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Crisis State

Cristina Rivera and Dr. Katie Krauskopf

Cristina Rivera and Dr. Katie Krauskopf say recovery is often a winding process marked by frustrating times and bumps in the road.

 

Christine Palmieri has read the numbers regarding a spike in overdose deaths in Massachusetts over the past couple years. But to her, they’re not just numbers.

“My role is to oversee our community-based programs that work with people who have experienced mental-health issues, substance-use disorders, and homelessness. As part of that, we run residential recovery programs for people who have a dual diagnosis, and we also run a number of different housing programs for people in recovery,” said Palmieri, vice president of Recovery and Housing at the Mental Health Assoc. (MHA) in Springfield. “And over the past year, maybe two years, we as a program have experienced more deaths by overdose than at any other time in my career.

“That’s troubling. There’s definitely times when it feels very hopeless and very frustrating, but I think our programs have done an excellent job of showing up every day, meeting people where they’re at,” she went on. “One of our programs is called GRIT, and that’s how I would describe what we need to keep coming back every day, and what the people we’re supporting in recovery need to keep coming back every day.”

After several years of decline, the rate of opioid-related overdose deaths in Massachusetts increased by 8.8% in 2021 compared to 2020, according to a June report by the Massachusetts Department of Public Health. Drug-overdose deaths in Massachusetts continue to trend lower than nationwide figures, but the statistics are still startling, with the rise in death rates reflecting the effects of the COVID-19 pandemic and an increasingly poisoned drug supply, primarily with the powerful synthetic opioid fentanyl.

“Massachusetts and the rest of the country have definitely seen a rise in overdose rates during the pandemic,” said Dr. Katie Krauskopf, medical director of Substance Use Disorder Services at MiraVista Behavioral Health Center in Holyoke. “It looks like Massachusetts’ trend is better than nationally, and there is some indication that 2022 might be better than 2021. But we clearly saw people struggling during the pandemic, and a lot of that probably had to do with difficulty accessing care and the isolation that came along with it.”

In her experience, the pandemic impacted two groups differently: many of those with substance-use disorder who were already in treatment programs did better during the pandemic because the social restrictions helped them avoid some of the triggers they might normally have encountered more frequently. Meanwhile, regulatory changes around access to treatment allowed patients to take home medications they could not previously.

“People are reluctant to hire somebody with an history of opioid addiction; people are reluctant to house somebody with a history of opioid addiction, in lots of ways that aren’t based in reality, but based in fear, based in discrimination, based in stigma.”

“So patients in treatment have done quite well,” she went on. “The real issue was the patients who were not already engaged in treatment and were unable to do so.”

The DPH found clear evidence that the COVID-19 pandemic had a profound impact on mental health and led to increased substance use and poorer mental health across the Commonwealth, especially among BIPOC communities and LGBTQ+ individuals.

“We continue to be relentless in our commitment to increase access to harm-reduction services, low-threshold housing, and treatment,” Health and Human Services Secretary Marylou Sudders said. “By working to destigmatize addiction and meeting people where they’re at, including with an expanded array of harm-reduction tools, we can reverse this negative trend.”

Locally, organizations committed to improving behavioral health — and removing the stigma and barriers that keep people from accessing care — are doing just that.

 

Support System

Palmieri said it’s important to remember that recovery doesn’t happen in a vacuum, but is tied to social determinants like housing and economic stability.

“Whether it’s opioids or anything else, our role is to help people understand what’s getting in the way of their recovery and help fill the void that used to be filled with drugs or alcohol with things they can find meaning in,” she told BusinessWest. “We’re not only interested in sobriety and helping people stop using, but also, what are you going to do instead? Our primary goal in our residential programs and our housing programs is to make sure people have a safe, affordable place to go to live after treatment, someplace that isn’t necessarily the same neighborhood where they started using in the first place, someplace they can afford and sustain — but also to find employment, something that gives their life meaning beyond using, something they can wrap recovery around.”

René Piñero, vice president of Behavioral Health & Clinical Operations at MHA, said the pandemic curtailed some services in the community to counter addiction.

“But I definitely agree that it’s not all about accessible treatment; it’s about having housing and other supports. The state has provided funding for these programs and services, but it’s also about where people go to live after treatment, what supports they have, and opportunities to find employment. Even if we have treatment that is accessible for them, if we can’t find them a home address, it’s going to be more difficult.”

For those lacking access to care, the pandemic-driven isolation people felt didn’t help, Palmieri added — and in some cases increased a sense of stigma around seeking help.

René Piñero and Christine Palmieri

René Piñero and Christine Palmieri say addiction recovery often goes beyond treatment and entails social supports like stable housing.

“People are reluctant to seek support and services because asking for help means admitting there’s a substance-use issue that’s going on, and the stigma that surrounds opioid addiction is sometimes insurmountable,” she said, adding that stigma isn’t a one-way street. “We’re trying to get people connected, but we face barriers all the time. People are reluctant to hire somebody with an history of opioid addiction; people are reluctant to house somebody with a history of opioid addiction, in lots of ways that aren’t based in reality, but based in fear, based in discrimination, based in stigma.”

Krauskopf said the Greater Holyoke area has plenty of resources in place, from increased naloxone distribution to facilities like MiraVista, which offers a full continuum of substance-use programming, from acute inpatient detox to a clinical stabilization service to outpatient programs like an intensive, four-week program that teaches skills ranging from emotional regulation to mindfulness to dealing with triggers. “It’s not one-size-fits-all here at all. We have all these programs, and patients can really fit themselves into what they need at any given time and move through the services depending on where they are.”

The state has been aggressive with programming as well, expanding substance-use-disorder treatment and overdose-prevention initiatives since the start of the pandemic and investing $120 million in prevention programs from 2016 to 2022, as well as distributing well over 150,000 naloxone kits since March 2020 to opioid-treatment programs, community health centers, hospital emergency departments, and houses of correction.

 

Try, Try Again

Cristina Rivera, director of Outpatient Services and Substance Use at MiraVista, said everyone’s addiction-recovery journey is different.

“We know that recovery is ongoing, and there might be bumps in the road. In that sense, we help people wherever they’re at. If you start using substances again, it’s not like we’re not going to accept you into our program and try to get you back on track.”

Piñero said it’s helpful to recognize that mental-health and substance-use challenges require the same attention as any chronic, physical medical issue.

“Recovery has its ups and downs just like other medical issues. Often, with diabetes, cancer, and other medical conditions that aren’t stigmatized, people are more willing to recognize that.”

Krauskopf agreed, citing studies suggesting that rates of relapse and loss of control in addiction recovery are similar to those in people managing diabetes, asthma, and high blood pressure.

“The notion that recovery is a straight line is not realistic; it’s really up and down. Part of the disease is that patients will relapse, and we’ll help them get their footing back,” she told BusinessWest. “People have begun to pivot to understand this condition as a long-term chronic condition that requires people’s full attention at different levels of intensity, and we try to provide that here.

“Recovery is about medication for some, but lifestyle modification, too,” she added. “When you think about diabetes, many people do well with changes in their diet and exercise, and many people do that and need something else at well. It’s all the same goal.”

While the need for more resources is high, she said, especially when it comes to residential programs, the hope is that those struggling with addiction will see past the persistent stigma and seek help from the many resources that are currently available, and that those overdose numbers will start to fall again.

After all, they’re much more than just numbers.

 

Joseph Bednar can be reached at [email protected]

Health Care

Staying Power

The Arbors puts a focus on resident quality of life.

The Arbors puts a focus on resident quality of life.

For the past 25 years, Sara Robertson and her family have run one of the most successful assisted-living facilities in Western Mass. and now Northern Conn. But she stressed repeatedly that this success did not come easily.

“We learned early on about the importance of all the hard work and dedication that our grandparents and parents put into evolving and growing the company,” she said, “and just how challenging making your own success truly is.”

Robertson, co-owner, her sister Emily Quinn, and cousin Amie Hanrahan grew up working for their parents and grandparents. Starting as teenagers, they handled just about every job one can take on at an assisted-living facility — landscaping, dishwashing, housekeeping, and more. Those assignments taught some invaluable lessons and have helped guide them every day as they manage Arbors Assisted Living Communities, grow the family business, and take it in new directions in this broad sector — everything from home care to memory care, as we’ll see.

Those same lessons helped guide the company and its leadership through the pandemic and the myriad challenges it brought to all those working in assisted living and related businesses.

“We learned best practices to keep our residents in communication with their families and loved ones when they weren’t able to visit,” Robertson told BusinessWest. “We adapted to new ways of activities and dining options. We eventually found our new normal, and all the practices we have in place to keep our residents and staff safe are a part of our everyday life now.”

 

Building Blocks

As the Arbors celebrates 25 years of success, growth, and evolution, Robertson reflected on where this family has been, where it is today, and where it might go in the future. She began with some history, starting with the venture known as E.A. Gralia Construction, launched by their grandparents.

“They would build everything from hotels and plazas to senior housing like Wilbraham Commons and facilities like that,” said Robertson. “Then my parents basically started to focus on senior housing.”

They built more than 5,000 housing units, as well as schools, hotels, nursing homes, and several elderly-housing developments, she went on, adding that, when this second generation took control of the family business, it evolved into what is now Arbors Assisted Living Communities.

From the beginning, the family sought out growth opportunities, and took full advantage of them.

Indeed, senior housing was available in Agawam and Wilbraham, but not in many other places around Western Mass. at the time, Robertson said. The first Arbors facility was built in Amherst in 1998. Five more facilities were added by 2009, in Chicopee, Greenfield, Stoughton, Taunton, and Westfield.

“At the locations [Agawam and Wilbraham] that our parents managed, we would do landscaping or activities or housekeeping,” she explained. “From there, they evolved into creating assisted living. Assisted-living facilities were few and far between at that point in time; we were one of the first assisted living in the area. And it obviously is an industry that has grown exponentially from there.”

“We eventually found our new normal, and all the practices we have in place to keep our residents and staff safe are a part of our everyday life now.”

The Arbors offers independent-living, assisted-living, and memory-care services. Robertson told BusinessWest that all needs are diverse and vary from person to person, so individuals are able to create their own service plan, detailing their personal-care needs and preferences.

Each resident has their own private apartment with a full kitchenette, private bathroom, living room, and bedroom. Staff members assist individuals with everyday tasks, such as bathing, dressing, preparing meals, and managing medications.

Respite services and short term/trial stays are also possible at the Arbors. With move-in-ready apartments, individuals are able to stay and make sure they find the right fit.

In 2010, the third generation took over the Arbors management, making it a women-owned and operated family business. Robertson, Quinn, and Hanrahan started Integra Home Health Agency and built new assisted-living facilities in Dracut and Stoneham. The third generation also created a Connecticut brand, the Ivy at Ellington and the Ivy at Watertown.

“At this point, we were fully immersed in the senior-living industry and our careers, so we decided to grow again,” Robertson said. “Our assisted living was all-inclusive. A lot of assisted-living facilities at the time were starting to transition into levels of care. We didn’t really want to do that because we liked that it was all-inclusive pricing at the time. So we were utilizing Integra Home Health to kind of fill that void to cover additional services that our residents needed that we weren’t able to offer. It took the business to the next level.”

Integra Home Health Agency offers personal healthcare services for those who feel more comfortable staying at home but need additional support beyond the basic assisted-living services. Integra’s staff can work alongside hospice agencies and also provide services to those in senior housing and nursing homes. They provide transportation to doctor appointments, as well as companion services to keep clients company, spend quality time, reminisce, and play games. The company also offers a variety of personal-care and memory-care services right in clients’ homes.

The Arbors has also diversified into memory-care services through its Reflections Memory Care Program, designed with four specific, resident-centered focus areas — life enrichment, personal care, serenity enrichment, and multi-sensory dining — to specifically address the challenges of living with memory loss and cognitive challenges.

Residents live in a specifically designed neighborhood that provides a safe and secure home with private apartments for each resident. The environment of Reflections is designed to minimize challenges and barriers, and to inspire confidence, peace of mind, and independence so each resident has the freedom to move about in a familiar, recognizable environment.

Through the years, Robertson said the leadership team at the Arbors has “fine-tuned the services we offer with current trends,” such as offering ‘anytime dining’ at its Connecticut locations and providing levels of care for services since assisted living is not a one-size-fits-all scenario.

“We listen to what our customers want and hopefully can work those suggestions into our offerings,” she said. “We also have a full array of activities and programming in our communities; social-engagement directors and memory-care directors create monthly calendars of a wide variety of options. Some examples might be exercise programs, card games, outings on the van, travel series, entertainment, cocktail hours and socials, lectures, religious services, arts and crafts, and so much more. There is something for everyone.”

 

At Home with the Idea

Robertson told BusinesWest that in college, she studied business and hospitality, but Quinn, co-owner and regional marketing and sales director, and Hanrahan, co-owner and co-director of Integra Home Health Agency, pursued degrees in communications and marketing, so they all have their own specialty when it comes to the business.

As long as Robertson can remember, the family business was something she’s always wanted to pursue.

“Growing up in a family business is unique in that your entire world revolves around business; you hear it at the dinner table, at family get-togethers, even at holidays,” she told BusinessWest. “I think at one time or another, all of us pondered what we really wanted to do in life, but the family business pulled us in. We had to be willing to put in the same amount of hard work, determination, and dedication that our parents and grandparents did.”

Robertson’s parents and grandparents never had to experience a pandemic like COVID-19. But the third generation took lessons from those who came before them — especially those involving hard work, determination, and dedication — to persevere through a period that tested them in every way imaginable.

Because assisted-living facilities have the most fragile populations to protect and keep safe, Robertson and her team had to learn to adapt and pivot in real time. There were safety guidelines coming from different agencies that had to be maintained and communicated to the staff weekly.

Robertson described the past few years as “by far the most challenging of our careers.” Not only did they have to pivot on the fly and adjust to constantly changing guidelines, but they had to cope with rising amounts of fear within the community about senior-living facilities, home care … essentially every aspect of their multi-dimensional business.

She went on to explain that making “huge life decisions” became even more challenging than they already were. The main goal was making residents comfortable with where they were and what they needed from the facilities and their loved ones.

Recovery took time, she added, as people needed time to feel comfortable again with placing their loved ones in an assisted-living community or to allow a caregiver into their homes.

“We had to be patient, yet stay front of mind,” Robertson said. “We had to get more creative in our marketing efforts, hosting outdoor events, drive-through dine-and-dash events, hot-chocolate deliveries, home visits, and so much more.”

The pandemic threw the Arbors facilities a curveball since it forced the company to stop growing its brand, so its leadership could focus all of its efforts on the safety of its current residents and on recovering and improving services.

Robertson said that they wouldn’t have made it through the pandemic without their staff. “They worked tirelessly under difficult circumstances for several years now. We were and are lucky to have them.”

As COVID restrictions loosen and the pandemic comes to a close, Robertson and her Arbors teams are continuing to grow the business. The industry has matured, and smaller family businesses have diminished, but being able to assist and serve more residents and more families has always been the top priority, moreso now than ever.

“I think people in general have learned to navigate the pandemic, making choices that are right for them and their families. We still have safety protocols in place in our industry,” she told BusinessWest. “We will always have the most fragile population that lives with us, so we have to remain diligent now and in the future knowing public-health crises are possible.”

She went on to explain that she has always said, “it is our family taking care of your family.” Robertson, Quinn, and Hanrahan are heavily involved in the daily operations and intend to continue in those roles. Whether there is an issue to address or someone just needs a friendly face to talk to, the third generation is right on the front lines, just as those who came before them.

