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One Step at a Time

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Changing Times

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

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

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

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

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

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

Dr. Grace Makari-Judson

Dr. Grace Makari-Judson

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

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

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

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

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

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

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

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

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

Personal Impact

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging

The Power of Movement

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Small Steps

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

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

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

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

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

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

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

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

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

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

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

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

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

Special Connections

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

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

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

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

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

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging

The Dream and the Journey

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Big Picture

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

An architect’s rendering of Hillside Residence.

An architect’s rendering of Hillside Residence.

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

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

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

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

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

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

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

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

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

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

State Elder Affairs Secretary Alice Bonner

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

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

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

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

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

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

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

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

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

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

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

The Next Chapter

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

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

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

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

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

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

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

Business of Aging

Changing the Landscape

By George O’Brien

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Course Change

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lisa Fugiel says society is becoming more accepting of male nurses

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

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

Labor of Love

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Making a Difference

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

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

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

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

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

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

Business of Aging Sections

Support System

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

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

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

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

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

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

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

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

Maggie Bergin

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

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

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

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

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

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

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

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

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

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

Time and Energy

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

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

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

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

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

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

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

Marie Ball

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

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

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

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

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

First Steps

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

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

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging

Fresh Ideas

Pat Roach

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dawn of a New Day

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

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

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

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

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

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

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

bowles

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

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

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

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

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

Back to School

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging Sections

Re-connecting the Dots of Life

By Alta J. Stark

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

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

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

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

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

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

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

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

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

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

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

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

Life’s Work

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Still Growing

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

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

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

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

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

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

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

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

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

Cardillo praises SLR for being innovative.

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

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

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

“We have the distinction of being the first Dementia Friendly Community on the east coast,” she noted. “It’s part of a drive to make towns friendlier and safer to those experiencing dementia. We wanted to create an environment where, if an individual with memory loss went into a restaurant or other establishment, staff would know the right steps to handle the situation.”

Every EMT in Westfield has been trained in the program, along with Baystate Noble Hospital, Baystate Noble VNA, Councils on Aging, schools, chambers of commerce, family members, and the community at large.

“My job is really to educate people,” she explained. “We feel it’s really important to prepare people for interactions with someone whose memory may be a little topsy-turvy. We started this campaign here, then all Senior Living Residences decided to do that in their community, and now there’s a whole movement called Dementia Friendly Massachusetts.”

Community Resource

Armbrook Village also provides support groups once a month for people in the community. Presently there are about 15-20 people who attend each month, sharing experiences, advice, and sympathy.

“Our role is to make sure everybody gets a chance to talk, and get their questions answered,” said Cardillo. “It’s meaningful for them, and us. We’ve gotten really close with these people.”

Cardillo said she sees Armbrook Village as an educational resource in the community. “We see a need, and we figure out what to do to meet the need,” she says.

Armbrook offers a variety of options along the continuum of aging, its 122 units encompassing independent living, assisted living, and what’s known as Compass Memory Support Neighborhood, a secure setting where residents receive constant treatment and supervision.

Research-based memory support programs, including Reconnections lifelong learning, and specialized art and music classes, contribute to increased social engagement and greater cognition.

“Four or five women are of Italian descent, so we started to learn Italian,” said O’Donnell. Every day she puts up a vocabulary word for the day and the women practice. “It brings them back to their childhood, and their roots.”

A year ago, Armbrook started a Memory Café for people in the community newly diagnosed with Alzheimer’s disease or other dementias. “We offer a place for folks to go monthly with their caregivers to meet other people like them. It’s not a support group; it’s a chance for them to meet people who have the same stuff going on, and share an activity from yoga and painting to art and ice cream sundae socials,” said Cardillo.

Her next venture, which is still in the research phase, involves a new movement of music therapy called the ‘Giving Voice Chorus.’

“All the current research points to the importance of music in people’s lives,” said Cardillo. “And we’re seeing amazing success stories of people living with dementia coming together and forming a chorus.”

Stay tuned.

“We’ve learned to be flexible,” Cardillo said in conclusion. “We want to give our residents the best quality of life possible, and we keep raising the bar. We work until we get it right.”

Business of Aging Sections

Passing Interest

It’s hardly news that America’s Internet and smartphone culture has transformed the way people live.

