears.

The brain is able to counter the false signal within seconds or a minute, but the vertigo, which can be severe enough to make the person feel like they are about to fall, can cause acute anxiety that can continue long after the spinning feeling stops.

Obtaining an accurate diagnosis is critical because dizziness can be caused by a number of other things. Kareem says a diagnosis of BPPV involves taking the patient’s history and administering a test called the Dix-Hallpike maneuver, which involves moving the head in a position that causes vertigo. This test can help localize the problem, but it may not be positive in every patient with BPPV.

Although no one wants to be diagnosed with a condition that can’t be cured, the good news is that the exercise, combined with the Epley maneuver, can move the loose particles into a part of the ear where they stop causing symptoms, which resolves the problem, at least temporarily, for about 90% of people.

“Once people understand the problem and know that it is not a serious, life-threatening illness, they feel comfortable managing it. With the daily exercise regimen, they feel significantly better,” said Kareem.

Tardif’s physician sent her to Attain Therapy and Fitness in Wilbraham, where she received vestibular rehabilitation. Her vertigo went away after a few sessions, and when she had another dizzy spell 18 months ago, additional treatments resolved the problem again.

Quality of Life

Lisa Blain, a certified vestibular therapist at Weldon Rehabilitation Hospital in Springfield, says many people suffer with BPPV for years because they don’t know it can be remedied.

Lisa Blain

Lisa Blain says tiny floating particles in the ear canal can lead to sudden bouts of dizziness when their motion is misinterpreted by the brain.

“The people I see have often been treated with medication or tried other things that didn’t work, and restrict their activity level because they fear moving too much will cause them to become dizzy,” she told BusinessWest.

“BPPV can be aggravating, irritating, and frightening, and a lot of people are unaware there is a treatment for it that works, but it’s important to have it correctly diagnosed,” she continued, mirroring Kareem’s statement and adding that different types of vestibular rehabilitation can be used for vertigo problems that result from concussions, stroke, or following long periods of immobilization.

She explained that the vestibular system, which is responsible for maintaining balance, consists of three parts: the central nervous system, the inner ear, and vision, which all need to communicate and work together seamlessly.

Blain advises people being treated for BPPV to bring someone with them and not plan on returning to work after a treatment because the Epley maneuver is designed to bring on dizziness, and the person may feel off balance after a session, even though the induced vertigo quickly passes. “It works well, but it can be uncomfortable in the short term,” she noted.

Caitlin Eckhoff, a physical therapist from Attain Therapy and Fitness who treated Tardif and specializes in vestibular rehabilitation, agrees, and says people often become anxious about the treatment.

She said it’s critically important for the therapist to know which ear and which canal is affected. “But 80% to 90% of patients have their symptoms resolved within two to six visits.”

Researchers do not know what causes the crystals in the ear to break off, and it can be difficult for people with BPPV to pinpoint what movements cause the onset of dizziness.

“For some, just going to the grocery store and moving their head around to find something on a shelf can cause a problem,” Eckhoff said, adding that doing exercises at home speeds the recovery process. “It’s a difficult issue for people, and a lot of people think they have to live with it. But it’s very rewarding to treat, as it’s the closest to an instant fix that I can offer someone.”

Indeed, in a day and age where people want problems resolved as quickly as possible, exercises and vestibular therapy can seemingly work small miracles.

Business of Aging Sections

Giving a Lift to Those Who Served

Jesus Pereira


Jesus Pereira founded Vet Air to enable veterans to “fly first class” to appointments at VA hospitals.

Dave Shields remembers that first flight being more than a little bumpy. And the plane’s cabin was even smaller than he’d imagined, and took a while to get used to.

Such sentiments, clearly not meant to convey dissatisfaction or disappointment, were to be expected, though. After all, while Shields was certainly no stranger to flying, his 21 years in the Air Force were mostly spent in and around the giant C-130 Hercules transport plane. In fact, the majority of his time serving in Vietnam was spent at Tan Son Nhut Air Base, just outside Saigon, training South Vietnamese crews in how to maintain the workhorse aircraft, which has now been in continuous use by the Air Force for more than 60 years.

It was his time in the service, which also included a lengthy stint at what is now Westover Air Reserve Base in Chicopee, that explains why Shields found himself in that tiny Cessna 172 just over a year ago. Well, that’s where the story starts.

As a veteran, Shields is entitled to receive care for service-related medical issues at the many Veterans Administration (VA) hospitals around the country (such as the one in Leeds) and healthcare providers affiliated with them, such as Yale-New Haven Hospital.

Diagnosed with cancer in his ear, Shields would eventually receive care at both the VA center in White River Junction, Vt., and Yale-New Haven. Getting to either place from his home in Greenfield, while certainly doable, was logistically difficult and quite time-consuming.

Or not, as things turned out, because of a unique nonprofit organization, based in Holyoke, that had just taken flight, quite literally. Called Vet Air, it recruits volunteer pilots to ferry vets like Shields to VA facilities along the Northeast corridor.

Jesus Pereira, founder, a veteran himself (Army Guard, with a 10-month deployment to Kuwait on his résumé), and one of those pilots, explains its basic mission and the many rewards for those who make it happen.

“These people served our country,” he explained. “This is something we can do for them to make things easier and less stressful for them and treat them like first-class, first-rate flyers. I love doing it, and all the pilots feel the same way.”

Pereira, who learned to fly at a tiny airfield in Turners Falls a dozen years ago, said that, to date, Vet Air is averaging maybe two or three flights per month, and has arranged maybe 60 in all. He has piloted roughly a quarter of them, and has taken Shields to several of his appointments.

He noted that, while the pilots are the ones who actually transport veterans to their respective destinations, it takes, well, an army of supporters, including area residents who support its various fund-raisers, to enable the agency to carry out its mission.

For this issue, BusinessWest took to the air with Pereira to gain some insight into Vet Air and its work, which is uplifting, in every sense of that word.

Plane Speaking

To call the flight from Northampton Airport to the even smaller field in Turner Falls a ‘short hop’ would be to greatly understate matters.

It’s 10 minutes door to door, or runway apron to runway apron, as the case may be. But Pereira, who flew BusinessWest to that small town just east of Greenfield to meet Shields — he was already doing some flying that Saturday afternoon and volunteered to do a little more — made the most of that time as he talked about Vet Air, its mission, and the challenges to meeting it.

Indeed, in between frequent bits of routine discourse with officials at both airports during the flights out and back, he explained that this agency is off to what all of those involved consider a very solid start.

Indeed, while only in business, if you will, for 18 months or so, Vet Air has already helped script a number of poignant success stories.

Jesus Pereira, left, with frequent passenger Dave Shields.

Jesus Pereira, left, with frequent passenger Dave Shields.

For example, there’s ‘Karen,’ an Army interrogator, who was severely injured when a prisoner she was questioning struck her with his handcuffs, breaking her jaw and causing damage to her eyes as well. Vet Air flew her to an appointment at a balance center, where she received specialized care in order to help her with her vision and balance.

Then, there’s Ben Bauman, a Marine from the Bay State who hadn’t been home to see his family in more than two years for personal and financial reasons; Vet Air took him on the last leg of an emotional journey home last Christmas.

To write such stories, Vet Air relies on volunteer pilots, said Pereira, noting that there is a small cadre of them who have made most of the flights to date, usually to the VA facilities in White River Junction and West Haven, Conn., although there have been other destinations as well.

There are three or four Western Mass. area pilots who take part, as well as a colorful individual from Maine who flies a pontoon-equipped plane nicknamed ‘the Moose,’ and handles a number of assignments in Northern New England.

“A lot of them do it because they have the time and means to just go flying,” he said. “But mostly they do it because they recognize the importance of what we’re doing and want to be part if it.”

In many cases, those being transported are veterans in the process of trying to determine if health matters are, indeed, service-related, he explained, adding that this process usually requires several visits to VA doctors, which explains why most Vet Air clients have used the service on multiple occasions.

Many of the servicemen and women who have found Vet Air are veterans of Desert Storm or post-9/11 campaigns in Iraq and Afghanistan, said Pereira, but some, like Shields, served in Vietnam.

Clients simply have to get to the airport closest to where they live, and Vet Air essentially takes it (or them, to be more precise) from there, he told BusinessWest, adding that it arranges ground transportation from the destination airport to the provider in question — usually in the form of a vehicle loaned by one of the airport’s fixed-base operators (FBOs).

There are certainly other means to take such vets to appointments at various providers, Pereira went on, adding that shuttles run between the VA hospitals to take individuals for specialized care at facilities where such services are provided.

“But taking the shuttle can often make a half-hour appointment take all or most of the day,” he explained, noting that a shuttle will make at least a few stops along its route to pick up additional veterans bound for the same destination. And it won’t return home until all those aboard are done with their respective visits.