 

Kailey Houle can be reached at [email protected]

Back to School Daily News Education Health Care

SPRINGFIELD — For the second consecutive year, The Enterprise Holdings Foundation has awarded funding to support Square One’s Campaign for Healthy Kids. This year’s gift totaled more than $14,000.

The contribution is made possible through Enterprise Holdings Foundation’s FY22 ROAD (Respect Opportunity Achievement Diversity) Forward program. This is an employee-driven initiative focusing on the improvement of social and racial equity in communities they serve.

In presenting the donation, Shawn Fleming, group Human Resources manager, said, “we are so proud to continue to support Square One in its commitment to providing opportunities for children and families in greater Springfield, for a second year. Advancing diversity, equity and inclusion is a company-wide priority for Enterprise Holdings, and we’re committed to strengthening our community with the help of outstanding organizations like Square One.”

“We were beyond excited to learn that Enterprise selected Square One to receive this very generous gift, again this year” said Kristine Allard, vice president of Development & Communication for Square One. “Our success in serving the children and families in our region is dependent upon the generosity of business and individuals who recognize the need to support our important work. We are so grateful to the Enterprise Holdings Foundation for this amazing gift.”

Last summer, Enterprise Holdings launched its inaugural local ROAD Forward grants to nearly 700 nonprofits addressing social and racial equity gaps facing youth and families in local communities.

The Campaign for Healthy Kids is a multi-year fund development initiative focused on Square One’s commitment to providing healthy meals, physical fitness, social-emotional wellbeing, and a healthy learning environment. All funds raised will directly support the children and families who rely on Square One to help meet their early learning and family support service needs. The campaign includes numerous opportunities for businesses and individuals to become involved as donors and partners.

Square One currently provides early learning services to more than 500 infants, toddlers and school-age children each day; and family support services to 1,500 families each year, as they work to overcome the significant challenges in their lives.

Health Care

A Tradition of Caring Lives On

Gov. Charlie Baker, Sarah Yee

Gov. Charlie Baker, Sarah Yee, center, and Mercy Medical Center President Deborah Bitsoli at last month’s announcement of plans for the Andy Yee Palliative Care Unit.

Sarah Yee recalls that, during her husband’s final stay at Mercy Medical Center before he succumbed to cancer — a week in the intensive care unit in late May 2021 — there was some subtle “bending of the rules,” as she called it.

Most of it involved visitation, and, more specifically, the number of people who could visit and the hours when people could drop in, she noted. But there was more to it, especially efforts to make his room more like home, she said, adding that steps involved everything from the music playing — Earth Wind & Fire — to the Disney movies he would watch with family members, to pictures of family and friends that were brought in and placed around the room.

Summing it all up, Yee said that it wasn’t long before she called for an ambulance to bring Andy to Mercy for that final stay, that she decided that she didn’t want him to die at home.

Andy Yee was a successful entrepreneur

Andy Yee was a successful entrepreneur known for his passion for giving back. The palliative care unit is a continuation of that legacy.

“We love our house and the memories that we made here … but I didn’t want these to be our last memories of him,” she said, adding quickly that she did want him to die in a setting that was as close to home as she and family members could make it.

And the desire to enable others to enjoy that same home-like setting has prompted members of the Yee family, working in concert with those at Mercy Medical Center, to conceptualize the Andy Yee Palliative Care Unit, which is slated to open its doors before the end of this year.

Eight rooms are planned in space on the fifth floor of the hospital that had been a med-surg unit. Plans call for those private rooms, family respite places, private meeting rooms, and an outdoor terrace.

“This will be a specialized unit with specialized care,” said Deborah Bitsoli, president of Mercy Medical Center. “The rooms will have a particular color scheme, there will be a garden for the families, there will be particular types of furniture so the patients can stay overnight, and we will also outfit the rooms so some of the hospital equipment is behind walls, so that the environment would almost be like a home setting.

“The ICU is very institutional-looking,” she went on. “These rooms will not be institutional-looking; they’re going to look like a family room; this will be a very unique model for Springfield.”

The center will take the name of a man known for his many business accomplishments — he was a serial entrepreneur known in recent years for partnering with Peter Picknelly and others to save the Student Prince restaurant and then the landmark White Hut eatery — but also for his philanthropy.

At an elaborate press conference to announce the creation of the palliative care unit, staged last month in Mercy’s courtyard, several speakers, including Gov. Charlie Baker and Lt. Gov. Karyn Polito, both of whom became friends with Yee in recent years, talked about how the facility would not only meet a need, but speak — and in dramatic fashion — to Yee’s passion for giving back.

Indeed, before talking about the new unit, what it would offer, and what it would mean for patients and their families, Bitsoli set the tone by first turning back the clock to the early weeks of the pandemic, when Yee arranged to bring a Peter Pan bus full of food for staff at the hospital.

“There was another time when I called Andy and said, ‘I need your help,’ and he immediately said ‘what can I do?’” she recalled. “I said ‘it’s been a tough day for the staff; I need 1,000 roast-beef sandwiches. He said ‘when?’ I said ‘tomorrow.’ He said ‘I’ll get them there.’ And he did get them there.”

This desire to give back to those at the hospital and to support employees continued until that last stay in the ICU, said Bitsoli, noting that before he fell gravely ill, Andy Yee and officials at Mercy were planning a large, thank-you-to-staff celebration that would take place in that same courtyard as the press conference. That celebration never happened, but the spirit that spawned it would inspire something with more-lasting impact on the hospital and the patients it will serve.

Indeed, in the latter stages of her husband’s battle against cancer, Sarah Yee said she had many conversations with Andy’s oncologist, Dr. Philip Glynn, Bitsoli, and others about how donations in Andy’s name to Mercy Medical Center might best be used. There was talk of funding additional infusion rooms, she said, referring to facilities where infusion therapy is administered to cancer patients.

But officials at Mercy identified a greater need — one for palliative care facilities that would cater to critically ill patients who are mostly at the end of their lives.

Such facilities are not common, said Bitsoli, noting that fewer than 20% of hospitals offer palliative care.

“There are not many units like this; it really takes a combination of a vision and particular type of expertise,” she noted, adding that the unit will be overseen by Glynn and Dr. Laurie Loiacono, chief of Critical Care at Mercy. “It also takes a particular type of administration that feels committed to providing that type of experience for patients and families. It’s a particular unit that is resourced and outfitted in a very unique way, and you have to be behind that vision — and we’re all behind that vision.

“As the population ages, there is considerable focus on palliative medicine, which focuses on how someone passes in a dignified way, in a setting where they are surrounded by loved ones and in a supportive manner,” she went on. “There is a level of expertise and specialty around that, and Dr. Glynn has that type of expertise.”

Those at Mercy have been involved with the project for several months now, said Bitsoli, adding that there have been meetings with architects and room designers to finalize color schemes and other aspects of overall design. A committee has been meeting every week to get updates and keep the project on track for a fall ribbon-cutting.

Tim Stanton, vice president of Philanthropy for Trinity Health of New England, Mercy’s parent company, agreed, and noted that there is clear need for such a facility in this region.

“Sometimes, a family may feel it is desirable to have the patient come home during those last days,” said Stanton. “But oftentimes, it’s not practical or logical. So we want to create an environment here that replicates many of the comforts of home.”

Stanton said Mercy has embarked on what he expects will be a six-month campaign to raise money to help defray the cost of the new unit, which he projects will cost between $500,000 and $1 million in its initial stage.

Those wishing to donate may do so by visiting https://give.mercycares.com/andy-yee-palliative-care-unit

Daily News Elder Care HCN News & Notes Health Care Healthcare Heroes News Retirement Planning Senior Planning Summer Safety

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

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

But there are hundreds, perhaps thousands of heroes whose stories we still need to tell, especially in these times, when the COVID-19 pandemic has brought many types of heroes to the forefront. And that’s where you come in.

Nominations for the class of 2022 are due July 29, and we encourage you to get involved and help recognize someone you consider to be a hero in the community we call Western Mass. in one (or more) of these seven categories:

• Patient/Resident/Client Care Provider;

•  Health/Wellness Administrator/Administration;

• Emerging Leader;

• Community Health;

• Innovation in Health/Wellness;

•  Collaboration in Health/Wellness; and

• Lifetime Achievement.

Nominations can be submitted at

https://businesswest.com/healthcare-heroes/nominations/

For more information call Melissa Hallock, Marketing and Events Director, at (413) 781-8600, ext. 100, or email to [email protected]

Health Care

Support Systems

The past few years have been extremely challenging times for all those in healthcare, but especially the nurses on the front lines. The stress and long hours stemming from COVID have led many to leave the profession — intensifying an already-critical shortage of nurses. In an effort to better attract and retain nurses, area hospitals are taking a number of steps — everything from dramatic increases in pay and signing bonuses, to the introduction of ‘quiet rooms,’ where nurses can unwind during their shifts, to initiatives to create a wider pipeline of nurses. These measures are being implemented to create a better work environment and, overall, help stem a workforce crisis that has taxed hospitals in every conceivable way.

 

“Quiet rooms’ like this at Mercy Medical Center

“Quiet rooms’ like this at Mercy Medical Center are just one of the initiatives aimed at helping nurses and other healthcare professionals battle stress.

 

Kelly Chevalier, DND, is a military veteran, having served in the Air National Guard at Barnes Airport in Westfield.

She said there have been many comparisons between actual combat and day-to-day life in hospitals and other healthcare settings at the height of COVID. She believes they are valid.

Recalling those days, Chevalier, director of Nursing Education at Mercy Medical Center and director of the Emergency Department, said healthcare professionals would show up for work facing a great unknown and danger to their own health and safety.

“That made me proud to be a part of this career and proud to be a nurse,” she said, comparing the nurses she worked beside to soldiers going into battle. “They showed up when a lot of people didn’t want to.”

But while most nurses did, indeed, show up, combatting COVID and its many side effects has taken its toll — on both the nursing profession locally and everywhere, and on facilities trying to maintain a full staff of nurses.

As Chevalier and others told BusinessWest, COVID prompted many nurses who were at or near retirement age to take that step and leave the profession behind. And for some not near retirement, the COVID fight and a desire not to endanger the health of loved ones prompted them to look at other career options, with many eventually finding opportunities elsewhere.

Kelly Chevalier says many nurses were pushed into retirement

Kelly Chevalier says many nurses were pushed into retirement by COVID, while others went into other professions or became travel nurses.

This dramatically altered landscape has left area hospitals scrambling to fill their nursing ranks, often resorting to the hiring of very expensive travel nurses, individuals willing, as that name suggests, to travel (sometimes long distances) to take nursing positions at different kinds of facilities.

In the wake of COVID, but in some cases before it arrived, hospitals have been taking steps to more effectively attract and retain nurses and create work environments that help them confront the stress and strain of everyday work. Such initiatives range from signing bonuses and generous wages to ‘appreciation meals’ and so-called ‘quiet rooms.’

Spiros Hatiras, president and CEO of Holyoke Medical Center (HMC), said his institution has put in place generous sign-on bonuses and other initiatives, steps that were in place long before COVID, to not only bring nurses to HMC but draw people into the nursing profession.

“From day one, I’ve implemented, one of, if not the most generous education benefits in the valley, to help people go back to school and advance their degrees,” he explained. “The last element is reaching out to new grads, but we need to make it so we offer something they can’t say ‘no’ to. We’ve decided to offer each new grad nurse $50,000 when they sign on with us, check in hand, as long as they sign to work with us for four years.”

Spiros Hatiras

Spiros Hatiras

“From day one, I’ve implemented, one of, if not the most generous education benefits in the valley, to help people go back to school and advance their degrees.”

Not only do new nurses get a bonus, but already employed nurses can receive an additional $20,000 to their annual income if they agree to work with Holyoke Medical Center for another five years.

For this issue and its focus on healthcare, BusinessWest looks at the current landscape in nursing and how area hospitals are working to address the many ongoing challenges they, and their nurses, are facing.

 

Supply and Demand

The challenge of securing adequate numbers of nurses is nothing new for area hospitals. With the aging of the Baby Boom generation, matching the number of retirements with new hires has been a difficult assignment.

And COVID, and the so-called Great Resignation, have only exacerbated the problem. Indeed, according to Nursing Solutions Inc., the national healthcare retention and registered nurse (RN) staffing report of 2021 said that for the first time ever, retirement is one of the top three reasons for resignations among registered nurses.

This phenomenon has created what Joanne Miller, chief nurse executive, Baystate Health and chief nursing officer, Baystate Medical Center, called an ‘experience gap.’

Joanne Miller

Joanne Miller

“We’re investing in and learning more about the antidote to fatigue and burnout — that is the ability for our nurses to become resilient. In order to identify and address stress, we’re creating an environment where we can openly share and discuss these feelings.”

“The experience of the complexity gap has widened,” she explained. “Meaning the nursing workforce experience has dropped and the complex care that patients need today is rising. So the overall growth of an RN workforce is primarily new graduates.”

Contending with this gap is just one of the challenges facing hospitals, said those we spoke with, adding that COVID pushed more nurses into retirement and other professions, while it inspired others to join the ranks of travel nurses, and, in doing so, earn much more than they were making.

“We had a large group of nurses that jumped on the travel nurse wave,” said Chevalier, adding that for many in the profession, the chance to earn the wages being offered by travel-nurse agencies was an opportunity they could not pass on.

Hatiras agreed.

“Some people don’t mind traveling and bouncing around from facility to facility and seeing the country,” he noted. “Because of the shortage, the amount of money these agencies were offering nurses to do that was incredibly high, so more nurses left regular full-time jobs to do that. It’s a supply-and-demand issue.”

All three hospitals we spoke with have been working hard to increase the number of staff available on their floors, many of which are again operating at or near full capacity as COVID cases wane.

One way that facilities are combating the issue of staffing is moving staff to areas where the help is needed most and make greater use of certified nursing assistants (CNAs).

The ‘comfort cart’ at Mercy Medical Center

The ‘comfort cart’ at Mercy Medical Center’ is one of many steps being taken to improve morale and battle stress.

“Before, we only had a few (CNAs) on the floor,” said Hatiras. “There were only two nurses and four CNAs on the floor. Now, we’ve teamed up every nurse with a CNA and they work as a team. It’s a one-to-one ratio, and it has helped out a lot,” said Hatiras.

CNAs are able to assist nurses by fulfilling tasks that don’t require a nursing license, such as gathering supplies and medications, documenting important information, assisting in procedures, and transporting patients.

Each facility has its own kind of float pool to help nurses in other areas of the hospital. Nurses are able to volunteer to be moved to other areas that need more assistance, said Hatiras, stressing the importance of volunteering; moving nurses from a unit they enjoy can cause “a lot of dissatisfaction.”

Hospitals are also taking steps to improve the pipeline of nurses from area colleges through various programs designed to only provide experience but introduce them to the institutions in the hope that they will stay with a hospital after they graduate from college.

Baystate and Mercy have partnerships with colleges in the region whereby nurses are able to join an internship program, known as clinicals, and can have a paid position with the facility.

“It’s a great opportunity to be exposed to nursing from an ancillary level with some infusion of higher level of learning from a registered nurse’s perspective,” said Chevalier. “It’s a great way for us to pick from the best of the best that’s out there and really make sure they’re not just an academic good fit, but a cultural good fit.”

Miller told BusinessWest that one step taken at Baystate was to hire 39 student nurses from a Student Nurse Association Program (SNAP) to help further their learning at Baystate Medical Center. The program provides experience for the student nurses and introduces them to Baystate — and the job opportunities there. “They’re not nurses yet, but they’re in college,” she explained. “They do this outside of their clinical practicum. In their junior or senior year of college, a student is able to get a job at the local hospital, practicing and learning since we know they’re in a nursing program; we show them the ropes a little bit more. It’s a great experience for a nursing student.”