But not everyone knows they’re also changing the way people die — or, more specifically, how they plan for death and the often-difficult process of transferring key information, end-of-life wishes, and even treasured memories to their loved ones.

cakeTake Cake, for instance. This free online platform helps people determine and share their end-of-life wishes. Similar to the popular dating app Tinder, Cake outlines and organizes these wishes by presenting users with a number of questions on which they can swipe yes or no. Based on the answers, the app creates a profile divided into four categories — legacy, health, legal/financial, and funeral — each of them accompanied by action steps one could take to carry out those wishes.

“Each and every one of us should have a say in how we live our lives, from beginning to end (and even beyond),” the Boston-based Cake creators note. “Gift your loved ones with the information of what you would want, and how you want to be remembered.”

For many people, they note, thinking about the end of life isn’t a morbid activity, but can be a motivating factor to live life to the fullest. “It can put things in perspective and give you and your loved ones more peace of mind. It is a very considerate act to let your loved ones know what you would want. You can go at your own pace, and plan as much as feels right to you.”

Even folks with a will can benefit from such a service, the company notes, because many aspects of end-of-life planning — right down to the food one would want served at one’s funeral — are typically not be covered in that document.

“Additionally, medical preferences can be difficult to think through,” they go on. “Cake helps uncover your values so you can be clearer on your preferences, and so that your loved ones can be clear on them too.”

Plenty of Options

But Cake is far from the only player on this unique scene, which mixes some time-honored concepts with a decidedly 21st-century twist. Here are some of the others.

everplansEverplans, in some ways similar to Cake, is a digital vault for a person’s end-of-life plans, described as “a complete archive of everything your loved ones will need should something happen to you.” The app allows users to securely store wills, passwords, funeral wishes, and more in a shareable vault. Documents may include anything from wills, trusts, and insurance policies to bill-payment schedules, advance directives and do-not-rescuscitate orders, as well as final wishes and funeral preferences.

Users begin by taking a short assessment survey to see how much planning they’ve already done, how much else they need to do. Based on that information, the service, which costs $75 per year, creates a to-do checklist and helps prioritize that list. The user then assigns specific ‘deputies’ for the plan, so loved ones can find everything neatly in one place.

mydirectivesMore of an emergency-care tool than an strictly an end-of-life plan, MyDirectives allows people to speak for themselves — digitally. Users populate their ‘medical ID’ with date such as their health information and end-of-life plans. This allows doctors to have access to this information right from a patient’s iPhone lock screen.

The four basic parts to this free service are ‘My Decisions,’ which outlines care preferences, values, and treatment goals; ‘My Thoughts,’ which uses messages, video posts, music, and photos to help caregivers know more about the patient; ‘My Healthcare Agents,’ which outlines who represents the patient during a health crisis when he or she can’t communicate; and ‘My Circle,’ which keeps key contact information in one place.

principled-heartThe creator of Principled Heart, a certified financial planner, said his goal was to help answer a common question: where do we keep all our planning documents and information — and how will my loved ones know what to do? His site encourages people to keep only what is necessary, including passwords (or instructions on where to find them) for financial accounts, social media, and other accounts. Other features include instructions for pet care, key contacts, and space to upload up to 60 documents.

Three specified people are required to validate the account owner’s death, and then the site, which costs $45 a year for up to one gigabyte of storage, will provide access to all the information stored inside.

afterstepsAfterSteps, created by a Harvard Business School student, also requires the names of three verifiers, who will be notified in the event of the user’s death and will get access to all information stored on the site, which includes wills and other legal forms, passwords and instructions for digital accounts, funeral-arrangement wishes, and other data. It costs $60 a year or $299 for life.

Most services of this sort are recent developments, but a few have a longer history. DocuBank was created in 1993 as a registry to give members 24-hour access to their advance directives. More than 200,000 members have used the service ($55 per year) since then, and DocuBank has added new features, including an online vault called SAFE that provides a place for members to store files. The site’s latest ‘Digital Executor’ feature allows members to designate one person who will be able to access all of their online files once they’ve presented proof of the member’s death or permanent incapacity.

Celebrating Life After Death

Many end-of-life planning apps are about more than financial and funeral arrangements; however, crossing over into the realm of preserving history and sharing memories.

safebeyondFor example, SafeBeyond ($48 to $96 per year) defines itself as a ‘legacy-management service.’ As such, this app allows users to keep record of their life story in the form of meaningful digital content. SafeBeyond’s distribution capabilities then allow for the future delivery of this content in the form of personalized messages accessible by specific loved ones – almost like emotional life insurance through which one can be remembered.

