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Innovative Treatment

 

Parkinson’s disease is a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination. Symptoms usually begin gradually and worsen over time. As the disease progresses, people may have difficulty walking and talking. They may also have mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue.

Patients diagnosed with Parkinson’s disease and experiencing interference with their day-to-day movements may greatly benefit from Lee Silverman Voice Therapy – Big, also known as LSVT–Big, said Amanda Martins, a physical therapist at Baystate Wing Hospital. LSVT–Big is a nationally recognized rehabilitation-therapy program that has helped people with Parkinson’s disease improve upon the disease’s impact on their walking, balance, and other activities of daily living, such as writing and dressing.

“People living with Parkinson’s disease or other neurological conditions often move differently, with gestures and actions that become smaller and slower,” Martins said, noting that patients facing neurological illnesses have always been an area of interest for her and the physical therapy team at the hospital.

LSVT has two branches: ‘big’ and ‘loud.’ The treatment protocol is designed for individuals with Parkinson’s disease and other neurological conditions.

“It is designed to involve large and exaggerated movement patterns to move better, increase confidence, and improve safety.”

“Because LSVT–Big treatment is customized to each person’s specific needs and goals, it can help regardless of the stage or severity of your condition,” Martins said. “The treatment is unique and customized to each patient’s goals, targeting gross and fine motor skills.”

These skills include walking, balance, and other activities of daily living, such as writing, getting dressed, and other job-related tasks, she added.

Although the LSVT–Big program was designed for individuals with Parkinson’s disease, it has been shown to be beneficial in the rehabilitation of individuals with other neuromuscular disorders, such as stroke, normal-pressure hydrocephalus, brain injury, and multiple sclerosis.

“The program consists of 16 sessions, four days a week for four weeks, and our patients are given daily homework and carry-over homework,” Martins explained. “It is designed to involve large and exaggerated movement patterns to move better, increase confidence, and improve safety.”

Martins received a bachelor’s degree in exercise science from Westfield State University and earned her doctorate in physical therapy from American International College in Springfield. She sees an array of patients of all ages and abilities, and expresses a passion for sports and stroke rehabilitation, as well as amputee and prosthetic rehabilitation. A former soccer player, she understands the physical, emotional, and rehabilitative aspects of getting the patient back to the highest quality of life — and an athlete back in the game or on the field.

“I have worked with patients who have had strokes, spinal-cord injuries, multiple sclerosis, and Parkinson’s. I have personally found working with this population to be gratifying. It wasn’t until I had the opportunity to shadow the LSVT program and saw its positive results that I decided to take it upon myself to get certified in this special treatment.”

Business of Aging Special Coverage

Before the Fall

Early in Kate Clayton-Jones’s nursing career, she was struck by the cost — both financial and personal — of neglecting preventive care.

Specifically, of the feet.

“I kept seeing a whole bunch of people getting their feet amputated or having surgeries for having fallen,” she said, “and I thought, ‘my God, this is just so preventable.’”

That thought eventually (after plenty of planning, training, and persistence) became FootCare by Nurses, a model for preventive foot care that meets clients — mostly older people — where they are, especially in their homes.

“This isn’t nursing care like, ‘let me come in every day and feed you, clothe you, whatever else,’ but nursing care that could come episodically, once a month, or once every other month, and do this much-needed work, which is taking care of the feet of older adults.”

She explained that her nurses sit on the floor and look for circulation problems, sores, and calluses, and release tension in the toes that can limit flexibility and lead to falls. They also check the fit and lacing of shoes and make recommendations about socks. “All our work is designed to improve quality of life. This is an alternative pathway for foot care from typical podiatry or nail salons that most people know.”

For those who would prefer a clinic to a home visit, FootCare by Nurses also has offices in Greenfield, Lenox, and Fitchburg.

“It can be as simple as showing someone how to lace their shoes. We have an opportunity to spend time with people to help them understand simple changes like the way their shoes and socks fit, and skin care. We do a lot with balance and trip hazards,” Clayton-Jones explained.

“Elders are getting touched, and they’re having meaningful conversations. The work we do restores dignity and quality of life. Because we come in as nurses, we can talk about other things as well, and we see them on a regular basis, not just when they have an acute incident.”

While podiatrists are medical doctors whose responsibility is to diagnose and fix problems — recommending treatments and performing procedures — she and her team are licensed nurses with extensive training in foot care, whose responsibility is to prevent problems from happening in the first place. And there is some overlap.

“We have many podiatrists who support this work, though podiatry is a medical intervention, and a lot of this is not medical; it’s basic activities of daily living, and nursing is ideally suited to take care of people in that way,” she said. “There was this gap, and a huge opportunity to do something that is so meaningful, and it’s just a delight.”

The work is important, Clayton-Jones said, because people can become embarrassed by neglected feet and neglect them further — often with dangerous and even tragic results. She was thanked recently by a man whose edema was diagnosed by FootCare by Nurses, and he got the treatment he needed before the situation grew dire.

But even beyond such critical interventions, she said, people are happy when they can simply find pain relief and be able to leave their house or walk with their loved ones.

“We support quality of life in so many ways,” she said. “We not only make a difference when we walk in, but we give them peace of mind. It’s the only type of nursing I’ve done where I’ve heard someone say, ‘I can’t wait for that nurse to come back.’ It’s just such a nice intervention.”

 

Finding Her Footing

Clayton-Jones didn’t start off as a nurse; in fact, she earned a business degree and was working in aviation before shifting her flight plan to nursing school.

About a decade ago, while working on various floors of Berkshire Medical Center, she encountered patients with inflamed, infected feet, or — even worse — who had broken a hip in a fall, where poor foot care had been a factor. So she asked herself, “why can’t we, as nurses, take care of feet? I can learn to do it.”

So she sought further education through the Wound, Ostomy, and Continence Nurses Society. During that time, she recalls watching a toe amputation of a Korean War veteran who had developed an infection due to ill-fitting shoes a doctor had recommended.

Kate Clayton-Jones

Kate Clayton-Jones at the American Foot Care Nurses Assoc. 2023 National Conference.

“The surgeon did a beautiful job. He was very nice and kind and connected to this man. But the man was very angry because he was losing a part of his body.”

It occurred to her that no one had checked on him and his new shoes — a simple intervention perfect for a nurse’s assessment skills. And she wondered how many other serious infections, debilitating falls, and amputations could be avoided altogether with simple, home-based foot care … by nurses.

After becoming a certified foot-care nurse, Clayton-Jones started treating people’s feet in various setttings. When met with skepticism by people who suggested clients just visit a nail salon, she had a ready answer.

“I said, ‘you don’t understand this population. They’re not able to go out. You’ll never see these people; they’ll never be on your radar, but they are costing the healthcare system an inordinate amount of money when they fall.’”

More importantly, “it gave me great joy to bring dignity and function to these humans who have put so much back into the community,” she added. “These are really incredible people. It doesn’t matter how wealthy or poor you are or where you live — your feet still need to be taken care of.”

By 2016, she had become very busy and realized she couldn’t provide all the care on her own.

“I knew, if I’m going to take on the responsibility of taking care of all these people, this needs to be a real business, with people who want to do this work,” she told BusinessWest. “I will train these nurses, but it needs to be a business that solidly sits on its own foundation.”

In doing so — the business has expanded from three employees in 2016 to 42 today — Clayton-Jones said she’s not only taking care of the community, but providing good jobs for nurses on schedules that work for them, which is especially important if they have families.

“They can start a quarter after nine, after they drop off the kids, see six or seven people, and pick the kid up by three o’clock,” she said, adding that “foot care is not an emergency — it’s prevention.” So if a snowstorm strikes, appointments can be easily moved to a different day. In short, she’s providing nursing jobs with predictable, and not burdensome, schedules.

nurse at FootCare

At right, a nurse at FootCare by Nurses teaches three new nurses how to touch and treat feet.

“I wanted to give them autonomy and responsibility and quality of life while also a joyful, meaningful job that’s not just about trimming toenails, but restoring the best function to an older foot.

“It turns out feet are really, really important,” she added, noting that 40% of cardiac flow is related to foot and leg movement, and toes are part of the body’s ‘seeing’ system for positioning itself in space, so the healthier the feet and toes are, the less likely an older person will fall.

“It’s just preventable with good foot care, good foot function, knowledge about how shoes fit. I started pulling the pieces together — what was behind everything we were doing. And we keep evolving the science.”

And as age demographics in the U.S. keep trending older, it’s a growing problem, especially among the Baby Boom generation.

“They need help — not just care at a podiatry office or a nail salon; they’re going to need this help at home because many can’t drive, or they’re cognitively impaired, or frail. They need to stay home and have care come to them,” she explained. “So the business model was not working with one visiting nurse association or one long-term-care facility — we would work with many, and I would work regionally.”

 

Next Steps

And the practice is still growing. Clayton-Jones — who regularly speaks on foot-care issues nationally and around the world — recently announced that three new contracts will allow FootCare by Nurses to expand its services in Central Mass., the city of Springfield, and some towns in Connecticut.

A contract with the Program of All-Inclusive Care (PACE) in Springfield will allow Serenity Care case workers to refer clients to FootCare by Nurses. The PACE program is centered on the core belief that, given a choice, most elders, the disabled, and their families would choose to receive care in their homes and communities rather than in a nursing home — so it meshes well with Clayton-Jones’s own mission.

Meanwhile, a contract with Tri Valley Elder Services will expand FootCare by Nurses’ services into the area south of Worcester. Additionally, FootCare by Nurses will take on former clients of Connecticut-based Pedi-care.

“This expansion and continued growth means adding close to 1,000 new clients and $300,000 in new revenue, which will trickle in slowly as referrals for foot care come in,” she said, adding that she plans to add two administrative positions and 10 nursing positions — and is actively hiring for them.

“At the end of the day, if you want a meaningful nursing career, this is just an excellent place. If you’re community-minded, if you like one-on-one conversations where you can make a huge difference, this is really a good career,” she said. “My nurses speak of it as the most joyous job they’ve ever had. They thank me for the autonomy and responsibility, and they get to use all their nursing skills. And they feel connected to the community that they live in, supporting other people.”

As the company grows, its mission — to redefine elder care by making evidence-based foot care central to general health — will not change, she added.

“Our mission is prevention, and our passion is caring. Feet are literally the foundation for our body; they allow us to be mobile, they pump blood back to our hearts, and they connect us to the world. Any fault in feet affects the whole body, just like faults in a foundation affect the entire structure. Yet, feet are too often ignored or neglected, while their care and well-being are essential.”

In short, Clayton-Jones stressed, FootCare by Nurses is not an aesthetic service that simply makes feet and toes more presentable.

“These people need nursing care; it’s a nationwide problem. I can’t tell you how many times I’ve seen nail polish glossing over toenail fungus or a callus or corn, and it continues to perpetuate because no one’s done preventive education,” she said.

“Nurses are educators. We teach people how to take their medications, what the side effects are … a lot of people recognize we’re the healthcare teachers out there. Our mission is prevention. Yes, we’re great at taking care of toenails, but we’re also there to prevent falls or wounds from happening — and we save lives.”

Business of Aging Special Coverage

Wait of the World

Mark Auerbach says he’s ‘going public’ with his quest for a new kidney

Mark Auerbach says he’s ‘going public’ with his quest for a new kidney to help raise awareness about the importance of organ donations and perhaps shorten the time on the waiting list for some of those in need.

Mark Auerbach says he had started down the stairs in his home in Longmeadow that night in 2019 when he tripped over an untied shoelace and started falling. He recalls knocking a bannister out of the railing and slamming through his front door.

As a result of the fall, he broke his femur and his hand, eventually spending more than three months in inpatient rehabilitation. But the fall did something else. It “fatally injured” one of his kidneys, as he put it, accelerating a process of deterioration that had begun years earlier when he was diagnosed with diabetes.

“In 2019, my kidney doctor said, ‘you are heading for the need for a transplant, and you’re in stage 4; eventually, you’ll be in stage 5, and you’ll need one,” he recalled, adding that stage 5 essentially arrived in the spring of 2021.

Soon thereafter, Auerbach, a veteran arts reporter, owner of a public-relations firm that bears his name, and current ArtsBeat reporter for Pioneer Valley Radio, joined the lengthy list of people in this country on a waiting list for a donated kidney.

How lengthy? Well, he was accepted into a donor program at Massachusetts General Hospital and is now one of roughly 1,400 patients in a queue waiting for the proverbial ‘right donor.’ Nationwide, there are approximately 100,000 people on such lists.

“I didn’t really want to go public — you sacrifice your personal privacy when you put it out there. So I was really hesitant. But from a public-relations standpoint, I realized that if I didn’t tell my story, I couldn’t expect someone else to do it.”

While waiting for a kidney, many on those lists choose to be proactive and not simply wait. Some buy billboards stating their case, while others take out ads in newspapers and use social-media channels to encourage people to come forward and donate — not just for them, but for the myriad others waiting for a truly life-changing gift.

Auerbach is one of them. He said he has “gone public” — but in a quiet way, with personal appeals; regular postings on Facebook, LinkedIn, and Twitter; and interviews like this one and another on his ArtsBeat show with guest (and longtime friend) Patrick Berry, host of WWLP’s Mass Appeal — in his quest to find a donor for himself, but also to raise awareness about the urgent need for organs and to spur action.

“I didn’t really want to go public — you sacrifice your personal privacy when you put it out there,” he told BusinesWest. “So I was really hesitant. But from a public-relations standpoint, I realized that if I didn’t tell my story, I couldn’t expect someone else to do it.”

He started with letters to family members, close friends, and clients alerting them to his situation and framing it in the larger context mentioned earlier — that he is one of 100,000 people waiting for a kidney and ‘here are the things you can do to help me.’ That list included everything from becoming an organ donor on one’s driver’s license to learning how to donate, to perhaps giving specifically to him.

Dr. Ken McPartland

Dr. Ken McPartland says there is a huge need for living donations of kidneys.

Such proactive steps are becoming increasingly necessary, said Dr. Ken McPartland, medical director of the Transplant Division at Baystate Medical Center, who told BusinesWest that the number of people on waiting lists is growing, the waits are often becoming longer, and the situation has been made worse, at least temporarily, by the pandemic, which prompted many potential living donors to remain on the sidelines out of caution.

“If someone has a living donor, they can get a transplant pretty much right away, which is usually within a few months,” said McPartland, part of a team that handles 50 kidney transplants a year at Baystate on average. “But if they don’t, they sometimes have to wait five to seven years to get a transplant.”

Of the 41,000 kidney transplants performed last year in this country, he noted, only 6,500 involved living donors — the rest of the organs were from those who were deceased, and the waits for those can be very long.

“There’s a huge need for more living donations,” he explained. “We know that people can donate a kidney and do very well and live a normal life. There is a risk, but the risks are is really low, and this is the biggest opportunity for improving not just the number of transplants, but the quality of transplants; we’d be able to help more people earlier in the process.”

“If someone has a living donor, they can get a transplant pretty much right away, which is usually within a few months. But if they don’t, they sometimes have to wait five to seven years to get a transplant.”

Dr. Leo Riella, medical director of Kidney Transplantation at Mass General Brigham, agreed. He said the numbers — specifically those related to the number of transplants performed each year at his hospital and the number of people on the waiting list (170 and 1,400, respectively) — help tell the story of the importance of encouraging donations.

“That number of those waiting is growing by roughly 10% a year,” he noted, adding that there is a huge backlog of cases. And as people wait longer, their odds for achieving quality of life grow longer.

 

Organ Players

Auerbach quipped that it was easier for him to get into Mass General’s kidney-donation program than it was to get into the drama program at Yale.

He was exaggerating, obviously, but only to a degree. And the logistics of getting into a program constitute only one of the many challenges facing those who need a kidney — or any other organ.

For many, including Auerbach, there is the emotional trauma that comes with the news that they are essentially on a clock — they have so much time (in his case, 18 months to three years) to secure a donor before they will have to go on dialysis, or worse.

“That was a punch to the gut,” he told Berry on his radio program. “And I felt very alone at the time. My family, my partner, everybody was like, ‘that’s too bad — we’re here for you.’ But that’s not necessarily what I needed at the time. The only way for me to move forward was to take charge of my own life and to do my own planning.

“I thought, ‘worst-case scenario, if 18 months to three years is reality, you better have a will, you better have a way to transition out of your business, the people who work for you and depend on you — you better plan for that,’” he went on. “The other things is, do you want to be hooked up to a machine, or do you want quality of life? And I chose the good quality of life. But … my life will be expanded, knock on wood, if a donor comes through.”

And then, there is just the waiting, and not knowing if the phone is going to eventually ring with a caller delivering the news that a kidney has been found.

Unfortunately, as the population ages and with the numbers of donated kidneys — both from living donors and those who have died — being relatively stagnant, the number of people living in limbo (that’s the kindest word to use) is only increasing, said McPartland, noting that there are generally between 150 and 175 on the waiting list at Baystate Health at any given time.

Dr. Leo Riella

Dr. Leo Riella

“That number of those waiting is growing by roughly 10% a year.”

As noted earlier, those without living donors may stay on the list five years or longer waiting for a kidney to be donated, he went on, adding that, for some, especially older patients, their condition may deteriorate while they are waiting — to the point where they become too sick to qualify for a transplant.

For quality-of-life reasons, someone needing a kidney will certainly fare much better if they can receive that organ before they need dialysis, McPartland added. “The way to really help patients is to get a transplant before they ever start dialysis. The patients do better, they live longer, and the kidneys work better and for longer.”

Riella agreed, noting that, in many cases, kidney disease, which he called a “silent disease” because those suffering from it generally do not experience pain or discomfort, isn’t detected until late in life — in many cases, too late, as their disease has progressed to the point where they cannot move up a waiting list in sufficient time to ultimately improve their quality of life through a transplant.

This is why early detection is important, he said, adding that blood tests can reveal if and to what degree the kidneys are in decline.

Overall, the average wait time for a kidney is six years, said Riella, adding that this number has only increased in recent years, and for several reasons, especially the aging of the population. “The gap in the number of kidneys available and the number that is needed is huge.”

Like other hospitals that perform kidney-transplant surgery, Baystate and Mass General are very active in efforts to help encourage people to donate organs, and also in helping those on lists to get kidneys through various means, including matching programs.

For example, if someone on a list finds a willing donor, but that kidney is not compatible, that kidney can be exchanged for one that is compatible through a voucher program, enabling people to move up on a waiting list.