Meanwhile, hospitals are taking steps to improve the overall experience for nurses, through initiatives like quiet rooms, or what Mercy calls ‘zen rooms.’

Quiet rooms are specifically designed to have minimal noise, allowing nurses a welcome break from the stress of an average day. Nurses are encouraged to practice breathing techniques, meditate, and decompress while in these rooms. Most rooms even include a massage chair and minimal-interaction videos.

“We’re investing in and learning more about the antidote to fatigue and burnout — that is the ability for our nurses to become resilient,” said Miller, noting that Baystate has created eight quiet rooms for its nursing staff. “In order to identify and address stress, we’re creating an environment where we can openly share and discuss these feelings. It is very important to be able to do that. We’re working to promote and include self-care in their everyday lives.”

Space and quiet aren’t the only way hospitals in the area are making their nursing staff feel appreciated. Facilities are raising the bar when it comes to ongoing work to keep their nurses motivated and wanting to work.

“It’s a struggle to find fun things to do to keep people engaged and excited and interested that don’t tax our resources,” said Chevalier, adding that Mercy continues to look for ways to support its nurses.

 

Care Package

Facilities also offer smaller incentives such as food truck events, family and friend picnics, and an extra week of vacation to help nurses relax.

Mercy Medical Center has come up with the ‘comfort cart’ — the executive team travels the entire hospital with a car filled with snacks and “trinkets of appreciation,” said Chevalier.

A popular favorite at area hospitals has been meals and appreciation picnics with the families. Hatiras said his staff’s most popular pick is Chick-Fil-A meals.

Taking such steps is just one way hospitals are addressing a problem that began well before the pandemic but has been put into new perspective by what are challenging and truly unprecedented times.

Daily News Employment Health Care News Women in Businesss

HOLYOKEHolyoke Medical Center has announced the appointment of Lisa Wray-Schechterle, as the hospital’s director of Community Benefits.

Wray-Schechterle joins the hospital from Pyramid Management Group where she served as the marketing director of the Holyoke Mall at Ingleside, a position she held for more than 20 years.

Wray-Schechterle holds both a master of Arts in Communication and a Bachelor of Science in Business Administration from Western New England University. She serves as a marketing committee member for Girls Inc. of the Valley, a board member of the Holyoke Chamber of Commerce, and as an advisory board member for the Holyoke Community College School of Business.

“We are happy to welcome Lisa to our team,” said Spiros Hatiras, Holyoke Medical Center’s President and Chief Executive Officer. “Her proven ability to build collaborative partnerships coupled with her knowledge of Holyoke and the many community based organizations we work with throughout the region, will enable her to successfully manage and expand our Community Benefits program.”

Holyoke Medical Center Community Benefits provides programs and services to improve health in communities and helps to increase access to health care. This is done to advance medical and health knowledge in the community and relieve or reduce the burden of government and other community efforts. Wray-Schechterle has succeeded Kathy Anderson as the director of the department, following Anderson’s retirement. 

“I am excited to extend my knowledge and networking connections to help improve the health needs of the Pioneer Valley,” said Wray-Schechterle.  

“As the hospital has just completed their 2022 Community Health Needs Assessment, I look forward to creating the next implementation strategy based on the feedback we received and expressed needs identified by the community.”

Daily News Education Events Health Care

HOLYOKE – Holyoke Community College is now accepting applications for its free Community Health Worker training and apprenticeship program. 

The program begins in September and is tuition free thanks to a federal grant HCC received in 2020. 

The purpose of the four-year, $1.89 million grant, awarded in 2020 from the Health Resources and Service Administration (HRSA) is to increase the number of CHWs qualified to help children and families affected by opioid use.   

HRSA’s Opioid-Impacted Family Support Program supports training programs like HCC’s CHW program that enhance and expand paraprofessionals knowledge, skills, and expertise. 

 

The training involves college level coursework during the first year, as well as supervised field work experience at Behavioral Health Network in Holyoke. Classes are held in person at HCC and require basic computer proficiency and literacy skills. After the first year, students can apply for a full-time, paid apprenticeship placement — the first of its kind in Western Mass. 

 

During the pre-apprenticeship training at HCC, students take two core Community Health Worker classes across two consecutive semesters.

 

“The HCC Community Health Worker Apprenticeship Program is an initiative that offers free training for people interested in pursuing community health and human services,” said Tina Tartaglia, CHW project coordinator. “There is a specific focus on teaching students how to support children and families affected by opioid use and substance use disorders. Students with lived experience are encouraged to apply.”  

 

This is the third year of the four-year grant, which aims to train 25 individuals as CHWs each year. The grant also provides stipends to students as incentives to complete the program and seek employment in the field. Students who enter an apprenticeship after they finish training are eligible for an additional annual stipend of $7,500.

 

“COVID-19 has made clear how essential community health workers are in addressing the wide range of physical, behavioral and mental health issues faced by members of our community,” President Royal said in 2020 after the HRSA grant was awarded. “Through this program and with our partners, we will not only have the ability to support more families struggling with substance use, but we will also be creating more jobs in a sector central to our region’s economic growth.”

 

HCC’s partners in the grant include Behavioral Health Network, Holyoke Health Center, and the MassHire Hampden County Workforce Board.

 

For more information or to apply, please visit hcc.edu/chw-free

Daily News Education Environment and Engineering HCN News & Notes Health Care News Sports & Leisure Summer Safety Travel and Tourism

AMHERST — UMass Amherst has received a $10 million, five-year award from the Centers for Disease Control and Prevention (CDC) to create the New England Center of Excellence in Vector-Borne Diseases (NEWVEC).

The UMass-based center is one in a group of regional centers of excellence designated by the CDC to reduce the risk of vector-borne diseases – such as Lyme disease and West Nile virus – spread by ticks, mosquitoes and other blood-sucking arthropods across the U.S.

Stephen Rich, vector-borne disease expert and professor of microbiology, is the principal investigator on the project and will serve as the executive director of NEWVEC, whose three-pronged mission will integrate applied research, training and community of practice to prevent and reduce tick- and mosquito-borne diseases in New England. NEWVEC aims to bring together academic communities, public health practitioners and residents and visitors across the Northeast.

“We’re really excited about building this community of practice and embracing all the stakeholders in the region who need to know how to do things like reduce ticks and mosquitoes on school properties and public spaces. It is also important to inform the public on best practices to keep ticks and mosquitoes from biting people and their pets,” Rich said. “Part of that mission entails training public health entomologists — undergraduate, master’s and Ph.D.-level students — who are going to be the next generation of people confronting these challenges.”

Infectious disease epidemiologist Andrew Lover, assistant professor in the School of Public Health and Health Sciences, will serve as deputy director of the center, with co-principal investigator Guang Xu at UMass Amherst, and co-principal investigators at Northern Vermont University, the University of Maine, University of New Hampshire, University of Rhode Island and Western Connecticut State University.

“This center fills a critical gap in responses to vector-borne disease in the region,” said Lover, who aims to apply his prior work with regional malaria elimination programs to build strong networks across the Northeast region. “As pathogens and vectors don’t pay attention to borders, coordination across states is essential for public health response. Among other things, we’ll develop practical public health tools to understand how and where people are most likely to interact with ticks, which will then allow for well-targeted and efficient health programs.”

His lab also will provide technical assistance to directly support local health practitioners in optimizing vector surveillance strategies and designing operational research to improve program effectiveness.

Xu, research professor of microbiology, will be responsible for the center’s pathogen testing core and will conduct applied research in the evaluation of tick suppression approaches.

Rich notes that blood-sucking ticks transmit more vector-borne diseases than any other arthropod in North America, accounting for some 400,000 cases of Lyme disease alone every year. “And at least a half-dozen other pathogens are associated with the blacklegged tick,” commonly known as the deer tick, he adds. “It’s kind of a silent epidemic.”

The researchers say it’s critical to attack the problem on all fronts by using applied research projects to reduce tick populations and optimize personal protection and control products, and by training public health students and workers, as well as individuals.

Health Care

Seizing the Moment

Dr. Ira Helfand

Dr. Ira Helfand says the war in Ukraine presents an opportunity to gain real progress in ongoing efforts to ban the use of nuclear weapons.

Dr. Ira Helfand notes that, since Russia became the second nation to produce nuclear weapons in the late 1940s, the threat of a global nuclear conflict has always been real.

To most, though, it has never really seemed real, except for the duration of the Cold War, which officially ended more than 30 years ago, and especially that two-week crack in time in 1962 that came to be known as the Cuban Missile Crisis, said Helfand, noting that for many, that event is only something to be read about, not something they lived through.

But the events in Ukraine are changing this narrative, and in a profound — and urgent — way, said Helfand, a retired emergency room physician at Mercy Medical Center and co-chair of the Physicians for Social Responsibility’s Nuclear Weapons Abolition Committee, a name that clearly speaks to its mission.

He told BusinessWest that recent events — not just those in Ukraine but also those in North Korea, as well — have made the threat of nuclear war as real as ever. And while this is certainly a scary time because of these threats, it might also be considered a time of opportunity when it comes to the Nuclear Weapons Abolition Committee and its stated mission.

“If there is to be any good that comes out of this terrible disaster in Ukraine, perhaps it will be an understanding of the need around the world to eliminate nuclear weapons,” he said. “Which will lead to effective political action to achieve that.”

In recent months, Helfand, who has, over the years, spoken to groups ranging from local Rotary clubs to special sessions of the United Nations General Assembly on the subject of preventing nuclear war, has been ramping up such efforts — through speaking engagements, op-ed pieces, and interviews with media out like this one — and using current events to bring more attention to a 75-year-old issue.

“If there is to be any good that comes out of this terrible disaster in Ukraine, perhaps it will be an understanding of the need around the world to eliminate nuclear weapons.”

The initiative is called the ‘Back from the Brink Campaign,’ which is based on the nuclear-freeze campaign of the 1980s, which brought about an end to the Cold War arms race, he said. Except this time, the goal is to get rid of the weapons altogether.

Those behind the effort are “organizing around a simple platform, a simple statement of what U.S. nuclear policy ought to be — a key part of which is a call for the United States to begin now to negotiate with the other eight nuclear-armed countries for a verifiable, enforceable, mutual timetable to eliminate nuclear weapons,” he said. “This is not unilateral disarmament, it’s a call for the United States to lead the negotiations to achieve universal disarmament.”

Organizers have brought resolutions embodying this platform to cities and towns, civic organizations, and faith organizations across the country, he went on, adding that more than 60 municipalities, including Springfield, Worcester, Boston, and others in Massachusetts have signed the statement, as well as several state legislatures.

The goal is to gain a national consensus on the matter, said Helfand, adding that he senses momentum in the ongoing efforts to ban nuclear weapons and the potential for much more.

“The current war in Ukraine is putting this issue before people again in a way that will lead to a good outcome,” he noted. “This issue is back where it ought to have been all this time — on the table and on the public agenda. We’ve been trying to use this occasion to educate people about the danger.”

For this issue, BusinessWest talked at length with Helfand about Back from the Brink and ongoing efforts to prevent a nuclear war by banning such weapons. He expressed the hope that current events may just provide inspiration to bring change on a truly global scale.

 

Understanding the Consequences

Helfand, who has published studies on the medical consequences of nuclear war in the New England Journal of Medicine, the British Medical Journal, the World Medical Journal, and other publications, said one challenge to banning nuclear weapons is a lack of clear understanding among many people about just what a nuclear conflict would be like.

Indeed, he told BusinessWest that many still think in terms of 1945 and the weapons used then when they contemplate nuclear war.

So, he isn’t at all shy about painting what he said is a much more accurate picture, and he did so for BusinessWest.

“If the United States and Russia go to war today, it’s not going to be one relatively small bomb used on one or two cities, as was the case in 1945; it’s going to be many bombs used against many cities, and these bombs will be 10 to 50 times more powerful than the one that destroyed Hiroshima,” he said. “If that were happen, within a thousandth of a second, a fireball would form reaching out two miles in every direction, four miles across. Within this entire area, everything would be vaporized — buildings, trees, people … the upper level of the Earth itself would disappear.

“To a distance of four miles in every direction, the explosion would generate winds of 600 miles per hour,” he went on. “Mechanical forces of that nature destroy anything that human beings can build. To a distance of six miles in every direction, the heat would be so great that automobiles would melt, and to a distance of 16 miles in every direction, the heat would still be so intense that everything flammable would burn — paper, cloth, wood, gasoline, heating oil, plastic … it would all ignite. There would be hundreds of thousands of fires, which over the next half hour, would coalesce into a giant firestorm 32 miles across, covering more than 800 square miles. Within this entire area, the temperature would rise to 1,400 degrees Fahrenheit, all the oxygen would be consumed, and every living thing would die.

“In the case of Boston, we’re talking about 3 million to 5 million people, depending on the time of day,” he continued. “In the case of New York, 12 million to 15 million people, and if we have a major war with Russia, that’s what’s going to happen to every major city in both countries. In addition, the entire economic infrastructure of the country would be destroyed; we would see 200 million to 400 million dead in the first afternoon, but those who survived would be living in an environment with no electric grid, no healthcare system, no internet, no food-distribution system — none of the things we rely on to survive.”

Beyond all of this, there would be enormous effects on climate, he said, noting that perhaps 150 million tons of soot would be deposited into the atmosphere, blocking out the sun, and dropping temperatures across the planet an average of 18 degrees Fahrenheit “which is much colder than the coldest moment of the last ice age.”

Preventing such a calamity has long been the goal of Physicians for Social Responsibility, a national organization of physicians, other health professionals, and others who are concerned about the medical consequences of nuclear war. Started in 1978, the organization has a stated mission to educate the public and decision makers about those medical consequences, “in the hope that a better-educated public and a better-educated body of decision-makers would make smarter decisions about nuclear weapons than they have been making, unfortunately,” said Helfand.

The group is part of an organization called the International Federation for the Prevention of Nuclear War (IFPNW), which has affiliates in 55 countries. In 1997, the IFPNW started a global campaign to abolish nuclear weapons, which, in collaboration with some state governments, led to the adoption at the United Nations in 2017 of the Treaty on the Prohibition of Nuclear Weapons, which entered into force in January 2021.

 

Marshalling Forces

In recent months, the IFPNW has been increasingly active in pushing toward its goal of bringing an end to nuclear weapons, and as noted earlier, it is using the crush of current events to state its case and bring the issue to the fore — or back to the fore.

“For the past 30 years, since the end of the Cold War, the biggest obstacle we’ve faced in doing our work has been the fact that people had thought the nuclear danger had gone away,” Helfand explained. “Back in the ’80s, everyone understood that nuclear war was a real threat; people were concerned about it, and they took political action to try to end the Cold War, work that was ultimately successful. But when the Cold War ended, everyone assumed that the danger had passed, and they stopped paying attention to the issue.

“If the United States and Russia go to war today, it’s not going to be one relatively small bomb used on one or two cities, as was the case in 1945; it’s going to be many bombs used against many cities, and these bombs will be 10 to 50 times more powerful than the one that destroyed Hiroshima.”

“That has changed dramatically in the past few months since Putin invaded Ukraine and issued a series of very explicit nuclear threats,” he went on. “Which, by the way, were responded to by NATO with equally inappropriate nuclear threats.”

Elaborating, Helfand said the current events in Ukraine bring new meaning to sentiments expressed in a quote he attributed to Robert McNamara, U.S. Defense secretary during the Vietnam War.