A flight aboard the Cessna he usually pilots — it belongs to a friend, a flight instructor who lets him take it when he needs it  — can cut the trip down to an hour or two.

“We took a woman from White River Junction’s VA who had to go to the Traumatic Brain Injury Center on Long Island,” he noted, citing an example of Vet Air’s primary reason for being. “To drive from Northern Vermont to Long Island is quite a trip. Her appointment was six hours long, and to drive home after that — I don’t think most people could that, so now this becomes an overnight, with all those additional expenses.

“We flew her there and back the same day,” he went on, “and it cost them nothing.”

Soar Subject

This ability to chop several hours off a potentially day-killing visit caught the attention of Shields, whose first involvement with Vet Air centered on bringing it to the attention of other veterans, not securing a ride himself.

“I saw a quick news story about it on one of the local stations,” he explained, adding that his first reaction was to help create awareness. He did so by helping to secure the agency a presence at the annual camping and outdoor show at the Big E in the spring of 2015.

A few months later, though, Shields was diagnosed with cancer and had need for Vet Air himself.

He said there were other alternatives for getting him to the facilities where he was treated, but they involved far more time and logistics.

“This was the easiest way,” he explained. “The [VA] shuttle goes to West Haven, but it doesn’t go to Yale; with Vet Air, there was a courtesy car at the airport that took me right there. It’s a great service.”

Shields hasn’t had to dial Vet Air’s number in several months now, but the nonprofit isn’t far from his thoughts. In fact, he’s become an ardent supporter who has referred a number of veterans to the agency.

And it needs such assistance.

Indeed, as Pereira noted, it takes the help of many people to get that plane in the air and then get the client to the VA facility, said Vet Air’s founder, adding that, while the flyer’s time is donated, there are flight-related expenses — roughly $80 to $120 per hour in the air, depending on the plane used — that have to be covered.

There are other costs as well, he said, listing everything from the landing fees charged by some airports to the modest marketing efforts to bring attention to the agency.

Fortunately, Vet Air’s mission resonates with many individuals and businesses, he went on, citing, as just one example, the FBOs that will often donate a courtesy car, like the one Shields rode in, to get a veteran from the airport to a healthcare provider.

“Once they see what we’re doing and what the mission is, they want to be part of it,” he explained, adding that, moving forward, Vet Air needs more people to become part of its story.

The agency stages fund-raising events such as the recent Mother’s Day Bazaar at the Moose Lodge in Chicopee and a similar gathering coming up for Father’s Day, said Pereira, and also sells T-shirts bearing its logo on its website.

As awareness of the agency grows and need for its services escalates, fund-raising will become an ever-more-important focus, he explained, noting that those who want more information on the agency or wish to help can visit www.vetair.org.

Landing Lights

Like the plane Pereira was flying, Vet Air is certainly small in size as nonprofit agencies go, with a budget that extends to only five figures.

But it is having a big impact on the lives it has entered. That means everyone from the vets sitting in the back seat of that Cessna to the individual flying the Moose; from the families of those veterans to the individuals and related nonprofits who have helped make these flights possible.

Thanks to Pereira’s vision and the help of countless contributors, veterans in need of care are now flying first-class — even if the plane’s cabin is only four feet wide.

George O’Brien can be reached at [email protected]

Business of Aging Sections

Into the Light

 

Dr. Katherine White

Dr. Katherine White says tanning can be a difficult habit to break, due to the way it makes people look and feel.

In recent years, many teens have turned to tanning beds to enhance their looks on prom night and graduation day. But that practice is no longer possible, due to a new state law that Gov. Charlie Baker signed in February that bans anyone under the age of 18 from using a tanning bed.

Prior to passage of this measure, Massachusetts allowed teenagers between the ages of 14 and 17 to visit tanning salons with consent from a parent or legal guardian, and those under age 14 to tan if a parent or guardian was present.

However, research by the American Academy of Dermatology, the Melanoma Research Foundation, the American Assoc. for Cancer Research, and other prestigious groups have led to legislation in 42 states prohibiting young people from using tanning beds due to studies that prove exposure to artificial ultraviolet light before the age of 35 increases the risk of melanoma by up to 75%.

Melanoma is not only the deadliest form of skin cancer, it is the most common form of cancer in young adults 25 to 29 years old, and the second-most common form in young people 15 to 29 years old. It is also the leading cause of cancer death in women aged 25 to 30 and the second-leading cause of death in women between the ages of 30 and 35. In addition, ultraviolet radiation emitted by tanning beds can lead to basal-cell and squamous-cell cancer and cause wrinkles, lax skin, brown spots, and other signs of premature aging.

Dr. Catherine White, a dermatologist and founder of Hampshire Dermatology and Skin Health Center in Northampton, said dermatologists have been advocating for changes in the law for years, and herald the newly passed legislation, as well as the fact that the U.S. Food and Drug Administration proposed two new rules last year regarding tanning beds. The first would not only restrict use of sunlamps in salons to individuals 18 and older, but also mandate that users sign a certificate before their first tanning session and every six months thereafter acknowledging they have been informed of the risks to their health.

The second proposal would require sunlamp manufacturers and tanning facilities to take additional measures to improve the overall safety of their devices. Suggestions include improving eye safety by limiting the amount of visible light allowed through protective eyewear; improving labeling on replacement bulbs to ensure tanning facility operators are using the correct bulbs, which would reduce the risk of accidental burns; preventing the installation of stronger bulbs without recertifying and re-identifying a device with the FDA; and requiring all sunlamp products to have an emergency shut-off switch that users can easily find and identify by touch or sight.

Artificial tanning has become a $2.5 billion industry, so these measures are deemed critical to people’s safety. Approximately 7.8 million adult women and 1.9 million adult men in the U.S. tan indoors, and reports show that 35% of American adults, 59% of college students, and 17% of teens have used a tanning bed.

White acknowledges that most tanning salons are small businesses that are often owned by women and add vibrancy to local communities, and says it’s important to recognize that fact, but agrees with other experts that medical information regarding tanning beds must be transmitted to clients in a clear way that outlines the risks.

“The World Health Organization has said that ultraviolet light is a known human carcinogen,” she told BusinessWest. “Using a tanning bed is a dangerous activity and increases the risk of developing basal-cell cancer, squamous-cell cancer, and potentially life-threatening melanoma.”

Overcoming Obstacles

Dr. Richard Arenas, chief of Surgical Oncology at Baystate Medical Center, has seen patients in their early 20s with melanoma, and says researchers believe the intensity and type of ultraviolet radiation emitted by tanning beds may be forcing changes at an accumulated rate in cells. Environmental factors may also be at play, and some people may be more sensitive to UV light than others and have family histories that could predispose them to getting skin cancer.

Dr. Richard Arenas

Dr. Richard Arenas says the incidence of melanoma, which is a life-threatening cancer, is on the rise in young people.

“But the biggest challenge is determining at what age a person is capable of making a decision to acknowledge the potential risk of using a tanning bed,” he explained, adding that there has not been enough publicity about the dangers and the fact that the rate of melanoma is on the rise, especially in young Caucasian women.

White concurs, and says education needs to be ongoing, especially since tanning is part of youth culture; college students often rent limos and go tanning as a group, and she has heard of cheerleading coaches who bring their teams to a tanning salon prior to a meet.

“The light and warmth may feel good, and there may be social benefits, but the fact is, when ultraviolet light hits the skin, it damages genetic material,” she noted. “A tan is an emblem of injury, and is the body’s last-ditch effort to prevent DNA damage and protect against damage to the cells. Sometimes the body can repair the damage, but it’s not always possible.”

Still, most human beings love the sun, and the reasons for visiting tanning salons are complex and include societal reinforcements — people often tell others with a tan they look great — and many women consider going to a tanning salon a way to pamper themselves.

But the dangers that have come to light are clear, and the Commonwealth’s new legislation mirrors similar laws in California, Delaware, the District of Columbia, Hawaii, Illinois, Louisiana, Minnesota, Nevada, New Hampshire, North Carolina, Oregon, Texas, and Vermont that ban the use of tanning beds for all minors under 18.

However, experts say tanning not only is it a difficult habit to break, it can be addictive, which was documented in studies released in 2013 that show ultraviolet light increases the release of endorphins or feel-good chemicals that relieve pain and generate feelings of well-being.

“People like to tan. It’s calming, relaxing, and something that they may regard almost like a treat. And although most adults know it’s not a good thing to do, they have the right to visit a tanning salon. But they need information about the risks spelled out clearly,” White said, adding that dermatologists hope the FDA’s proposal to have adults sign consent forms acknowledging the risks of tanning beds will be adopted nationwide.

As for the addictive nature of the habit, researchers often compare tanning to cigarette smoking. “Both industries can injure customers, and it is to their benefit to start people young before they are able to make informed decisions. And both have an addictive quality which make them difficult to break,” White told BusinessWest.