It is for these reasons that Auerbach chose to go public despite his many reservations about doing so.

“I thought, ‘I’ll become the poster child for organ donations. Hopefully, I’ll get one, or at least the list will get whittled down, and I’ll move up the list faster. I’ll be the spokesperson for those 100,000 people.’ That was my motivation.”

While many fully understand the urgent need for kidneys and other organs, he explained, his story and that of others in similar situations must be told to reinforce the message and add a very needed personal touch.

Both McPartland and Riella agreed. They noted that, while much of the discussion about organ donations is focused on numbers — everything from how many individuals are on lists to how long their waits are — behind the statistics are real people, like Auerbach, facing quality-of-life, if not life-and-death, issues.

 

Bottom Line

Auerbach told BusinessWest that he tries not to think about the informal ‘clock’ he’s on — one doctor told him 18 months to three years, while another told him five years before he would need dialysis — and often wishes he was not given such estimates.

And he’s not alone in that sentiment. Such clocks, while helpful in the planning process, only increase the anxiety and make the waiting all the more tortuous, he noted.

“I’m trying to take it day-by-day and be optimistic,” he said. “To have a clock ticking as I’m watching and waiting would drive me crazy.”

The only thing that can shorten such waits is for more donors to come forward, said all those we spoke with, adding that this why stories like Auerbach’s need to be told. And why people need to listen — and respond.

 

It takes only five minutes to sign up to be an organ donor at www.organdonor.gov/sign-up. To learn more about becoming a living kidney donor, call Baystate Medical Center’s Transplant Program at (413) 794-2321, option 2, and speak with the living donor coordinator, or visit the Baystate Transplant website at baystatehealth.org/transplant for a confidential screening process.

Banking and Financial Services Business of Aging COVID-19 Daily News Employment News

FLORENCE — Florence Bank announced that president and CEO Kevin Day will retire on Nov. 25, and a focused search is underway for a new leader.

Day took over as president in January 2020 and became CEO in May of the same year.

When Day took the helm at age 64, he promised that nothing would change at the bank. Little did he know, he’d be called upon to usher Florence Bank through some of the most tumultuous times in history, including a pandemic and the resulting financial strife. Day led the bank in ensuring that countless homeowners and businesses were able to defer their payments during the pandemic and in helping business customers connect to grants and other available funding.

These measures helped customers navigate the financial turmoil and gave them much-needed time to adjust to new financial situations.

The bank also expanded over these past two years, opening a branch in Chicopee; creating a work-from-home program for employees; and granting hundreds of thousands of dollars to nonprofit organizations in the Valley.

Day takes pride in the bank’s stability but shares the credit with the full banking team.

“Our goal in this transition is to identify an individual to lead the bank into the future while preserving the values and mission of the past that have proven so successful here,” he said. “I am proud to say that Florence Bank is fundamentally sound in every way. We have an experienced executive management team, a solid officer team and a dedicated staff. I am confident that the bank will continue to prosper for many years to come.”

Day joined Florence Bank in 2008 as chief financial officer, responsible for finance, facilities and risk management. His responsibilities expanded to include compliance in 2013, residential lending in 2014 and retail banking in 2016. He was also promoted to executive vice president in 2016.

Business of Aging

When Memory Falters

By Mark Morris

 

As we age, the occasional struggle to find a word, or a sporadic lapse of memory, is hardly a cause for alarm. It becomes a concern when short-term memory or trouble finding words becomes a constant battle, because those are often signs of dementia.

Memory loss is usually observed by others and not the person who is afflicted. According to Lori Todd, executive director of Loomis Lakeside at Reeds Landing, a person tends to lose their short-term memory — such as not remembering what they had for breakfast — while their long-term memory stays sharp, and they can tell you all about what happened in 1950.

“We also see the person ask a question, get an answer, and then, 10 minutes later, ask the same question,” Todd said.

Understanding the difference between benign memory loss and early stages of dementia can be difficult for families of aging parents because confronting dementia often comes with lots of fear and denial.

“They know you are an important person in their life, and they know there is an emotional connection. Words aren’t as important as the emotions.”

Beth Cardillo, executive director of Armbrook Village in Westfield, works with families to better understand what is happening with their loved ones. Overcoming their fear and denial is the first big hurdle.

“Family members might admit that mom has a little dementia, but not Alzheimer’s,” Cardillo said. “They treat Alzheimer’s like it’s a dirty word.”

While there are more than 100 types of dementia, Alzheimer’s disease accounts for nearly two-thirds of all dementia diagnoses. Cardillo noted that it’s not unusual for someone to have Alzheimer’s as well as one or two other types of dementia.

On the last Wednesday of each month, she runs a caregiver support group that gives families a chance to hear what others are going through while caring for an aging parent.

Beth Cardillo

For loved ones of individuals with dementia, Beth Cardillo says, overcoming fear and denial is often the first challenge.

“I don’t say much; I’m simply there as a resource,” she said. “Most of the talking is done by group members who help clear up misconceptions and help others realize they are not alone.”

Cardillo called it a true support group, one that has been active for 10 years, the last two years via Zoom, and she welcomes any caregiver to join the group. “And I mean anyone because it’s a virtual group. We have family members from all over the country who join in the discussion.”

 

Keep Talking

Open communication with families can help them overcome some of the fear and denial that comes with seeing a loved one losing their cognitive abilities. This can also lead to better interactions.

One past practice which is now discouraged was to try to reality-orient an individual with dementia. For example, if a 95-year-old asks to see her mother, the natural tendency is to point out that her mother would have to be 130 years old. Todd recommends, instead of a rebuttal, just going with it.

“It’s an opportunity to engage and say, ‘let’s talk about your mother and all the wonderful things about her,’” she explained. “By going on that journey, it makes them feel good and improves their quality of life.”

Often, a son or daughter will insist on asking the parent with dementia to say their name and then, if they can come up with it, assume they are having a good day. Cardillo said knowing their children’s names doesn’t really matter and can cause embarrassment for the parent if they don’t succeed.

“They know you are an important person in their life, and they know there is an emotional connection,” she added. “Words aren’t as important as the emotions.”

At Reeds Landing, people with dementia live among the other residents. While resident assistants are there to help when needed, those with dementia have a daily routine and feel more included.

Lori Todd

“Concentrate on what makes them happy. Their long-term memory is still there, so it’s an opportunity to encourage talking about good memories they have.”

“We try to keep them at their highest level of functioning in more of a home-like setting rather than an institutional one,” Todd said.

People with dementia are capable of learning and in many ways remain the person they have always been, Cardillo added. “There are still moments of lucidity. Just because you have dementia, does not mean you are stupid.”

Programs that encourage a fail-free environment tend to work well for those with dementia, such as the painting program at Armbrook Village called Memories in the Making.

“Lots of conversation comes out during these sessions,” Cardillo said, recalling one resident who painted a summer scene. When she asked what that meant to the artist, she reminisced about vacations in Maine many years ago. “It doesn’t matter what they are painting; it’s really an opportunity to share their feelings and tell their stories.”

While staff at local senior communities are trained to look for signs of dementia in residents, it can be more difficult for seniors living at home. Todd usually sees an increase in phone calls after someone comes home for Thanksgiving, assuming their mom or dad is doing fine, only to discover things are not going well.

“We encourage people to talk with their parent’s physician when there has been a change in behavior,” she said. “The physician is a good resource because they know the baseline health of the parent.”

 

Past Meets Present

Helping people understand dementia is a constant activity for Cardillo. Seven years ago, she started the Dementia Friendly movement at Armbrook. Through a partnership with the city of Westfield, Armbrook staff train city employees, first responders, local businesses, and the public on how to recognize the signs of dementia and to better communicate with those afflicted with it.

Both Cardillo and Todd acknowledged that dementia can be frustrating for the person and their family. Because there is no cure for dementia, the emphasis then becomes on the person’s quality of life.

“Concentrate on what makes them happy,” Todd said. “Their long-term memory is still there, so it’s an opportunity to encourage talking about good memories they have.”

Music can also be an effective way to promote good memories. Cardillo referenced a study of a group of people with dementia who were suffering from depression. Researchers asked their families what music the person enjoyed when they were young and made a playlist of that music to play on headphones.

“It woke up their brains and changed their moods,” Cardillo said. “We all hear music and it brings us back to a certain time.” Because music gives most everyone fond memories, she added, it’s no surprise that music brings pleasure to those with dementia as well.

Whatever the milestones along the journey, once family members can move past their denial and fear, she noted, they can really make a difference for their parents.

“When people understand that dementia is not something to be feared, they can begin to accept it and be there for their loved ones.” u

Business of Aging

Room for Improvement

By Elizabeth Sears

 

Cooley Dickinson has a vintage 1973 Emergency Department — functioning well beyond its expected lifespan.

Even though this older facility has been a workhorse through the pandemic, helping support its community through what is now four waves of COVID-19, it has some obvious bottlenecks. Due to a constriction of space, those at Cooley Dickinson have found themselves getting creative, using hall beds in order to get by. However, an intriguing, $15.5 million solution is currently in the works for 2023.

The plan, “Transforming Emergency Care: Campaign for the Cooley Dickinson Emergency Department,” will include the renovation of 17,000 square feet, plus a 6,600-square-foot expansion. In 2019, Cooley Dickinson completed a master plan for facilities, and the Emergency Department was identified as an area greatly in need of expansion and and renovation.

“We looked at the entire institution, and the Emergency Department emerged as the number-one priority,” said Diane Dukette, chief Development officer at Cooley Dickinson. “Then came the pandemic, and that only further heightened that need we had to take over the endoscopy space to create a specialized respiratory Emergency Department.”

This project was delayed due to the COVID-19 pandemic; the initial plan was to start in 2020. However, this has allowed for plenty of time to plan, and those at Cooley Dickinson are feeling optimistic about the current timeline.

Diane Dukette

“We looked at the entire institution, and the Emergency Department emerged as the number-one priority.”

“The more planning you put into this, the better your construction phase is going to be, so we plan to really work with Consigli, our construction manager, to roll out a good phased-construction plan so it goes smoothly,” said Dr. Robert Redwood, an emergency-medicine specialist at the hospital.

Since this project is occurring in an endemic-COVID world, the plan is incorporating HVAC needs like filters and negative airflow throughout the Emergency Department. This will be essential for taking care of patients during an ongoing respiratory pandemic, Redwood said.

The ED expansion and renovation project continues to be the top priority of the organization. The Emergency Department is roughly 40% undersized right now for the population it serves, and that figure does not take into account the Pioneer Valley’s constantly growing population.

Due to the current space limitations in the existing ED, Cooley Dickinson’s staff strategically makes decisions every day about where to put patients. This is not ideal for anyone, but the staff is doing everything they can to ensure patient care, Dukette said.

“Our staff are spending more time doing workarounds and showing up and providing exceptional care in this space,” she told BusinessWest, adding that more space will allow them to do their jobs more efficiently.

Redwood spoke of the ‘triple aim’ in healthcare, which focuses on better outcomes, population health, and patient satisfaction. Now, there’s been considerable interest in a ‘quadruple aim.’ The Institute for Health Improvement has developed a four-part framework which includes care for the care team — something that has been key during this pandemic, he said. This factor will certainly be reflected in the upcoming project.

Dr. Robert Redwood

“We are sort of in the midst of a burnout epidemic as well during the COVID epidemic, and we want our facilities to be a place where staff feel proud to work and are able to take care of patients but also take care of themselves.”

“There’s going to be good lighting for the staff, staff respite areas and we’ll really try to take care of the people providing the care as well,” he said. “We are sort of in the midst of a burnout epidemic as well during the COVID epidemic, and we want our facilities to be a place where staff feel proud to work and are able to take care of patients but also take care of themselves.”

 

Space Exploration

It has been firmly established that crowding in emergency departments leads to poor outcomes, which is especially evident from the ED crowding that has been seen across the nation due to COVID-19. This has only emphasized the importance of streamlined processes where medical professionals can move their patient population through their space and get the emergencies diagnosed and stabilized in a rapid fashion, Redwood said.

“There are time-sensitive drugs,” he explained. “If you come to the emergency department with a stroke, my goal is to get you tPA — it’s called alteplase — within 60 minutes, and a key step there is getting this CT scan in a timely fashion, so the closer the CT is, when it’s co-located in the department, the quicker you can do those critical-care pathways.”

Another focus of this renovation project is creating a more geriatric-friendly facility. This includes features like large hallways, accessible bathrooms, nutrition stations, mobility aids, good acoustics, good signage, and bright lighting.

“These sound like no-brainers now, but they’re really not no-brainers,” Redwood explained. “You have to build it, you have to design it, elegantly. When patients come into the ED with dementia, they can easily have sensory overload, and then have behavioral changes due to sensory overload, so you want to have an environment that supports care for patients with dementia.”

Cooley Dickinson’s Emergency Department has received geriatric emergency department accreditation by the American College of Emergency Physicians, making it a pioneer within its larger healthcare system, Mass General Brigham. Indeed, it is the first hospital within the 13-hospital system to receive that accreditation. Other facilities in the system are going to follow suit, Redwood noted.

Another improvement to be included in this project is a larger behavioral-health pod, the need for which has only been exacerbated by two years of pandemic.

The phenomenon has been referred to as the “syndemic” — the COVID-19 pandemic plus a mental-health epidemic. Many of the support structures people have for their mental-health needs are lacking, Redwood explained, calling for improvements in behavioral-health resources.

“We’re going to have a dedicated behavioral health pod,” he said. “The current pod for behavioral health has four beds, and, for example, we have pediatric psych warding as a challenge in Massachusetts. We have two patients who have been there for well over a month in the pod, so those are beds that aren’t turning over, they aren’t readily usable. An expanded behavioral-health pod will be just really beneficial for the community.”

As noted, the price tag for the project is $15.5 million. Dr. Lynnette Watkins, president of Cooley Dickinson Health Care, recently announced a $1 million gift given by John and Elizabeth Armstrong of Amherst to contribute to the project. Additional fundraising efforts have been launched in these early stages of the project.

“What’s particularly exciting is that we had a group of individuals that came together to help us get this launched and gave us collectively a million-dollar challenge: to raise a million dollars by March 1, and then they’ll give us another million dollars,” Dukette said.

In regard to that $1 million goal, Cooley Dickinson has $117,000 left to raise over the next two weeks before it can garner the matching $1 million. Toward the end of the year, the hospital anticipates reaching out to the community for fundraising, which will coincide with when construction starts.

“This is a project that truly touches everyone in our community, and the club is honored to support the hospital,” said Steve Roberts, 2021-22 president of the Northampton Rotary Club, on the club’s recent $5,000 gift to the campaign.

 

Bottom Line

Redwood emphasized that, at the end of the day, what the Cooley Dickinson Emergency Department really needs is real estate.

“We need physical beds, and having an expanded footprint will allow us to really meet our community’s needs,” he said. “So we’re building an ED for 40,000 to 48,000 ED visits per year. Right now we’re around 32,000 to 34,000 visits per year, but the Valley is a popular place, it’s only growing, and we know we’re going to need that capacity.”

Both Redwood and Dukette enthusiastically stressed that this project is essential for the well-being of their community.

“We’re extremely proud of the fact that we are very inclusive, and we do everything we can to make whoever shows up in our emergency room feel welcomed and cared for,” Dukette said. “We’re a team.”

Business of Aging Special Coverage

Peace of Mind

Ruth’s House

Ruth’s House dedicates its lower-level Garden neighborhood to memory care.

 

The connection between music and memory is a complex and often surprising one. Just ask the families of loved ones with dementia at Ruth’s House, the assisted-living residence on the JGS Lifecare campus in Longmeadow.

“We ask, ‘what sort of music did your loved one enjoy?’ Then we have volunteers come in and build personal playlists,” said Susan Halpern, vice president of Development and Communications at JGS. “It’s amazing to see the reactions — to see someone who’s agitated get less agitated, or someone who had been very quiet come out of their shell because they’re hearing something that’s very familiar to them.”

Mary-Anne Schelb, director of Business Development, has also seen the results of what JGS calls its music and memory program.

“Maybe they’re not much of a talker, and suddenly they’re singing this song. It’s hard to carry on a conversation with them, but when the music comes on, they remember every word. The artistic and creative ability is really the last to go. It’s in there — we just need to know how to pull it out.”

Or, as Halpern put it, “it’s about meeting them where they are.” That’s why residents’ families fill out a long (around eight pages) resident profile upon admission, Schelb added.

“We really want to get to know your mom or dad, and we want to know what they like and don’t like, because then we utilize that.”

“If they can’t stand bingo, we’re not going to try to push bingo. Or if they love hot-air balloons, we can go up to them and ask, ‘hey, do you know we’re showing a hot-air-balloon movie in the movie room?’ You see their face light up — ‘you are? I love hot-air balloons.’ The profile is time-consuming, but we really want to get to know your mom or dad, and we want to know what they like and don’t like, because then we utilize that.”

Meeting residents where they are is especially important for those with early- to mid-stage memory impairments and other dementia-related diseases who live in the Garden at Ruth’s House, a separate, secure neighborhood that caters to individuals with increased cognitive and physical limitations, including Alzheimer’s and dementia, and where staff members are specifically trained to care for individuals in need of memory care.

Sue Halpern (left) and Mary-Anne Schelb

Sue Halpern (left) and Mary-Anne Schelb say incorporating memory care into the entire JGS continuum makes sense with people living longer and dementia becoming more prevalent.

But what some might not know, Schelb said, is that JGS has, over the years, incorporated specific memory-care training across its contimuum of services, from Spectrum Home Health & Hospice Care to Wernick Adult Day Health Care; from the Leavitt Family Jewish Home to the Sosin Center for Rehabilitation.

Why? Because the memory-care population is on the rise as Americans live longer than ever — and early-onset dementia in younger people is ticking up as well. So the model JGS has adopted, of making sure all the points along its continuum of services can handle different levels of dementia, is one increasingly taking hold in the world of senior living and care.

“We were the ones who spearheaded dementia-friendly Longmeadow a few years ago, which was really important to us, to make people aware of the differences of folks that have this higher level of memory loss, because people really didn’t know how to deal with them. They didn’t know what to do, how to act,” Schelb explained. “We wanted to make people aware, so I worked with the senior center, some emergency responders, and we worked with the Alzheimer’s Association and got certified as a dementia-friendly town.”