“Everyone’s life story is unique and constantly affected by change,” the creators write. “Our platform provides an innovative online and mobile-app solution for the easy and secure management of your life story and your meaningful digital content, with enhanced distribution capabilities for the future delivery of personalized messages and digital assets. You decide when, where, and with whom your messages and other digital assets will be shared.”

The app allows people to record text, audio, and video messages throughout their life and store them in a heavily encrypted ‘digital vault.’ Then, SafeBeyond will send messages on behalf of its clients for up to 25 years after they die. Many users choose to schedule those messages on birthdays or on the anniversary of their passing. After the user dies, their recipients are e-mailed a notification telling them to download the app so that they can, one day, receive a message from the grave.

eterniamMeanwhile, Eterniam provides a free, secure online locker for one’s personal digital assets, including photos, videos, and other documents, and then releases them after the user’s death to whomever he or she specifies. Rather than focus on death, the app encourages users to ‘celebrate life,’ and to capture moments and upload them to the cloud.

Bcelebrated ($20 yer year, $100 for a lifetime membership) enables members to create a multi-media website that will become their autobiographical memorial site when the time comes. They may share their story in words, images, and audio; write password-protected private messages for loved ones; and essentially leave a permanent site where friends and family can celebrate a life.

Members create password-protected private pages for loved ones, record their last wishes, and assign a charity to receive donations on their behalf. The service also sends automated notification e-mails at the time of a member’s death and provides a list of numbers for those who need to be called.

Finally, on a different, slightly more downbeat note, Life Countdown is a free app that asks users to pick the date they think they’ll live to, then sends notifications at random intervals about how much time they theoretically have left. The app, its creators say, has a philosophical bent: “to cultivate the contemplation of death.”

Some might feel that’s a worthy-enough goal. For those who want to do more than contemplate, but instead do some real planning about what they’ll leave behind, today’s online culture offers plenty of options.

Business of Aging Sections

Aging in Place

Suzanne McElroy

Suzanne McElroy says it’s important to match a family with the right caregiver to ensure there’s a comfort level on both sides.

As the Baby Boom generation continues to advance into the golden years, the demand for home care continues to rise, as families embrace a model that keeps seniors stay in their homes while helping them with everyday needs. That means the need for qualified caregivers is rising, too — and it’s not always easy to find them.

Home care is a far cry from, say, plumbing, Suzanne McElroy says. Sure, both careers require specialized skills, but not a lot of plumbers are turned away because they just don’t … feel right.

“I’ve often tried to compare this to other industries, and you can’t,” said McElroy, owner of Home Instead Senior Care in Springfield. “A plumber can come in and fix your pipes, and you don’t have to worry about what they look like or smell like, or how they talk; they just come in and fix your pipes. But I’ve had caregivers rejected for silly things, like a tattoo in the wrong place, or things I’m not legally able to consider, like age, race, or religion.”

Paul Hillsburg, owner and president of Amada Senior Care in West Springfield — who left financial services for a career in this fast-growing field — has observed similar difficulties matching caregivers to families, starting with his own life.

“I saw the challenges we had with my mom in finding qualified caregivers,” he said, noting that she utilized home care in the early stages of her dementia. “My dad fired the first seven. I realized that was an important part of providing care in the home — the personalities need to match. So we take a personalized care approach.”

After all, McElroy said, she has to consider things from the family’s perspective, and why they need a certain comfort level with someone who will be spending lots of time in the home. “It’s not like fixing pipes and leaving; they’re going to be staying and sitting with your mom.”

SEE: List of Home Care Options

The problem, both she and Hillsburg, noted, is that the challenge of making those matches, plus the surge of Baby Boomers into their senior years — around 10,000 are turning 65 every day, on average — are ratcheting up the pressure on home-care agencies to find and retain talent.

“More and more people want to stay at home, and hospitals are actually suggesting home care during discharge,” Hillsburg said. “People want to age in place, to be at home, where their family can come and visit, and where they feel more comfortable.”

Home-care services run the gamut from companionship and household help to assistance with ambulation and medical needs, and the popularity of this option continues to grow, creating worries that demand will eventually outstrip the number of qualified caregivers. That means competition among agencies, which are bringing myriad tools to bear with the goal of helping seniors live as independently as possible.

The Right Choice?