“He said, famously, ‘we lucked out — it was only luck that prevented nuclear war,’” noted Helfand, adding that have been countless times over the past 77 years when the world almost experienced nuclear war, but didn’t, for reasons that have little to do with the conventional wisdom regarding these weapons.

“There has been this myth, with enormous power attached to it, that nuclear weapons are so terrible that they will deter their own use — no one will ever make the mistake of using them,” he explained. “We know that over the decades, that has not been true.”

Elaborating, he said that over the years, the United States has threatened to use nuclear weapons repeatedly, in many circumstances involving countries that did not have nuclear weapons, and Russia has as well. And beyond these threats, there has always been the threat of something happening by accident.

“There have been many, many occasions when we have come within minutes of nuclear war because one side or the other received a false alert and believed they were under attack by the other side,” he explained. “On many of these occasions, we came within minutes of all-out nuclear war because of a computer glitch or some similar technical mistake.”

Given the immense amount of tension in the world now, another glitch of this kind may well lead to calamity, he said, bringing even more urgency to the matter of banning such weapons.

That course is the only logical choice for the planet, said Helfand, adding that the alternative, staying the current course, is not sound thinking.

“Our current policy — maintaining these enormous arsenals with the expectation that they will never be used — is nothing more than the hope for continued good luck,” he told BusinessWest. “And this is a fairly insane basis for national security policy. We need to plan for the future based on reality, not hopes and prayers.

 

Looming Questions

Returning to that question about whether he’s sensing any momentum on the IPPNW’s broad mission to prevent nuclear war by eliminating such weapons, Helfand said there are a few narratives that could flow from the present situation.

“Those who build nuclear weapons will argue that we need to have more of them — that argument will gain some traction,” he said. “They’ll say ‘the Russians are really bad — we need to be even stronger, as if the 6,000 nuclear weapons we already have are not enough to do what anyone could possibly want to do with them.

“But there will be another narrative as well,” he went on. “As happened after the Cuban Missile Crisis, when both Kennedy and Khrushchev recoiled in horror from what they had almost done, people around the world are going to look at this moment and say, ‘this was a world-wide near-death experience; we cannot keep rolling the dice and hoping that we’re going to be luck every time — we have to get rid of the weapons.’”

That’s why he looks on this very scary time in the history of the world as something else — an opportunity.

Health Care

Shining Example

By Elizabeth Sears

The team at Charlene Manor

The team at Charlene Manor displays the banner announcing that the facility has been honored with the Silver Achievement in Quality Award.

Sometimes accolades and honorifics cannot compare to the rewarding aspects of certain fields of work.

Just ask the staff members at Charlene Manor, a skilled nursing facility in Greenfield that is part of the Berkshire Healthcare system. When speaking with BusinessWest, employees at the facility were unanimous in their opinion that while winning awards — and Charlene Manor recently earned a notable honor — is important, it’s the reasons behind those awards that are far more significant.

“In a hospital, you have people that come and go; in a skilled nursing facility, many of these residents are with us for a long period of time,” Margie Laurin, Charlene Manor’s marketing communications coordinator, explained. “We experience their milestone birthdays with them, we experience their joys and their pains. It’s much more than just providing clinical care — it’s providing that care with a level of compassion that I have not seen in any other work that I’ve done prior to being in this industry.”

Charlene Manor is celebrating its 35th year in operation, having opened in 1987. It has been growing and evolving ever since while remaining true to its mission — to give back to the community and provide a quality level of specialized programs and services that range from cardiac recovery to hospice and palliative care; from diabetes management and education to stroke recovery.

Which brings us to that award. The facility achieved an important distinction in 2021 — the American Health Care Assoc./National Center for Assisted Living (AHCA/NCAL) Silver Achievement in Quality Award.

“We experience their milestone birthdays with them, we experience their joys and their pains. It’s much more than just providing clinical care — it’s providing that care with a level of compassion that I have not seen in any other work that I’ve done prior to being in this industry.”

“Silver recipients have to outline their systematic approaches, and they have to demonstrate their quality and clinical outcomes and the sustainability of their organizational and process results that are linked to these outcomes to ensure success — how they meet certain challenges, and make sure that they meet key customer requirements,” said Laurin, noting that

Charlene Manor was one of two facilities in the Commonwealth that received this achievement.

To put that into perspective, there are more than 400 facilities providing such services in the state. Charlene Manor is the only skilled nursing facility that received this award — the other winner was an assisted living facility from eastern Mass.

“With our silver award, we were able to clearly demonstrate that we made improvements,” said Ashley LeBeau, administrator of Charlene Manor. “We responded to the feedback, which is really the key when you’re asking someone for feedback. You must then respond to it, put plans in place to improve it; we were very much able to do that.”

The team members at Charlene Manor can speak to this improvement with concrete evidence from over the years. The facility has a five-star rating from the Department of Public Health, and that rating has been maintained for more than two years. Customer satisfaction surveys from both short-term and long-term residents have shown improvement as well, and that demonstration contributed to Charlene Manor earning the silver award, said LeBeau.

For this issue, BusinessWest talked with Laurin and LeBeau about the Silver Award, but more about what went into earning it and what the honor says about the facility and its team.

 

Shining Examples

The term ‘skilled nursing’ oftentimes is used interchangeably with assisted living and nursing homes, when in actuality they are quite different. Skilled nursing care refers to a patient’s need for care or treatment that can only be performed by licensed nurses. It can take place in a variety of settings — hospitals, assisted living communities, and in the case of Charlene Manor, skilled nursing facilities.

Skilled nursing is regulated by the Department of Health Centers for Medicare & Medicaid Services (CMS). To be certified by CMS, skilled nursing communities must meet strict criteria. They are subject to periodic inspections to ensure the quality standards are being met.

“That’s why this silver award is so critically important and such an honor — because these are such stringent criteria to have to be met so above and beyond,” said Laurin.

Skilled nursing can encompass a wide range of care. It can mean short-term care after someone has had surgery, physical or occupational therapy, IV therapy, as well as many other forms of care.

“With our silver award, we were able to clearly demonstrate that we made improvements. We responded to the feedback, which is really the key when you’re asking someone for feedback. You must then respond to it, put plans in place to improve it; we were very much able to do that.”

The majority of Charlene Manor’s referrals come from hospitals, but its reach has recently expanded. Due to its high-quality service and the surge seen in hospitals from the pandemic, the Department of Public Health chose to partner with Charlene Manor. Another important collaborative relationship Charlene Manor has is with Pioneer Valley Hospice & Palliative Care.

Skilled nursing staff include a variety of positions including RNs, LPNs, CNAs, medical directors, speech/language pathologists, and resident care assistants. And these professionals work together as a team.

Resident care assistants (RCAs) play an integral role within the facility. It’s an introductory role where individuals who are just starting off in the healthcare career can explore if it’s the right fit for them. They spend an intimate amount of time with residents, providing the most amount of care per day to patients while simultaneously building strong relationships with them.

Charlene Manor focuses on recruiting and aiding those entering the field, now more than ever — since the pandemic began, the skilled nursing industry has lost 241,000 caregivers according to AHCA.

“For this reason, it is critically important for us as an organization — we put in place strategies and do everything we can to encourage and nurture and promote these skilled caregivers within our facilities,” said Laurin. “And Charlene Manor specifically has been a community that has had a really strong history of providing employment opportunities and having good care around these positions.”

LeBeau started as a dining services aid at Charlene Manor’s sister facility in Leeds when she was in high school. She’s been with the organization ever since, going from working in dining services to becoming the director of Admissions. She then earned her AIT, went on to get her administrator’s license, and has been administrator at Charlene Manor now for 11 years.

“One of the things that I am most proud of as a Berkshire Healthcare employee is that our opportunities for growth in this organization are unmatched,” she went on. “There are so many opportunities for growth in this organization.”

LeBeau’s story provides just one example of such growth and opportunities for advancement. Indeed, Berkshire Healthcare offers a nursing program called Stepping Stones which, if accepted, provides aspiring healthcare professionals a tuition-free path to earning certifications and attending nursing school.

“We’ve had a number of entry-level staff go through nursing programs through our Stepping Stones program to become LPNs, RNs … some have gone through to get their BSN, and it’s just incredible the amount that we reinvest because we are not-for-profit,” said LeBeau. “We have a mission, and part of our mission is to reinvest in our people, and we do that every single day here.”

Indeed, while the AHCA/NCAL Silver Achievement in Quality Award is a noteworthy honor, recognition is not the motivation behind Charlene Manor’s skilled nursing services. The most rewarding aspect for those working at the facility is the ability to serve those in Franklin County and beyond.

“The rewards are immense. But speaking about providing care to this population — our residents and patients that we serve become much, much more than that,” said Laurin. “They’re like family. That’s why it’s critically important to recruit and invest in long-standing employees, because these are relationships. This is an industry that is about relationships. Not just the relationships with the residents, but with their families as well.”

A Focus on Care

Simply put, Charlene Manor has put in extraordinary efforts to help take care of their community members, and its Silver Achievement in Quality Award Silver is just one of many examples of how their work is paying off.

“As an organization, we are very proud of the work that Charlene Manor, and Ashley and her team, have done — especially during such a challenging time,” said Laurin.

Health Care Special Coverage

Mind Over Matters

By Mark Morris

Alyssa Bustamante

Alyssa Bustamante, an occupational therapist with ServiceNet.

According to the Center for Neurological Studies, someone in the U.S. sustains a brain injury every nine seconds. You can do the math.

All brain injuries that are not hereditary are considered acquired brain injuries. One well-known type is a traumatic brain injury (TBI), which results from a car accident, sports injury, a fall, or other incident. The other type of acquired brain injury (ABI) results from events such as a stroke, encephalitis, a brain tumor, or other medical issue.

The effects of a brain injury are unique to each individual. The professionals who work with afflicted patients design individualized treatment plans for each patient. Everyone involved shares a common goal — to help the patient get back to their maximum level of function and independence.

BusinessWest talked with three professional groups that work with brain injury patients at different stages of the recovery process. Those associated with these groups shared common thoughts on what they do and the underlying goals behind their work.

A brain injury is very often a life-changing event, they said. And those who work with those who have suffered such injuries dedicate themselves to helping patients get the most out of what could be considered their new life.

 

Thought-provoking Examples

When a person suffers a brain injury, they receive their initial care at an acute care hospital such as Baystate Medical Center or Mercy Medical Center. The next step is a stay in a rehabilitation facility such as Encompass Health Rehabilitation Hospital of Western Massachusetts in Ludlow, where the typical patient may spend from seven up to 21 days, depending on the severity of the brain injury.

“In the beginning we spend lots of time educating patients and their families about what to expect with brain injuries and how the brain heals.”

Because our brains affect all our physical and mental functions, evidence-based research has shown that a multi-disciplinary approach to treatment results in the best outcomes. According to Julie Bugeau, an occupational therapist with Encompass, their approach to care involves making sure the medical staff, along with the occupational therapist, physical therapist, and speech therapist work closely together as a team.

“Brain injuries are complex, so we need all these disciplines to make sure the patient’s needs are addressed,” she told BusinessWest.

When brain injury patients arrive at Encompass, each one has a different level of severity, so the first few days are usually spent on developing a plan for recovery and preparing the patient for what they will encounter in therapy.

“In the beginning we spend lots of time educating patients and their families about what to expect with brain injuries and how the brain heals,” said Stefanie Cust, a physical therapist with Encompass. “We would like to get them up and walking right away but not everyone is ready for that so we may take a couple days to understand where they are and what they can do.”

Managing expectations for the patient and their family is an important part of the therapy process because everyone progresses differently and at their own pace. Bugeau said patients will often have a personality change and become easily agitated or inappropriate in the way they speak or interact with others.

physical therapist

Stefanie Cust, left, a physical therapist at Encompass Encompass Health Rehabilitation Hospital, and Julie Bugeau, an occupational therapist at Encompass, demonstrate a device to improve use of the hand and wrist.

“We don’t want families to get angry with their loved ones because they are acting in a certain way,” Bugeau said. “That’s why constant communication with the family and everyone on the team is critical to managing their expectations.”

A walk through the facility at Encompass reveals what looks like a large gymnasium with people working out on various machines. While standard fitness machines are part of the mix, there is also an array of specialized equipment designed to help people regain movement in areas of their bodies that were affected by brain injury.

Sometimes the equipment is as simple as parallel bars to aid in walking or a set of stairs. Other times high-tech equipment is used such as interactive touch screens to help the patient regain coordination, reaction time and cognitive abilities.

Cust and Bugeau demonstrated a Bioness H200 a device that fits on the forearm and is used to simulate normal wrist and finger movement for neuromuscular rehabilitation. By using a tablet, a therapist controls the H200 to aid the patient in opening and closing their hand. It’s also used to help build back wrist and hand muscles through repeated movements.

“People with brain injuries need someone to encourage them to get up and move, otherwise they will just sit and do nothing.”

The goal of the therapists at Encompass is for patients to return home. Before patients are discharged, they leave with a recovery plan to help the patient going forward. A case manager gets involved to prepare the family and prepare the home before discharge. In many cases the patient will need outpatient treatment, whether at a facility or at home. Encompass puts patients and families in touch with community resources to keep moving toward recovery goals.

 

Finding a New Way

As late as the 2010s, patients with brain injuries in Massachusetts who required care beyond what they could get at home were mandated to live in nursing homes. A class-action suit resulted in creating two waivers, one for ABI and one known as a Moving Forward Plan (MFP) waiver. Both waivers make it possible for other organizations in the community to provide long-term treatment for people suffering from brain injuries.

Mental Health Association (MHA) created the New Way Services Division to specifically offer treatment for people with ABI. The agency owns nine houses located in communities in and around Springfield. Each residence looks like a typical family home and accommodates up to four adults.

“These residences are the person’s home for as long as they need it to be,” said Sara Kyser, vice president of the New Way Services Division at MHA. “While some folks are likely to spend the rest of their days there, we also have many people who gradually need fewer services and they are able to return to their families.”

Each person has an individualized treatment plan, most of which include regular visits from occupational, physical, and speech therapists. Nurses also visit each home to assist with such things as re-learning taking medication and other tasks. One of the homes is designed to be a transition step where instead of receiving highly intensive support the person is more on their own but still has a safety net.

Lexi Stockwell

Lexi Stockwell says the Strive Clinic at ServiceNet helps those with brain injuries continue to make progress in their recovery.

“The goal is to bring people back to where they were or to a less-restricted setting,” Kyser said. “When possible, they can return to their family and still access outreach supports.”

One of those supports is The Resource Center (TRC) run by MHA. Serving as a day service, Kyser explained that this is where people can work on an array of interesting activities to help with physical and mental rehab in ways that don’t feel like therapy.

“Instead of squeezing a tennis ball, they are doing art projects, engaged in writing, and one of our most popular activities working on wood projects,” Kyser said.

While these activities provide physical therapy, they also help people work on their social skills. Kyser said impulse control is often affected by a brain injury, so learning how to interact with the world again takes some practice.

When BusinessWest visited, staff at TRC were preparing gardening kits in time for planting season.

“The idea is for these folks to learn about and actually plant their own gardens at their own homes,” Kyser said. “They will then harvest and incorporate the fresh fruits and veggies into their nutrition program to bring the whole thing full circle.”

 

Striving for Improvement

ServiceNet is also a provider of long-term rehabilitative care. Through its Enrichment Center in Chicopee, ServiceNet runs the Strive Clinic to help those afflicted with brain injuries to continue to make progress in their recovery.

