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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.’

In these times, many people will be working remotely. In addition to accessing BusinessWest online, readers may wish to add their home address. To do this, e-mail [email protected], visit  https://businesswest.com/contact-us/subscribe/, or call 413.781.8600.