McElroy, who has lectured many times on the topic of choosing a senior housing plan, outlined several considerations that families must discuss, including:

• Physical needs, including activities of daily living — from shopping, cleaning, cooking, and pet care to more intensive help with bathing, ambulating, and eating — and medical needs, which could arise from a sudden condition, such as a heart attack or stroke, or a more gradual condition that slowly needs more care, such as Alzheimer’s disease.

• Home maintenance. “If you’re living alone, your current home may become too difficult or too expensive to maintain,” she noted. “You may have health problems that make it hard to manage tasks such as housework and yard maintenance that you once took for granted.”

• Social and emotional needs. As people age, their social networks may change, with family and long-time friends no longer close by, and neighbors moving away or passing on. At the same time, they may no longer be able to drive and have no access to public transportation. The desire to be around a community of friends and take part in social activities may be paramount.

• Financial needs. “Modifying your home and long-term care can both be expensive, so balancing the care you need with where you want to live requires careful evaluation of your budget.”

The answers to these questions may very well point to assisted living as a better option than home care, but others may be able to age in place, accessing home-care services to better manage activities of daily living, while still enjoying the comfort and security of a residence they have lived in for years or decades.

Aging in place is a less effective senior-housing option once your mobility is limited. Being unable to leave your home frequently and socialize with others can lead to isolation, loneliness, and depression. So, even if you select to age in place today, it’s important to have a plan for the future when your needs may change and staying at home may no longer be the best option.”

“You may also be able to make home repairs or modifications to make your life easier and safer, such as installing a wheelchair ramp, bathtub railings, or emergency response system,” McElroy said.

Home care is a good option, then, for people who can access transportation; live in a safe neighborhood and in a home that can be modified to reflect changing physical needs; don’t have an overwhelming burden of home or yard maintenance; have physical or medical needs that don’t require a high or specialized level of care; and, perhaps most important, have a network of nearby family, friends, or neighbors.

“Aging in place is a less effective senior-housing option once your mobility is limited,” she added. “Being unable to leave your home frequently and socialize with others can lead to isolation, loneliness, and depression. So, even if you select to age in place today, it’s important to have a plan for the future when your needs may change and staying at home may no longer be the best option.”

Individuals and families who do choose home care, Hillsburg said, still have to overcome that initial reluctance to invite a stranger into their home.

“When I meet clients, I do my own personal assessment, trying to link their personalities with the personality of the caregiver,” he explained. “And when the caregiver goes to the family’s home for the first time, I meet them there and introduce them to the family, make sure there’s a comfort level there.”

Hillsburg said his company, part of a national network of Amada franchises, also performs extensive background screening — credit history, DMV records, criminal records, sex-offender registries — to ensure client safety, and also assists people trying to figure out how to pay for care, whether that’s a long-term care policy, veterans’ benefits, reverse mortgages, even life-insurance policies that can be sold back, swapping death benefits for current care.

Paul Hillsburg

Paul Hillsburg says the biggest challenge for home-care companies is finding and retaining quality caregivers in an increasingly competitive arena.

But to build a team of reliable caregivers at a time when the competition for talent is becoming fiercer by the month, a company has to make sure they’re paid well and happy in their jobs, he told BusinessWest.

“It’s a very, very competitive field. The biggest challenge going forward is going to be finding and retaining good, quality caregivers. That’s why we provide 20 hours of free training, or more, if they want it, to all our caregivers, and we pay them while they’re in that training,” he explained. “They want to be treated like a person and respected.”

Cost is still a major consideration for families, McElroy said, especially when agencies have to pay their caregivers competitively. While lower-income services are available through Medicaid and MassHealth, home care still isn’t within reach of everyone who needs it. “That’s only going to change in importance when enough people feel this pain, or the right people feel this pain.”

High-tech, High-touch

At the same time, Hillsburg said, home care continues to absorb technological advances that make it easier for families and companies to assess results, from an online portal Amada offers called Transparent — which allows families to see which duties a caregiver has performed — to a GPS system that lets the company know whether caregivers show up at the right place and time.

Meanwhile, the company’s Discharge Admissions Reduction Team (DART) works with care managers to negotiate transitions between hospital and home care with the goal of reducing hospital readmissions.

“The need for care is going to continue to increase for the next 30 years before we hit the end of the Baby Boom generation,” Hillsburg said by way of explaining the ways companies are honing their services to meet the needs of this population.

Still, at the end of the day, McElroy said, families are most concerned with whether the caregiver increased their loved one’s quality of life. She recalled one client who requested someone versed in quilting, to help her thread needles and otherwise allow her to continue enjoying her favorite pastime.