According to Ellen Werner, director of operations for ServiceNet’s Enrichment Center and Strive Clinic, the motivation for Strive became apparent after learning about people who were sitting at home with brain injuries who needed therapy.

“People with brain injuries need someone to encourage them to get up and move, otherwise they will just sit and do nothing,” said Werner.

Part of the recovery process also involves persuading people to try things when they don’t think they need to participate. Alyssa Bustamante, an occupational therapist with Strive, said that she and her colleagues try to make patients understand that recovery happens when all the therapies work together. Left to their own devices, patients will tend to only take part in their favorite activities.

“Everyone loves physical therapy, so they all want that,” said Bustamante, adding that one patient felt she didn’t need speech therapy because she just wanted to be able to get dressed. “This person had trouble sequencing the steps to get dressed, which is cognitively based, and speech therapy helps with that,”

Keeping active is essential to prevent brain injury patients from reaching a plateau and backsliding in their recovery. At the beginning of the pandemic many brain-injury patients lost therapy sessions. By the time they were able to return, Werner said that many came in deconditioned and could not do as much as before.

“They still had the foundation of the therapy, but they had lost endurance,” Werner said.

The Strive Clinic has adopted the motto of “Never say Never” to encourage patients to always set new goals in rehabilitation. As an example of that spirit, Werner and Bustamante discussed the case of a gentleman named Bill (not his real name.)

Bill had suffered a stroke more than 10 years ago, and had a below-the-knee amputation. Though he had a prosthetic device for his leg he wasn’t interested in leaving his wheelchair. Enrolled in the day program at the Enrichment Center, Bill would sit in the hallway outside of Werner’s office. When she would attempt to engage and ask, ‘What would you like to do today?’ Bill’s response was, ‘Shut up and leave me alone.’

Bustamante and Lexi Stockwell, a physical therapist with Strive also began speaking with Bill and gradually convinced him he was capable of more than just sitting in his wheelchair.

“At first, with help from others Bill could take about five or six steps on the parallel bars,” Stockwell said. “Now he can pull himself out of his wheelchair, grab the walker on his own and walk 50 feet. That’s big progress in a year.”

Bustamante said Bill has also developed better coping strategies and he speaks in more positive terms. “He’s finding the joy in himself and spreading it.”

Werner added, “Bill now refers to himself as the mayor of the Enrichment Center and he’s become an advocate for our program.”

Bill’s story is an example of how it’s never too late to make progress with a brain injury.

“Everyone needs to keep busy, especially people with brain injuries,” Werner said. “Just because someone says they don’t want help, we keep asking to see how we can get them moving and get them involved.”

Kyser spoke to a misperception that contends the first 90 days after diagnosing a brain injury is the real opportunity to make progress on a patient, but after six months that opportunity is gone.

“That’s baloney,” Kyser said noting that in the past, services didn’t exist after six months, so without engagement it was no surprise that the person was hitting a plateau.

 

The Bottom Line

Thanks to the efforts from agencies like Encompass, MHA and ServiceNet, brain injury patients are making progress every day re-gaining the use of their muscles, many can walk again, and, most importantly, live with independence after their injuries.

“There’s so much that can be done as long as the person is engaged in their therapies,” Kyser said. “My hope is as we’re getting better at this, we will see even more progress.”

Health Care

Speaking from Experience

By Elizabeth Sears

 

Dallas Clark

Dallas Clark says lived experience and empathy are key to what makes recovery coaches so effective.

Dallas Clark is in the business of spreading empathy and sharing hope. 

He is a recovery coach in the Recovery Coaching program at MHA’s BestLife Emotional Health and Wellness Center in Springfield. Inspired by the positive influence his own recovery coach had on him, Clark helps individuals who are facing the challenges of addiction to meet their goals and connect back into the community. 

A recovery coach is someone who has gone through the recovery process themselves and has completed the certifications required to become a coach. They act as a bridge to recovery, a ‘concierge’ of sorts, helping clients take control and regain power in their lives by providing them with wellness plans, encouragement, and other forms of assistance.

This model of treatment works because of the trust that is built between coaches and clients. Due to walking a similar path, recovery coaches are able to understand the experiences and emotions of their clients in a way others without such life experience cannot. They know what it is like to have an addiction and can connect on a personal level with someone looking to begin their own recovery. 

“The peer-to-peer counseling that recovery coaches provide is a very vital part of the process.”

“One thing that’s important about being a recovery coach is that we have lived experience. When we talk about empathy, we’ve been in those shoes,” Clark said. “I know it’s very important that you be supported by somebody that really does understand what you’re saying.”

Tommy Smyth, another recovery coach in the program, echoed this sentiment.

“The peer-to-peer counseling that recovery coaches provide is a very vital part of the process in terms of offering the comfort level of a shared experience,” he noted. “We are among the first supports someone beginning recovery encounters and often where they begin to trust the process. I continue to meet with them in addition to whoever and whatever else becomes part of their recovery.”

Recovery coaches help to motivate, support, and empower clients in a way that meets their specific needs. This help sometimes involves providing referrals. Clark recalled recently helping one of his clients find a primary-care physician and helping others with goals like finding a dentist or changing medications. 

Tommy Smyth

Tommy Smyth says no one should feel stigma or shame about seeking treatment for addiction.

Other times, recovery coaches help individuals communicate with their family, assist in building a broad support team, and provide resources for family members who may feel helpless. Whatever the case, clients are met exactly where they are in their recovery process, whether in the very early stages or further along. 

“We collaborate on a wellness plan, prioritizing goals and building on individual strengths to empower their recovery. It is their recovery,” Smyth said. “I can use my recovery as an example and in understanding what they are dealing with or feeling, but recovery is about giving power back to the individual to take charge of their healing and eventually their lives.”

 

Meeting a Growing Need

MHA’s Recovery Coaching program launched on Feb. 17, 2020 — less than a month before the World Health Organization declared COVID-19 a pandemic. The inability to meet clients in person proved to be a noteworthy obstacle for coaches to try to overcome, as well as trying to bring clients back into a community that was shut down.

“The major issue was not having the one-on-one connection because recovery coaching is really based on relationship building. Not being in-person and getting to meet the individual, it was hard to build a strong relationship over the phone,” Clark said. “It was a lot of meetings being on Zoom. A lot of people didn’t know how to use Zoom, so that was a difficult part, and just connecting people back into the community.”

However, the pandemic’s impact did not mean a slow start for the program. There was only one coach at the time of its initial launch, but an immediately full caseload emphasized a need to add more staff. Since then, MHA has added four certified recovery coaches for a total of five coaches in the program. They are continuing to expand, planning to take on more coaches as needed.

“We’re starting to build collaborations with other agencies, which are providing more referrals for us, so that’s one reason we’re expanding the Recovery Coaching program,” Clark said.

The program has now shifted to a hybrid format, offering a combination of in-person and remote coaching. Also, the impact of certain resources reopening after previously closing during the pandemic has been felt greatly by members of the program. 

“We’re getting back to that place now where recovery centers are back open. Drop-off centers are back open, and that’s a big plus because, when the pandemic hit, a lot of places had shut down that are recovery-oriented,” Clark said. “People didn’t have those safe places to turn to.”

Smyth spoke on the recent death of Jimmy Hayes, an NHL hockey player from Massachusetts who died from a combination of fentanyl and cocaine. Hayes’s father expressed fear of the media portraying his son as a “junkie.” In response to this, Smyth emphasized the importance of treating individuals who experience addiction with empathy and dignity, as well as providing them with the help they need. 

“If you want to get help, there are people out there, including recovery coaches who have been where you are, willing to walk and fight with you. You don’t have to keep going through what you are going through alone — you can take control, and you will get your life back.”

Addiction is a disease with a gripping nature that cannot be overstated, and with the especially risky nature of drugs being laced with cheaper and more lethal substances and sold to unsuspecting buyers, resources like MHA’s Recovery Coaching program are essential for members of the community experiencing addiction, Smyth noted.

“Recovery coaches can and do make a difference. The more we can educate the public about addiction and the role recovery coaches can play, the better,” he said. “No one should be stigmatized or judged for having an addiction to a substance. No one should be made to feel shame, rejection, or failure in seeking treatment to start and sustain recovery.”

 

From Despair to Hope

The feelings of empathy and hope that Clark and Smyth exude can be felt in a single conversation with them. Smyth concluded with a word of encouragement for anyone seeking to regain control of their lives from an addiction. 

“If you want to get help, there are people out there, including recovery coaches who have been where you are, willing to walk and fight with you. You don’t have to keep going through what you are going through alone — you can take control, and you will get your life back.”

When asked what message he would like to leave with BusinessWest’s readers, Clark spoke, without a single hesitation, of hope.

“I think the most important part is providing that hope for others. I always tell people that I didn’t know what that looked like. I didn’t even believe in myself, but somebody believed in me. I didn’t have hope — somebody gave hope to me.”

Health Care

New Lease on Life

Daniella Grimaldi

Daniella Grimaldi says it often takes weeks for clients to warm to the program — but the results speak for themselves.

 

Daniella Grimaldi has worked with young addicts long enough to know it can happen to anyone.

“I say this to everybody: you don’t know what you don’t know about your kids. You could have the best kids in the world and raise them the right away, but all they have to do is hang out with someone who’s doing the wrong thing. That’s when kids fall behind.”

And fall, all too often, into substance abuse. That’s where Goodwin House comes in.

“We are one of the only programs like this in the state,” said Grimaldi, program director of the house in Chicopee opened by the Center for Human Development in 2017 and named after its long-time CEO, Jim Goodwin. Its clients are teenage boys, ages 13 to 17, who live there, often after a stint in detox, for 30 to 90 days in order to recover from addiction and learn the coping mechanisms and life skills they need to be successful — and remain drug-free — afterward.

“There aren’t a lot of these programs for adolescents,” she went on. “But this is the age where, if you get the help you need, you’ll be more successful than if you get the help at 30 or 40 years old and know you’ve wasted all that time engaging in substances and not getting help.

“I think it’s critical. A lot of our kiddos who leave us call us a year or two later and say, ‘I’m really thankful for the opportunity,’” Grimaldi added. “I recently talked to a kiddo who left us at beginning of 2020, and he was like, ‘Daniella, do you remember me? I’ve been sober for 399 days.’ That’s something I’m really proud of, when kids call back, and they’re proud of themselves.”

“This is the age where, if you get the help you need, you’ll be more successful than if you get the help at 30 or 40 years old and know you’ve wasted all that time.”

At first, Goodwin House focused solely on substance abuse, but earlier this year, it became ‘co-occurring enhanced,’ which means it focuses on both substance abuse and the mental-health piece. In doing so, the client-to-staff ratio shrank from 1:5 to 1:3. “We changed the ratio to better support the residents we serve, and we hired a bunch of new positions,” Grimaldi said.

Among those are a recreational therapist. “She was a teacher, so she’s always worked with adolescents. She’s able to do therapeutic relationship building with our residents and tie it all back into their therapeutic approach, which I think is awesome. You never think about how teaching clients how to play basketball together could actually be a therapeutic group. You think it’s just you out here playing with your friends; it’s just basketball — but it’s not. It’s more than that.”

Goodwin House also hired an educational liaison to help clients bridge the gap between their work at Liberty Preparatory Academy — a recovery-focused high school in Springfield they attend during their time in the program — and their normal school districts. “It makes for an easier transition; it’s not so chaotic,” Grimaldi explained.

“They don’t want to be here,” she was quick to admit. “I’ve never had a kid who really, truly wanted to physically be here, but they work the program, and then they realize it’s not as bad as they think, and they do the work so they can gain the sobriety they need.”

And then come those post-program phone calls, when Grimaldi hears them say they’re glad they stayed.

 

Busy Schedule

Clients are referred to Goodwin House from many sources, she told BusinessWest.

“It could be self-referral from the adolescent themselves, from teachers, schools, courts, the DYS system, the DCF system, or it can be from their own parents. Anyone can make a referral to Goodwin House. We accept all different types of insurance, and if we don’t accept your insurance, the biller of last resort pays — so DPH picks up cost, or DCF — so no kid is left behind and everyone is entitled to treatment.”

Goodwin House opened in 2017

Goodwin House opened in 2017 focusing solely on substance abuse, but recently became ‘co-occurring enhanced’ to focus on mental health as well.

The house’s capacity is 15 residents, although it’s running under that during the pandemic. A typical weekday has clients attending Liberty Prep, then returning for a snack and ‘room time’ so they can settle down from the day.

“Some kids don’t like school; it can be traumatic, triggering, and bring a lot of anxiety, so we let them have a cool-off period of about 30 minutes,” Grimaldi explained.

That’s followed by a strict regimen: a group therapy session, recreational therapy, dinner, chores, another clinical group, maybe a local recovery meeting with Alcoholics Anonymous or Narcotics Anonymous, then phone calls, down time, and bed.

The weekends are similar, with school replaced by recreational activities in the community, such as bowling outings. That is, as long as they’re eligible to go. The program operates on a motivational ‘level’ system, and clients progress from orientation to level 5, with more privileges the higher they go.

“If you work the program, the program works for you,” Grimaldi said. “What you’re willing to put in is what you’ll take out of it.”

Often, the residents aren’t serious about the program for the first month, she noted. “I call it the honeymoon period, or the adjustment period. Often, the work doesn’t start until 35 or 40 days in, and a lot of times that’s when you see kids really struggle with themselves and their internal issues, and they’re asking, ‘can I do this without substances, or can I not?’

“Sometimes we see kids have to return,” she added. “But a lot of times, those are the kids who are actually more successful. At first they didn’t get it, but they try it again, and it works for most of them.”

Goodwin House also encourages family engagement and involvement during the client’s stay, Grimaldi said. In fact, last month, all the families were invited to the house for Thanksgiving dinner, each family seated in a separate area so they could have a meaningful holiday together.

“I’ve never had a kid who really, truly wanted to physically be here, but they work the program, and then they realize it’s not as bad as they think, and they do the work so they can gain the sobriety they need.”

“A lot of times, a client will come to Goodwin House and will have a poor relationship with their parents. ‘Oh, my parents are mean because they put me here. My parents don’t care about me.’ We hear that all the time. So we try to work on that family relationship. We rebuild that through family therapy as well as family engagement and involvement.”

By the time clients leave, Grimaldi and her team want them to have a sponsor, be able to work their recovery, and also to have success academically. The center’s after-care coordinator keeps in touch with clients for a month after they leave, helping connect them to outside resources they can call upon to support their continued recovery.

“I’ll give them my business card, and a lot of them call me,” she added. “They’re interested in what’s happening. Sometimes it’s the kid who had the worst behaviors who wants to call back and say thanks. The one who was 399 days sober, he had a lot of incidents while he was here, but he turned it around and did what he needed to do and realized his life was worth living. And once you realize your life is worth living and there’s something to live for, your mindset changes.”

 

Breaking the Stigma

While stigma around mental health and substance abuse has lessened in society in recent years, it’s still an issue for many, especially parents of struggling teenagers — and it’s one factor keeping some families from seeking help, Grimaldi said.

“Stigma is always going to be there. But I tell parents, ‘it’s not what people think about you, it’s what you do to help your kid’ you’re the one bothered by your son being in a drug program, not him. He’s here to get the treatment he needs.”

Part of that is building life skills, she explained.

entrance to Goodwin House.

This apt message recently greeted people at the entrance to Goodwin House.

“We’re not just a substance-abuse and mental-health program. We teach them a lot of independent-living skills, all the different skills they haven’t learned at home. A lot of kiddos, when they come to us, they don’t know how to do basic chores. They were never taught.