Misconceptions also exist that range from benefits associated with ultraviolet light and vitamin D — experts say taking supplements is safer — to the fact that some people believe it’s a good idea to get a base tan in the winter before going to a sunny locale such as Florida or the Caribbean.

But that is indeed a myth. “There is nothing protective in going to a tanning salon before a trip, because each exposure increases the risk of developing skin cancer, especially in young people,” White said. “We know that intense ultraviolet exposure is more dangerous early in life than it is later on, and people with a history of childhood sunburns are at greater risk for cancer.”

Prevention is Key

Ultraviolet radiation is made of UVA and UVB wavelengths, or rays. UVA rays cause aging of the skin, while UVB rays are short, more powerful, and can lead to cancer.

The sun delivers both, but Arenas says tanning beds deliver a more significant dose of both UVA and UVB.

“The damage caused at a young age can carry forward for the rest of a person’s life. Tanning beds are an unnatural source of UV radiation and are dangerous,” he noted, adding that the propensity for problems may be exacerbated if people are fair-skinned, sport red hair, or have a lot of moles. In addition, the fact that people are living longer means they will have more exposure to the sun, so putting oneself in harm’s way at a young age is even more dangerous than it may have been generations ago.

Arenas urges people to be their own advocates when it comes to skin cancer, and said everyone should get a full skin checkup each year.

“Insist that your doctor examine your entire body, including the cracks and crevices,” he told BusinessWest, explaining that skin cancer can occur on the palms of the hands and bottoms of the feet, as well as in the genital and anal areas. “You really need to have respect for your skin. We can’t avoid the sun, but people need to appreciate the fact that it causes changes that could lead to skin cancer.”

White says people who love the look of a tan can achieve the same result with spray tans, bronzers, and gradual self-tanners, and since many salons offer spray tans, clients who have purchased tanning packages should ask to have their sessions converted to spray tans. She also advises people using tanning as a means of pampering themselves to think of other ways to reward themselves that they find equally relaxing.

“The bottom line is that skin cancer can be prevented, and the new laws will help,” Arenas said. “All it takes is good judgment.”

Business of Aging Sections

Peace of Mind

Anne Thomas (left) and Joelle Tedeschi

Anne Thomas (left) and Joelle Tedeschi say it’s critical that the Garden at Ruth’s House tailors programs to the individual interests and abilities of residents.

While researchers have hope, so far there’s no cure for Alzheimer’s and many other forms of dementia — conditions that currently affect some 5.3 million Americans but could soar in frequency as the massive Baby Boom generation heads into the golden years. That trend places greater importance than ever before on memory-care units, specialized neighborhoods in assisted-living and skilled-nursing facilities that seek not only to care for residents with dementia, but strive to give them back as much of their old lives as possible.

It’s not always easy to walk in someone else’s shoes, especially when that person suffers from dementia. But at Loomis House in Holyoke, they’re trying.

The training program for Loomis employees who work in the memory-care unit includes a mandatory activity called a ‘virtual dementia tour.’ They’re put through a sensory simulation including shoe inserts to make their feet uncomfortable, hazy goggles that mimic macular degeneration, headphones pumping in white noise like a ringing phone and an ambulance siren, and gloves to impair sense of touch.

“Then we ask them to do tasks. They quickly understand the frustration,” said Lori Todd, Loomis House administrator. “What we try to teach them is, you’re experiencing this for 10 minutes; imagine this all day long. Some people call it sundowning, but after eight hours, I’d be frustrated.”

A perceived need for better training led to the adoption two years ago of new regulations for Massachusetts nursing homes. Specifically, workers in specialized Alzheimer’s and dementia-care units are now required to undergo at least eight hours of initial training to care for such residents, and four additional hours annually. Proponents noted at the time that increased training is critical because roughly 60% of nursing-home residents have some form of dementia.

Lori Todd

Lori Todd says Loomis House works to counsel and reassure families, who are often dealing with wrenching emotions around their loved ones’ dementia.

At Loomis House, which maintains two separate memory-care units totaling 41 residents — there’s always a waiting list — administrators have taken staff training seriously for much longer than that, Todd said. In fact, the way staff assesses and engages its Alzheimer’s and dementia population is indicative of a wider trend in senior care, one that acknowledges that dementia is not going away as the Baby Boom generation continues to stream into its retirement years.

For example, while many facilities place residents with dementia into one of three categories of memory function, Loomis uses seven, in order to develop as individualized and specialized a care plan as possible. “If you’re stage three, you may be able to do a 100-piece puzzle for an activity,” Todd said. “In further stages, you may still be able to do a puzzle, but it may be a four-piece puzzle so you’re not frustrated.”

That said, the goal is to maintain as much independence as possible for residents through an individualized plan that determines what activities will keep them active and engaged. “We have to get an understanding of who they were and what made them tick — basically utilize that information to develop a plan that will be of interest to them.”

Similar strategies are put into play at Ruth’s House in Longmeadow, an assisted-living residence operated by JGS Lifecare. It features the Garden, a 30-bed memory-impaired unit with a central kitchen and living area and an enclosed, secured outdoor courtyard.

“It’s very home-like, which is really important,” said Anne Thomas, vice president of residential health. “But the one thing that distinguishes us from others is our exceptional programming structure, which is really important to people with dementia. If they’re not given some structure, they don’t do well. They need that schedule, that routine.”

Joelle Tedeschi, executive director of Ruth’s House, explained that every new resident is evaluated by the resident care director to determine how they fit into the site’s programming, which includes sensory activities, art and cooking groups, cultural-enrichment programs, and much more.

“We try to find out as much as we can about each person and craft programs based on that,” Thomas added. “It’s about engagement, but also creating an environment as much like their real home as possible. All the things a person enjoyed before should continue here — it shouldn’t change.”

Like Todd, Thomas noted that the population is aging, and the number of Americans living with some form of dementia — currently 5.3 million — is only expected to rise, meaning more nursing homes and assisted-living facilities are making a commitment to taking care of this population.

“With dementia, unfortunately, there’s no cure in sight; we don’t see the disease going away,” Thomas said. “Our responsibility is to create a wonderful program. Boomers are very discerning; they have disposable income, and they expect a lot, and they should. We’re designing things that we as Boomers would want for ourselves and our parents.”

Individual Focus

That begins with meeting each resident where they are, Todd said.

“There’s a lot of emphasis on understanding that we are guests in the home of the people who move in here. When people come to the dementia unit, they stay here; this is their home,” she said, explaining Loomis’ long-time philosophy of person-centered care. “So, if they want to get up at a certain hour, they can have their medicine when they wake up, rather than right at 8 in the morning. The satellite kitchen is open 24 hours a day, and they can eat when they want.”

Tedeschi said the Garden provides a similar sense of autonomy, including no set times for going to bed or waking up, and a kitchen where eggs can be cooked to order at any time. “Some folks don’t want to be up early for breakfast, so we’ll make them breakfast right before lunch if that’s their preferred time.”

The touches of home — and even pampering — continue with amenities like a full-service salon, live entertainers who get residents singing and dancing, and rules that allow residents to bring their pets with them. In addition, family members often volunteer to lead enrichment programs.

“Just today, one of the resident’s families brought in some old tools, and the residents sat around and reminisced about their lives. There were tools there I couldn’t identify, but some of our residents worked on farms as children and worked all day with these tools, and they talked about it. It was one of the most beautiful things I’ve ever seen.”

The Garden also recently introduced holistic-wellness activities including Reiki, aromatherapy, and reflexology, all conducted by student volunteers, said Mary-Anne DiBlasio, sales manager at JGS Lifecare, who has a background in alternative health. Meanwhile, a small activity room is being converted to a sensory meditation room.

In addition, JGS Lifecare takes part in the Music and Memory program, which works with residents’ families to develop a personalized playlist of meaningful songs, which they can play on donated iPods.

“We’ve seen some remarkable success stories with it,” said Alta Stark, director of marketing and public relations. “One woman’s daughter said she could tell immediately if her mother had her music therapy that day because she could have regular conversations with her. She said that had not happened for such a long time — it was like getting her mother back.”

Thomas is equally effusive. “I witnessed something walking through one day on the weekend — a resident in memory care was weepy, crying, and she wanted to go home. A life-enrichment person came over and consoled her, reassured her, got her iPod and earphones … and it calmed her down immediately.”

Tedeschi said it’s always a challenge to customize individualized programs when dementia has such a wide range of stages. Some residents can live relatively independently but need to be in a secure environment, she noted, while others wouldn’t even know how to press an alert pendant if they need help. “We need to anticipate what their needs would be. We have to customize a program for everyone and continue to add services according to their care needs.”