Similarly, making JGS a dementia-friendly campus was a natural evolution, she noted. “Except for Genesis independent living, every single piece of the campus concentrates on memory care.”

 

Gardening Tools

The Garden gives Ruth’s House an element of security and higher-level care for individuals with dementia, Schelb explained.

“Maybe you start out in traditional assisted living, and as they progress [with memory loss], we could add services to the apartment as long as they’re not a wander risk, and if they do become a wander risk, we’ve got the secure Garden level, which is beautiful inside and out,” she said, noting the waterfall, scenic walkways, and benches out back; the fact that the area is safely fenced in is obscured by the landscaping.

“We just wanted to make it this gorgeous, park-like environment. A lot of people like to walk, and and here they can be outside, and it gives them that sense of freedom.”

In the Leavitt skilled-nursing facility, two nursing neighborhoods are dedicated to caring for people with memory impairments, Halpern explained, while staff of the other JGS programs, like Wernick and Sosin, are trained in working with people with memory loss as well.

“As a campus, we’re caring for elders, and it sort of goes hand in hand that, as people get older, they’re suffering memory loss,” she told BusinessWest. “So we take the care of people with dementia, memory loss, and Alzheimer’s disease as a central care delivery that we train our staff on during orientation.”

That orientation, when staff are taught how to engage with people with dementia, is followed by annual reviews and specific skills-training events during the year, she added, noting that JGS will be using grant funds to expand that skills training.

Ruth’s House’s memory-care residents

Ruth’s House’s memory-care residents take part in both indoor and outdoor activities intended to engage their minds.

“We’re a person-centered campus, and we deal with memory impairment across our entire campus the same way,” Halpern added. “You take the approach that you’re meeting the person where they are.”

Added Schelb, “we’re finding a lot more people suffering from memory loss at earlier ages. Early-onset dementia and Alzheimer’s is something very real that a lot of people are experiencing, so we need to pivot and shift to make sure we can care for our folks here on the campus in any way, shape, or form.

“We’ve even got our home health dealing with folks with memory loss, or even end-stage Alzheimer’s in hospice,” she went on. “Unfortunately, we have seen more of it, across the board; I think healthcare in general has seen a lot more. And we want to be able to give our residents as fulfilled a life as possible.”

“We just wanted to make it this gorgeous, park-like environment. A lot of people like to walk, and and here they can be outside, and it gives them that sense of freedom.”

Many times, Halpern said, a senior-living facility is one of the first places family members contact when they suspect a memory issue.

“People reach out to us when they need help. And when do families need help? Often, it’s when they have a loved one who’s suffering from dementia and memory impairment, and they’ve tried to work with them at home. So we’ll work with them at home with our Spectrum Home Health Care, but then it can get to a point where you just can’t handle it. Maybe it’s the incontinence, maybe it’s the wandering and the risk of that, but we find that families are reaching out to us when they’re willing to give up their loved one. And it is a tough decision to place your loved one in a care setting.”

Even people with dementia who are able to live at home with family members can benefit from Wernick’s day programs, Halpern added.

“We were one of the first adult day health centers in Western Mass., back in the ’70s. We get a lot of people needing adult day care who have memory impairment and forgetfulness, and they are benefiting from being in social settings — and we offer social settings, be it in adult day care or assisted living, that helps people not feel isolated, and we help give them experiences that are failure-free.”

 

High-tech, Human Touch

Some of those experiences at Ruth’s House take place in a sensory room that allows residents to have experiences that reduce agitation and frustration, especially late in the day, a phenomenon known as sundowning.

“Some don’t want to be touched, or don’t like bright lights or loud sounds. They react differently to activities,” Schelb said, explaining that the sensory room is softly lit, soothing music often plays, and the room incorporates tactile technology, on touchscreens and activity panels, that stimulates in a calmer way.

“We downplay the aggravation for them. We teach staff how to recognize it and what to do, and it’s part of their care plan. We know what activities they like. And any new technology they have out there, we try to get and incorporate into our care plans and train staff to utilize them properly.”

Beyond its own programs, Ruth’s House works with families on their own communication, Schelb said.

“Sometimes we find families don’t know how to interact with their loved ones, causing frustrations. There’s a level of resentment because it really engulfs their whole life. We say, ‘let us help you; let us be the caregiver, and you go back to being the son or daughter or husband or wife.’ It’s really hard to do both.”

By focusing on the relationship and not the caregiving, families learn to move past the frustrations of life with Alzheimer’s or dementia, especially during the early stages when they’re just getting acclimated to the situation.

“They can get upset with mom or dad: ‘I just told you that; how do you not remember that?’ But they’re not purposefully forgetting; this is just part of the disease,” Schelb said, so family education and support groups are crucial — as is understanding when it’s time to seek the appropriate level of help. “Sometimes they can stay at home, and we can help. But sometimes they realize it’s just too much, and they realize they have options on our campus.”

It’s a campus that embraces not only person-centered care, Halpern said, but — at least in the Sosin Center — the ‘green house’ model of small-house care, which focuses on three goals: an authentic, home-like setting; meaningful life; and empowered staff.

“We recognize the environment is important to peoples’ well-being and how they feel,” she noted, adding that a second phase of what’s been called Project Transformation will bring the green-house model of renovations to the Leavitt Jewish Family Home as well — arguably a more important site for it, since it’s a long-term facility where residents will live the rest of their lives.

In short, Halpern said, JGS continues to look at ways to meet residents where they are.

“That affects how we care for people with dementia as well,” she added. “It’s part of our philosophy.”

Business of Aging Special Coverage

‘We’re Like a Cruise Ship’

By Mark Morris

Cheryl Moran supervises a balloon volleyball game

Cheryl Moran supervises a balloon volleyball game at the Atrium at Cardinal Drive.

Visit any senior-living community and it’s easy to notice all the activities residents take part in. But there’s more to all that activity than just fun and games.

Indeed, while providing entertainment, activities also contribute to the well-being of seniors in every setting, from independent living to assisted living and memory care, and even in skilled-nursing facilities.

It all begins with crafting an activities calendar. Sondra Jones, chief marketing officer for the Arbors Assisted Living communities in Amherst, Chicopee, Greenfield, and Westfield, said residents have a full schedule of activities from 9 a.m. to 7 p.m. They can take part in anything from exercise sessions to religious services to food classes and lectures. On one sunny day in October, residents in Chicopee took part in an outdoor drumming circle. Calendar offerings change all the time based on the types of activities that interest residents the most.

“Because people live here, we’re in essence an apartment building,” Jones said. “And in some ways, we’re like a cruise ship, because residents have all their meals and activities here, too.”

Even with nearly a dozen scheduled activities available each day, some residents might want to take part in something that’s not on the calendar. That’s OK with Cheryl Moran, executive director at the Atrium at Cardinal Drive in Agawam, who noted that this is their home and the staff are visitors in the home.

“The activities our residents take part in are all geared to keeping these skills a part of their everyday life. When they begin to struggle with a skill, we step in and help them find a different way to succeed.”

“One woman likes to spend her time doing crossword puzzles, and another just likes to paint because it makes her feel like an artist,” Moran said.

Heidi Cornwell, director of Marketing & Sales for Kimball Farms Life Care in Lenox, said most facilities make sure they cover five key areas when planning an activities calendar: gross motor skills, socialization, self-care, sensory, and memory. Specific activities are usually modified to fit a particular setting to help everyone keep moving and engaging as part of their daily routine.

“The activities our residents take part in are all geared to keeping these skills a part of their everyday life,” Cornwell said. “When they begin to struggle with a skill, we step in and help them find a different way to succeed. We work very hard to be a failure-free environment.”

According to Lori Todd, executive director for Loomis Lakeside at Reeds Landing in Springfield, when a person needs medical attention in a skilled-nursing setting, activities remain an essential factor in the patient’s recovery.

“Activities definitely help patients by encouraging the kind of wellness behaviors that contribute to the healing process,” she said.

Meanwhile, in settings such as assisted living, the level of functioning varies from person to person. Moran said she likes to have everyone together because it creates a dynamic in which people of different levels of function help each other with activities or just daily life.

Residents at the Arbors in Chicopee

Residents at the Arbors in Chicopee participate in an outdoor drumming circle.

“Our high-functioning residents enjoy helping people in wheelchairs or those who need help in some other way,” she told BusinessWest. “For the person who functions on a higher level, it gives them a sense of purpose.”

 

Much More Than Bingo

In the past, senior-living activities usually concentrated on gathering for bingo. While bingo remains popular, Todd said many group activities now aim to incorporate exercise so they can combine something fun with meeting a patient’s rehab needs at the same time.

“When setting up the calendar, we make sure to include plenty of wellness activities, whether they are emotional, physical, social, reminiscing, basically anything that helps memory or keeps people physically active,” Todd said. They also insert fun social activities such as a happy hour with an entertainer. “We strive for feel-good activities as well as ones that promote healing.”

Physical and social activities are certainly not limited to schedules on a calendar. Cornwell discussed how the actions of a resident leaving their apartment, walking down the hall, perhaps taking an elevator, and then walking to the dining area all contribute to physical activity. Once they arrive, they sit with a friend or neighbor and then engage in conversation, which adds to their social experience.

“When setting up the calendar, we make sure to include plenty of wellness activities, whether they are emotional, physical, social, reminiscing, basically anything that helps memory or keeps people physically active.”

“This is where senior living provides much more physical movement than if the person was at home,” she added, “where a caregiver brings them a meal and they might not leave their chair all day.”

Activities involving music are popular in every senior-living setting. While singers are not yet allowed in most places due to COVID-19 concerns, Cornwell said it’s a form of therapy when violinists, pianists, and other musicians come to play.

“Studies show music touches a part of the brain and leaves a positive impact,” she noted. “Music goes a long way toward self-care and helps people feel better about themselves.”

Jones credits her activities staff for finding an innovative way to include singers into music performances while still following COVID mandates.

“We had singers outside in the courtyard area while the residents gathered in the library with the doors open so they could see and hear the entertainment from a safe distance,” she said.

As mandates continue to gradually ease, everyone who spoke with BusinessWest expressed gratitude for all the difficult work the staff at senior-living communities performed during the worst days of the pandemic.

At the height of COVID, residents were essentially quarantined in their apartments, so staff at each facility made an extra effort to stay engaged with them.

Residents at Kimball Farms engage in tai chi.

Residents at Kimball Farms engage in tai chi.

“Our resident-care attendants and activity teams all turned into nail technicians, hairdressers, and personal stylists,” Cornwell said. “They did everything to keep residents looking good, feeling good, and feeling like someone cared.”

At the peak of the pandemic, when frequent temperature taking was essential, staff would dress up as a lion or some other whimsical costume just to get a laugh out of the residents.

One common practice at several facilities involved opening apartment doors and encouraging residents to socialize from the entrance of their unit. Staff would also use the hallway as the focal point for a bingo game and, in one instance, as a socially distanced bowling alley. “All the staff found creative ways to keep things social,” Jones said.

Added Cornwell, “the pandemic has been difficult and extremely challenging. Our residents rallied, and I give our staff 100% props for their out-of-the-box thinking to keep people safe and engaged.”

Before vaccines were available and while COVID was rampant, Todd said patients at the skilled-nursing facility at Loomis Lakeside at Reeds Landing could not have any visitors in their rooms. Fortunately, that unit is located on the first floor.

“Families were able to visit their loved ones through the window and could communicate by phone or iPad through the glass,” she explained. “We wanted to address social isolation while at the same time keeping everyone safe.”

Without that effort to engage with residents, the lack of socialization can quickly lead to depression, Jones noted. “Once they could leave their rooms again, I heard one woman say to another, ‘I haven’t held anyone’s hand in so long.’ Social interaction is a good distraction.”

For nearly four years, Gladys Fioravanti has lived at the Arbors in Chicopee. She believes activities are an important part of staying healthy.

“If you sit in your room day after day, you start thinking too much,” Fioravanti said. “You think of your loss, then you break down and cry and need some pills to calm you down, so I think it’s good to have something to do.”

She takes part in a number of activities because they keep her busy, but not too busy.

“I like the exercise class in the morning followed by the Mass right after,” she said. “After exercise, the Mass allows you to cool down.”

One afternoon, Fioravanti was sitting in the library area with several friends, including Claire Henault, whom Fioravanti met at the Arbors.

“We play cards together,” Fioravanti told BusinessWest. “We cheat together — I mean, Claire cheats.” At which point Henault chimed in, “I can’t be cheating because I never win.”

 

Moving Toward Normalcy

While residents are free to move around their facilities, families are not yet allowed in common areas but may visit loved ones in their apartments, where they can eat in the unit or take the resident out for dinner. Before COVID, families could join the loved ones during activity time.

“Recently, a family member called just to ask when they can attend the activities again because they enjoyed it too,” Moran said.

All the managers praised the patience families showed during the worst days of COVID. Since the beginning, Cornwell said, they have educated families on the latest protocols and good safety habits. “And we’re still educating them.”

The use of iPads and other tablets were a key to connecting families with their loved ones when no visitors were allowed. Cornwell said Kimball Farms parent Berkshire Healthcare Systems invested in tablets so residents could speak to family members on Skype or FaceTime. Even for residents who were aphasic and had trouble with verbal communication, that connection was still important for all involved.

“Even if the resident couldn’t verbally express their feelings, they could at least see the faces of their loved ones and hear their voices,” Cornwell explained. “Family members were able to see the resident’s smile and maybe even some blush on their face when our care attendants would put some makeup on them to help them look beautiful for the camera.”

As more people receive the COVID vaccine and booster shot, Moran hopes to eventually see families back inside the Atrium at Cardinal Drive.

“It’s enjoyable when we have lots of people here with the residents and the families are all talking with each other,” she said. “I don’t know when we’ll be able to invite everyone back in, but I hope we eventually can because I miss them.”

Like many industries, senior care is always looking to add more staff. Still, Jones noted, while the Arbors had some challenges, staffing is not a big issue.

“We have several staff members who have been with us for more than 20 years,” she said. “We will always have turnover, but we also have a core of stable employees, so that’s a real positive.”

During the height of COVID, Moran hired a number of Harbor Universal Associates (HUAs) to accommodate residents who may want coffee before 9 a.m. when breakfast is served. By having this extra staff person to help and engage with residents, Moran can offer what she called parallel programming.

“We may have one main activity going on in the center of the room, while several smaller groups are doing what they want around the perimeter,” she said. “The HUAs provide that added level of support for our residents who want to do their own thing.”

When a family comes to visit a new resident, Jones said, her goal is to be able to tell them, “your mom is busy right now.”

Ultimately, she added, all the activities available for seniors creates what she called a healthy distraction. “It beats having dinner with Pat and Vanna every night.”

Business of Aging Special Coverage

Breaking Through

By Mark Morris

Sina Holloman has grown HomeCare Hands

Sina Holloman has grown HomeCare Hands to more than 200 caregivers and employees.

Back in 2003, Sina Holloman discovered she loved working with seniors in a one-on-one setting. That passion eventually inspired her to start HomeCare Hands, one of the fastest-growing homecare agencies in Western Mass.

Initially trained as a nurse, Holloman was looking to make a career change and began to work privately for several families in an elder-care role.

“I managed all aspects of the senior’s care from mental, physical, financial, everything that had an impact on the individual,” Holloman said. “I did that for several years, then decided to try my hand at business.”

In 2013, she stayed up many nights with her laptop computer studying how to start a home-care agency, how to understand the needs of the community, and what it means to be a woman in business.

After several months, she took out a “tiny ad” in the Reminder offering in-home care for seniors, listing her cell phone as the contact.

“That first call had me jumping for joy,” she said. Her elation was quickly replaced with concern when she heard the specific demands of the assignment. Located in Southington, Conn., this family needed a live-in caregiver for three months for their loved one. The family specified they wanted a mature person, which they defined as 45 to 55 years old, and this person must speak Italian.

“That was our first call,” Holloman said. While uncertain she could find someone to meet all those criteria, she made it work, and the three-month assignment lasted a year.

“We know this is more than a business — these are lives we’re responsible for. We come to work to take care of folks and to make sure caregivers and clients alike are getting what they need.”

“This was our first client, first caregiver, first anything,” she said. “Since then, we’ve built on that success and haven’t stopped.”

These days, HomeCare Hands boasts more than 200 caregivers and employees. Headquartered in Springfield, the agency has offices in Northampton, Greenfield, Boston, and Hartford, with coverage extending to communities surrounding those locations.

While providing caregivers for the home remains its core business, HomeCare Hands has also branched out as a staffing agency for hospitals, assisted-living communities, and other medical facilities.

The arrival of the pandemic aggravated an already-challenging situation with healthcare staffing.

“We saw the needs during the worst of the pandemic and asked how we could help,” said Angie Thornton, marketing coordinator for HomeCare Hands. “The answer was to do something about the lack of staff in all these facilities.”

Achieving this level of growth, diversity, and reputation within a highly competitive market has not come easily. Overall, Holloman attributes the company’s success to going the extra mile when it comes to helping the caregivers they hire — quite literally, as we’ll see — and finding creating ways to meet client needs.

“We know this is more than a business — these are lives we’re responsible for,” she said. “We come to work to take care of folks and to make sure caregivers and clients alike are getting what they need.”

 

At Home with the Idea

It was not so long ago that Holloman developed a formal business plan for HomeCare Hands and faced constant rejection from banks and other avenues of funding.

“As a result, we have no government contracts, and we have no debt,” she said. “We have no back-up plan, and we run on grit.”

It was with this grit and that aforementioned passion for working with seniors that Holloman started her business from a small office on Main Street in Springfield in 2015. After a number of years, as the business grew, she moved to new quarters on State Street. In October, HomeCare Hands took over a larger space that she knows is already too small for their future plans.

The office staff at HomeCare Hands, which has branched out beyond home care and become a staffing agency for hospitals and other facilities as well.

The office staff at HomeCare Hands

The office staff at HomeCare Hands, which has branched out beyond home care and become a staffing agency for hospitals and other facilities as well.

“We’re now looking for our own building,” she said. “We need the extra space because we continue to grow and we are hoping to open a CNA training school in 2022.”

How HomeCare Hands has grown so quickly and profoundly is an intriguing business story, one about a company adapting to meet merging needs and diversifying to find new ways to not only generate revenue, but serve seniors and area healthcare providers.

And in many ways, the company has the right services at the right time.