“Or they’ve never done dinner as a whole, like we do here,” she went on. “They’re like, ‘why are we all eating together?’ They’re not used to it. It’s sad because you think, at their age, they would be used to having dinner with their family, but they’re not, so we teach them how to exist within a big, cohesive family.”

Grimaldi has some advice for families whose kids may not necessarily be struggling with addiction: talk to them before they get to that point. Because, again, it can happen to anyone.

“So many people wait until their kid gets into the worst point, when they’re in the hospital, getting stomach pumped, getting Narcan, but we shouldn’t wait until it gets to that point. We should be able to help our kids from the start, realizing there’s small changes that can happen, and those small changes lead to the bigger things.”

For example, a teenager might suddenly stop hanging out with long-time friends or engaging in a sport they’ve loved all their life.

“Instead of waiting until the school calls and says, ‘hey, your kid was caught with a cigarette,’ or ‘your kid was smoking pot up on the hill,’ be more attentive right now. There’s more to life than the busyness.”

It often starts with the most basic questions to get communication flowing between parent and child — and lessen the chances of those signs being missed.

“Ask, ‘how was your day? What did you learn today? What did you have for lunch today?’ These are basic questions parents don’t ask. I’ve seen parental visits where they just stared at each other because they don’t know how to talk to each other. They never took the time to get to know their kid. And I think it’s because people are so busy doing busy things.”

Goodwin House keeps Grimaldi plenty busy, and she loves seeing clients progress through the levels — and, more importantly, progress into sobriety and independence.

“I love my job. I love being able to work with so many different youth in such a short period of time,” she told BusinessWest. “You’re able to work with them and see where their struggles are. I love what I do because I think we make a difference, in the sense that we’re able to support them and help them gain sobriety. Even if it’s just 90 days, it’s 90 days they didn’t have before.”

Which then becomes 399 days — and counting.

Health Care Special Coverage

When It Can’t Wait

Mercy Medical Center

Mercy Medical Center, like all area hospitals, has seen a series of COVID surges over the past two years, including the current one.

Last month’s DPH guidance to hospitals, telling them to postpone all non-essential procedures that could result in an inpatient stay, is a challenge on multiple levels, local hospital leaders say. One, it’s not so easy to simply redeploy personnel from one department to another. Two, there’s no one-size-fits-all definition of ‘non-essential.’ But most important, it’s critical that patients seek out the care they need and let doctors make the judgment calls — and the fear is that this new guidance will chase those patients away. It wouldn’t be the first time.

It’s never good to put off necessary treatment, Spiros Hatiras said, whether that be cardiac screenings, lab tests, or cancer surgery.

“The outcome is not going to be good,” said the president and CEO of Valley Health Systems, which includes Holyoke Medical Center. Yet, that’s exactly what has happened over the past two years, due to a combination of people’s fear of public places and guidance from the hospitals themselves for people to stay home during the early height of the COVID-19 pandemic in 2020.

“People were initially scared; they wanted to stay away from the hospital,” Hatiras said. “Then we started reducing capacity and told people, essentially, ‘don’t come to the hospital.’ We started seeing people come back over the summer and fall, and now we’re back to telling people to stay away.”

He was referring to the Massachusetts Department of Public Health’s (DPH) guidance to hospitals concerning non-essential, elective, invasive procedures, which took effect Dec. 22.

“We started seeing people come back over the summer and fall, and now we’re back to telling people to stay away.”

“To preserve healthcare personnel resources, all hospitals are directed to postpone or cancel all non-essential elective procedures likely to result in inpatient admission in order to maintain and increase inpatient capacity,” the guidance reads. “Patients are reminded to still seek necessary care at their hospital or from their healthcare provider.”

The guidance comes as the Omicron variant has pushed hospitals to capacity limits with a new COVID surge.

Dr. Robert Roose

Dr. Robert Roose says treating all patients, urgent and non-urgent cases alike, is part of Mercy’s mission, but it will abide by the state’s guidance.

“Hospital capacity is stretched more than it has ever been since the beginning of the healthcare emergency,” Massachusetts Health & Hospital Assoc. (MHA) President and CEO Steve Walsh said in recent testimony to the state Legislature. “After two years of fighting this virus, our caregivers are simply exhausted.”

He acknowledged that “some of these pressures, we feel, are not COVID-related and may have also been mounting for several months.” Still, a strained healthcare workforce is facing a staffing shortage that has contributed to the loss of approximately 500 medical/surgical and ICU hospital beds since the beginning of the year.

Still, Hatiras questions the wisdom of simply assuming caregivers can be efficiently redeployed to other tasks.

“The idea is that, if we don’t do these surgeries, it opens up resources to redeploy in the hospital. But we know that’s not so easily done. You can free up nurse, but in a lot of cases, there’s not a whole lot they can do. It’s not like they can suddenly be an ER nurse or an ICU nurse. There are a lot of issues around that in terms of training and competencies. So the value of actually redeploying staff is somewhat questionable.”

He suggested what might work better is to issue the guidance as an advisory. “We can advise hospitals to find ways to create capacity. At the end of the day, there’s not a single hospital that would leave a patient untreated because they’re going to schedule a plastic surgery ahead of that patient. What we really need is more staff, which we don’t have.”

Dr. Robert Roose, medical director of Mercy Medical Center, said his team takes pride in caring for all the needs of the community, so the DPH guidance poses a challenge.

“Hospital capacity is stretched more than it has ever been since the beginning of the healthcare emergency.”

“It is important for us, from a mission perspective as well as from an operations perspective, to be able to be there when patients need us, whether for emergency care or non-emergency care,” he said. “All types of care across the continuum support individuals’ well-being and wellness.”

That said, “Governor Baker and the Department of Public Health have issued an executive order for hospitals to suspend non-emergency procedures that could result in an inpatient stay. In order for us to fulfill our obligations as a hospital, we are, of course, complying with those orders. We recognize this can be a concern for patients, as well as our providers and colleagues who wish to continue to provide the care they are so expertly trained to do. This is not an ideal situation, but one we find ourselves in, and we look forward to resuming all care in the very near future.”

 

What Is Non-essential?

To help redirect resources, Gov. Charlie Baker activated the Massachusetts National Guard on Dec. 22 to address the non-clinical support needs of hospitals and transport systems. Up to 300 of these Guard members will support 55 acute-care hospitals, as well as 12 ambulance service providers across the Commonwealth.

DPH surveyed hospitals and ambulance service providers and, in concert with the MHA, identified five key roles that non-clinical Guard personnel can serve in support hospital operations for up to 90 days: driving ambulances used to transfer patients between two healthcare locations, such as when patients are discharged from a hospital and transferred to a long-term-care facility; providing continuous or frequent observation of a patient who is at risk for harm to themselves; helping to maintain a safe workplace; bringing patients via wheelchair or, if needed, stretcher, from their patient room to tests such as X-ray or CT scan, or from the emergency department to their inpatient floor; and delivering patient meals to their rooms.

Spiros Hatiras says very few procedures can be deemed non-essential when one considers the health effects of delaying them.

But if resources are, indeed, being directed away from non-essential procedures, the question becomes what, exactly, constitutes a non-essential procedure. And the answer, in many cases, is complicated.

“The decision of what can be safely postponed, even for a week or three or four, is left to the discretion of the surgeon or clinical team,” Roose said. “That is an incredibly important fact because, ultimately, the providers are the ones responsible for the care of the patient, and we never want to see something untoward occur during the period of time when they could have been attended to. At Mercy, just like at other hospitals, those decisions are made by the treating providers and patients in collaboration, with their best interest in mind.”

Hatiras agreed. “When we talk about necessary procedures, first of all, there’s no particular approach; every individual is different. If you think about it, there are very few procedures where postponing it enhances one’s health. We’re talking about surgery here. When somebody gets to the point where they need surgery, it’s not like getting a haircut, where it can wait until next month.”

Exceptions to this rule might include discretionary plastic surgery and perhaps Lasik, where the worst-case scenario might be a few more months of wearing glasses or contacts.

“But that’s about the only things I can think of,” Hatiras said. “With other things, you’re doing it because you’re in pain or your health is deteriorating in some way.”

Take bariatric surgery, which some people might put in the non-essential category. Those patients start the process six months before surgery and tackle issues such as diabetes and blood pressure — “all the issues that make COVID deadlier,” Hatiras said. They typically have to lose a certain amount of weight before surgery and undergo psychological screening and counseling.

“When they meet all the milestones and the date approaches where they’re ready for surgery, should we now tell them, ‘guess what? We can’t do your surgery; we’ll let you know when we can.’ That would be wholly detrimental to the patient, who worked for six months to get to a point they might never get back to.

“Could you call that elective?” Hatiras added. “When you do the surgery, the diabetes gets better, the blood pressure gets better, the heart gets better. I take issue with what some people consider elective.”

Or take knee and hip replacements, he went on. “Is that really elective when there’s a risk of blood clots because they can’t walk or they’re risking other illnesses because they’re taking pain medications to cope with it?”

 

Call Your Doctor

Hatiras and Roose both hope the new state guidance doesn’t chase people away from seeking the care they actually need. That’s what happened last year, and hospitals and patients are still feeling the effects.

“At this point in the pandemic, our concern is that we have started to see the impacts of people in the community delaying care during prior waves of the pandemic,” Roose said. “We want to encourage members of the community to seek out important primary care, preventive care, and non-urgent care that can contribute to their health and wellness.”

In other words, let doctors and facilities decide what’s necessary — and how that care can be delivered.

“We have seen the pandemic shift many things in healthcare, including the way people seek care, which now is occurring far more through digital or virtual means than prior to the pandemic,” Roose said. “We’re seeing high demand for additional services in the home after a hospital stay, or in skilled nursing and other facilities. We are paying attention to how we can provide a service that delivers both in terms of convenience and excellence, because the pandemic has changed fundamentally the way care will be delivered for many years to come.”

The MHA, the DPH, and hospitals are united on one front: the unvaccinated far, far outnumber the vaccinated when it comes to taking up inpatient beds — and especially ICU beds — with COVID, in turn making it harder for hospitals to provide other services.

“When somebody gets to the point where they need surgery, it’s not like getting a haircut, where it can wait until next month.”

According to the DPH, 97% of COVID breakthrough cases in Massachusetts have not resulted in hospitalization or death, and unvaccinated individuals are five times more likely to contract COVID than fully vaccinated individuals and 31 times more likely to contract COVID than individuals who have a booster.

The MHA’s executive committee recently released an “urgent plea” for Massachusetts residents to do five things if they haven’t already: get vaccinated for both COVID-19 and the flu, and get boosted when eligible; always wear a mask when in public and when social distancing isn’t possible; get tested for COVID-19 if you develop symptoms or if you come into close contact with someone who has tested positive; keep up with regular medical appointments, “as we are now seeing the devastating effects of delayed care from the first waves of the pandemic”; and seek care from a doctor or urgent-care center when appropriate.

“When in doubt, you should never hesitate to visit your local emergency room,” the committee noted. “But for many medical situations, these settings can provide you with more timely and efficient care.”

It’s notable that, along with the expected advice to vaccinate and mask up, these medical professionals would warn against delaying care, even amid the DPH’s guidance to hospitals to postpone some procedures.

“Cumulatively, I think we’re dropping the health status of individuals,” Hatiras said, noting that people have put off colonoscopies, mammograms, and other procedures that are key to detecting issues early, before they develop into health crises. Holyoke Medical Center has responded with a public campaign to bring patients back, so they don’t keep delaying important visits.

“Don’t put something off. Don’t make that decision yourself,” he added. “To me, there is no safer place than a hospital. To me, a hospital is a lot safer than a restaurant, a lot safer than the mall, whatever you want to compare it to, because we have personnel aware of infection-control issues. We wear masks indoors, we hand sanitize, we know how to avoid infection.”

And don’t put off behavioral-health needs, either, Hatiras added, noting that isolation and anxiety have soared during the pandemic. “We see a lot of people deteriorating, in both their physical health and mental health, and that combination is never good.”

Roose agreed that it’s critical for individuals to seek the care they need, no matter what the state is saying, and let their doctor guide their next steps.

“There’s a lot of attention on capacity in hospitals, but we would not want anyone to delay care for important business, like mammograms, colonoscopies, lab tests, or emergency or urgent care,” he told BusinessWest. “We are here to take care of you, and we want to continue to send that message.”

 

Joseph Bednar can be reached at [email protected]

 

Cover Story Health Care

Critical Condition

Workforce challenges are common to virtually every industry these days — in fact, it’s the dominant economic story of our time, affecting everything from wages to employee relations to damaged supply chains. In healthcare, the pandemic has only exacerbated workforce issues that were already present. Hospitals, nursing homes, and other providers have to keep providing their services, of course, but the stress, burnout, and soaring costs resulting from the talent crunch have many saying the current environment is simply unsustainable.

While workforce shortages in healthcare are not a new story, Spiros Hatiras said, COVID-19 certainly didn’t help the situation. Far from it.

“We had some challenges even before, but really, the pandemic has created a sort of crisis situation,” said Hatiras, president and CEO of Holyoke Medical Center and Valley Health Systems, noting that industry estimates peg current healthcare vacancies around a half-million jobs nationally. “There’s a mixture of reasons why they left, and a lot of them had to do with the pandemic.”

Essentially, he explained, many nurses and specialists have re-evaluated what they want to do for a living, while others who were close to retirement anyway decided to make that transition earlier than they might have. Others who had been part of a double-income household stayed home with the kids during the pandemic and decided they wanted to continue to do so.

“You have people who got burned out dealing with acute illness and decided to stay in the profession, but looked for a setting where they weren’t dealing with acute illness,” he went on. “Then you had some people with an existential crisis, saying ‘healthcare is not for me.’ We certainly had some of those. Put it all together, and we had a lot of folks leave the profession on the clinical side.”

Entry-level, non-licensed jobs in healthcare, like housekeeping and dietary services, have been a struggle to fill as well, Hatiras said, but nowhere near as difficult as on the clinical side.

Adam Berman also recognizes that these issues predate COVID. Well before the pandemic — for several years before, actually — Berman, president and CEO of Legacy Lifecare, would attend trade-association panels and conferences and speak with state and national colleagues, and one topic would always be at the forefront.

“It was always workforce, workforce, workforce,” he said. “This was pre-COVID, and it’s what kept providers up at night.”

However, at Legacy’s two partner companies, JGS Lifecare and Chelsea Jewish Lifecare, Berman agrees with Hatiras that the pandemic took an already-worrisome problem and worsened it.

“We had some challenges even before, but really, the pandemic has created a sort of crisis situation.”

“When COVID came, many individuals who may have been considering careers in healthcare went for it, but for others, COVID gave them pause. And some people elected to retire earlier than they were otherwise going to. For many people, there was the calculus of determining whether they’d stay at home taking care of somebody versus re-entering the workforce.

“That’s not just in healthcare; that’s in general,” Berman added. “You see it across every industry. There are fewer people overall than were previously in the workforce.”

The growing labor shortage in healthcare is starting to have serious bottom-line effects, as organizations boost wages to compete for scarce talent and swallow skyrocketing rates being demanded by travel-nurse agencies.

A recent study conducted by Premier, a national healthcare-improvement company, found that U.S. hospitals and health systems are paying $24 billion more per year for qualified clinical labor than they did pre-pandemic, and approximately two-thirds of hospitals’ current costs are from wages and salary.

Spiros Hatiras

Spiros Hatiras says hospitals like Holyoke Medical Center are feeling the bottom-line impact of soaring workforce costs.