The complexity of caring for this population is why the Department of Public Health pushed for the new mandatory-training rules two years ago. In order to comply, staff members must be trained in the foundations of Alzheimer’s and other dementias, communication and connecting with these residents, techniques and approaches to care for this population, the components of person-centered care, working with families, the dietary needs of residents with Alzheimer’s and other dementias, social needs and appropriate activities in the care of such residents, recognizing and responding to caregiver stress, and preventing, recognizing, and responding to abuse and neglect of residents.

“Everyone who works here — even maintenance and housekeeping — has to have 12 hours of training,” Todd said. “And I’ve seen the benefits in training, retraining, and sensitizing. The regulations are strict, but it benefits the residents; it really does.”

Family Burdens

No one wants to admit their parent has dementia, Todd said, but the services provided in a specialized memory-care unit are critical when that decision looms.

“Most people who live here are a little more advanced than you see at home, and they’re at risk being in the community. Really, it’s a safety issue, and the caregiver can’t do it anymore,” she explained, noting that Loomis House provides a continuum of care that includes hospice services near the end of life.

It’s emotionally wrenching, she added, when someone understands that their loved one doesn’t recognize them in the same way anymore, but noted that Loomis provides a social worker to help families process that experience, and family support groups that help each other through the transition.

“At first, there’s a lot of fear, guilt, and anxiety,” she went on. “Then they begin to trust us. They see they can go home at night and their parents will be cared for. They have to trust that our people are caring for their parents because their parents can’t always tell them.”

Thomas agreed. “Sometimes it’s harder on the family than on the person who has this illness, to see that person changing before their eyes. That’s why we offer support groups for families.”

In addition, as part of the admissions process, Tedeschi said, families help residents assemble a shadowbox of photos and memories, to hang outside their room. Not only do the boxes help residents identify where their rooms are, they give the staff a better idea of what that person is all about. Families also fill out a profile about their loved one’s likes and dislikes, interests and hobbies, to help the staff build a satisfying daily routine.

Once they’re comfortable in their new home, DiBlasio said, “family members don’t have to be full-time caregivers anymore. We let sons be sons, daughters be daughters, and we become the caregivers. If we know the idiosyncrasies of the person, we can become part of the family, and they look at us as part of the team.”

The worst feeling a loved one can have, Thomas said, is the idea that “‘this is my mother; there’s nothing left to her.’ We want to demonstrate that this person has a lot left, and we want to bring that out in them. That’s our job, to bring out the best in the person so the family can experience that as well. The employees that work here find it gratifying that they can make a difference in many small ways, just by getting to know the person.”

Joseph Bednar can be reached at [email protected]

Business of Aging Sections

Emperor of All Maladies Author Says the Pieces Are in Place

Dr. Siddhartha Mukherjee

Dr. Siddhartha Mukherjee says the so-called ‘cancer moonshot’ will provide a road map for advancing the fight against the ‘emperor of all maladies.’

As he delivered his talk, “The Changing Landscape of Cancer,” to a large audience at CityStage earlier this month, Dr. Siddhartha Mukherjee had a PowerPoint presentation running on a large screen behind him.

In a way, it represented a seriously condensed but still highly informative version of his book, The Emperor of All Maladies: A Biography of Cancer, for which he won the 2011 Pulitzer Prize for general nonfiction, and it led with what amounted to a trailer for the Ken Burns-produced PBS film documentary based on the book.

One of the slides, kept on the screen for several minutes, depicted one of the now-famous full-page ads that ran in newspapers across the country in December 1969 with the screaming headline: “Mr. Nixon: You Can Cure Cancer.”

While one might debate whether those spots legally constituted false advertising, Mukherjee implied, they certainly amounted to wishful thinking — very wishful thinking.

Indeed, neither the nation’s president nor anyone else could cure cancer 47 years ago, he explained, because the scientific community simply didn’t know enough about the disease to remotely approach that ambitious goal.

Mukherjee said those ads, inspired by and paid for by Mary Lasker, the noted health activist, philanthropist, and champion of medical research, were a prime catalyst for what he called “the war on cancer 1.0” — a war declared far too early to result in even partial victory, but one that set the stage for later triumphs.

“We had no understanding of the physiology of a cancer cell, let alone what caused it to turn cancerous, and yet a war on cancer was launched without that understanding,” he told his audience, there, as he was, to celebrate the expansion of the Sr. Mary Caritas Cancer Center. “People have often said that this is like saying, ‘we’re going to the moon’ without having seen a jet engine; that’s what the situation was like.”

Nearly a half-century and seven U.S. presidents later (many of whom have declared what amounted to their own versions of a war on cancer), the situation is much different, said Mukherjee, because the world knows exponentially more about the physiology of a cancer cell and why a cell becomes cancerous.

And this new landscape certainly provides more optimism for the latest declared war on this disease — the so-called ‘cancer moonshot’ (a term that only reinforces Mukherjee’s analogy) — that was announced in January.

“We understand cancer at a cellular and molecular level that we didn’t understand before,” Mukherjee told BusinessWest prior to his talk. “We understand what causes cancer, we understand its progression, we understand some, but not all, of its risk factors, and we have not one, not two, but really several dozen important breakthrough therapies for several forms of cancer.

“The question now is how to deliver those therapies carefully, how to deliver them to the right people, how to pay for them, and much more,” he went on. “Meanwhile, there are many cancers that are difficult to cure and difficult to treat, and they will remain frontiers.”

In essence, the cancer moonshot is expected to yield a road map (a term Mukherjee would use early and often) — actually, several of them — for crossing those frontiers and answering all those questions, he went on, adding that this initiative will bring new layers of progress to what he called a “transformative impact” on understanding and treating the many cancers seen over the past half-century.

For this issue and its focus on the business of aging, BusinessWest took the opportunity to talk with one of the world’s leading cancer physicians about the stunning progress achieved to date and how the next chapter in cancer’s biography will unfold.

A Hard Cell

Reducing a few thousand years of conflict between humans and cancer down to a 55-minute presentation wasn’t easy, but Mukherjee, an assistant professor of Medicine at Columbia University and staff physician at Columbia University Medical Center in New York City, managed by focusing on basic science, the milestones in the history of cancer treatment, and the people who made them possible.

Thus, his powerpoint featured slides on everything from surgeon William Halsted’s 19th-century “radical mastectomy” to Mary Lasker’s newspaper ads, and on everyone from Rudolph Virchow, often called the father of modern pathology and noted for his early work on leukemia, to Sidney Farber, considered the father of modern chemotherapy, to Barbara Bradfield, a pioneer (she was patient zero) in the development of Herceptin, a treatment for breast cancer.

His lecture on the history of the disease and mankind’s attempts to cure it focused on several stages he detailed in his 594-page book. They include, more recently, ‘cancer as a disease of cells’ — the period roughly from 1860 to 1960; ‘cancer as a disease of genes’ (1970-1990); ‘cancer as a disease of genomes’ (1990-2010); and the current stage, ‘cancer as a pathway disease.’

He brought his audience from the first identification of cancer some 4,600 years ago by the Egyptian physician Imhotep to current events, including groundbreaking initiatives to rapidly determine the sequencing of genes in tumor cells, leading to new treatment platforms.

Describing what’s been accomplished to date, he used words such as “remarkable” and “unprecedented,” words he says are fitting given the resilience, complexity, and sheer uniqueness of the disease and each case of it.

“Every single cancer, at the genetic level and the genomic level, is its own cancer, and every single patient is its own patient,” he explained. “We knew this 100 years ago, but we really learned this 100 years later.

“There is no disease — and I will argue that there are few problems in human history — where the level of diversity of the problem, the level of complexity of the problem, is equal to the number of people who have the problem,” he went on, urging his audience to consider the magnitude of what he just said. “Cancer is that problem … and that makes it different than any other disease, and that’s what makes it the emperor of all maladies.”

But while his book, and his lecture, amounted to history lessons, Mukherjee said his current focus is obviously on what comes next, and this brings him back to the cancer moonshot.

“This is an incredibly important effort,” he told BusinessWest before his talk. “It clarifies what the goals are, and that is to have a transformative effect on cancer care over the next 100 years.”

When asked what the initiative, officially named Cancer Moonshot 2020, might accomplish by that date, he said simply, “a line in the sand,” before elaborating and returning to that analogy of drawing a road map.

“What will happen over the next four years is that we will clarify that road map, which will hopefully stay with us for the next 80 to 100 years to remind us what the big goals are and whether we met the goals or didn’t meet the goals,” he explained. “We may at times go off the road because we don’t understand something, but as long as we have a sense of what that landscape is like, we can stay on track.”

Again, there will likely be several road maps drawn, he went on, adding that there are, indeed, several fronts in any war on cancer.

One is obviously treatment, he said, noting that considerable progress has been made with some cancers, including blood cancers — leukemia and lymphomas — as well as lung cancer, breast cancer, colon cancer, and prostate cancer.