Indeed, demand for in-home senior services has seen huge growth simply because of demographics. U.S. Census figures show nearly 10,000 Americans turning 65 every day, a trend expected to continue until 2030.

On top of that growth, Holloman said more people are looking for home-care services since the pandemic. Meanwhile, concern for personal safety has reduced the number of available healthcare workers, as many will no longer work in medical facilities or in people’s homes.

All this has made the pandemic a time of both opportunity and challenge.

At the height of the pandemic, clients and families were cancelling in-home services, and caregivers were as hard to find as many of the supplies needed to keep them safe. Holloman worried about her agency’s survival.

“When we didn’t have enough coverage, our whole management team got into scrubs and went to see clients,” she said. “We also made our own hand sanitizer and other supplies when they were hard to get.”

As they worked through the many challenges of the pandemic, HomeCare Hands gradually placed caregivers, as well as certified nursing assistants and home health aides, for their clients. Recruitment is an ongoing process because the need for staffing never stops.

“We have become the go-to agency for those who are not able to find professionals to meet their needs,” Thornton said, adding that the phone keeps ringing because of solid word-of-mouth referrals.

One key to the company’s success is its willingness to work with caregivers to help them succeed in their jobs with matters such as transportation.

“When necessary, we will pick up our caregivers for their shift and bring them back home. If they are willing to work, we will make sure to support them.”

Agencies commonly require in-home workers to have a dependable vehicle as a job requirement. That’s not an unreasonable demand because clients live in many different areas, most of which are not on a bus line.

Nicole Grimes, chief operating officer for HomeCare Hands, heard about caregivers who were willing to work but had no means to get to people’s homes. This challenge led to the company creating what she called a transportation division.

“When necessary, we will pick up our caregivers for their shift and bring them back home. If they are willing to work, we will make sure to support them,” she explained, adding that, while she will drive caregivers herself in a pinch, this service is offered only until the caregiver can get back on their feet and afford their own car.

Meanwhile, in-home work often requires someone to cover limited hours for only a few days a week. That can be difficult for caregivers seeking a full-time paycheck. Grimes works with caregivers to schedule multiple shifts for those who want more hours. It’s all part of helping people succeed and become independent.

“Caregivers know they can come to us, even for personal matters such as finding an apartment or help with arranging childcare,” she said.

Making that extra effort is all part of the culture Holloman wants to build.

“We take time to get to know each caregiver who joins us,” she told BusinessWest. “When people come here, we want them to stay and be part of the team.”

To help clients and caregivers feel safe, Thornton said vaccinations are a must.

“Anyone new who joins us must be vaccinated,” she noted. “At this point, none of our clients wants someone in their home unless they are vaccinated.”

Because the need for services can often occur outside of business hours, Holloman and her team rotate who is on call to provide 24/7 coverage.

“It could be a Saturday afternoon and someone calls us because they just visited their mom or dad and realize they need services, but don’t know what to do,” she said. “We are there so they don’t have to wait until Monday to get answers to their questions.”

 

Bottom Line

On Jan. 1, HomeCare Hands will celebrate its seventh anniversary. Holloman reflected on the challenging, scary, and ultimately satisfying journey so far. “In 2015, I was asking, ‘how am I going to do this?’ and now, as we approach 2022, I’m asking, ‘OK, what are we doing next?’”

Needless to say, she will answer that question with creativity, enthusiasm, and, yes, a healthy amount of grit.

Business of Aging Special Coverage

Pivoting … Again

By Mark Morris

David Ianacone says infection-control expertise

David Ianacone says infection-control expertise in the skilled-nursing world predates COVID by far.

Just when it seemed COVID-19 was getting under control, the Delta variant of the virus took hold — and has encouraged many communities in Western Mass. to once again mandate wearing masks indoors.

With the variant showing no signs of slowing, BusinessWest checked in with several companies that serve seniors in the area — through home care, assisted living, and skilled nursing — to ask how they are navigating this stubborn virus that won’t go away.

They all have different stories, but one constant stands out: all of them have kept safety protocols in place that exceed the requirements of state and local mandates.

For David Ianacone, administrator at the Center for Extended Care and Rehabilitation at Amherst, rigid protocols are in place at all times to prevent infection problems.

“In the nursing-home business, we’re experts in infection control,” he said. “Long before the virus, we’ve had protocols in place known as ‘universal precaution.’”

Indeed, everyone who enters the facility must get their temperature taken and fill out a health questionnaire. Masks are required for staff and visitors at all times. Ianacone said 99% of the patients are fully vaccinated, and he estimated that 92% of the staff have received the vaccine.

“We have around 15 unvaccinated staff, most of whom work in the office or dietary area and are not in direct contact with patients,” Ianacone said. “They are tested every day before their shift begins.” If the test comes up positive, they have to leave.

The protocols have certainly been working; since January, when one patient at the center contracted the coronavirus, no staff or patients have tested positive.

This clean bill of health has allowed visitors to once again see their loved ones in person, but Ianacone pointed out there are restrictions based on the visitor’s vaccination status.

“If they are vaccinated and their loved one is also, they can meet with them closely in their room,” he explained. “But if a visitor is not vaccinated, we have a special room where they can visit in private, but they must maintain social distancing.”

Visitors to Cedarbrook Village at Ware have also returned to restricted visits with residents due to the resurgence of the virus.

Before Delta, Executive Director Kelly Russell said, families could visit with loved ones in their apartments and take meals with them. Since the resurgence, only a few guests can meet with the resident in a designated area that is disinfected after each visit.

“We’re actually going above and beyond what the CDC is recommending for our community,” she noted.

Before the Delta variant, the assisted-living facility was starting to return to normal activities like outings and even a trip to MGM Springfield.

“The residents had a great time at the casino, but we had to stop all trips like that because of the variant,” she said. “We also had to cancel the one-year anniversary of our opening that we had planned for September.”

Russell said her focus is now on “out-of-community risks,” meaning staff and residents out in public, residents coming out of acute settings, and visitors. Protocols are in place to mitigate risk in all these areas.

Patricia-Lee Baskin-Scholpp says she requires her home-care staff to be vaccinated to protect senior clients.

Patricia-Lee Baskin-Scholpp says she requires her home-care staff to be vaccinated to protect senior clients.

With vaccination rates among Cedarbrook staff at nearly 80%, the next challenge will be a state mandate that takes effect on Oct. 31 requiring everyone who works with seniors to be vaccinated.

“We have a responsibility to keep the residents in our community safe,” Russell said. “If there are still some people who refuse to get vaccinated, there’s a good chance they will not be able to work here.”

 

Girding for Battle

Patricia-Lee Baskin-Scholpp isn’t waiting for the state to act. The owner of Caring Solutions, a home-care company based in West Springfield, will not hire anyone who is not vaccinated. And, while 98% of her current staff is vaccinated, home care is an industry with lots of turnover.

“It’s already hard to find candidates, and by requiring a vaccination, the pool becomes that much smaller,” Baskin-Scholpp said. “Despite that, I won’t put my seniors at risk.”

A nurse by training, she discussed the reason she is passionate about vaccinations to prevent the spread of the coronavirus. “When you hold someone’s hand who is dying of COVID, it changes something in you.”

Baskin-Scholpp also believes we are in a war against COVID, and that one battle strategy worth embracing is wearing a mask. “I have N95 masks in many colors so our staff can make them part of their wardrobe,” she said. “We have to wear a mask anyway, so let’s own it.”

After several months without them, residents at Cedarbrook are back to wearing masks when they leave their apartments. For most, Russell said, it’s simply retraining.

“We opened at the height of COVID when many of our residents moved in. At that time, they had their masks with them at all times. Now they just need occasional reminders.”

“We opened at the height of COVID when many of our residents moved in,” she recalled. “At that time, they had their masks with them at all times. Now they just need occasional reminders.”

Because the virus is prone to change, Ianacone said he and his peers at other long-term-care facilities have an open communication stream with the Massachusetts Department of Public Health and the state office of epidemiology. “From time to time, they will recommend new protocols for us to implement to keep everybody safe.”

State health officials had raised concerns when several nursing homes discovered cases of the Delta variant. Ianacone pointed out that the protocols to protect against the Delta variant are the same as protecting against the original coronavirus, so staying consistent in COVID-prevention practices works.

“Because our patients are vulnerable, we always go the extra mile in our safety measures,” he added.

Baskin-Scholpp and her staff of 70 caregivers routinely go the extra mile based on a simple principle.

“If you treat people the way they want to be treated, it works,” she said. “We believe people should be able to stay in their own home and shouldn’t have to pay a fortune to do so.”

She named her company Caring Solutions because she believes every challenge has a solution, even COVID.

“This virus isn’t going anywhere right now, so let’s do everything we can to keep everybody safe,” she told BusinessWest. “It’s really less about individual rights and more about protecting each other.”

As a new facility, Cedarbrook still has apartments available for new residents. When the pandemic first hit, many seniors and their families were fearful of moving into a senior community.

Since that time, as everyone gains more knowledge about the virus, Russell and her staff have continued their diligence with cleaning and safety protocols, which have helped many of those fears to subside.

“People are still able to take tours, and we simply follow a cleaning schedule after the visit,” she said. “As a result, we’re seeing four to six move-ins a month, which is great.”

 

Life on the Front Line

Reflecting on the past 18 months, Ianacone said he appreciates how grateful the families of his patients have been during a time of constant adjustment.

“Hearing from the families is very warming to us staff members because they feel we are doing a good job taking care of their loved ones and keeping them safe.”

While these senior service professionals wage their fight against a stubborn virus, they continue to succeed in keeping seniors in our community safe. Baskin-Scholpp may have summed up the reason for everyone’s dedication.

Simply put, she said, “I am very passionate about our seniors.”

Business of Aging

An Impactful Gift

 

Allison Vorderstrasse says the $21.5 million gift from the Marieb Foundation

Allison Vorderstrasse says the $21.5 million gift from the Marieb Foundation will allow the nursing program to move forward with its mission more rapidly.

 

Transformative.

Allison Vorderstrasse acknowledged that this is a powerful word with specific meaning; it is not, or should not be, used arbitrarily.

But when it comes to the $21.5 million donation from the Elaine Nicpon Marieb Foundation to UMass Amherst, and, more specifically, its College of Nursing — the largest single gift ever given to the school — that descriptive adjective certainly fits.

“We know that, in order to transform care, we must first transform education,” said Vorderstrasse, dean of the school of Nursing, noting that the school will now bear the name of the woman who graduated with a master’s degree from the program in 1985 and passed away in 2018. “As a center of discovery — and true to our namesake — the Elaine Marieb College of Nursing will inspire individual and collective growth as we help prepare tomorrow’s leaders and advance the field.

“This gift will support multiple areas of our mission that align so well with Elaine Marieb’s legacy,” she went on. “It will certainly allow us to move forward in those areas in a more rapid fashion than we could without it.

These areas include the university’s Center for Nursing and Engineering Innovation, said Vorderstrasse, adding that the gift will also impact how the school delivers its curriculum and programs, enable enhanced use of simulation, and, perhaps most importantly, put more nurses in the pipeline at a time when they are desperately needed.

“There is a demand for nurses, obviously, and for us to be able to provide a program that can facilitate nurses coming into the profession, especially here in Western Massachusetts, where we’ve seen an even more dramatic nursing shortage, is an important part of our mission.”

When asked about the gift, how it came about, and what it means for the university and its Nursing program, Vorderstrasse started by talking about the message it sends and the trust it implies, something that’s very important to her.

Elaine Marieb

“What was really exciting to me was the enthusiasm at the foundation about honoring Elaine Marieb’s legacy in this way, and the faith and the trust that they had in us as an institution and a college to really make this gift transformative,” she explained. “They truly felt that the work we were doing was innovative, exciting, and, in many ways, unique, and this meant it was a good fit with her legacy and that they would see the impact of that gift. It was very exciting to hear the degree of enthusiasm that they had for what we do.”

For this issue, BusinessWest talked at length with Vorderstrasse about the many ways her program, and the university, intend to honor that trust and put this gift to work in ways that have far-reaching implications.

 

Paying It Forward

The gift from the Marieb Foundation, announced on Sept. 16, is only the latest significant donation to come to UMass in recent months.

It comes after a $50 million gift from Rob and Donna Manning aimed at increasing access and opportunity across the five-campus university system (see story on page 28), and a $170 million gift from the Morningside Foundation to UMass Medical School, further positioning the university as a leading public education institution in the nation.

Together, these donations provide growing evidence that the system and its individual programs are growing in stature and reputation and are “well-positioned to advance education, research, and access for students at scale in the Commonwealth,” said UMass President Marty Meehan in a prepared statement.

Vorderstrasse echoed those sentiments and noted that this latest gift — again, the largest ever given to UMass Amherst — creates more momentum, enthusiasm, and exposure for the school at a pivotal time in its history.

“It’s such an exciting time for the whole university to see this come in,” she said, “because it says that the foundation and others who have been good friends of the university for a long time really do feel that this is a pivotal time to support UMass.”

Meanwhile, the $21.5 million gift is only the latest of many from Marieb and the foundation she created to area schools. Previously, she had made gifts of more than $2 million for campus-wide scholarships at UMass Amherst. She and the foundation have also made several gifts to Holyoke Community College and its Center for Life Sciences, which now bears her name.

Marieb, a Northampton native, died in 2018 at age 82, and ranks among the nation’s most influential nursing educators. As noted, she earned a master’s degree from UMass Amherst’s College of Nursing in 1985 with a specialization in gerontology. Prior to that, she received a Ph.D. in zoology from the College of Natural Sciences at UMass in 1969. She also held degrees from Holyoke Community College, Fitchburg State College, Mount Holyoke College, and Westfield State College. Her distinguished career included time teaching at Springfield College and Holyoke Community College.

Ultimately, Marieb became the author or co-author of more than 10 bestselling textbooks and laboratory manuals on anatomy and physiology after she started writing textbooks to address complaints from her nursing students that the materials then available were ineffective. Her work has been read by more than 3 million nurses and healthcare professionals practicing today.

Marieb’s impact on nursing education will only become more profound with the foundation’s latest gift, said Vorderstrasse, adding that it comes after six to nine months of collaborative discussions with foundation leaders about nursing education, the UMass program, and its mission moving forward.

In many ways, the nursing engineering program, launched last January, became a catalyst for the gift. Seed-funded by other donors and friends of the School of Nursing, the initiative was conceptualized to support graduate students in their research training and experience at UMass across various disciplines, Vorderstrasse explained.

“It functions at that nexus of healthcare, engineering, and healthcare professionals, especially nurses, and the development and application of new technologies or even existing technologies — how we apply those in an ethical manner and develop them in such a way that takes into consideration patients and the people who will use them, as well as nurses who are on the front lines using these technologies.

“We hope that it will evolve into a center that collaborates not only on our campus, but with industry partners, because Massachusetts is a hub for healthcare technology,” she went on, adding that the grant from the Marieb Foundation will fund research at the center, especially new initiatives and pilot programs that need seed funding to get off the ground.

Meanwhile, the gift will be used to help expand the nursing programs and put more nurses into the pipeline, she said. Plans call for student scholarships to be expanded to improve access for underrepresented students, and to link scholarships to academic and professional success.

Elaborating, Vorderstrasse said the traditional bachelor’s-degree program graduates roughly 65 students each year and sees more than 2,000 applicants for those seats.

Expansion of that program will be incremental, perhaps eight to 10 students at a time, she told BusinessWest, adding that a program like this cannot, and should not, double in size overnight. But over a period of years, growth can be achieved that will make a significant impact in the number of nurses entering the field.

Growth is also projected for what’s known as the second-degree nursing program, for individuals who have a degree in another field and want to venture into nursing, said Vorderstrasse, adding that this program currently graduates roughly 90 students each year.

 

Bottom Line

Getting back to the word transformative, it is saved for those occasions when someone or something can bring about profound, meaningful change.

The someone in this case, Marieb, has already done so much to change the landscape when it comes to nursing education. The something is a gift, the latest of many, that will accelerate the pace of growth and progress for the Nursing program and enable more people to earn degrees there.

As Vorderstrasse said, that adjective ‘transformative’ certainly fits in this case.

 

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

Business of Aging

Regaining Control

By Kimberley Lee

 

In addition to community-based programming, Nigel Cooper serves as program coordinator for one of nine residences MHA operates as part of its New Way division in the Greater Springfield area for individuals with acquired brain injury.

The division, which also includes a day component, serves those whose brain injury is severe and acquired after birth as the result of a trauma or medical condition. Impairments can range from the physical to the cognitive to the behavioral.

“Our residents were not born with their disabilities,” Cooper said. “Some are college graduates, some have had jobs, some have wives, husbands, children. Something happened in their lives, could be an accident, they could have had a stroke, something that causes the brain not to function as well as it did.”

The specialized care an acquired brain injury patient might need often results in a nursing-home placement, something Cooper calls “unfortunate,” as “some are 30 years old, 50 years old, and find themselves living their life out there. A week or month or days before, they were going through their everyday life in their community.”

This is when New Way, under division Vice President Sara Kyser, can help those referred by the state, after assessment by a skilled-nursing facility, transition from that facility into one of its neighborhood residences.

“Basically, we are transitioning them back to life. They may not have the same life as they had before, but we try to make it as close to that as possible.”

“We interview the individuals and find a good fit for them in one of our homes,” Cooper said. “Basically, we are transitioning them back to life. They may not have the same life as they had before, but we try to make it as close to that as possible.”

His determination and respect for New Way residents mirror how staff engage with them and the programming that includes both rehabilitation and outreach. Services are aimed at helping residents integrate back into their community life, be it through work, volunteer opportunities, or participation in the Resource Center, a New Way program that is also open to those with a disabling medical condition.

“Yes, we provide care, but what I like to say is that we provide support — the difference being that, whatever our residents can do, we approach them to keep on doing that,” he explained. “That is where we meet them; that is where we start our work with them.

“We don’t want people to get discouraged because they need support,” he went on. “There can be depression and a lot of anxiety. So, if someone can cook, we encourage that. If someone can wash their clothes, we encourage that. If someone can bathe themselves, we encourage that.”

The goal, he said, is “to build an independent life for them as far as we can with their injuries.” In the case of one resident in his 30s whose memory was greatly impacted by a drug overdose, this meant getting the support need to be matched with a job, finding his own way over time to and from certain destinations, and eventually moving from a four-bed New Way residence into a less supervised two-bed home.