As reported by the Massachusetts Hospital Assoc., Premier found that “overtime hours are up 52% as of September of 2021 when compared to a pre-pandemic baseline. At the same time, use of agency and temporary labor is up 132% for full-time and 131% for part-time workers. Use of contingency labor (or positions created to complete a temporary project or work function) is up nearly 126%.”

The Premier study follows a September study from Kaufman Hall projecting that hospitals nationwide will lose an estimated $54 billion in net income over the course of 2021, even taking into account the funding they received from the federal CARES Act.

Meanwhile, Moody’s Investor Services also predicted hospital margins will continue to fall. “Over the next year, we expect margins to decline given wage inflation, use of expensive nursing agencies, increased recruitment and retention efforts, and expanded benefit packages that include more behavioral-health services and offerings such as childcare. Even after the pandemic, competition for labor is likely to continue as the population ages — a key social risk — and demand for services increases.”

All of this results in what healthcare leaders are increasingly calling an unsustainable situation — one that’s necessitating a great deal of flexibility, creativity, and, yes, anxiety.

 

Heightened Competition

In the world of home care, COVID posed some very specific issues, said Mary Flahive-Dickson, chief development officer and chief medical officer at Golden Years Homecare Services and Golden Years Staffing Agency.

“We already had an ongoing issue with a shortage of healthcare providers, but with COVID, people were moving loved ones out of facilities and into their homes — getting them out of skilled nursing and assisted living, keeping them out of hospitals. But now they needed home care, and a lot of it — not just an hour here and an hour there. These were people with 24-hour needs.”

The government’s generous unemployment policies didn’t help, she added.

“When the government pays you to stay home, why the hell would you go to work? If you’re getting paid $15 or $16 an hour to potentially expose yourself to COVID by entering someone’s home, why not stay home and get paid $25 an hour to stay home? We had the same issues every other industry had: the government simply made it way too easy to stay home.”

All that became what Flahive-Dickson called a “perfect storm” of increased home-care needs when the worker pool was dramatically shrinking — a simple matter of supply and demand, really. She understands the reluctance to work last year — not just because of the unemployment benefits, but because it was unclear, especially early on, how COVID spread and how serious the risk was. But almost two years after the pandemic began, the workforce disruption still resonates.

Adam Berman

Adam Berman

“When COVID came, many individuals who may have been considering careers in healthcare went for it, but for others, COVID gave them pause. And some people elected to retire earlier than they were otherwise going to.”

This past year did bring some relief, she noted, from the end of the extra-large unemployment checks to the expedited vaccine rollout to healthcare workers in February and March. However, the tight labor market has also created a competitive situation in which nurses, certified nursing assistants (CNAs), home health aides, and others are willing to jump from job to job for a pay bump — and companies are, indeed, offering those bumps.

“If I work for company A and company B offers me a quarter more an hour, I’m going to company B,” she said in explaining the mindset. “Then, if company C offers more than company B, I’m going to company C. Competition for home-care workers and other healthcare workers is through the roof.

“The reimbursements haven’t gone up, but payouts have gone up,” she went on. “A lot of companies are just not able to do that; if you don’t have a certain volume, you’re out of business.”

Wearing her staffing-agency hat for a moment, Flahive-Dickson noted that Massachusetts is the only state in the country that puts a cap on what a staffing agency can charge a facility; in fact, it’s illegal to go over the cap.

“If you’re getting paid $15 or $16 an hour to potentially expose yourself to COVID by entering someone’s home, why not stay home and get paid $25 an hour to stay home? We had the same issues every other industry had: the government simply made it way too easy to stay home.”

“Everyone is trying to outbid each other, and these employees find themselves jumping from opportunity to opportunity simply because the opportunity is there. You can’t blame them for doing that, but it’s completely unsustainable.”

Agency nurses are causing financial problems for hospitals because of the pay they command, Hatiras said. As a result, nurses are leaving their employers, signing on with agencies as ‘travelers,’ and then often returning to the same hospitals at two or three times the pay.

“The staff is making significantly more money, and it enriches those agencies, but the hospitals and consumers are footing the bill,” he said. “That’s an additional problem for us, but we’re not alone.”

HMC offers stability of schedule, without the travel, that agencies can’t, he noted, and has been offering incentives — like bonuses for signing up and for staying on for a certain amount of time, as well as tuition reimbursement and loan forgiveness. “But we can’t match the $100 an hour agencies are paying.”

What all this means, Berman said, is that “employees have far more power to be very discriminating about their future employment. I think that’s wonderful — it does require employers to think differently than in the past. You can’t take for granted that people will show up at your door. You need to do a better job of messaging: ‘this is a good place to work; everyone is treated fairly.’”

And not just say it, but back it up, he added.

“Competitive providers are raising wages, which is one of the positive impacts. It’s tough on employers, but those employers are becoming more competitive in terms of working conditions and wages, and that should not be minimized.”

 

Priming the Pump

Hatiras said the lack of interstate licensing reciprocity doesn’t help efforts to boost nursing staff, and state-level efforts to create reciprocity have run into union resistance. But he added that any effort to put more workers in the pipeline locally would be welcome.

“I don’t know if the pandemic has discouraged people who ordinarily would want to get into nursing but are staying away from it,” he told BusinessWest.

Mary Flahive-Dickson says many people want to remain in healthcare

Mary Flahive-Dickson says many people want to remain in healthcare, but not in acute-care settings because of stress and burnout.

One step Holyoke Medical Center has taken is to reduce the volume of non-clinical work that its nurses do, like personal hygiene, handling phone calls, and procuring supplies. In that way, the workforce crunch is lessened not by hiring more nurses — which the hospital would do if it could — but giving them more time to do the clinical work they’re uniquely trained to do.

“We decided to go to a model where we add more more staff that acts in a support role — certified nursing assistants, phlebotomists, secretarial help. At times when staffing is down, those support functions will take some of those duties and responsibilities off nurses and give nurses more time to be able to do medication management, care documentation, all that.”

The goal in the past has been one CNA for each two nurses on a shift, but HMC is now shooting for a one-to-one ratio. “The feedback from nurses has been tremendous,” Hatiras said. “Given everything going on, we think this is a good solution.”

It’s a way to reduce the burnout factor, which is real and significant, Flahive-Dickson said. When it’s not chasing healthcare workers toward early retirement, she noted, it’s making others more picky about their work setting. Her staffing agency hears from some clients who want to stay away from high-stress hospital and acute-care settings, and ask instead about shifts in schools, clinics, camps, and the like.

Berman said his industry has long had to stay on message simply because the role of a nurse in a skilled-nursing facility has never been the most glamorous-sounding job. While some people have a passion and calling for it, others need to be persuaded that this is fulfilling work, he noted.

“I don’t think this is going to be a short-lived situation. It’s going to take a long time to dig out from under … you can’t refresh the pipeline immediately.”

“Everyone is looking for staff, and everyone is being bombarded with different messages recruiting people. That becomes more challenging for us.”

Some organizations have become creative in building their own talent pipeline. Faced with a shortage of CNAs in the region, Legacy Lifecare created its own school, covering the cost of training for several dozen individuals so far and hiring many of them.

Likewise, Golden Years offers a 75-hour home health aide certification course, a $1,200 to $1,500 value, for free. “We’re giving them an education and certifying them and, in return, ask them to sign on for six months,” Flahive-Dickson said. “It’s one of the ways we try to offset the incredible need that COVID posed.”

Hatiras understands that other industries are facing similar headwinds when it comes to the availability and rising cost of talent. “You’ve seen everyone struggle. Look at the restaurant industry. When I see McDonald’s advertising high pay rates and tuition reimbursement, you know how bad things are.

“I don’t think this is going to be a short-lived situation,” he added. “It’s going to take a long time to dig out from under … you can’t refresh the pipeline immediately.”

Steve Walsh, president and CEO of the Massachusetts Health & Hospital Assoc., took a similar perspective during a recent meeting of the Health Policy Commission’s advisory council.

“I get that people fully want to go back to some semblance of normal,” he said, “but our healthcare organizations don’t have that option.” u

 

Joseph Bednar can be reached at [email protected]

Health Care

Shot in the Arm

Following updated guidance from the Centers for Disease Control and Prevention (CDC), the Baker-Polito administration has outlined how families in Massachusetts can access Pfizer COVID-19 pediatric vaccines for children ages 5 to 11.

Children will be able to receive the Pfizer pediatric COVID-19 vaccine from more than 500 locations, including retail pharmacies, primary-care practices, regional collaboratives, local boards of health, community health centers, hospital systems, state-supported vaccination sites, and mobile clinics. Some appointments are available now for booking, with additional locations and appointments expected to come online in the coming days.

“Pediatricians and parents should be very excited about the approval of the COVID-19 vaccine for children ages 5 to 11,” said Dr. John O’Reilly, chief of General Pediatrics at Baystate Children’s Hospital. “Some parents may be reluctant to have their children in this age group vaccinated, but if a day of soreness can get your child safely back to playing with friends and visiting relatives, then the benefits clearly outweigh the discomfort.”

As a pediatrician, O’Reilly said he had been hoping for this approval for months.

“Some parents may be reluctant to have their children in this age group vaccinated, but if a day of soreness can get your child safely back to playing with friends and visiting relatives, then the benefits clearly outweigh the discomfort.”

“I was very glad that the FDA took the time to be sure that the vaccine was safe and effective for children in this age group before it was approved,” he added. “Clinical trials of over 3,000 children who received the vaccine found it produced protective levels of antibodies with only mild reactions to the shot, such as pain at the injection site, fatigue, and headache.”

He understands that some parents might have safety concerns, but noted that much misinformation has been spread about the development of the mRNA vaccines, especially considering how fast the COVID vaccines were rolled out. The truth, he noted, is that scientists have been working on the development of mRNA vaccines for decades. The basic scientific advances in gene sequencing and gene modeling allowed companies to quickly adapt mRNA technology to the COVID-19 virus.

“Vaccine development is very expensive, and companies developing other vaccines would be slower in developing them because of the cost,” he explained. “Operation Warp Speed gave companies billions of dollars in support and guaranteed purchases, allowing companies to use those funds to quickly ramp up clinical trials and manufacturing. The trials themselves followed the highest standards of research, and the FDA has reviewed all of the trial data to be sure that the COVID- 19 vaccines are safe and effective.”

O’Reilly noted that children infected with COVID-19 tend to experience mild symptoms, but for some, it can be more serious. Since the pandemic began, about 1.9 million children ages 5 to 11 have been infected, about 9% of all U.S. cases. More than 8,300 in this age group have been hospitalized, with about one-third requiring ICU care, and 94 have died, according to federal data. Children ages 5 to 11 who are black, Native American, or Hispanic are three times more likely to be hospitalized with COVID than white children.

Also, several thousand children infected with the virus have developed severe cases of inflammation throughout their bodies known as multi-system inflammatory syndrome, while others are reporting long COVID symptoms similar to adults, such as headache, cough, fatigue, and more.

“Parents who vaccinate their children not only protect them, but they also protect everyone their children come in contact with,” O’Reilly said. “In school, it protects vulnerable classmates and adult staff whose medical conditions put them at risk for severe COVID-19. It also protects family members and makes visiting at-risk family members at the holidays safer for everyone. Vaccinating our kids also helps to protect our communities. The higher our community immunization rates, the lower the risk of COVID-19 rapidly spreading through our at-risk community members.”

Parents who prefer to have their child vaccinated by their primary-care provider should call their provider’s office directly. Others may visit the VaxFinder tool at vaxfinder.mass.gov for a full list of hundreds of available locations. Residents will be able to narrow results to search for locations that are offering the Pfizer pediatric COVID-19 vaccine, with some appointments available now for booking. Additional appointments will be available online in the coming days. Many locations will be booking appointments out weeks in advance.

“Parents who vaccinate their children not only protect them, but they also protect everyone their children come in contact with.”

For individuals who are unable to use VaxFinder, or have difficulty accessing the internet, the COVID-19 Vaccine Resource Line (Monday through Friday from 8:30 a.m. to 6 p.m., Saturday and Sunday from 9 a.m. to 2 p.m.) is available by calling 211. The COVID-19 Vaccine Resource Line is available in English and Spanish and has translators available in approximately 100 additional languages.

All state-supported vaccination clinics will offer low-sensory vaccinations for children with disabilities.

Additionally, the administration has partnered with several non-traditional, youth-friendly locations for pediatric vaccination clinics, including the Discovery Museum in Acton, the Museum of Science in Boston, the Springfield Museums, and the EcoTarium in Worcester. Appointments for these clinics are available now on the VaxFinder tool. Visit www.mass.gov/covidvaccinekids for more information.

While infection rates have been trending down from an early-fall spike, the Massachusetts Department of Public Health reported 1,586 new, confirmed COVID cases in the state on Nov. 4, bringing the total since the start of the pandemic to more than 800,000. Health officials said the total number of confirmed cases in the state, as of that date, was 801,567.

The DPH also reported 23 additional COVID deaths in the state, bringing the total number of confirmed deaths since the start of the pandemic to 18,671. As of Nov. 4, there were 509 people hospitalized for a coronavirus-related illness, including 147 in intensive care.

State health officials say getting vaccinated remains the most important thing individuals can do to protect themselves, their families, and their community. Individuals do not need an ID or health insurance to access a vaccine and do not need to show a vaccine card when getting a vaccine.

Massachusetts leads the nation in vaccine administration, including adolescent vaccination, with more than 80% of youth ages 12-17 having received at least one dose. More than 4.7 million individuals in the Bay State are fully vaccinated, with more than 92% of all adults having at least one dose.

“I can’t emphasize enough how important it is for parents to make the right decision to vaccinate their children,” O’Reilly said. “It can be life-saving for your child and further protect those in your household as well as the community from this terrible disease that spares no one. I am looking forward to a holiday season when kids are fully vaccinated and we can all gather with friends and family to celebrate being together without fear of COVID.” u

Health Care

‘A Wonderful, Wonderful Fit’

 

Dr. Lynnette Watkins says she is most definitely her father’s daughter.

By that, she meant she is a second-generation ophthalmologist, following the lead set by her father, L.C. Watkins, who is one of the first African-Americans practicing in that specialty in St. Louis.

“When I say that I stand on the shoulders of giants, I don’t take that lightly, and first and foremost is my dad,” she noted. “He’s been my biggest supporter, mentor, and point of light.”

But there were other influences as well, including her mother, an educator, and, more specifically, an early-childhood-development administrator, who was one of many who taught her the importance of giving back.

“It was always expected that, with the privileges and opportunities that were afforded to me, there was an expectation to serve and to give back,” she said. “Which is why, with each position and opportunity that I’ve pursued, I’ve always had that mindset first and foremost in my mind; it’s why I wanted to have a career in healthcare.”

This is the philosophy Watkins brings to her latest assignment, as president and CEO of Cooley Dickinson Hospital in Northampton. 

She takes the helm at CDH after a lengthy stint as chief medical officer for the Baptist Health System/Tenet Healthcare – Texas Group, and arrives at an obviously stressful, tenuous, and uncertain time for all healthcare providers, one still dominated in every way by the COVID-19 pandemic and its latest surge.

“While there’s been a lot of challenge and a lot of sadness during the pandemic, there’s also been some wonderful lessons and teachings in the resilience of people.”

Watkins, who arrived at the hospital on Sept. 27, brings to this challenge, and CDH, a wealth of experience. Like a growing number of those leading hospitals and healthcare systems, she has made the transition from direct patient care to managing those who provide that care. For her, it was a seismic but, in many ways, natural change.