“That’s the heart of what we’re doing. Yes, we’re helping them out of bed and into the shower, but if we can help someone live the live they want, that’s what’s driving the spirit of our business,” she explained. “It’s hospitality; it’s customer service. You have to love what you’re doing. You have to love the mission and love the work.”

After all, “whenever I have someone raving about a caregiver, it’s not because they came in for a few hours and got the job done; it’s because they made a difference in someone’s life,” McElroy said. “They can be doing the grossest thing ever, but when they leave, if the person takes their hand and says, ‘I don’t know what I would do without you,’ they’re flying. They can’t wait to go back.”

Joseph Bednar can be reached at [email protected]

Business of Aging Sections

A Matter of Time

Dr. Rajiv Padmanabhan

Dr. Rajiv Padmanabhan says the initial 911 call triggers a chain of events at the hospital that ensures everyone is in place to treat a stroke quickly when the patient arrives.

Everyone knows women who are fiercely independent and used to doing everything for themselves. Getting to the hospital after a stroke — or, more likely, getting a friend or loved one there — shouldn’t fall into that category.

“We stress to stroke patients that we want them to come to the hospital quickly,” said Patti Henault, coordinator of Stroke Programs at Mercy Medical Center. “Every minute someone is having a large stroke is a minute that is wasted, and a little part of your brain is going to be damaged. Basically, the quicker you get treatment, the better the outcome usually is. But to arrive as fast as possible, you should call EMS. People think an ambulance takes longer, but the thing is, EMS lets us know they’re coming, so we can get everything in place. That helps a lot.”

Once the patient calls 911, she explained, the ambulance crew is in contact with the hospital, so doctors and CT-scan technicians are in place the moment of arrival. “The first diagnostic test for stroke is do a CT scan, so we know what’s going on inside the brain,” Henault said. “It’s a quick test, but the faster we can do it, the faster we can know whether it’s something we can treat.”

Dr. Rajiv Padmanabhan, a neurologist with Baystate Health, said the system has an algorithm — a chain of command, if you will — for stroke response, and it begins with the EMS team.

“When they call into the hospital, we are on standby, with the CT scan and neurology team and the emergency room; we’re all aware that a patient with a stroke is coming on the ambulance,” he told BusinessWest. “The 911 call triggers the whole thing. They go straight to the CT scan, and we also look at pictures of the arteries.

“The most important lesson is to get them treated fast,” he went on. “Every minute, 1.9 million neurons are lost in the brain. The sooner we treat them, the better chance we have of getting blood supplied back to the brain, which is what we aim for. Once the patient calls 911, the likelihood of a good outcome increases. It sets up a chain of command, which notifies techs, the lab, pharmacy, and the ER. It triggers a chain of events that leads to faster delivery of care. 911 makes a difference.”

According to the American Stroke Assoc., stroke is the third-leading cause of death for women and the fifth-leading cause of death for men; each year, 55,000 more women have a stroke than men. And because women live longer on average than men, strokes often have a more negative impact on their lives. In fact, women are more likely than men to live alone when they have a stroke; require the services of a long-term healthcare facility after a stroke; and have a worse recovery overall.

But with proper management of risk factors, and a quick response when an event occurs, women, as well as men, have a better chance of decreasing mortality rates from stroke and boosting quality of life.

On the Clock

Once a stroke patient arrives at Mercy, Henault said, a consultation is conducted with a neurologist from Massachusetts General Hospital in Boston through that institution’s stroke telemedicine program. “They can see the patient, give directions, answer patient questions, they can even zoom close up on eyes and check the pupils. It’s pretty amazing. They can give us advice on how to treat the patient.”

Patti Henault

Patti Henault says many risk factors for stroke — like high blood pressure, obesity, and smoking — are manageable with lifestyle choices.

Mercy began using the Mass General service in January 2016 because they are always ready to consult. “The neurologists in our area are often with patients, and it’s difficult to stop what they’re doing. We decided we’d get quicker service with telemedicine. And it really has made an impact.”

About 85% of all strokes are ischemic, caused by a clot, while the rest are hemorrhagic strokes, which are treated differently. In the case of an ischemic stroke, the first line line of defense is the blood-thinning agent tPA (tissue plasminogen activator), known colloquially as a ‘clot buster.’