“We helped move him out of a nursing home and recreated a life that would work for him and his injury,” Cooper said.

For another resident, it has meant regaining the ability to eat without assistance and working toward being able to stand and walk again with less help. “We push 150% to get the residents in all our homes into the communities they live in — reuniting them with family members, keeping them involved in activities outside the residences.

“We are not into just housing people,” he added. “We want to get people out and into society to do whatever they want to do. We are not just ‘housers’ of our residents.”

One key to success, he said, is the trust that develops between staff and residents.

“The job is about making relationships and being motivators, getting people to invest back in themselves — helping them to understand their situation happened, but it is not the end of the world. There is life, there are resources, there is a way you will now live that is different from before, but you will eventually get to a point where you can enjoy your life.”

He added, “I tell staff all the time that the house will get clean, the floors will get swept.”

Cooper noted that “what we need to build is relationships through consistency and being there. We are the people the residents see every day and depend on and trust for support. Once a relationship is built, residents will go to appointments with you, allow you to do personal care and take suggestions. They understand you are in this with them.”

Richard Johnson, who works under Cooper as a site manager, echoed his comments.

“We are all about making the residents feel comfortable,” said Johnson, whose job includes coordinating volunteer opportunities for residents such as cooking and serving meals for the homeless or preparing and distributing COVID hygiene packages for seniors.

He also arranges for residents to attend events like Springfield College’s recent “Be the Change” presentation that was held to promote community service. Staff and residents attend events together but without any indication of their association.

Johnson said such outreach is about the residents continuing to “build relationships” on their own terms and improving their integration skills.

“One of the residents who attended the Springfield College event told me that it was the most comfortable he has felt in years in terms of being out in the community and talking to people,” he noted. “Everything was free, and he just liked being able to go up to a vendor, get nachos and a drink. That engagement on his own was important to him in building a sense of normal for himself.”

Johnson said he builds relationships with the residents through “really hard, honest conversations through which I learn how to navigate and pick up on what they like and what they want to do.”

He noted that transitioning into more active community engagement is not always easy for residents with their disabilities, but he enjoys helping them make that transition and working with Cooper to find related opportunities.

Cooper added that it is this “giving someone a chance to have possibilities and control in their life again” that gives him job satisfaction.

“A lot has been taken away from our residents,” he went on. “The life they were used to living is no longer. They are not living with their families. They can’t just go out to the store or into the kitchen to make what they want to eat or jump on an airplane and travel. What makes me feel good is to see some sort of normalcy return to their lives and for them to get to a certain level where they have control.”

 

Kimberley Lee is vice president of Resource Development & Branding at MHA.

Business of Aging Special Coverage

House Calls

While the pandemic may have challenged the home-care industry, it certainly didn’t suppress the need for such services. In fact, demographic trends in the U.S. — where about 10,000 Baby Boomers reach age 65 every day — speak to continued, and growing, demand for care services delivered in the home. That means opportunities both for agencies who specialize in this field and job seekers looking for a rewarding role and steady work.

Michele Anstett says business was like “falling off a cliff” when COVID hit, but client volume has returned to normal.

Michele Anstett says business was like “falling off a cliff” when COVID hit, but client volume has returned to normal.

By Mark Morris

In early 2020, Michele Anstett, president and owner of Visiting Angels in West Springfield, was pleased because her business was doing well. As a provider of senior home care, she managed 80 caregivers for 50 clients.

“We were going along just fine,” she said. “And when COVID hit, it was like falling off a cliff.”

The business model for companies like Visiting Angels involves interacting with people in their homes, so when early mandates encouraged people to keep away from anyone outside their immediate ‘bubble,’ it hit the industry hard.

Even though caregivers were designated as essential workers, Anstett saw her numbers shrink to 39 caregivers who were now responsible for only 19 clients. In order for her business to survive, she continued to provide services for her clients who needed personal-care services around the clock and for those who had no family members in the area.

“Where possible, we asked family members to step in to help out,” she told BusinessWest. “At the beginning of the pandemic, there was less risk to everyone when a family member could be involved with their loved one’s care.”

Anstett also incorporated a detailed checklist of risk factors for each caregiver to review to prevent COVID-19 from spreading to them or their clients.

“I thought patients weren’t following up because of a language barrier. As it turns out, they weren’t responding because they didn’t understand the severity of the situation.”

“We talked with caregivers about the people in their circle,” Anstett said. “It was similar to contact tracing, but we did it beforehand, so people would understand what they had to consider to protect themselves, their families, and their clients.”

A Better Life Homecare in Springfield runs two home-care programs. In one, it provides personal-care services such as helping seniors with grooming, cooking, laundry, and more. The other program provides low-income patients with medical care in the home, such as skilled nursing services, occupational therapy, and physical therapy.

On the medical side of the business, licensed practical nurses (LPNs) handle many of the home visits, while certified nursing assistants (CNAs) and patient care assistants (PCAs) are the main frontline workers on the personal-care side. A Better Life also employs case workers to supervise PCAs and CNAs and to set up other resources a patient may need, such as Meals on Wheels and support groups.

When COVID hit, said Claudia Lora, community outreach director for A Better Life, she and her staff made patient communication a top priority.

Claudia Lora

Claudia Lora says communication with clients was key to navigating the pandemic.

“We implemented daily phone calls to our patients that also served as wellness check-ins,” she recalled. Because a majority of the company’s clients are Spanish speakers, A Better Life employs many bilingual staff. At the beginning of their outreach efforts, Lora became concerned when some patients didn’t seem to follow up and respond to communications.

“I thought patients weren’t following up because of a language barrier,” she said. “As it turns out, they weren’t responding because they didn’t understand the severity of the situation.”

On the other hand, she said some patients temporarily stopped their home-care service out of concern about interacting with anyone in person. The system of daily phone calls helped address patient concerns and keep them current on their treatments. In addition, patients received whimsical postcards to lift their spirits and care packages of hygiene products and food staples.

“The pandemic opened our eyes in different ways,” Lora said. “It made us aware that we needed a system of daily phone calls in both programs, which we will continue even after the pandemic is no longer a concern.”

 

Growing Need

The lessons home-care agencies learned from the pandemic — some of which, as noted, will lead to changes in how care is provided — come at a time when the need for home-based services is only increasing.

That growing need is due in part to people living longer, of course. According to government data, once a couple with average health reaches age 65, there is a 50% chance one of them will live to age 93, and a 25% chance one of them will see age 97. With the increased longevity, there is also a greater chance these seniors will need some type of assistance with daily chores or treating a malady.

Receiving care at home, with an average cost nationally of $3,800 per month, is less expensive than moving into a nursing home (approximately $7,000 per month), and nearly everyone would rather stay in their home. When seniors need assistance, Anstett said, they often rely on family members out of fear of having an outside person come into their home.

Now that concerns about COVID are easing, she reports that people are increasingly more willing to have someone come in to their home to help, but there are still some who resist. “I wish they could understand we are not there to take away their independence, but to give them more independence.”

Lora said some of her patients were reluctant to allow people to come into their homes until they considered the alternatives.

“The only other option for people receiving medical care would have been checking into a skilled-nursing facility or a nursing home,” she noted. “I knew that was the last place they wanted to go.”

She added that the extensive news coverage of high rates of COVID in nursing homes and the high case rate locally at the Holyoke Soldiers Home convinced most people that care at home was a wise choice.

Anstett and Lora both pointed out that their companies always make sure anyone providing home care wears appropriate personal protective equipment and follows the latest guidelines for preventing the spread of COVID. Anstett said she encourages her caregivers to get vaccinated, but doesn’t force the issue because she recognizes some people have health issues.

“However,” she added, “I make it clear to the unvaccinated folks that the pool of clients willing to see a caregiver who is not vaccinated is fairly small.”

While the pandemic may have slowed down business in the short term, demographic trends still remain strong for the years ahead. According to U.S. Census Bureau data, about 10,000 people reach age 65 every day. This trend is expected to continue until 2030, when all living Baby Boomers will be at least 65 years old.

 

Looking Ahead

Fifteen months after the chaotic early days of the pandemic and with many people now vaccinated, Lora said A Better Life is busier today than before the pandemic.

“In the last six months, admissions have increased by around 50%,” she noted. “That’s more than I have seen in the past three years; it’s been insane.”

She added that her company is now short-staffed because of the rapid growth it is seeing and has been offering incentives to try to bring more CNAs and PCAs on board.

Anstett said her client numbers and caregiver numbers are back to where they were before the pandemic and noted that she has not had any problem filling open positions.

“I just cut 80 paychecks, and we are anticipating even more growth,” she said, adding that her secret to hiring is treating caregivers with respect and encouraging them to grow in their careers. “I stay in touch with every one of our caregivers. They’re the reason I’m working, so I treat them with the utmost respect.”

While many professions look to push out older workers, Anstett said she appreciates more seasoned workers and looks forward to hiring them. “Caregiving is an opportunity to keep working for those who want to, and we welcome their experience.”

Pointing out that she hired another case manager last week, Lora added that, while her organization is expanding, it has not forgotten its mission.

“Even with our growth,” she said, “we see our patients as part of a family and a community, not just a number.”

Business of Aging

Wave Dynamics

Since they started entering the world just after World War II, the Baby Boomers have influenced society in general, and the business community in particular, in all kinds of ways. The same is true when it comes to the healthcare sector, especially as the oldest members of this huge and proud generation turn 75. The impact of such a large and aging group can be seen in everything from hearing practices to the many facets of the long-term care system. And in some ways, COVID has provided a preview of what it is to come.

 

As she talked about the massive Baby Boom generation, how its oldest members turn 75 this year, and about how almost all the Boomers could now be classified as senior citizens, Dr. Maura Brennan summoned a phase she attributed to her mother, but which she uses often as well: “No one gets out of life alive.”

She used those words to convey the thought that, while this Baby Boom generation may in many ways be healthier than those that preceded it — fewer smokers and more exercisers, for example — and it has enjoyed access to better healthcare and innumerable advances in treatment, from artificial joints to improved cancer care, its members will eventually see their health decline, and they will need increasing amounts of care. And many already do.

“I don’t believe this generation, which I am part of, will readily tolerate limited access to the best care.”

While Brennan — a 70-year-old geriatrician and palliative-care physician — says people being able to live longer is in itself a success story, it has also become a challenge, for today, and especially tomorrow.

Which brings us back to those oldest Boomers, those born just after World War II, who turn 75 this year. That’s the age when, statistically, people begin to see their needs for healthcare increase, said Brennan, adding that, as one might logically assume, when a large number of people hit that threshold all at once, the system will be taxed — in all kinds of ways.

“As one might imagine, it’s going to impact virtually every sector and specialty, with the possible exceptions of OB and pediatrics,” she explained. “We’re going to see increasing numbers of older people; not all those folks are going to be frail and complicated, but there will be an increasing number of people with multiple medical problems.

Dr. Maura Brennan

Dr. Maura Brennan says the healthcare system is struggling to meet demand for direct-care workers, and the situation might get worse.

“The numbers and the complexity will rise,” she went on. “And it will impact every area of healthcare, with probably the biggest impact being in home care and nursing-home care because, personally, I don’t believe this generation, which I am part of, will readily tolerate limited access to the best care that’s going to allow them to stay in their homes and communities as long as possible.”

Mary Flahive-Dickson, chief operating officer at East Longmeadow-based Golden Years Home Care, agreed. She said the milestone age being reached by the oldest of Baby Boomers provides an opportunity to look hard at what’s in store for the healthcare system and ask the question: is it fully prepared for the challenges to come? And, if not, what needs to be done so it might be better prepared?

In many ways, Flahive-Dickson said, the COVID-19 pandemic has actually provided a preview of sorts for what’s coming as this large generation ages, with regard to everything from telehealth to the way the overall healthcare system was tested by sheer volume of cases and even vaccination efforts, to the manner in which the need for home-care services is growing.

During the pandemic, this need was fueled by growing fears of nursing homes and other senior-living facilities. Many of those fears still persist, but for Baby Boomers, by and large, the greater issue is simply wanting to remain independent — and in the home — as long as possible.

Eric Aasheim, a certified senior advisor and owner of Oasis Senior Living of Western Massachusetts, agreed. Aasheim, who assists seniors and family members through the complex process of transitioning from home to senior-living communities across this region, said the entire long-term-care sector will be tested by the aging of this generation.

“What I see, and what I worry about, is that the long-term-care system — and that includes in-home care, nursing homes, and assisted living — is just not ready for the sheer volume of patients and residents that they’re going to have,” he told BusinessWest. “And even though these individuals living longer and their resources are being depleted, there are so few places that have any kind of programs for low-income seniors. Unless something dramatically changes in terms of the number of assisted-living facilities that can serve low-income residents, there won’t be needed options for seniors.”

Meanwhile, besides sheer size and that sense of independence and not wanting to rely on others, the Baby Boom generation boasts some other characteristics as well, including what could be described as denial when it comes to getting old and admitting some aspects of their health have deteriorated.

“That’s not a disaster or a tsunami. That’s one of the greatest success stories in modern history; people are able to live longer and enjoy their lives better.”

And that’s why, even though she is generally seeing more patients than she was years ago, Dr. Susan Bankoski Chunyk, an audiologist, says she’s seeing a continuation of, and perhaps even an exacerbation of, an annoying trend whereby people will put off seeking help for their hearing years after they acknowledge they have a problem, due to lingering perceptions about hearing aids making people look old and feeble, even though modern technology has changed that landscape.

And that’s just one example of why there are still many question marks about how and to what degree this generation will present challenges and opportunities moving forward.

 

Age-old Challenges

Before getting into any real detail about the Baby Boom generation and its advancing age, Brennan wanted to set the proper tone for the discussion.

Indeed, she told BusinessWest that years, if not decades, of talk about a ‘silver tsunami’ have succeeded in casting discussion about the aging Boomers — and, again, she’s a proud, card-carrying member of that generation — in often-negative tones.

Mary Flahive-Dixon

Mary Flahive-Dixon says most Baby Boomers want to age in place, in their own homes.

“This notion of the silver tsunami makes the aging of the population sound like an impending natural disaster over which we have no control that’s going to sweep everything away,” she said. “It feels to me, and most geriatrics leaders, like we’re framing things wrong; we’re setting this up as ‘us versus them’ — us young healthy, productive people against those old people who are going to overrun the system. These people are … us. They’re our neighbors, our teachers, our relatives.”

That said, a lot of ‘us’ are getting on in years. Indeed, maybe half or more of all Boomers can now get a senior discount at the movies, the golf course, and the pharmacy. And large numbers of them are now over 70, which means many aspects of the healthcare system — from eye care to urology; orthopedics to hearing care — are certainly already seeing an impact, and it will only grow as more Boomers reach 70, 80, 90, and beyond.

Restating the matter (again, she doesn’t want to classify it as a problem), Brennan said the Baby Boom generation is indeed large (it’s estimated that, by 2035, 10% of the population will be 85 or older; it’s closer to 6% now), and its members are living longer than the generations that preceded them, again, because of better health and better healthcare.

“That’s not a disaster or a tsunami,” she said. “That’s one of the greatest success stories in modern history; people are able to live longer and enjoy their lives better.”

That’s true, but so is what her mother said so often: that no one gets out of life alive.

“Some period of decline is going to occur for virtually all of us — unless we die in our sleep from a funny heart rhythm or get hit by a truck crossing Main Street,” she told BusinessWest. “And the causes of death in recent years have shifted; if you look back 50 or 80 years, the causes of death were frequently things like trauma, infection, death in childbirth — things that take you rather quickly when you were reasonably functional prior to that. That is no longer true. And with the successes we’ve had, and with people living longer, they are increasingly likely to die of multiple progressing chronic diseases.”

What does all this mean? Increasingly, Brennan said, people will need more care from more people as they age and approach end of life — a team-based approach, if you will.

“We’re going to have to think about care a different way because it’s not all about the doctors and the nurses,” she explained. “People will need hands-on home care, they’ll need symptom management, they’ll need direct-care workers who are grossly underpaid and overworked, and who churn through the system, with tremendous turnover.

“We’re struggling to meet those needs now, and it’s perceived to be, and is, a major problem,” she went on. “And if we do not alter the way we are paying, recruiting, supporting, and respecting those people, it will be infinitely worse. We’re going to need to restructure things, pay people differently, and offer them different kinds of professional development and career ladders that will make those positions more attractive; otherwise, we have a self-perpetuating situation. It’s the classic axiom — the system produces exactly the kinds of results it was designed to produce. If we don’t change the system, you get what you’ve got.”

Another issue that will have to addressed regards the number of specialists that will be needed to care for this larger generation of older residents, said Brennan, referring to geriatrics doctors, general nurse practitioners, social workers, pharmacists, and more.

Dr. Susan Bankoski Chunyk

Dr. Susan Bankoski Chunyk says people still put off seeking treatment for hearing loss due to outdated perceptions about hearing aids.

“As the number of older folks is increasing, the number of experts is not increasing, not one iota,” she told BusinessWest. “And, in fact, in some fields, such as geriatric medicine, the number of certified geriatricians has actually probably declined somewhat because we’re not replacing people who are retiring with equal numbers of new grads.”

 

The Shape of Things to Come

Flahive-Dickson agreed, noting that among the Boomers now in or approaching retirement are large numbers of healthcare workers. Replacing them and making the kinds of systemic changes Brennan mentioned will be just some of the many challenges facing the healthcare system moving forward.

Several of the others involve the growing trend of people wanting to age in place — and especially in their own home.

And this brings her back to COVID and what has been learned during the pandemic.

“More care was moving toward the home, basically as a result of general anxiety about facility care — about being in hospital, about being in a skilled nursing facility,” she explained. “Because of this crisis, we’ve seen more people want to get their care in the home.”

And this is a trend she expects will continue into the future as more people from this huge generation confront questions about the care they need and how and where they want it provided.

But questions arise from this supposition — many of them, in fact, including whether there will be enough providers to care for all those people who will want to stay in their homes, and also whether the payers are willing and able to adjust to a changing landscape of need and pay for services they currently don’t cover.

Again, Flahive-Dickson said the pandemic has provided an intriguing lens for looking at the problem — and the future as well.

“If COVID has done anything for us, it has previewed what is to come,” she told BusinessWest. “The pandemic has shown us that this surge in home care is a glimpse of the future. And it has provided this glimpse not only to healthcare professionals and the general population, but also to regulatory bodies, such as Medicare and Medicare Advantage.