Another front is prevention, which of course plays a huge role in the larger effort to stem the tide of the disease and greatly reduce the numbers of individuals who will die from it. And within the discussion concerning prevention lies the overarching question concerning whether cancer — or specific cancers — can indeed be prevented.

Some carcinogens, such as smoking, have been identified, said Mukherjee, adding that great uncertainty remains about how many more are still to be recognized. And this is a huge issue moving forward.

“That’s an open question on the table and a very important question: are there still out there major preventable chemical carcinogens — have we missed some?” he asked rhetorically.

“And if we haven’t missed some, what do we do about the fact that the rest of it is spontaneous errors, accidents when cells divide?” he went on. “That has many, many, many consequences, and there have been four or five highly controversial papers back to back in major scientific journals, one claiming the former, the second claiming the latter, one saying it has to do with cells making errors when they divide, the other making the claim that the environmental impact has been underappreciated, and there may be some hidden, unknown carcinogenic input.

“We need to sort that answer out,” he continued, “because it’s a fork in the road, whether we move in one direction or the other.”

There will be several similar forks to confront in the years to come, he said, adding that, beyond treatment and prevention, there are other large issues to be addressed, such as handling the cost of this battle, deciding how resources are to be committed, and drafting a plan for making this a truly international moonshot, not a solely American initiative.

Prescription for Progress

Almost immediately after Cancer Moonshot 2020 was announced, skeptics said it is as unlikely to achieve its stated goals as the initiative launched by President Nixon nearly five decades ago.

Mukherjee is far more optimistic. He notes that the pace of progress has greatly accelerated in recent years as more becomes known about the disease, and that enough will soon be known to not only draw a map, but enable society to reach its destination, one where cancer is far less the killer that it is now.

And he should know. After all, he wrote the book on the subject — a biography for which there are many chapters still to write.

George O’Brien can be reached at [email protected]

Business of Aging Sections

New Frontiers

Dr. Matthew Richardson (left) and Dr. John McCann

Dr. Matthew Richardson (left) and Dr. John McCann say Baystate’s clinical-trials program both helps current patients and advances research down the road.

When Linda Tedone was diagnosed in September with multiple myeloma, it wasn’t long before her oncologist at Baystate Medical Center, Dr. Syed Ali, came across an opportunity not available to many patients — yet.

It was a national clinical trial, one of dozens in which Baystate patients are enrolled at any given time. In Tedone’s case, her chemotherapy includes a drug, carfilzomib, that was FDA-approved in 2012, but only for relapsed patients who had undergone other therapies. Now, researchers are studying its effectiveness for first-time diagnoses.

“They explained it to me and my family, and we talked about it and were very interested,” Tedone told BusinessWest. “I have a lot of confidence in Dr. Ali. Being in a clinical trial, not only do I have him and his expertise, but lots of other great minds are involved in this, all watching my progress. And I’m reacting well to the medication; the chemotherapy is doing exactly what Dr. Ali wanted it to do.”

A robust clinical-trials program at Baystate — patients are currently participating in about 60 different ones — is available for both adult and pediatric patients, depending on need and what’s available, said Dr. John McCann, a medical oncologist at Baystate who works with adult cancer patients.

“Basically, we’re an academic medical center, so we’ve had a clinical-trials program here for quite a few years,” he explained. “The newer clinical trials are focusing on the specific molecular features of patients’ individual cancers and bringing new treatments to the cancer center that we can use. Because we have an entire team of clinical researchers working with us, we’re able to do sophisticated clinical trials right here at home, so patients don’t have to travel to go to another academic medical center.”

He cited, as one example, a new trial that seeks to evaluate three immunotherapy drugs given simultaneously for patients with advanced melanoma. “It’s very important that patients get really leading-edge clinical trials right here in Western Mass.,” he added, noting that Baystate’s clinical-trials division accesses national trials through organizations like the National Cancer Institute, the National Institutes of Health, and pharmaceutical companies.

And Baystate isn’t alone. When Cooley Dickinson Hospital merged with Mass General Hospital in 2014, it opened up a referral pipeline for oncology patients being treated at CDH to enroll in the kind of clinical trials Mass General has been involved in for decades.

“We joke that doctors frequently have hallway conversations, and we have the same thing, except the hallway is Route 90,” said Avital Carlis, administrative director of the Mass General Cancer Center at Cooley Dickinson Hospital, which opened last fall. “And these relationships are where our connections to clinical trials emanate from.

“I’m very excited that the Mass General Cancer Center will be integrated with the clinical trials available there,” she went on. “Our doctors constantly review cases, and if a patient has unique circumstances, they’ll reach out to their colleagues in Boston, and the doctors in Boston might say, ‘great trial available,’ or ‘perfect match’ or ‘we really should get them in this,’ and we can get our patients involved in these clinical trials. There is a huge spectrum of trials open to us.”

Mercy Medical Center, like Cooley Dickinson, will soon be able to access trials through a new affiliation — in its case, with Smilow Cancer Hospital at Yale-New Haven Hospital, with which is has signed a letter of intent to pursue a relationship that will enhance cancer care at Mercy.

The partnership with Smilow will create new opportunities for patients in Western Mass. to enroll in clinical trials for a wide variety of cancers, said Dr. Philip Glynn, director of medical oncology at the recently expanded Sr. Caritas Cancer Center on the Mercy campus.

Dr. Philip Glynn

Dr. Philip Glynn

“Trials are really important because people get a chance to see if a new treatment can help them — or help a population of patients in general,” he explained. “It’s almost like having a built-in insurance policy; you know you’re getting the most recent treatment. It’s been reviewed by experts, and you’re being very carefully monitored by your doctor.”

The downside, of course, is that previously unknown side effects may arise, and the treatment simply may not work.

“Ideally, you’re being carefully monitored so you can be taken off if it becomes clear it’s not working and there are another alternatives,” Glynn said. “Another downside is that some of these trials have placebos, and people don’t necessarily get the treatment they hoped they’d get.”

With more hospitals joining Baystate locally in providing access to clinical trials available nationwide, it’s a decision patients will increasingly have to answer.

Put to the Test

Simply put, Glynn said, a clinical trial is a research study, and patients participate to answer a question or help improve or advance treatment of a disease.

“In my field, oncology, patients volunteer for clinical trials that test new treatments, to see how they compare with current treatment standards. Sometimes they test lifestyle changes to see if it lowers the chances of getting cancer. Sometimes they test new ways of finding out if people have cancer — diagnostic studies.”

Typically, trials are divided into three types, he explained. Phase 1 trials, which are most commonly conducted in a university setting, aim to answer questions about safety in terms of timing, dosage, and side effects. Phase 2 — the type of trial most-often available locally — delves further into safety but focuses more on effectiveness. Phase 3 trials compare the new treatment with the current standard, by placing patients randomly (and blindly) into one group or the other.

Not everyone who wants to take part in a trial may do so, Glynn noted, due to any number of contraindication factors. “There are times people may want to be in a study but are excluded based on pre-existing conditions.”

But plenty are able to enroll, McCann said, noting that some patients inquire about what opportunities are available to try new therapies, while others are steered toward trials by their doctor.

“If a patient is eligible for a trial, we go through the process in detail and talk about risks and potential benefits,” he explained. “Then the patient makes the decision whether or not they wish to participate in the trial.”

Which means they’re well-informed of all known risk factors, he went on. “Every clinical trial has risks associated with it. We are committed to the highest standards in terms of minimizing risk and also explaining very clearly to patients what risks are associated with the treatment.”

In many cases, however, patients have reached a point of desperation, said Dr. Matthew Richardson, a pediatric oncologist with Baystate Children’s Hospital.

“For some conditions, where the prognosis with traditional medicine is poor or at least not optimistic, I think people are motivated to try new things,” he told BusinessWest. “They also realize it may help other children in the future. I think that appeals to many patients — that ability to help other families and other people’s children in the future.”

The goal of any clinical trial, particularly in phase 3, is to compare new treatments or tests to standard tests, and that can’t be done with just one or two patients; researchers need hundreds — and because certain pediatric cancers are so uncommon, no single center will be able to provide that, he explained. That’s why Baystate is part of the Children’s Oncology Group (COG), which gives patients there access to the same trials offered at other children’s hospitals across the country.

Richardson is one of several doctors — as well as pharmacists and people not directly involved in the medical community — who sit on an institutional review board (IRB) that evaluates clinical-trial opportunities to make sure they’re appropriate for Baystate, that the science is sound, and that potential risks are not worse than the standard treatment — or, if the risks are high, that the potential benefit outweights the risk.

“We conduct a very thoughtful analysis, through very extensive discussions, before a clinical trial even begins at the hospital,” he said. “And if a member of the IRB is involved in the clinical research, they’re not allowed to weigh in on approval.”