“If there is a problem like a clot blocking an artery or arteries are very narrowed because of artherosclerosis, we might be able to resume blood flow to the brain,” Henault said. “The idea is, if we can resume blood flow to the brain, the brain cells stop dying because they’re getting the nutrients and oxygen they need.”

For patients that require a more dramatic intervention than a clot buster, a cutting-edge device in use at Baystate known as the ‘stentriever’ can actually be inserted into the artery to remove the clot.

“We’ve incorporated that as part of the protocol,” Padmanabhan said. “We want to make sure we have the right tools, state-of-the-art tools, to respond 24/7/365 and get all patients to the right treatment immediately.”

He added that doctors are waiting on trials and studies examining whether such interventions may be employed more than seven hours after a stroke, which is considered the current limit. (Clot busters like tPA are typically administered no more than four and a half hours out). “Expanding the window might capture more big strokes before disability and death. We won’t get them all, but we can decrease mortality.”

The best medicine, of course, is not to have a stroke at all, and fortunately, most risk factors are lifestyle-related and can be managed in most people.

“High blood pressure is huge one,” Henault said. “A lot of people think high blood pressure is kind of harmless, but it’s insidious because it does damage to blood vessels every day, and if you have high blood pressure, it’s constantly wearing down the side of the blood vessel, and one crack can develop a blood clot because the body is trying to fix it.”

Other risk factors, she went on, include being overweight, lack of physical activity, and behaviors like smoking, excessive drinking, and drug abuse. “Our younger stroke victims, especially, tend to have some high-risk behavior such as that.”

Some stroke risks require medical intervention, such as atrial fibrillation, or irregular heartbeat, which increases an individual’s chance of developing blood clots. Many with this condition take blood thinners on a regular basis.

“The most important risk factors are hypertension, diabetes, high cholesterol, and obviously smoking,” Padmanabhan said. “Quitting smoking and controlling sugars are important for treating blood pressure. Sleep apnea also has a correlation, so if you feel foggy and tired all the time, check it out and make sure it’s treated. You don’t have to be obese or have a metabolic syndrome to have sleep apnea.”

Although it sounds simple, he added, regular doctor visits can go a long way toward preventing strokes, as will following the American Heart Assoc. guidelines to engage in 20 minutes of moderate exercise five times a week. “The important thing is knowing your numbers. You won’t get to your goals in a day.”

For recovering stroke patients without these risk factors, Padmanabhan said, Baystate’s stroke clinics in Springfield and Greenfield conduct diagnostic cardiac testing to try to determine a cause. But there’s no one way to rehab from a stroke, Henault added.

“No two people are the same. Every section of the brain controls different things, so everyone’s treatment after a stroke is different. Younger brains tend to recover more quickly.”

Different for Women

Each year, according to the American Stroke Assoc., stroke kills twice as many women as breast cancer. But the public tends to be less knowledgeable about the risk factors and don’t perceive themselves at risk for stroke.

In addition to the general risk factors like family history, high blood pressure, high cholesterol, diabetes, smoking, lack of exercise, and being overweight, women face some unique risk factors, including:

• Taking birth control pills. The greatest concern about using oral contraceptives is for women with additional risk factors, such as age, cigarette smoking, high blood pressure, or diabetes;

• Being pregnant. Stroke risk increases during a normal pregnancy due to natural changes in the body such as increased blood pressure and stress on the heart;

• Using hormone-replacement therapy, a combined hormone therapy of progestin and estrogen, to relieve menopausal symptoms; and

• Suffering from migraine headaches with aura. Migraines can increase a woman’s stroke risk two and a half times, and most people in the U.S. who suffer migraines are women.

Women may also report symptoms that are different from common stroke symptoms. These can include loss of consciousness or fainting; general weakness; difficulty or shortness of breath; confusion, unresponsiveness, or disorientation; sudden behavioral change; agitation; hallucinations; nausea or vomiting; pain; seizures; and hiccups. Because these are not typically recognized as stroke symptoms, treatment is often delayed.

Henault said men and women should at least know the FAST symptoms. That’s an acronym stroke-care professionals use to help people recognize the signs of a stroke. The letters stand for facial drooping, arm weakness, speech difficulties, and time — which is of the essence, so call 911 immediately.

“It sounds silly,” she said, “but little kids understand that, and sometimes they end up calling 911.”

It could be the most critical call they ever make, because it launches a chain of events at the hospital designed to save lives — and, more often than ever, does just that.

Joseph Bednar can be reached at [email protected]