“They have had to relax a lot of rules,” she went on. “As the Medicare population is continuing to grow, Medicare benefits haven’t caught up to that, and this is a huge problem. There are fewer than a dozen states that even offer non-medical home-care services to be paid for by a plan, and that plan is a singular plan, and that’s Medicare Advantage. In Western Mass., no one has a Medicare Advantage plan that offers the benefits of non-medical support, so it’s either out of pocket, or you have to qualify for one of the few programs that cover this.”

As for home-care workers, she said a number of demographic trends (Boomers generally had smaller families than the generations that preceded them) and other issues point toward individuals needing someone outside the family to care for them — and real challenges when it comes to having a steady supply of workers to provide that care.

That’s another lesson from COVID, she said, referring to the law of supply and demand, which was certainly exacerbated by a pandemic during which many had apprehensions about working in others’ homes.

“Fewer and fewer family members are capable of being a caregiver, either because there are fewer families, period, or … because family members might be on a different coast,” she explained. “Just because you grew up in Springfield doesn’t mean you stay in Springfield.”

Aasheim agreed, noting that these demographic trends are just some of the challenges facing the Baby Boom generation. Another is their own lack of preparedness for what is to come — financially and otherwise.

He said that only one individual in 10 has long-term-care insurance, and this is a matter to be addressed — just not when someone is 75 or even 65; those products have to be bought much sooner. Meanwhile, not enough members of this generation (and it’s not exactly unique in this regard) have their ducks in a row when it comes to needed documents — and needed preparation for poor health that often comes on suddenly and without much warning.

“What I try to focus on with the Boomers are the things they can do now, before that eventuality,” he explained. “This includes having discussions with your family about what your preferences are in terms of long-term care, gathering the documents together, getting power of attorney and a healthcare proxy, all those things. That’s what I hammer away with them — get that stuff done now, while you’re still healthy and you have the energy and the mental capacity to deal with it, so your family doesn’t have to handle it in crisis mode a few years down the line.”

Unfortunately, he said, many don’t heed this advice.

“They all nod when I talk to them in these presentations, but are they going home and getting that stuff together? My thought would be, probably not,” he went on. “Because most of the calls I get are from people who are in crisis mode.”

Bankowski Chunyk is another who wishes that more Boomers would heed some advice. Or at least listen to family members telling them they can’t hear as well as they used to, and should do something about it.

She told BusinessWest that the hearing industry talked a lot about the Baby Boom generation years (make that decades) ago, and how its size and advancing age would comprise a great opportunity for audiologists, one they should be prepared to seize.

Bankowski Chunyk did prepare, but she said the wave hasn’t been nearly as big as all those experts predicted it would be, largely because of … well, human nature, as well as lingering perceptions about hearing aids and what they say about those who wear them.

She said data shows that, between 1989 and 2019, the average age of an individual being fitted for a hearing aid for the first time fell from 66 to 65.

“I’m not sure a lot of progress was made getting people to address their hearing,” she said with some sarcasm in her voice, adding that, while there are certainly more people of that age than there were several years ago, sheer volume is not creating the immense opportunity that was predicted back in the ’80s and ’90s.

Whether it will materialize eventually or not, she doesn’t know — but she does know the Boomers are perhaps more vain when it comes to hearing aids than the generations that preceded them, so her industry has some work to do to change those perceptions.

 

Bottom Line

Perceptions are not the only thing that will have to change if the Baby Boomers, and those in the healthcare system who will care for them, will adequately manage this sizable demographic shift.

Brennan is right when she warns about this challenge becoming an ‘us versus them’ scenario, but she’s also right (and her mother was right) when she said that no gets through life alive.

As this generation ages, it will present enormous challenges to a healthcare sector that in many ways seems unprepared for what’s coming. That’s evidenced by the number of comments that began with the words ‘if things don’t change’ — comments referring to everything from workforce to accommodations for low-income seniors.

Only time will tell if things will, indeed, change. What is known is that the Boomers, as they have at every other phase of their life, will alter the landscape as they reach 75 — and beyond. And in all kinds of ways.

Business of Aging

Peace of Mind

By Mark Morris

 

Heidi Cornwell says families looking for a senior-living community should consider its continuum of care.

Heidi Cornwell says families looking for a senior-living community should consider its continuum of care.

Between now and 2030, 10,000 Americans each day, on average, will reach age 65. That type of growth affects all the industries that serve the senior population — and, not surprisingly, senior living is one industry paying close attention to this trend.

Kimball Farms Life Care provides independent and assisted living as well as dedicated memory-care services. In 2020, the Lenox facility received more inquiries about its residential offering than in any year prior. Heidi Cornwell, marketing and sales director for Kimball Farms, said potential residents are doing more online research to educate themselves about senior community living.

“Many people are ‘shopping around’ earlier because they saw their own parents ill-prepared for this part of their life journey,” Cornwell said. She also noted that, as people live longer, they are moving into senior at a later age.

As a continuing-care retirement community (CCRC), Kimball Farms offers increasing levels of care for those who need it. Residents can easily move from independent living to assisted living, giving the individual and their families greater peace of mind.

For residents who develop dementia or Alzheimer’s disease, Kimball Farms offers memory-care services through its Life Enrichment Program (LEP). Cornwell explained that the program is centered around a philosophy know as habilitation, which increasingly emphasizes a person’s remaining skills instead of the skills they have lost.

For example, if a sandwich is placed in front of a person with dementia, they may not be able to process what to do with it. “However, if someone sits across from them with a sandwich, picks it up, and takes a bite, that is the only queuing they need to understand what to do,” Cornwell said, adding that they can then enjoy their lunch without any further assistance.

“We are so grateful to our residents and their families because they worked with us to find creative and innovative ways to stay engaged and informed, while at the same time keeping everyone healthy.”

Singing is another good example of emphasizing a remaining skill. “The individual may not sing along to a song by themselves, but if an activities person or nurse sings with them, they can sing with pride and remember every word.”

The LEP puts its focus on maximizing quality of life for each resident. Regular routines and programs built around the interests of the individual keep them busy all day and into the evening. As a result, the residents thrive, Cornwell said, noting that the stimulation helps residents with dementia maintain the abilities they still have for as long as possible.

“We place no expectations on them, but encourage them to be the best person they can be,” she said. “We celebrate the good days, bolster self-esteem, and we treat them with the utmost dignity and respect.”

 

Safe Spaces

As research on dementia has evolved, caregivers have increased their understanding on how to manage the condition. Embracing the skills that remain for those with dementia can encourage feelings of acceptance and personal success. That’s important, Cornwell said, because, even though the disease can have an effect on a person’s ability to communicate or recall recent events, they still have a sense of the quality of life they desire.

Or, as she put it, “although they may no longer be able to dance, they still enjoy the music.”

Kimball Farms social worker Jackie Trippico leads what is known as Reminisce Group. This weekly activity begins with staff presenting a specific topic and asking residents to recall a significant memory related to that theme. Cornwell said one popular reminiscence involved talking about a trip to an ice-cream parlor.

Providing comfortable spaces is also part of the program. Kimball Farms’ memory-care neighborhood is a secure, self-contained community. Private apartments are modeled after a typical home with an open floor plan, while residents also have access to a secure outdoor courtyard so they can garden, see visitors, or take part in other activities. The staff ratio is higher than traditional assisted living, and they have all been trained in specialized dementia care.

When COVID-19 hit last year, families could no longer make in-person visits to residents in LEP. Cornwell said the activities professionals and nursing team quickly adapted to using tablets to arrange virtual visits or phone calls so families could stay informed on the care and well-being of their loved ones. Celebrating special occasions simply became virtual events.

“Zoom birthday and anniversary parties, as well as Skype holiday festivities, became our new normal,” she explained.

As COVID vaccine levels rise, Kimball Farms is able to welcome families to visit by appointment. Cornwell reported that residents and their families have been thrilled to resume the personal visits.

“We are so grateful to our residents and their families because they worked with us to find creative and innovative ways to stay engaged and informed, while at the same time keeping everyone healthy.”

As more Americans reach their senior years and live longer than previous generations, the demand for memory-care facilities to treat dementia and Alzheimer’s disease will continue to increase.

According to Seniors Housing Business magazine, from 2013 through 2018 (the latest figures available), the number of new memory-care units increased by 55%.

Cornwell advises those who are looking at senior-living options to consider the continuum of care a community offers. Healthy seniors who may choose independent living in senior housing to downsize from their homes need to think about future needs as well, she said.

“The community they choose should be a place that will provide them with the best quality of life, for the rest of their life, with increasing levels of care when and if they need it.”

Business of Aging Special Coverage

Taking Shots

Rob Whitten, executive director of the Leavitt Family Jewish Home

Rob Whitten, executive director of the Leavitt Family Jewish Home, gets vaccinated in January. For the public, the process has been thornier.

February was the month all seniors in Massachusetts would finally be able to get the COVID-19 vaccine.

Instead, it was a month of frustration.

“It’s simply inexcusable, in a state with the healthcare infrastructure and high-tech reputation we have, that the vaccine rollout was allowed to fall behind every other state so quickly,” state Sen. Eric Lesser told BusinessWest, calling the state’s scheduling website “an obstacle course with all these links and hoops to go through, instead of making it simple, like Travelocity or KAYAK or Open Table.”

That’s when it wasn’t crashing altogether, like it did two weeks ago, when the state opened up vaccine appointments to all individuals 65 and over, as well as individuals age 16 and older with two or more co-morbidities, from a list that includes asthma, cancer, obesity, diabetes, and a host of other conditions.

Later in phase 2, access will roll out to workers in the fields of education, transit, grocery stores, utilities, agriculture, public works, and public health, as well as individuals with one co-morbidity. Phase 3, expected to begin in April, will include everyone else.

Lesser hopes the process — not just to schedule a vaccination, but to get one — improves well before then. One positive was the establishment of a 24/7 call center for the many people who lack internet access (see related story on page 30), something he and dozens of other state lawmakers demanded.

Before that, with online-only signup, “you were locking out whole categories of people,” he noted. As for the website, “it is improving, but it’s still far too confusing and far too hard for people.”

In an address to the public last Thursday, Gov. Charlie Baker acknowledged the frustration around scheduling appointments, but noted that most of it comes down to supply and demand.

“I know how frustrated people are with the pace of the vaccine rollout and how anxious they are to get themselves and their loved ones vaccinated,” he said, but noted that about 450,000 requests for first-dose vaccines arrive each week from hospitals, community health centers, and other entities, but the state receives only 130,000 first doses of vaccine weekly from the federal government.

“We’re putting every dose we get to work each week,” Baker said. “But we don’t receive anywhere near enough vaccine each week from the feds to provide our existing vaccinators with what they request, or to work through most of the currently eligible population that wants a vaccine now. We want people to get vaccinated. We want people to be safe.”

In a hearing with legislators that day, the governor noted that residents have been able to book more than 300,000 appointments through the system despite its flaws, and that Massachusetts is first state in the nation in first doses administered per capita among the 24 states with more than 5 million residents.

While she understands the supply-and-demand issues, Dr. Nahid Bhadelia says the state’s website troubles have still been “a bit of a disappointment.”

While she understands the supply-and-demand issues, Dr. Nahid Bhadelia says the state’s website troubles have still been “a bit of a disappointment.”

State Rep. William Driscoll, the House chairman of the Joint Committee on COVID-19 and Emergency Preparedness and Management, was having none of it. “I just really want to stress that I think you’re missing how broken the system is right now,” he told Baker, “and the approach is not working for the citizens of the Commonwealth. It needs to be addressed.”

Baker’s hopes for more vaccine entering the state may get a boost from Pfizer and Moderna both annoucing plans to double production in March from February’s levels, and by the Johnson & Johnson vaccine nearing emergency authorization.

“They have some very good efficacy data, and they said they’ll deliver another 20 million doses. That’s a one-dose vaccine, so that’s 20 million more people, hopefully, immunized by the end of March,” said Dr. Nahid Bhadelia, infectious-disease physician and medical director of the Special Pathogens Unit at Boston Medical Center, in a Facebook Live conversation with state Sen. Adam Hines, also on Thursday.

Bhadelia understands Baker’s frustration with supply … to a point. “Demand really outweighs supply, still. But last week’s challenges with the website were kind of drastic,” she said. “That was a bit of a disappointment.”

She and Hinds agreed that a waiting list for a vaccine is one thing, but a waiting room just to get on the site is understandably frustrating for people.

However, she also noted some positives, like a movement at the state level toward delivering more doses to pharmacies and local clinics, after perhaps over-emphasizing the mass-vaccination sites (of which Western Mass., to date, hosts only one).

“I’m glad the governor is going back to clinics. We have to get them where people can access them,” Bhadelia said, adding that distribution through doctors’ offices and pharmacies is a tougher organizational challenge, but worth the effort to help people go to providers they trust.

She didn’t deny the website problems, however. “If they try and can’t access it, one day they will give up.”

 

Confidence Boost

And if there’s one thing healthcare professionals don’t want, it’s for people to lose their enthusiasm for getting vaccinated. That’s why the state and various health organizations have rolled out public messaging around the benefits of the vaccine, especially targeting people who might be skeptical of its benefits.

“We recognize it’s a journey, and folks might not feel comfortable with it today, but maybe you’ll feel comfortable tomorrow,” said Lindsey Tucker, associate commissioner of the Massachusetts Department of Public Health (DPH). “We want to be sure that, when you’re eligible for the vaccine, you can access it when you’re ready for it.”

“Even though you’re vaccinated, you still need to wear a mask, stay six feet apart, avoid crowds, and wash your hands frequently.”

Tucker said those words during a webinar held last month by the Public Health Institute of Western Massachusetts, which also featured input from Dr. Sarah Haessler, lead epidemiologist and infectious-disease specialist at Baystate Health, who has emerged as a leading local voice in public information around COVID-19.

Haessler detailed the amount of data that emerged from clinical trials for the vaccines, and noted that the FDA will approve one only if the expected benefits outweigh potential risks.

“The FDA reviewed all the data — it’s pages and pages and pages of data — around every single thing they did in these clinical trials to be sure of the safety and efficacy of the vaccination,” she said, noting that multiple mechanisms are currently in place to track instances of side effects.

While significant side effects are rare — anaphylaxis is one, which is why individuals receiving the shots must remain at the vaccination site for 15 to 30 minutes — most people experience nothing more than arm soreness, fever, chills, tiredness, and headache; most symptoms fade after a day or two, although they last longer in rare cases. Many people feel no effects at all.

“It’s certainly a lot safer to get the vaccine knowing there are just minor side effects than to take your chances getting infected with COVID-19,” Haessler added. “The more people we vaccinate, the closer we get to herd immunity, and the closer we get to going back to life, where we can see our family and friends and return to pre-pandemic activity.”

Also in February, during the Massachusetts Medical Society’s monthly COVID-19 conference call with DPH physicians, State Epidemiologist Dr. Catherine Brown talked about the DPH’s public vaccine-confidence campaign.

“The campaign recognizes that there are particular populations, especially people of color and other minority populations, that may have understandable increased concern about receiving the vaccine,” Brown said, noting that Public Health Commissioner Dr. Monica Bharel considers health equity to be a primary priority. “Therefore, DPH is having additional, ongoing conversations about the best ways to try to improve vaccine confidence among some of these groups that are harder to reach.”

At the same time, Haessler was quick to note that the vaccine is not a license to stop doing the things that slow the viral spread. It takes about 10 days for someone to begin developing immunity after the first dose, and full protection doesn’t arrive until about 14 days after the second dose. But it’s still unknown how easily vaccinated individuals can spread the virus to others.

“The bottom line is, even though you’re vaccinated, you still need to wear a mask, stay six feet apart, avoid crowds, and wash your hands frequently,” she explained, noting that vaccination is the last layer of protection, but far from the only one.

It is, of course, a critical one, and that’s a message she continues to spread to those who might be anxious about making an appointment.

“Educate yourself about vaccine safety and talk to trusted sources — your own personal healthcare provider as well as people you know who have been vaccinated,” Haessler said. “Many, many healthcare workers in our community are vaccinated now because we went first.

“I think a lot of our healthcare workers were anxious at first, but as they saw their colleagues getting the vaccine and doing fine with it, they were excited, because now there’s a light at the end of the tunnel — there’s some hope that helped bolster confidence in it,” she went on. “The more we know about this, the more people will feel comfortable with it. Knowledge is power.”

 

Better Days?

Bhadelia, who is also an assistant professor at Boston University School of Medicine and has spoken on CNN and MSNBC about the pandemic, said she’s optimistic about the fact that COVID cases in Massachusetts have been trending down, while acknowledging that testing has also gone down in the Bay State during the vaccine rollout.

Still, she added, “there is a general consensus that it’s not only the testing that’s gone down; it seems there is truly a drop in cases.”

Concern lingers about the COVID-19 variants, which are currently circulating in Massachusetts, particularly the South African variant, which may affect the efficacy of vaccines. But she noted that, even against that variant, vaccination will reduce the risk of severe hospitalization and death.

Taking a federal perspective, Bhadelia also praised the Biden administration’s approach to the vaccine rollout, which she said is science-based and features regular briefings. “The science is always changing, so it’s really great to stay on top of it instead of just guessing at what’s behind the curtain.”

Most Americans, of course, just want to know what’s down the road. So does the governor.

“We want people to turn the corner on COVID, and I can’t tell you how much we would like to see that happen faster,” Baker said. “But to put to work all the folks who are available today to vaccinate our residents and dramatically increase the number of people able to get vaccinated each week here in the Commonwealth, we’re going to need to see a dramatic increase in federal supply coming to Massachusetts.”

 

Joseph Bednar can be reached at [email protected]

Business of Aging

Building Momentum

Pat and Craig Sweitzer

While their workload is like a typical year, Pat and Craig Sweitzer say, the way facilities are designed in the age of COVID-19 is not.

Ryan Pelletier says that, while it was “scary at times,” he believes life has returned to something approaching normal — although ‘normal’ is certainly a relative term — when it comes to construction within the broad and all-important healthcare sector in Western Mass.

And he should know. He’s project manager for Houle Construction in Ludlow, a family-run operation (his father, Tim, is president) that does the bulk of its work within the healthcare sector, including projects for most area hospitals and a number of private practices as well.