Expanding the Pipeline

An added benefit to clinical trials, Glynn noted, is that people feel gratified to be able to help advance new types of research.

“That’s absolutely true,” said Tedone, the Baystate patient. “I mean, this is definitely my journey, and I want to have success, but at the same time, I also know that, if this is going to work for me, it will work for other people and make their journey easier, too. I’m all about research, and we need to get rid of this horrible disease — get rid of all these cancers.”

Patients intrigued by opportunities to participate in this type of research have to be gratified by the new opportunities cropping up in Western Mass., from Mercy to CDH to, yes, a widening pipeline at Baystate.

We’re referring to UMMS-Baystate Health, a campus of UMass Medical School expected to open in Springfield in the fall of 2017. The project — a collaboration between the medical school, UMass Amherst, and Baystate Health — is intended to meet three goals: increasing access to students in Massachusetts seeking an affordable medical education, responding to the healthcare needs of the Commonwealth by increasing the number of Massachusetts physicians trained in urban and rural primary care, and applying academic research to improve population health, reduce health disparities, and make healthcare better integrated, more efficient, and more effective.

“It’s really a game changer for the region,” said Dr. John Schreiber, chief physician executive for Baystate Health, and one of the reasons is access to new avenues for clinical trials through UMass Medical School. “We’ll be able to offer patients in the Pioneer Valley much more than we have previously.”

And one of the goals for physicians coming out of the program is that they understand how to be part of a clinical trial and how to connect patients with experimental therapies. “We want to be able to access that across the Baystate system, not just in Springfield. The outlook is bright.”

With all the optimism over clinical trials, CDH’s Carlis stressed that eligibility criteria can be narrow. “What’s nice about our relationship with our colleagues in Boston is, many of these physicians are world-renowned experts in their field; they know these criteria backward and forward. So, if we think a patient might be eligible, there’s no assumption made until they speak with the people in Boston for a full criteria check.”

That said, the big picture is important. “Through clinical trials, we’re trying to identify where care is going in the future, what are the best combinations of drugs. It opens opportunities for patients they would not otherwise have access to.”

Glynn agreed. “Clinical trials are designed by experts to answer specific questions about therapies,” he explained. “It’s very important, especially today, because there are so many new therapies available for patients in oncology. We want to be able to offer patients as broad a spectrum of potential treatment options as we can.”

Seeking Answers

After all, Richardson concluded, these are matters of life and death.

“We’ve gone from acute lymphoblastic leukemia in children being a uniformly fatal disease to having some types of leukemia with a 90% cure rate,” he said. “And that’s only been through cooperative clinical trials.”

Tedone, who has been active in her trial for more than four months, tracks other cancer research as well.

“In the past few months, three new medications came out for my specific cancer; the FDA has approved them,” she told BusinessWest. “They’re making progress on my specific cancer by leaps and bounds, which is good news for me, that’s for sure.”

In the meantime, she said, “I’m being positive. I feel like I’m getting great care, and if I have lots of scientists watching me, that just more people on my side.” n

Joseph Bednar can be reached at

[email protected]

Business of Aging Sections

Age-old Arguments

By ANN I. WEBER, Esq.

Ann Weber

Ann Weber

When you become a ‘senior,’ defined variously as 60 to 70 or older, you become eligible for legal benefits that are not available to your younger compatriots.

While many of these laws are needs-based, some are not — for example, Social Security, Medicare, and others which are available to all of us. The following is a non-exclusive list of some of these laws which might be of interest.

Timing Social Security Benefits

When you turn 62, you become eligible for early withdrawal of Social Security benefits, and this is a great benefit for people who for one reason or another cannot continue to be employed or who do not have a long life expectancy. However, for individuals born between 1943 and 1954, the monthly benefit at age 62 will be 75% of the full monthly benefit at age 66.

If you can wait for benefits until you are 70, there is an additional 8% increase every year for the four years between 66 and 70. So, before making a decision about when to start collecting these retirement benefits, consider the differences, taking into account your estimated life expectancy and your financial situation. For people who can afford to wait or who are worried about outliving their resources, waiting to file might be a good option to consider.

Medicare Hospice

As you probably know, for beneficiaries who are 65 and older, Medicare pays not only for medical and hospital services, but also for some home services and medical equipment used in the home. Less well-known perhaps are the hospice services available to anyone with a prolonged, life-threatening diagnosis.

Although the diagnosis must state that death is likely within six months, hospice now allows not only palliative but curative care, with the result that many individuals end up renewing their eligibility for the program in six-month installments, sometimes multiple times, or graduating from the program entirely.

Hospice services include scheduled in-home care and emergency 24/7 care, which can often obviate the need for routine medical appointments and some emergency-room visits. In addition, Medicare hospice assigns a licensed, professional social worker to beneficiaries to help the patient and family deal with the social and emotional ramifications of an end-of-life illness. It is a comprehensive home-healthcare program, and it’s free.

Charitable Giving from Retirement Funds

As a general rule, any withdrawal from a traditional individual retirement account (IRA) results in income taxation of the full amount withdrawn. However, if you are 70 1/2, you can make charitable gifts from your IRA up to $100,000, receive a full charitable deduction, and have the amount contributed count toward your required minimum distribution.

If you are charitably inclined and meet the age requirement, this is a great way to partially fund your charitable gifts with money that would otherwise be going to Uncle Sam.

Declaration of Homestead

In Massachusetts, a homeowner receives automatic protection from unsecured creditors up to $125,000 so long as the owner or covered family member occupies or intends to occupy the property as his or her principal place of residence. With a declaration filed on the land records, this protection is increased to $500,000 in total for the property.

However, for individuals 62 or older, a homestead may be filed on each individual’s behalf, so, for example, for two homeowners 62 or older, the aggregate protection increases to $1 million.

Reverse Mortgages

A reverse mortgage is similar to a purchase mortgage in that it is a loan from a bank or mortgage company to an individual. However, instead of using the funds advanced by the bank for purchase of a residence, a senior homeowner (62 or older) can use a portion of his or her home equity as collateral and receive cash in return.

Reverse-mortgage payments are not taxable, nor are the payments considered countable income for purposes of MassHealth (Medicaid) eligibility. However, reverse mortgages have fees due upon origination and servicing fees annually which can be substantial, and the loan will have to be repaid with interest which has accumulated over the life of the loan when the homeowner dies or no longer lives in the home as his or her principal residence.

In the right situation, these loans can be life savers, but, because of the fees and technical provisions, it may be wise to consult with a knowledgeable attorney before committing.

Durable Powers of Attorney

Durable powers of attorney are used to allow one person, the agent, to act for another, the principal, in financial matters. These provisions can take place immediately or be triggered by incapacity. Though powers of attorney can be utilized by people of all ages, signing a durable power of attorney can be one of the most important steps you can take if you are getting older to make sure your financial affairs are handled by the person you want and in the manner you would choose.

Under the Massachusetts Uniform Probate Code enacted in 2012, power of attorney was given additional muscle.  Specifically, in the event of an unreasonable refusal of a third party to honor the authority of a valid durable power of attorney, the agent can sue for damages.  This can be really helpful if the failure to honor an agent’s directions — for example, in a sale or purchase of property — results in a loss to the principal.

There are many other laws and programs which are available to seniors on a needs-based basis which have not been covered here. Additional information can be found at local senior centers and various government agencies, or by contacting an elder-law attorney. n

Attorney Ann I Weber is a partner at Shatz, Schwartz and Fentin, P.C., and concentrates her practice in the areas of estate planning, estate administration, probate, and elder law. She is a fellow of the American College of Trust and Estate Counsel and past president of the Hampden County Estate Planning Council, and has been recognized by Super Lawyers, Top Fifty Women Attorneys in Massachusetts, and Best Lawyers in America; (413) 737-1131; [email protected]

Business of Aging Sections

Cause and Effect

Dr. Mitchell Clionsky

Dr. Mitchell Clionsky says many conditions can mimic attention deficit disorder, so obtaining an accurate diagnosis is critical before treatment begins.

People with attention deficit/hyperactivity disorder (ADHD) have endured all sorts of labels — lazy, stupid, even crazy — while dealing with the self-berating that accompanies an inability to stay focused and complete tasks. Enter the ADD Center of Western Massachusetts, which opened in the 1990s and today serves as a neuropsychological diagnostic practice, providing a pathway for ADHD sufferers of all ages to get the help they need.

Dr. Mitchell Clionsky often suggests two books to patients diagnosed with attention deficit/hyperactivity disorder, which is commonly referred to as ADHD. The first is Driven to Distraction, and the second is You Mean I’m Not Lazy, Stupid or Crazy?! The Classic Self-Help Book for Adults with Attention Deficit Disorder.

The second tome recognizes the fact that many people with ADHD have been labeled any or all of those things — lazy, stupid, or crazy — and that they also berate themselves for their inability to stay focused, complete tasks, or even make money, which Clionsky says is a common problem for small-business owners because they frequently start too many projects at once, fail to bill clients in a timely fashion, or become overwhelmed by bookkeeping and detailed paperwork.

“There is so much shame and stigma associated with ADHD,” said Clionsky, the board-certified neuropsychologist and co-founder of the ADD Center of Western Massachusetts in Springfield. “Children feel stupid if they fail an exam because they got distracted, skipped a page, or forgot they were supposed to multiply rather than divide. They often do their homework but forget to turn it in, and feel embarrassed and defensive when their parents reprimand them.

“But they are not lazy, and they are not stupid,” he went on. “They have a deficit that involves their brain’s ability to produce or release the chemical known as dopamine, which allows people to stay focused.”

The Mayo Clinic defines ADHD as a chronic condition that affects millions of children and often persists into adulthood. It includes a combination of problems, such as difficulty sustaining attention, hyperactivity, and impulsive behavior. Children with the disorder frequently struggle with low self-esteem, troubled relationships, and poor performance in school. It occurs more often in males than in females, and behaviors can be different in boys and girls.

Two years ago, the Centers for Disease Control and Prevention reported that up to 11% of children in the U.S. have been diagnosed with ADHD. Thankfully, about half of them will outgrow it in their teens and 20s, but millions of adults remain undiagnosed, and even if children improve, they may still exhibit some signs of the disorder throughout their lives.

However, many other medical conditions cause similar symptoms, and Clionsky said depression, anxiety, and trauma can lead to an inability to concentrate and stay focused. In addition, frequent bouts of tonsillitis that cause children to sleep poorly can make it difficult for them to concentrate and perform well in school because they are always tired. But a number of studies, including a recent one conducted by the University of Michigan, show that when children diagnosed with ADHD have their tonsils removed, half of them no longer exhibit the problematic behaviors.

The same situation can result if a person has obstructive sleep apnea.

“We recommend that many people have a sleep study done before they start taking medication for ADHD; in some cases, the symptoms resolve once they are treated for the apnea,” Clionsky noted, adding that the inability to get enough oxygen while sleeping can make people inattentive during the day.

“No one has ADHD until it’s been proven — it’s a medical problem that requires a careful and detailed evaluation,” he continued. “When it is correctly diagnosed and properly treated, children and adults can perform so well that it seems miraculous. But the diagnostic process is complex, and there is a lot of variability.”

He explained that ADHD appears to have a genetic component and tends to run in families; if a parent has ADHD, his or her children have more than a 50% chance of being diagnosed with the disorder, and if an older child has ADHD, their siblings have more than a 30% chance.

However, some people have two conditions that exist at the same time. For example, Clionsky says a person with ADHD and obsessive compulsive disorder may have everything perfectly lined up in their cabinets, but be completely disorganized in almost every other aspect of their life. Meanwhile, a child may be depressed and also have attention deficit disorder.

“It’s a neurologically based condition. But there is no blood test, litmus test, or MRI scan that can prove a person has ADHD, which is what makes a clinical diagnosis so complex,” Clionsky told HCN, noting that people who have a hard time concentrating due to ADHD can pay attention under novel or interesting circumstances. “A 7-year-old may act completely normal when his mother takes him to the doctor; it’s a novel experience, so the doctor doesn’t see the child exhibiting any of the symptoms she describes. But if the appointment took two hours, he would notice everything she spoke about.”

But since everyone occasionally exhibits traits found in people with ADHD, diagnosticians look for entrenched patterns of behavior that fall outside the range considered normal for their age.

Complicated Undertaking

Clionsky opened the ADD Center in the ’90s with four partners, who planned to provide all the services people with the condition might need. But they soon discovered most clients simply wanted a diagnosis, and when the evaluation was complete, they returned to their own physicians and counselors for medication and help.

So, today, the ADD Center has become primarily a neuropsychological diagnostic practice.

“We evaluate about 200 people each year and have seen more than 4,000 patients since we opened,” Clionsky told BusinessWest, explaining that children must be at least 6 years old because, prior to that age, there is not enough evidence for a diagnosis to be conclusive as most young children have short attention spans and are very active.

Testing done on the first visit takes one to two hours and begins by collecting in-depth information.

“We get a comprehensive history that includes the person’s academic, medical, psychiatric, and family background, and they fill out a detailed questionnaire and are asked to rate a variety of symptoms on a scale of one to five,” said Clionsky. “We also interview the individual who is being studied as well as their parents or spouse.”

In addition, the person suspected of having ADHD takes a 15-minute, computerized performance test, which is purposely designed to be boring. “It compares their vigilance and ability to focus and respond consistently against people of own their age, and is used to determine how capable the person is of staying on task,” Clionsky explained.

When those tests are complete, the results are tabulated. However, if the case is complicated by medical or psychological issues, several more hours of evaluation may be needed that include testing the person’s reasoning and looking at their learning and problem-solving skills, their ability to memorize things, their intelligence, and their emotional state.

In order to be diagnosed with ADHD, six out of nine diagnostic symptoms must be rated ‘moderate’ or ‘severe,’ and they have to have been present since before age 12 and have created problems in more than one area of the person’s life.

“The symptoms have to have interfered with their academic, occupational, or social functioning and can’t be due to another cause such as anxiety, depression, a trauma, or a concussion,” Clionsky said, explaining that the symptoms of a concussion can mimic ADHD, but are typically temporary.

He added people with ADD fall into two categories. The first group has attention-impairment problems that lead to disorganization.

“It’s not that they can’t pay attention, but they are easily distracted or lose focus if something is boring, routine, difficult to understand, or has too many variables,” he explained. “Adults with ADD often become distracted or impatient during lectures where there is no interaction. They also have trouble completing tasks; they begin one thing, get distracted, and start another, which leads to something else, without ever realizing their primary objective.”

The second group has problems related to hyperactivity and impulsivity. “It predisposes them to a higher likelihood of auto accidents, orthopedic injuries, and head traumas because of their risk-taking behaviors. They tend to engage in activities that stimulate the release of dopamine, such as motocross or mountain biking, and are more likely to be in trouble with the law,” Clionsky said. “They also tend to speed, jump red lights, and do things such as leaping off the walls of a quarry without knowing its depths.”

If a person is diagnosed with ADHD, Clionsky talks to them about the condition and how it is affecting their life. He also suggests appropriate medication, which they can get from their own physician, and may recommend counseling to improve their organizational skills. Educational planning is included in the center’s services for students, and academic accommodations are usually recommended, which may involve having them take tests in a separate classroom and allowing them extra time to complete the work.

“We also tell students with ADHD to sit as close to the front of the room as possible,” he explained. “Most tend to sit in the back, which makes it really difficult, because there is an ocean of activity in front of them, which can be distracting.”

The testing is repeated during a six-month follow-up exam, but the medication usually works. Side effects are minimal, and negative long-term effects of the drugs are almost unheard of, Clionsky said.

Coping Mechanisms

ADD is a developmental disorder that starts in childhood, and even though some young people learn to compensate with help from adults, in many cases, it catches up with them.

For example, adolescents who get extra help from their teachers or have parents who carefully monitor their schoolwork often do well in high school. But once they enter the adult world or go to college, they are unable to manage on their own.

“I see many clients who have left law school or college; they’re bright, but they are failing,” Clionsky says, adding that they miss class, don’t allow themselves enough time to complete assignments, and are often distracted and thrown off track during exams by something as simple as someone dropping a pencil.

He added that many small-business owners who work in the trades, including landscapers and contractors, have come to the ADD Center for help.

“They may be really good at their job, but they are not good business people. They are working 70 to 80 hours a week, but are in debt because they fail to collect payment for their bills or have too many things going on at once, which keeps them from ever finishing anything,” Clionsky noted. “People with ADHD are the most wonderful people in the world, but they frustrate others because they don’t return calls, are late coming home because they make too many stops, and are disorganized. They make dates and promises but forget about them, and although their spouses love them, they can’t count on them. So, resentment builds up, their home lives become very disruptive, and they have trouble retaining jobs or relationships.”

However there is an exception: If the person with ADHD is working on something they really enjoy, they can block out everything else, and many adolescents and adults exhibit this behavior when they are playing video games because they are fast-moving and demand total attention.

But Clionsky says it’s never possible to know for sure if someone has the disorder until a full evaluation is done. He recently diagnosed a 20-year-old with anxiety disorder whose mother was sure she had ADHD.

“She couldn’t seem to pay attention to anything or finish filling out college applications,” he explained. “But the real problem was that she was so anxious, she worried constantly.”

The example points out the importance of examining every factor of an individual’s life that could cause symptoms commonly seen in people with ADHD.