He told BusinessWest that things were busy just after COVID-19 arrived in the 413 almost exactly a year ago, as a number of hospitals and other providers needed some retrofitting of sorts and other types of work to do battle with the pandemic, but then, things got quiet in a hurry and stayed that way for a while, before starting to revert to something akin to pre-pandemic conditions.

“We were very busy for a few weeks, and then … it just died,” said Pelletier, referring to the early months of the pandemic, and noting that hospitals and private practices simply didn’t want more people on site than absolutely needed to be there. “But in the last several months, things have started to come back. There’s a comfort level now — the hospitals and private practices are getting back to business as usual, or as usual as they can.”

But that word ‘scary’ was used in reference to much more than the number of projects in the pipeline. Indeed, it also referred to everything from the daunting task of keeping employees — and everyone else on a job site — safe to the cost and availability of materials.

And he was not alone in that assessment, especially when it comes to the price hikes.

“We’ve seen steel and lumber costs rise exponentially — they’ve almost doubled within the past year.”

“We’ve seen steel and lumber costs rise exponentially — they’ve almost doubled within the past year,” said Dan Bradbury, director of Sales and Marketing for South Hadley-based Associated Builders, which works within a number of sectors, including healthcare. He noted that these rising costs could, and probably will, impact everything from decisions on whether projects move forward in the near term to what kind of construction takes place — new or renovation of existing space (more on all that later).

As for now and the immediate future, those we spoke with said that, after going mostly and then almost completely silent in the weeks after COVID hit, the phones are starting to ring again with greater regularity — in general, and within the healthcare sector in particular.

Pat and Craig Sweitzer, co-owners of Monson-based Swietzer Construction, which specializes in healthcare construction and especially dental offices, said they have a number of projects in progress and on the books, including three new dental offices, a medical building with a dental office as part of the lineup, two new medical spas (including one in East Longmeadow, adjacent to an Ascent Dental office they built), a cannabis dispensary, and work at Adaptas Solutions in Palmer, which is now making parts for COVID testing.

Ryan Pelletier stands in the atrium at Mercy Medical Center

Ryan Pelletier stands in the atrium at Mercy Medical Center, one of the many projects within the healthcare sector undertaken by the company in recent months.

Noting how he needs to be at a number of different sites on a weekly of not daily basis, Craig Sweitzer joked, “I need to buy an airplane.”

Those sentiments express just how much the market has rebounded — if that’s even the right word — and how the outlook has brightened since the darkest days of the pandemic.

Bradbury agreed. “Especially in this new year, 2021, there’s been a more positive outlook, and we’re starting to have the phone ring more and see more potential jobs in the pipeline for this year and for next,” he said, adding that this sentiment applies, again, to construction in general and healthcare construction more specifically.

But there are still many question marks about just what the future will bring, and for this issue, we talked with these experts about what can and likely will happen, both short- and long-term.

 

Concrete Examples

Rewinding the tape on the past 12 months of COVID, those we spoke with echoed the sentiments of business owners and managers in every sector when they said the changing landscape brought with it both challenges and opportunities, and certainly more of the former.

Indeed, some construction projects in the healthcare sector were put on the shelf because of the way the pandemic impacted the client in question financially. Meanwhile, and especially in the beginning, it brought about some new work, as Pelletier explained.

“When COVID first hit, the hospitals were scrambling to get prepared for potential overflow — spikes and surges — and they wanted us to help them with that, whether it was installing plexiglass shields or building out existing spaces in their facilities to house incoming patients,” he explained. “We had to work around the clock, and it was a little nerve-wracking at first because no one was quite sure what COVID was and how dangerous it was — and they were asking us to send our guys out there not knowing exactly what they were getting into, and the crews had mixed feelings.”

Again, opportunities and challenges.

The challenges came in waves and in different forms, from meeting the many new regulations and protocols regarding when and how work can be done to handling new and different employee needs — from more sick time, if needed, to PPE, to working in settings that were often the front lines of the COVID crisis.

The opportunities have come in various forms as well, and sometimes unexpectedly. That was certainly with the case with Adaptas Solutions.

“They’ve kept us quite busy through all this because they’ve been ramping up and needed construction facilities to accommodate the work they were doing,” said Pat Sweitzer, adding that the company has some projects ongoing there.

“When COVID first hit, the hospitals were scrambling to get prepared for potential overflow — spikes and surges — and they wanted us to help them with that.”

Meanwhile, the airplane the company doesn’t have yet would also be going to several other projects across the region, the sum of which adds up to what Pat described as a fairly typical year, volume-wise.

What isn’t as typical is the nature of the work being undertaken, said Craig, noting that COVID has changed the way facilities are designed and operated, with additional emphasis on HVAC and, more specifically, air movement and air quality.

“Dental offices are ground zero — these are individuals working in a patient’s mouth, which is the means for transmitting COVID,” he explained. “These doctors and their hygienists are at ground zero as far as risk is concerned, so we’ve paying a lot of attention to our design/build criteria.

“And the lion’s share of that goes back to HVAC, so we’ve redesigned our standard operatory,” he went on, adding that, with these redesigns, instead of air being drawn up from the patient’s mouth past the doctor, it is drawn down to the floor, into the ductwork and away from the doctor’s face.

The company is also installing UVC systems, which kill COVID; additional air changers; larger, tighter air filters; and, increasingly, washers and dryers so staff can wash their clothes during the day.

“We’ve really been refining how we lay these design/build projects out,” Pat said, noting that the modern dental office now resembles a hospital operating room in many respects.

Looking ahead, those we spoke with said COVID will likely continue to impact the healthcare construction scene, even if the pandemic eases, as most project that it will.

Indeed, there is general uncertainty about when or even if the rising prices on materials will start to ease, and this uncertainty could play a role in whether some projects move forward or not.

Berkshire Facial Surgery facility in East Longmeadow.

Among the many healthcare sector projects undertaken by Associated Builders in recent months was the construction of this Berkshire Facial Surgery facility in East Longmeadow.

Bradbury told BusinessWest there is inclination among some in healthcare (and in other sectors, obviously) to try to wait these increases out with the hope that prices will start coming down.

“But there is no guarantee that prices will come down,” he said. “One thing I always tell people is that, while they think they can wait out the increases in materials costs, there are never any guarantees that they will, so we encourage people to move forward with projects — if it fits their timeline and their budget, because there are no guarantees.”

Meanwhile, COVID will likely impact the healthcare construction market in another way, said those we spoke with, specifically the lasting impact it seems destined to have on the real-estate market. Even when COVID eases, they said, it seems almost certain that some companies will settle into smaller spaces as more people work at home, bringing more commercial real estate onto the market, which will, in turn, impact new construction.

“Renovating existing space is almost always less expensive than building new, especially when you consider those amazing price increases we’re seeing,” Bradbury said. “A lot of our business is new construction, and we’re contending with a lot of empty office space; long-term, there will be more available office space to lease on the market, which, across some industries, will tamp down new construction, but it will bring an opportunity for more build-out and renovation of existing space.”

 

Bottom Line

Looking back, and ahead, those we spoke with said a sense of normal — or a new normal (there’s that phrase again) — is returning to the healthcare construction scene.

But there are many question marks still looming over the scene and a number of variables that could impact how much work and what kinds of projects move into the pipeline.

There has been a great deal of pivoting over the past year — for the construction firms and their clients as well — and there is certainly more to come.

But for now, momentum is building in a number of ways.

Business of Aging

No Time Like the Present

By Mark Morris

The senior-living industry is preparing for a “gray tsunami.”

According to the U.S. Census Bureau, nearly 10,000 Baby Boomers will turn 65 every day for the next 10 years, while the oldest Boomers will start turning 80 in 2025.

Robert Kelley, in-house counsel for Everbrook Senior Living, predicts that, once Boomers start reaching that age, the demand for senior-living communities will increase significantly. That’s one of the many reasons he’s excited about his company’s newest community, Cedarbrook Village in Ware.

From its corporate office in Southampton, Everbrook already manages three senior-living communities in Windsor Locks, Hebron, and Bozrah, Conn., and Cedarbrook is its first community in Massachusetts.

Originally planned for a July opening, various delays postponed the ribbon-cutting ceremony until Sept. 14. Kelly Russell, executive director of Cedarbrook Village, has worked in the industry for more than 20 years and has overseen plenty of community openings, but this one was different.

“For this grand opening, we made sure to have plenty of PPE on site for anyone who needed it,” Russell said. Moving people into their apartments safely during COVID-19 also required a new approach.

“We set up different times and arranged for people to use different doors, so they would not run into each other,” she said, adding that social distancing and cleaning between move-ins was all part of the extra planning and organization necessitated by the pandemic.

When families help their parents move into senior living, it’s often a stressful time, she said, and the added stress of COVID-19 has only intensified the anxiety and guilt family caregivers feel. With all the restrictions imposed by COVID-19, families now worry they won’t be able to see their loved ones.

“We reassure family members that we are taking all the necessary precautions so they can schedule visits in a safe environment and stay in touch with their loved ones,” Russell said.

For example, scheduled visits are a departure from pre-COVID times when families could drop in anytime.

Kelly Russell

Kelly Russell says senior living is an attractive option during a pandemic because the safety measures in place give families peace of mind.

“We would tell families this is their home, too. If they wanted to come spend the night with their loved ones and eat in the dining room with them, they were welcome to do all that,” Russell said.

Unfortunately, that wide-open policy is on pause — one of many ways life is different right now in the senior-living sector. But the fact that Cedarbrook opened at all during such a year is a reflection of the growing demand for such facilities, and how this multi-site company intends to continue meeting that need.

 

Safety First

Keeping an aging loved one safe at home during the pandemic can mean a great deal of work for a family. That’s why senior living is a good option, Russell said, noting that Cedarbrook has extensive COVID-19 safety measures in place which can ease the burden for families and give them peace of mind.

“We saw this location as a good fit, and the town of Ware was very accommodating to work with.”

“Even if families don’t see them as much, they know their loved ones are getting all the care they need and still being able to socialize with the residents,” she noted, adding that she also reassures families through social-media postings.

“Whether we’re using FaceTime or sending videos, I post a lot online,” she said. “This way, the families who can’t visit their loved ones often enough can see them smiling and engaged in activities with other people. It lets the family know their loved one is OK.”

Among its 119 units, Cedarbrook offers independent living, assisted living, and a memory-care center. Russell explained there are many reasons why people choose to move in.

“Folks usually move in to our independent-living apartments because they are tired of taking care of a house and a yard, or their laundry is in the basement and stairs have become too difficult, things like that,” she said, adding that independent residents can either make meals for themselves or join others in the dining room.

“Those who move into assisted living usually need some help with everyday tasks such as eating, dressing, and grooming,” she continued. Instead of sitting home alone watching TV, they can be part of a community and engage in activities and exercise programs, and socialize with other people.

Independent-living residents

Independent-living residents can either make meals for themselves or join others in the dining room.

Everbrook chose Ware as the site for Cedarbrook because the Quaboag region, encompassing Ware, Brimfield, and surrounding towns, had no senior-living facilities; the closest options were located in the Wilbraham/Ludlow area to the west and Greater Worcester to the east.

“We saw this location as a good fit, and the town of Ware was very accommodating to work with,” Kelley said, adding that the building design incorporated local influences.

“Several design details of the building are reminiscent of the South Street School that once occupied this site,” he noted, while another example is the large-screen movie room at Cedarbrook, called the Casino Theatre, inspired by the iconic movie house once located on Main Street in Ware.

Trends in senior living have changed over the years. Twenty years ago, such communities tended to attract people in their mid- to late 70s. As longevity has increased, the average move-in age these days has risen closer to the 80s and even 90s.

In the past, inquiries from families focused on services and amenities offered, as well as activities and the level of care. Since COVID-19, Russell said, the questions have changed. “Now, we’re asked, ‘do you have a generator?’ ‘how do you respond to emergencies?’ and ‘what supplies do you have on hand?’”

As a new building that has only recently opened, Russell is able to market the community as having plenty of space for socially distanced meals in two large dining rooms. “Everyone can eat together because we can space them far enough apart.”

Cedarbrook also works with a primary-care physician whom residents can access through telehealth for routine inquiries, rather than going out to a doctor’s office. Meanwhile, an exercise physiologist runs the fitness programs for residents. At one time, exercise programs and other activities filled the calendar, but the number of activities has been reduced to allow for disinfecting equipment and rooms in between sessions. Russell described it as emphasizing quality and safety over quantity.

“If you’re smart about it,” she said, “you can still offer activities and keep everyone safe.”

 

Shifting Tides

By following that same approach, Russell continues to assure families that senior-living communities such as Cedarbrook are the right choice for their loved ones during this crisis.

“We want families to feel secure in knowing that there will always be support here for their loved ones,” Russell said, adding that, while no one can guarantee COVID-19 won’t find a way to infect people, Cedarbrook has measures and equipment in place in the event of an outbreak.

“If our residents have to quarantine, they will still get the care they need and still have their meals,” she said. “We will also help residents stay in touch with their families.”

Keeping safety as the main priority, Russell believes the key is to make adjustments as things change. “I don’t really feel like there is a ‘new normal’ because every day brings new and different challenges we have to face.”

And, like everyone, she looks forward to a time when COVID-19 restrictions are a thing of the past. “We can’t wait until we can fully open the community and share with families everything we have to offer here.”

Prior to Cedarbrook’s opening, Russell had another big event on her calendar this year — she was married on Aug. 28, a date she intentionally chose before the September opening.

“The wedding was much easier to plan than opening the building,” she said with a laugh — but is happy to have accomplished both during a year no one will forget.

Business of Aging

Shot in the Arm

As COVID-19 vaccines begin to roll off production lines, many questions remain — about how quickly they’ll reach the general public, about long-term efficacy and safety, about how many Americans will actually want one.

But on one issue, there is no doubt, Dr. Andrew Artenstein said.

“This is a spectacular achievement just to get where we’ve gotten so far, and I think we should appreciate that,” the chief physician executive and chief academic officer at Baystate Health told BusinessWest. “It’s been a whirlwind, and I mean that in a good way.”

Everyone in healthcare understands the upside — the dramatic promise — of a vaccine as the COVID-19 pandemic enters its 10th month.

“A vaccine is a major component of getting on the other side of this,” Artenstein added. “It’s not the only component, but it’s an important and necessary piece of shortening the duration of this pandemic and possibly preventing future waves.”

With Pfizer gaining emergency-use authorization from the U.S. Department of Health and Human Services to begin distributing its vaccine — and Moderna expected to do the same — the Baker-Polito administration announced allocation and distribution plans for the first round of vaccine shipments to Massachusetts, expected to begin around Dec. 15. The state’s first shipment of 59,475 doses of the Pfizer vaccine was ordered from the federal government and will be delivered directly to 21 hospitals across eight counties, as well as to the Department of Public Health immunization lab.

Doses will then be redistributed for access to 74 hospitals across all 14 counties for frontline medical workers. Another 40,000 doses of the Pfizer vaccine will be allocated to the Federal Pharmacy Program to begin vaccinating staff and residents of skilled-nursing facilities and assisted-living residences in Massachusetts.

In all, Massachusetts is expecting 300,000 doses of vaccines from both Pfizer and Moderna to be delivered by the end of December. Both vaccines require two doses administered three to four weeks apart. While all delivery dates and quantities are subject to change due to ongoing federal approval and allocation, state leaders expect to receive and distribute more than 2 million doses to priority population groups by the end of March.

Dr. Andrew Artenstein

Dr. Andrew Artenstein says the public should not let down their guard when it comes to masking and social distancing while they wait for the vaccine.

“It does make perfect sense,” Artenstein said of the prioritization plans, which reflect judgments on the federal level and ensure delivery to groups like healthcare workers, first responders, the elderly, and people with co-morbidities before the rest of the public. In the case of seniors, for example, “it’s not that they’re more likely to get the virus, necessarily, but they’re more likely to die if they get infected. They do worse.”

Meanwhile, he added, healthcare workers have a greater risk of coronavirus exposure than most other people.

“We’ve been inundated — inundated — with calls from other groups that they want the vaccine,” he said, placing heavy emphasis on that word. “But the truth is, it isn’t available for the general population now, and it may be several months before it is.”

Artenstein, an infectious-disease expert who founded and directed the Center for Biodefense and Emerging Pathogens at Brown University for more than a decade before arriving at Baystate, has been one of the public faces locally of the fight against COVID-19, and he was careful to temper optimism about a vaccine with a reality check on the timeline — and what people need to do in the meantime.

“A vaccine may eventually be the answer, but it’s only going to be part of the solution for the next six to 12 months, assuming we continue to get vaccines that are safe and effective. It’s going to take a while — even if all goes well — before we get enough immunity in the population to really put an end to this thing.

“In the meantime,” he went on, “we would benefit greatly by continuing to push the classic ways to interrupt transmission: masks, distancing, avoiding gatherings. All those things will continue to help us because, even after we start vaccinating parts of the population, it will take the better part of the year to roll it out to everyone, and we need to continue to interrupt transmission.”

Jessica Collins, executive director of the Public Health Institute of Western Massachusetts, agreed, even though it can be a challenge getting through to people suffering from ‘pandemic fatigue,’ who feel isolated and weary of all the changes in their lives over the past year.

“I’m sorry people are tired,” she said. “But the basic messaging isn’t hard — wear a mask, wash your hands, and don’t be inside spaces with a mask off with people you don’t know. I do think the holidays have created a tremendous sense of urgency to remind people again, especially with students leaving schools and coming back to their homes.”

Hopefully, health leaders say, vaccines will put a definitive end to the crisis. But that day is still far off, Collins added. “People need to wait it out.”

 

Making a List, Checking It Twice

In announcing the Commonwealth’s vaccine-distribution plans, Gov. Charlie Baker noted that Massachusetts goes further than national recommendations by prioritizing all workers in the healthcare environment, not only providers, but also food-service, maintenance, and other facility workers. Similarly, home health workers, including personal-care attendants, are prioritized on the list, recognizing their important role providing services to vulnerable individuals and the fact that they often reside in communities highly affected by COVID-19.

Jessica Collins

Jessica Collins

“Messaging is critical, and the messengers are critical. Hopefully, we’ll have good results, and more people will be willing to take it.”