“Some children and people just have bad habits. They procrastinate or are disorganized, so we are very careful about what we diagnose,” Clionsky said. “But if it is ADHD, it’s a real medical problem, and treatment can and will make a difference.”

Business of Aging Sections

Practicing What They Preach

Employees engage in unexpected ‘stress wellness breaks

Employees engage in unexpected ‘stress wellness breaks’ in which they are told to stretch, take a short walk, do push-ups, or engage in other physical activities for a few minutes.

On June 1, Karen Drudi completed her first five-kilometer run.

It was her 55th birthday, and she took third place in her age group. “I call it my marathon, and I have the medal I won hanging on a doorknob at home,” said the executive assistant at Dowd Insurance Agency in Holyoke.

Drudi is proud of her accomplishment, and knows that running a 5K is something she probably would never have attempted on her own. But thanks to the Dowd Wellness Program, which kicked off at the beginning of the year for employees in the company’s main branch and all its satellite offices, she was motivated to take up the sport.

The program was created to inspire people to eat a healthy and well-balanced diet, exercise on a regular basis, and engage in stress-reducing activities. It has had a marked effect on participants, and led employee Cathy Sypek to start a ‘Couch to 5K’ running group to share her love of the sport, which Drudi and other non-runners joined, meeting after work to train at the nearby Ashley Reservoir.

“I had tried running in the past, but had never been successful. So I thought that, whether I completed it or not, it would still be a challenge,” Drudi said. “We started in April, and within a few weeks, I felt it was something I could achieve. There was a lot of camaraderie, and whenever someone lagged behind, the rest of the group encouraged them to keep going. And since Dowd’s program began, other people have tried things like yoga or lifting weights. It’s motivating when we get together and hear about the success of other people.”

Catherine Palazzo, the company’s Human Resources director, conceptualized the idea for the Dowd Wellness Program after listening to representatives from other companies talk about wellness initiatives during a group meeting.

“When I returned, I did some research on wellness programs and found they were good for overall morale, health, and team building,” she said, adding that she presented the concept to President and CEO John Dowd Jr., who approved it wholeheartedly.

Which means that the company now follows the advice it gives others.

“We tell our commercial clients to try to implement an atmosphere in their workplace that inspires employees to be safe and stay healthy; it results in greater productivity and fewer sick days, and is also beneficial as it shows employees the company cares about their people,” said Dowd. “So I thought that, if we are going to preach it, we needed to practice it.”

Palazzo began designing the program with help from fellow employee Lynn Ann Houle, and asked people to volunteer for a wellness committee.

“The intent of the program is to support the overall health improvement and morale of our employee population,” Palazzo said, explaining that programs and activities have been designed to raise awareness about health and nutrition and increase overall physical activity levels, with recognition and incentives awarded on a regular basis.

For this issue, BusinessWest talked with employees at Dowd about how they created this program, and why they believe it is a blueprint for other companies to follow.

Changes in Behavior

The wellness program, which kicked off in February, features a number of components, including a weekly online questionnaire. Employees who reply earn points for positive responses to a series of health-related questions. They are asked about their food choices, whether they consumed eight glasses of water each day, and if they have engaged in the listed exercises, which range from doing an hour of cardiovascular activity during the week to lifting weights, running, or doing yoga.

Every few months, the activities on the list are changed  — with advance notice — to inspire people to try new sports such as kayaking or hiking.

Points are tabulated, and prizes are awarded at a monthly luncheon, where people’s birthdays, anniversaries with the company, and other milestones, such as exceeding sales goals, are also recognized.

At that time, the grand-prize winner receives a gift certificate to a sporting-goods store, and second- and third-place winners choose from an array of exercise-related items, such as yoga mats, cookbooks, and videos.

In addition, food in the company snack bar has been changed; unhealthy items have been replaced with fresh fruit and other nutritious offerings. Free fruit is also put out once a week at lunchtime, and Houle announces unexpected ‘stress wellness breaks,’ in which employees are told to stretch, take a short walk, or do other physical exercises.

There are also periodic activities that allow participants to earn bonus points. In July, Houle planned a golf outing, and employees from different offices played 18 holes of pitch and putt at Annie’s Driving Range in Chicopee. She brought a fruit salad in a watermelon, as well as healthy beverages. “We all had a blast,” she said.

The following month, her goal was to “bring out the inner child” in each member of the staff, which led to the creation of Dowd Field Day.

More than a dozen people gathered outside the Holyoke office and played ladder ball and hopscotch, took part in a hula-hoop contest and a sidewalk-chalk art competition, then enjoyed healthy snacks prepared by committee members who used Weight Watchers recipes.

Houle said the event was truly enjoyable. “There is nothing better than laughter and a smiling face. It makes you feel good about yourself and is projected in your outward demeanor.”

This is what organizers had in mind when the program was launched at the annual company meeting. On that occasion, Dowd talked to the employees about why it was being implemented.

“I told them the firm is concerned about each person’s well-being, and we wanted them to take steps to improve their health,” he recalled. “We challenged them to begin an exercise regimen and to eat healthy foods, and told them, if the opportunity came up to participate in a walk for charity or something similar, to do it. Good health is achievable with exercise and proper diet and results in positive benefits.”

Each employee received a kick-off goody bag, with information on how to log their food intake and activity on myfitnesspal.com, as well as a stress ball, a healthy snack, bottled water, and other health and fitness items. In addition, everyone has been encouraged to complete Health New England’s annual online health survey.

Palazzo said participation has steadily increased since the program began, and enthusiasm continues to grow. To that end, the agency subsidizes gym memberships, and committee members share articles, healthy recipes, and information on physical activity and exercises that people can do at home.

Healthy Outlook

Houle is chair of the program and plays an active role in keeping people motivated. She told BusinessWest that she speaks to employees about how they are doing and sends periodic upbeat e-mails to keep everyone encouraged.

Houle lost 40 pounds on Weight Watchers two years ago, and said it enhanced her self-esteem. “It made me passionate about feeling good and being happy,” she said, adding that, as a result, she loves playing a leading role in the program because she wants others to feel equally good. “The people who choose to participate in this really enjoy it.”

Carol Andruss has lost eight pounds since the Dowd Wellness Program began by making small lifestyle changes, and said participating employees have lost more than 100 pounds overall, an estimate garnered through conversations in the office and at the monthly meeting and extracurricular events.

“I’m trying to watch what I eat and have been walking a few times a week, which is more than what I was doing before this started,” she said.

But it hasn’t been difficult, because she joined the committee and is responsible for stocking the office snack bar.

“I buy things like trail mix, low-fat pretzels, and popcorn,” she said. “And I pick up fresh fruit or fresh vegetables and hummus once a month for everyone to enjoy in the afternoon. I volunteered to do this because I wanted to raise awareness about healthy eating and become more involved at the office.”

Sypek, meanwhile, is a dedicated runner, and was so inspired by the program, and the fact that many employees began walking together as a group at lunchtime, that she decided to start the ‘Couch to 5K’ running program.

“I announced it in all of our offices,” she said, adding that the program has a set agenda — with intervals of walking, followed by running, then walking again — until the person can run three miles non-stop, which equates roughly to five kilometers.

Much to her delight, five non-runners decided to join. “We met five days a week for 30 to 45 minutes after work,” she said, explaining that each runner chose a 5K run they wanted to complete, and everyone has met their goal. “I love running, and this has given me a true sense of satisfaction. Many people think they can’t run, but they can, if they go at their own pace.”

Long-term Benefits

Employees who have chosen to take part in the Dowd Wellness program say it has been extremely beneficial and has resulted in positive life changes.

For example, Debbie MacNeal joined Sypek’s running group, which was a new activity for her. “I completed the Taste of the Valley 5K Run in West Springfield,” she told BusinessWest. “I’m pretty active and go to the gym a lot, but the 5K is something I would never have done on my own. It felt great to finish, and I am still running.”

Andruss is more conscientious about her food choices, and says walking with a group of people at lunchtime is motivating. “It has been proven that people are more inclined to exercise if they have someone to do it with.”

The weekly online survey has made Sypek more conscientious about the amount of water she drinks and whether she is consuming her fair share of vegetables.

“This program is great. Everyone needs to be reminded from time to time about things they can do to improve their health,” she said.

Dowd is satisfied with the results and plans to keep the program going. “A lot of people are participating, which is exactly what we hoped for. There is strength in numbers; it’s very positive, and the enthusiasm it has generated has been contagious. Plus, it’s important to practice what we preach,” he reiterated.

Palazzo is also pleased. “I’m happy there has been so much interest in our wellness program. It has really taken off and is good for employee morale and team building,” she said.

Houle agreed. “It has great benefits and shows that management cares about our overall well-being. They are willing to assist us by thinking outside of the box.”