Phase one of vaccine distribution — which, as noted, includes healthcare-facility workers; police, fire, and ambulance workers; congregate-care settings, including not only senior-living facilities, but shelters and jails; and home-based healthcare workers — is expected to last into February. Phase two, expected to run from February to April, will prioritize individuals with co-morbidities that put them at higher risk for COVID-19 complications; all adults over age 65; as well as workers in the fields of early education, K-12 education, transit, grocery, utility, food and agriculture, sanitation, public works, and public health.

Phase three, expected to follow in April or May, will see the vaccine more widely available to the general public.

Baker’s announcement noted that vaccines go through extensive testing, more than any pharmaceuticals, including extensive testing in clinical trials. The U.S. Food and Drug Administration, which approves the vaccine, and the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which will make its recommendation for use, must ensure any vaccine is both safe and effective for the public before approval and distribution.

All this is necessary for emergency-use authorization of the Pfizer and Moderna vaccines, Artenstein said, but the testing process is far from over, and long-term effects won’t be known until, well, the long term.

The emergency-use ruling “is not licensure, but allows the immediate use of the vaccine pending more information that leads to licensure down the road — because we’re in a pandemic,” he noted, adding that he’s optimistic about further testing, as trials so far have shown about 95% effectiveness across all age groups, with no serious adverse effects.

“The data I’ve seen is pretty impressive for efficacy and safety of the vaccine. And there were around 40,000 people in the trial, so that’s a good sample,” he said — enough to start delivering some immunity to high-risk populations now.

The question, especially as distribution widens in the spring, is how many Americans will actually take the vaccine. Collins said the Public Health Institute has conducted preliminary outreach and found some skepticism and mistrust of the government when it comes to vaccine advice, especially in communities of color.

“In order to counteract that, we have been trying to find and lift up messengers in the community who are trusted people, whether faith-based leaders or other trusted messengers, to counteract skepticism and fear about getting vaccines, whether the flu vaccine or the COVID-19 vaccine,” Collins told BusinessWest, adding that the institute held a virtual town-hall event two days before Thanksgiving and asked 10 such messengers to share their wisdom on prevention measures.

Artenstein breaks down vaccine attitudes into three distinct groups of people — two of which are those champing at the bit for a vaccine, and a small but robust community of anti-vaxxers who express skepticism at vaccines in general.

“Then there’s a whole middle group who could be convinced to get the vaccine, but they’re concerned about safety and effectiveness,” he explained. “It’s a risk-benefit calculation, and based on what I know about vaccines, the risk seems low, and the risk of COVID seems pretty high, especially right now, with such high rates in the community.

Hampden County, in fact, currently ranks third among Massachusetts counties for transmission rate, with more than 50 positive cases per 100,000 residents.

Typically, around 70% of people in a community — or a nation — need to be exposed, either through natural infection or a vaccine, to reach the desired herd immunity, he added. “In the U.S., that’s a big number. But the risk-benefit calculation is obvious. You’d like, over time, to have enough people willing to get the vaccine to help the general population.”

 

Anticipation and Reality

While surveys currently suggest about 60% of Americans are willing to take a COVID-19 vaccine, that number could rise higher if early results from the priority groups demonstrate both effectiveness and safety.

“The U.K. is going first, and then U.S. healthcare workers have to go — which is obviously the right thing to do — then people over 65,” Collins noted. “It’s not like the general public is being made guinea pigs. We will actually be able to see a lot of people getting the vaccine, and the companies will see the reactions.

“So, messaging is critical, and the messengers are critical,” she added. “Hopefully, we’ll have good results, and more people will be willing to take it.”

Artenstein agreed, adding that, for the group of Americans ready to line up right now, the wait may be longer than they realize, but that’s OK.

“We’re a little over our skis on this,” he said. “There’s a lot of excitement and anticipation, but it’s going to come out as more of a slow roll; there’s a manufacturing process, an approval process, and a safety process. There won’t be 300 million doses available tomorrow, and that’s hard for some folks.

“There’s going to be a lot of interest, questions, and anxiety, and rightly so,” he added. “We’re living in a very different time, and people want to move very fast. But we have to make sure we do things in the safest possible way.”

 

Joseph Bednar can be reached at [email protected]

 

Business of Aging Special Coverage

Safe at Home

By Mark Morris

Cheryl Moran

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

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

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

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

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

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

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

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

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

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

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

Beth Cardillo

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

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

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

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

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

Visitation Consternation

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

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

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

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

Emily Tamilio

Emily Tamilio

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Winter Is Coming

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

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

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

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

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

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

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

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

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

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

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

Business of Aging

Team Approach

By Mark Morris

the Bioness L200

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

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

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

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

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

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

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

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

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

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

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

What’s the Plan?

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

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

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

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

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

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

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

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

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

help brain-injury patients

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

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

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

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

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

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

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

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

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

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

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

Steady Improvement

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

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

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

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

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

Business of Aging

Joint Effort

By Mark Morris

Brianna Butcher

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

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

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

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

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

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

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

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

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

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

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

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

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

Moving Experiences

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bottom Line

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

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

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

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

Business of Aging

Shifting the Balance

Visiting Angels Director Michele Anstett

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Return to Form

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

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

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

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

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

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

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

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

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

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

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

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

Constant Mission

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

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

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

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

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

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

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

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

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

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

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

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

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

Giving Back

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging

Care Connections

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

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

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

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

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

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

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

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

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

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

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

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

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

Safe Haven

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

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

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

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

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

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

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

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

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

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

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

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

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

Effective Model

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging

Sound Judgment

By Kayla Ebner

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

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

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

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

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

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

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

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

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

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

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

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

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

Beat of a Different (Ear) Drum

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Don’t Ignore the Signs

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

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

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

Dr. Deborah Reed

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

 

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

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

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

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

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

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

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

Business of Aging

And the Road to Recovery Program Needs More of Them

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Driving Force

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Ride Stuff

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

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

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

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

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

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

Business of Aging

A Warm Handoff

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

Addiction knows no boundaries.

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

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

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

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

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

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

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

And there certainly is a need.

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

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

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

Beyond the Medicine

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

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

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

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

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

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

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

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

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

Rewarding Challenge

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

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

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

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

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

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

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

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

Kayla Ebner can be reached at [email protected]

Business of Aging

Man UP

Joy Brock

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Breaking Barriers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dispelling the Myths

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

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

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

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

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

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

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

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

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

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

Taking the First Step

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging

Education Anywhere

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

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

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

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

Enter the online model.

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

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

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

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

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

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

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

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

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

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

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

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

Setting the Pace

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

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

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

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

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

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

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

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

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

Breaking Through

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

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

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

Furman agreed.

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

Joseph Bednar can be reached at [email protected]

Business of Aging

On the Path of Discovery

Skip Matthews says Louis & Clark

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Blazing New Trails

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

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

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

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

Kim Vigliotte, seen here in the fitting area

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

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

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

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

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

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

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

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

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

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

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

Charting a New Course

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

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

Rachel Duda says Louis & Clark has been very proactive

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Making More History

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

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

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

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

Business of Aging

Back in the Swing

Jared Bean

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

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

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

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

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

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

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

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

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

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

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

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

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

Broad Spectrum

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

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

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

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

Andrea Noel-Doubleday

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

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

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

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

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

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

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

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

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

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

A Vision for the Valley

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging

In Search of Heroes

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

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

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

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

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

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

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

• Patient/Resident/Client Care Provider;

• Health/Wellness Administrator/Administration;

• Emerging Leader;

• Community Health;

• Innovation in Health/Wellness;

• Collaboration in Health/Wellness; and

• Lifetime Achievement.

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

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

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

Patient/Resident/Client Care Provider

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

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

Health/Wellness Administrator/Administration

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

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

Emerging Leader

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

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

Community Health

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

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

Innovation in Health/Wellness

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

• 2018: TechSpring.

Collaboration in Health/Wellness

• 2017: The Healthy Hill Initiative;

• 2018: The Consortium and the Opioid Task Force.

Lifetime Achievement

• 2017: Sr. Mary Caritas, SP;

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

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

Business of Aging

One Step at a Time

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Changing Times

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

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

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

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

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

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

Dr. Grace Makari-Judson

Dr. Grace Makari-Judson

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

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

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

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

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

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

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

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

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

Personal Impact

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging

The Power of Movement

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Small Steps

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

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

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

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

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

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

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

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

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

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

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

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

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

Special Connections

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

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

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

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

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

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging

The Dream and the Journey

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Big Picture

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

An architect’s rendering of Hillside Residence.

An architect’s rendering of Hillside Residence.

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

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

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

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

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

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

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

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

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

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

State Elder Affairs Secretary Alice Bonner

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

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

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

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

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

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

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

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

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

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

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

The Next Chapter

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

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

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

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

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

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

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

Business of Aging

Changing the Landscape

By George O’Brien

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Course Change

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lisa Fugiel says society is becoming more accepting of male nurses

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

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

Labor of Love

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Making a Difference

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

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

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

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

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

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

Business of Aging Sections

Support System

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

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

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

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

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

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

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

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

Maggie Bergin

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

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

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

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

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

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

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

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

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

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

Time and Energy

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

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

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

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

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

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

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

Marie Ball

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

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

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

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

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

First Steps

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

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

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging

Fresh Ideas

Pat Roach

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dawn of a New Day

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

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

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

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

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

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

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

bowles

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

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

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

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

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

Back to School

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging Sections

Re-connecting the Dots of Life

By Alta J. Stark

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

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

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

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

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

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

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

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

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

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

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

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

Life’s Work

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Still Growing

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

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

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

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

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

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

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

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

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

Cardillo praises SLR for being innovative.

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

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

Cardillo is also proud of another first-of-its-kind educational program that started at Armbrook.

“We have the distinction of being the first Dementia Friendly Community on the east coast,” she noted. “It’s part of a drive to make towns friendlier and safer to those experiencing dementia. We wanted to create an environment where, if an individual with memory loss went into a restaurant or other establishment, staff would know the right steps to handle the situation.”

Every EMT in Westfield has been trained in the program, along with Baystate Noble Hospital, Baystate Noble VNA, Councils on Aging, schools, chambers of commerce, family members, and the community at large.

“My job is really to educate people,” she explained. “We feel it’s really important to prepare people for interactions with someone whose memory may be a little topsy-turvy. We started this campaign here, then all Senior Living Residences decided to do that in their community, and now there’s a whole movement called Dementia Friendly Massachusetts.”

Community Resource

Armbrook Village also provides support groups once a month for people in the community. Presently there are about 15-20 people who attend each month, sharing experiences, advice, and sympathy.

“Our role is to make sure everybody gets a chance to talk, and get their questions answered,” said Cardillo. “It’s meaningful for them, and us. We’ve gotten really close with these people.”

Cardillo said she sees Armbrook Village as an educational resource in the community. “We see a need, and we figure out what to do to meet the need,” she says.

Armbrook offers a variety of options along the continuum of aging, its 122 units encompassing independent living, assisted living, and what’s known as Compass Memory Support Neighborhood, a secure setting where residents receive constant treatment and supervision.

Research-based memory support programs, including Reconnections lifelong learning, and specialized art and music classes, contribute to increased social engagement and greater cognition.

“Four or five women are of Italian descent, so we started to learn Italian,” said O’Donnell. Every day she puts up a vocabulary word for the day and the women practice. “It brings them back to their childhood, and their roots.”

A year ago, Armbrook started a Memory Café for people in the community newly diagnosed with Alzheimer’s disease or other dementias. “We offer a place for folks to go monthly with their caregivers to meet other people like them. It’s not a support group; it’s a chance for them to meet people who have the same stuff going on, and share an activity from yoga and painting to art and ice cream sundae socials,” said Cardillo.

Her next venture, which is still in the research phase, involves a new movement of music therapy called the ‘Giving Voice Chorus.’

“All the current research points to the importance of music in people’s lives,” said Cardillo. “And we’re seeing amazing success stories of people living with dementia coming together and forming a chorus.”

Stay tuned.

“We’ve learned to be flexible,” Cardillo said in conclusion. “We want to give our residents the best quality of life possible, and we keep raising the bar. We work until we get it right.”

Business of Aging Sections

Passing Interest

It’s hardly news that America’s Internet and smartphone culture has transformed the way people live.

But not everyone knows they’re also changing the way people die — or, more specifically, how they plan for death and the often-difficult process of transferring key information, end-of-life wishes, and even treasured memories to their loved ones.

cakeTake Cake, for instance. This free online platform helps people determine and share their end-of-life wishes. Similar to the popular dating app Tinder, Cake outlines and organizes these wishes by presenting users with a number of questions on which they can swipe yes or no. Based on the answers, the app creates a profile divided into four categories — legacy, health, legal/financial, and funeral — each of them accompanied by action steps one could take to carry out those wishes.

“Each and every one of us should have a say in how we live our lives, from beginning to end (and even beyond),” the Boston-based Cake creators note. “Gift your loved ones with the information of what you would want, and how you want to be remembered.”

For many people, they note, thinking about the end of life isn’t a morbid activity, but can be a motivating factor to live life to the fullest. “It can put things in perspective and give you and your loved ones more peace of mind. It is a very considerate act to let your loved ones know what you would want. You can go at your own pace, and plan as much as feels right to you.”

Even folks with a will can benefit from such a service, the company notes, because many aspects of end-of-life planning — right down to the food one would want served at one’s funeral — are typically not be covered in that document.

“Additionally, medical preferences can be difficult to think through,” they go on. “Cake helps uncover your values so you can be clearer on your preferences, and so that your loved ones can be clear on them too.”

Plenty of Options

But Cake is far from the only player on this unique scene, which mixes some time-honored concepts with a decidedly 21st-century twist. Here are some of the others.

everplansEverplans, in some ways similar to Cake, is a digital vault for a person’s end-of-life plans, described as “a complete archive of everything your loved ones will need should something happen to you.” The app allows users to securely store wills, passwords, funeral wishes, and more in a shareable vault. Documents may include anything from wills, trusts, and insurance policies to bill-payment schedules, advance directives and do-not-rescuscitate orders, as well as final wishes and funeral preferences.

Users begin by taking a short assessment survey to see how much planning they’ve already done, how much else they need to do. Based on that information, the service, which costs $75 per year, creates a to-do checklist and helps prioritize that list. The user then assigns specific ‘deputies’ for the plan, so loved ones can find everything neatly in one place.

mydirectivesMore of an emergency-care tool than an strictly an end-of-life plan, MyDirectives allows people to speak for themselves — digitally. Users populate their ‘medical ID’ with date such as their health information and end-of-life plans. This allows doctors to have access to this information right from a patient’s iPhone lock screen.

The four basic parts to this free service are ‘My Decisions,’ which outlines care preferences, values, and treatment goals; ‘My Thoughts,’ which uses messages, video posts, music, and photos to help caregivers know more about the patient; ‘My Healthcare Agents,’ which outlines who represents the patient during a health crisis when he or she can’t communicate; and ‘My Circle,’ which keeps key contact information in one place.

principled-heartThe creator of Principled Heart, a certified financial planner, said his goal was to help answer a common question: where do we keep all our planning documents and information — and how will my loved ones know what to do? His site encourages people to keep only what is necessary, including passwords (or instructions on where to find them) for financial accounts, social media, and other accounts. Other features include instructions for pet care, key contacts, and space to upload up to 60 documents.

Three specified people are required to validate the account owner’s death, and then the site, which costs $45 a year for up to one gigabyte of storage, will provide access to all the information stored inside.

afterstepsAfterSteps, created by a Harvard Business School student, also requires the names of three verifiers, who will be notified in the event of the user’s death and will get access to all information stored on the site, which includes wills and other legal forms, passwords and instructions for digital accounts, funeral-arrangement wishes, and other data. It costs $60 a year or $299 for life.

Most services of this sort are recent developments, but a few have a longer history. DocuBank was created in 1993 as a registry to give members 24-hour access to their advance directives. More than 200,000 members have used the service ($55 per year) since then, and DocuBank has added new features, including an online vault called SAFE that provides a place for members to store files. The site’s latest ‘Digital Executor’ feature allows members to designate one person who will be able to access all of their online files once they’ve presented proof of the member’s death or permanent incapacity.

Celebrating Life After Death

Many end-of-life planning apps are about more than financial and funeral arrangements; however, crossing over into the realm of preserving history and sharing memories.

safebeyondFor example, SafeBeyond ($48 to $96 per year) defines itself as a ‘legacy-management service.’ As such, this app allows users to keep record of their life story in the form of meaningful digital content. SafeBeyond’s distribution capabilities then allow for the future delivery of this content in the form of personalized messages accessible by specific loved ones – almost like emotional life insurance through which one can be remembered.

“Everyone’s life story is unique and constantly affected by change,” the creators write. “Our platform provides an innovative online and mobile-app solution for the easy and secure management of your life story and your meaningful digital content, with enhanced distribution capabilities for the future delivery of personalized messages and digital assets. You decide when, where, and with whom your messages and other digital assets will be shared.”

The app allows people to record text, audio, and video messages throughout their life and store them in a heavily encrypted ‘digital vault.’ Then, SafeBeyond will send messages on behalf of its clients for up to 25 years after they die. Many users choose to schedule those messages on birthdays or on the anniversary of their passing. After the user dies, their recipients are e-mailed a notification telling them to download the app so that they can, one day, receive a message from the grave.

eterniamMeanwhile, Eterniam provides a free, secure online locker for one’s personal digital assets, including photos, videos, and other documents, and then releases them after the user’s death to whomever he or she specifies. Rather than focus on death, the app encourages users to ‘celebrate life,’ and to capture moments and upload them to the cloud.

Bcelebrated ($20 yer year, $100 for a lifetime membership) enables members to create a multi-media website that will become their autobiographical memorial site when the time comes. They may share their story in words, images, and audio; write password-protected private messages for loved ones; and essentially leave a permanent site where friends and family can celebrate a life.

Members create password-protected private pages for loved ones, record their last wishes, and assign a charity to receive donations on their behalf. The service also sends automated notification e-mails at the time of a member’s death and provides a list of numbers for those who need to be called.

Finally, on a different, slightly more downbeat note, Life Countdown is a free app that asks users to pick the date they think they’ll live to, then sends notifications at random intervals about how much time they theoretically have left. The app, its creators say, has a philosophical bent: “to cultivate the contemplation of death.”

Some might feel that’s a worthy-enough goal. For those who want to do more than contemplate, but instead do some real planning about what they’ll leave behind, today’s online culture offers plenty of options.