“Many people have asked if the transition was difficult, and I’ve said that it was not,” she explained. “That’s because I found myself at peace moving from a clinical role to one that still has clinical elements, but instead of being the one-on-one patient-physician relationship, which is incredibly treasured, it’s one where I have the ability to impact multiple patients and improve the working lives of staff, medical staff, and other providers. I can make a bigger impact on a broader scale.”

She said there were many factors that went into her decision to come to CDH, summing them up with that often-used phrase “it was a perfect fit.” Elaborating, she said the area served by Cooley Dickinson, mostly Hampshire and Franklin counties, is one with a great deal of need, and she has experience working with such populations, as we’ll see.

Beyond that, she said this opportunity allows her an opportunity to take what she has learned at many different stops during her career and apply them to what will be a different — and obviously significant — challenge.

Lynnette Watkins says one of her first priorities will be meeting with as many community leaders and constituencies

Lynnette Watkins says one of her first priorities will be meeting with as many community leaders and constituencies — as well as frontline caregivers and hospital staff — as possible.

Watkins said the learning process has continued through COVID, which she believes has brought out the very best in those working in healthcare, while also putting an even greater focus on teamwork, collaboration, and innovation.

“While there’s been a lot of challenge and a lot of sadness during the pandemic, there’s also been some wonderful lessons and teachings in the resilience of people, resilience of systems, the importance of self-care and downtime, and the importance of working with others and understanding that it’s OK to say, ‘I need help,’” she explained. “What this has also done is challenged us to innovate, whether it’s in processes, such as supply-chain initiatives with PPE or the distribution of vaccinations and other pharmaceuticals such as monoclonal antibody infusions, or working together in groups to really take care of our community.

“That resilience, that collaboration, that innovation, that devotion to self and others have really been positive,” she went on. “The patience and working with a team have really helped me grow — as an individual, as a physician, and as a healthcare leader.”

For this issue, BusinessWest talked at length with Watkins about her latest assignment, why she came to CDH, and … how being her father’s daughter will help her as she takes on this latest career challenge.

 

Background — Check

In some ways, Watkins said, coming to CDH is like coming home — or at least coming back to that part of the country where she did her residency.

Specifically, that would be Mass Eye and Ear in Boston. But she did get out to the Northampton area on several occasions during those residency years, so she’s not a total stranger to the 413.

There were several career stops between Boston and CDH, including a lengthy stint back at Mass Eye and Ear, where, from 1999 to 2004, she directed the Emergency Ophthalmology Service and walk-in clinic and was an attending physician in the Ophthalmic Plastic Surgery Service. And Watkins said all of them have helped her grow as both a provider of care and a manager of people. And she intends to put all of that experience to work at CDH.

Our story starts in Missouri, where Watkins, as noted, became intent on following her father into the medical field and earned her undergraduate and medical degrees at the University of Missouri – Kansas City and an internship in internal medicine at Truman Medical Center in Kansas City.

“I grew up wanting to go into medicine, and I was asked quite often if I was going to be an ophthalmologist like my father,” she recalled. “Candidly, I got tired of the question. It was through a series of rotations and the fact that I needed money for car insurance that my father said, ‘why don’t you come work for me in my office?’

“I did, and I liked it,” she went on. “I didn’t tell him for a while, but I did make that transition, and eventually declared that this was the specialty I wanted to be in.”

This decision brought her to Mass Eye and Ear in 1995 for her residency and stint at the at the walk-in clinic and Ophthalmic Plastic Surgery Service. She was there during 9/11, a moment in time and her career that convinced her to be closer to family and, in her words, “focus more on family.”

Elaborating, she said she went into private practice in Indiana and eventually became managing partner of a multi-specialty group, one with a large geographic footprint.

The administrative leadership of that group would later put it in “a significant financial disadvantage,” as Watkins put it, adding that she was thrust into the role of interim CEO. She said she would eventually wind down the two parent companies into multiple spinoffs, which are still ongoing today, an experience she described as both challenging and rewarding, and  one that would in many ways inspire her transition into management and leadership roles.

“We were able to keep patients seen, keep people employed, and move colleagues forward so they were able to practice — it was a huge, huge learning experience,” she told BusinessWest. “I joined one of the spinoff groups, but found myself wondering why I went through that experience.

“And it was actually a couple of colleagues, neither of whom had medical backgrounds but did have healthcare-industry backgrounds, who said, ‘this happened to you for a reason; you have this knowledge — why don’t you consider leading a hospital or healthcare system and pursue healthcare administration?’”

She thought about it and talked with family members, especially her father, to get buy-in and support. After securing it, she started pursuing healthcare administrative positions.

Her first stop was at Trinity Health in South Bend, Ind., and from there she joined Tenet’s Abrazo Community Health Network in Arizona as chief medical officer.

When that position was one of many eliminated in a round of budget cuts, she used connections she’d made to land a job as chief medical officer and chief operating officer at Paris Regional Medical Center in Texas, a system that was and is surrounded by some of the poorest counties in Texas and neighboring Oklahoma. Her time there was another important learning experience.

“One of the great joys of working there was working with people who keep in mind the individual who has limited access, limited transportation, and limited resources,” she said. “And in rural facilities where often there is one specialist or one type of provider, and there is limited access, having a high level of collaboration, particularly with the medical staff and the provider staff, is very important.

“Overall, that was an incredible learning experience, understanding the intricacies of running a facility that’s technically complex,” she went on, adding that, as chief medical officer and chief operating officer, she had oversight over just about everything except nursing, finance, and HR.

 

Right Place, Right Time

The learning experiences continued at the Baptist Health System/Tenet Health Care, where that system confronted not only COVID, but the severe — and highly unusual — weather pattern that visited most of Texas near the end of February.

Some called it ‘Snowvid,’ said Watkins, adding that healthcare systems had to confront not only the pandemic, but extreme cold that knocked out power and water to many communities.

“We had COVID patients, we had no electricity, we were on generators, and we did not have water, she recalled. “Managing through all that was a challenge, although what each of these events has shown is that it has not changed why we do what we do, but it does force us to change how we do it.”

Elaborating, she said some recent developments or trends will continue for the foreseeable future, including telehealth, which she described as a game changer for both the inpatient and outpatient sides of the equation. This became evident in Texas, as well as the hospital that would become the next line on her résumé.

Watkins told BusinessWest that the position at CDH came to her attention through a recruiter, and after more talks with family and friends, she decided that managing a smaller community hospital would be an appropriate next step on her career journey.

“It’s a wonderful, wonderful fit,” she said of CDH, adding that her views on the delivery of healthcare and areas of focus are in sync with those of the hospital and its staff. “First and foremost, I’m a physician, and I want to make sure that we’re delivering safe, high-quality care and that we’re great stewards of resources, whether it’s finance or personnel or capital, and that’s what Cooley Dickinson does.”

Elaborating, she said the opportunity to lead a hospital that is an affiliate of the Mass General Brigham system, formerly Partners Healthcare, was also appealing.

When she talked with BusinessWest before her arrival, Watkins said one of her first priorities is to familiarize herself with the community and meet with many different leaders and constituencies — in whatever ways COVID will allow. Which means a lot of Zoom meetings, some phone calls, and, when possible and appropriate, in-person gatherings.

“My goal is to get out there and meet the community where they are at as quickly as possible,” she said. “I think it’s also important that I meet the team; meet our front-line caregivers, staff, and providers; and understand what’s working well and where we have opportunities.”

Returning to her thoughts on the lessons learned from the pandemic, Watkins said that  managing through this crisis has enabled her to grow and mature as a leader — out of necessity.

“Physicians inherently have trouble delegating,” she told BusinessWest. “And I fully disclose that I am one of those physicians. It’s been a journey, but the pandemic has really helped me to leverage and trust the team and be a better partner, a better collaborator, and a better support.

“One of the things I work hard to do is listen and gather information before executing,” she went on. “And that’s been incredibly important during this time.”

When asked about the management style she brings to CDH, Watkins started by saying she is an optimist by nature, and she believes this is an important trait in this business.

“We have the singular privilege of being able to take care of patients and the community, whether it’s one-on-one or on a larger scale,” she explained. “And from that optimism, I assume good intentions and assume that those who chose this profession want to take care of people as well. We will have challenging conversations, and it will be important to challenge and push each other to do better and innovate, but I would like to consider myself to be collaborative, open, very much driven, direct, and someone who feels it’s important to have fun at work. That’s because this work makes for long days, and there needs to be some form of celebration, some sort of fun.”

 

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

Health Care

Danger Zone

By Mark Morris

MHA’s Alane Burgess (left) and Kristy Navarro

MHA’s Alane Burgess (left) and Kristy Navarro say social isolation during the pandemic has been problematic for young people.

 

According to the Centers for Disease Control and Prevention, the national suicide rate declined slightly in 2019, the last year for which full statistics are available.

Unfortunately, the latest government data does not take into account the arrival of COVID-19 early in 2020. But area mental-health professionals know what they’re seeing and hearing almost 20 months into the pandemic.

Amanda Hichborn, director of Outpatient Clinical Services for River Valley Counseling Center’s Westfield office, said the impact of COVID has in some ways been a double-edged sword when it comes to suicide risk.

“The risk factors for suicide have definitely increased,” she said. “At the same time, we’ve also seen protective factors that have come into play.”

On top of fears about our health, Hichborn explained, the pandemic also affected basic needs such as food — as evidenced by shortages in grocery stores — as well as the ability to sleep well, employment security, and freedom to move around wherever and whenever we want.

At the same time, she has seen people spend more time with their family, increase their fitness by taking walks to get outside, and improve their diets by eating more at home.

“Vulnerable groups like disenfranchised people were already struggling with basic needs. Throw the pandemic on top of it, and their needs are impacted tenfold.”

“These protective factors work to actually decrease the risk of suicide,” Hichborn said. “When we go through something as a community, we feel a kind of connectedness, which also helps decrease suicide risk.”

However, she was quick to point out that, while we may all be in this together, we’re not all in the same boat.

“Vulnerable groups like disenfranchised people were already struggling with basic needs,” she said. “Throw the pandemic on top of it, and their needs are impacted tenfold.”

Young people in particular have had a tough time with the pandemic. Alane Burgess, clinic director of the BestLife Emotional Health & Wellness Center at the Mental Health Assoc. (MHA), noted that, while depression and anxiety have increased for all ages, it’s been particularly tough for adolescents, and suicidal thoughts and attempts are on the rise.

“With adolescence, there is a sense of permanency that things won’t change,” Burgess said. “When they experience social isolation, it feels like forever to them.”

Kristy Navarro, a clinical supervisor at MHA, said keeping young people safe in a pandemic can run counter to how parents raise their kids.

“Normally we want our kids to share, but now we’re saying, ‘don’t share, and don’t touch anything,’” she said. “When we discourage sharing things with friends, it can be a hindrance to the growth and development of young children and adolescents.”

 

Managing the Stress

Dan Millman agrees that the pandemic has affected young people in unique ways.

“It can be hard for young people who miss rites of passage like graduations and other celebrations and rituals,” he said. “Another part is the social stuff like having fun with friends and being independent. All of that has been much harder to do with the pandemic.”

Millman is the director of ServiceNet’s DBT program, or dialectical behavior therapy, an evidence-based approach to psychotherapy that can be effective with people who are exhibiting self-destructive behaviors.

Amanda Hichborn says staying home more has benefited people’s health

Amanda Hichborn says staying home more has benefited people’s health in some ways, but the pandemic has had plenty of negative effects, too.

DBT differs from conventional therapy in that it follows a more structured protocol. The six-month program is designed to give clients the skills to manage the urges to engage in self-harming behaviors. Millman described four main techniques of DBT:

• Mindfulness, a skill that helps the client focus on healthy coping skills to prevent negative thought patterns and impulsive behavior, and which is integrated throughout DBT techniques;

• Distress tolerance, which is most effective in improving a moment with soothing or distraction skills. “The point of this skill is to help survive the crisis without making things worse,” Millman said;

• Emotion regulation, a technique that allows clients to strengthen their emotional resiliency to more effectively navigate powerful feelings; and

• Interpersonal effectiveness, which Millman described as developing assertiveness skills so clients can ask for what they want, better address their needs, and set limits when necessary.

“The point of DBT is to help people feel like their life is worth living and has improved,” he explained. “It’s not a good outcome to have someone stay alive while still suffering the torment they have been feeling.”

Relieving the torment starts with allowing the client to accept they have suicidal thoughts. In this context, acceptance means acknowledgement, not approval.

“When someone has suicidal thoughts, it’s a sign to them that something is wrong in their lives that needs to change,” he said. “Acknowledging those thoughts can actually be protective for the person.”

Another area of DBT involves stepping into painful emotions. Millman explained how human instincts try to protect us and avoid things that make us feel anxious, so we tend to put them off. Avoiding a difficult conversation is a good example of something that needs to be done, but creates anxiety before we do it.

“I talk with people about what they can and cannot control. Though we can’t control events outside, we can control ourselves and our responses to those events.”

One way clients deal with emotional pain is to engage in self-harming behaviors such as cutting themselves.

“We ask the client to just sit with the urge to cut themselves without acting on it,” he said. “In that way, we are asking them to step into the pain. It’s easier said than done, and it’s really challenging.”

The point is to show the client they confronted the moment and got through it. A distraction like a funny video or throwing themselves into an activity can also help, he added. “Once they are ready for the next step, they can use some of the other skills to influence the emotions that are underneath the urge and begin to think differently about it.”

 

Support Systems

The pandemic looked like it was going to subside this past spring as warm weather arrived and many people were getting vaccinated, but then the Delta variant reared its head, and vaccine levels plateaued. While that created frustration for everyone, it was particularly hard on people with pre-existing conditions related to anxiety and depression.

Dan Millman runs a program

Dan Millman runs a program that helps people take control of self-destructive tendencies.

Navarro said the confusion of starting to feel safe, and then, suddenly, not so safe, can lead to hopelessness, a huge risk factor in suicidal tendencies. A person who feels hopeless will often make vague statements such as “I can’t do this anymore,” “I don’t want to be here,” and “this is too hard,” she noted.

“I talk with people about what they can and cannot control. Though we can’t control events outside, we can control ourselves and our responses to those events.”

During the pandemic, social media can either help people feel more connected or lead to more hopelessness. Hichborn noted that, while it’s good to see friends and loved ones from across the country, social media also creates misleading impressions. The people smiling in the photo look happy, but they might be feeling lots of stress in their lives.

“The effect of social media is counterintuitive because it makes us feel more connected upfront, but in the long run makes us feel a lot more depressed and isolated,” she said.

Two other groups emotionally affected by the pandemic are very young children and seniors. Hichborn said she sees clients from ages 3 to 77. When a parent with young children dies, it can create a suicide risk.

“The child has a concept of mom or dad dying, and they want to see them again,” Hichborn said. “The child might feel like they have to die in order to see their mom or dad.”

Older people who are at risk of suicide tend to show warning signs such as saying goodbye to people, giving away their prized possessions, and cleaning out their house. When family members see this type of behavior, it’s important to talk with the person.

“If you see any suicidal ideations or any warning signs within a family member, don’t beat around the bush — ask them directly, ‘are you feeling suicidal? Are you having thoughts of harming yourself?’” she said.

If they’re not having those thoughts, Hichborn added, the question will not encourage people to start thinking about it. “It doesn’t work that way.”

In addition to asking direct questions, Burgess suggested active listening and being supportive.

“Sometimes the most important thing to do is listen and acknowledge the person’s experience,” she said. “They don’t need you to fix it, they just want to be heard.”

Hichborn recommends a safety plan displayed on the refrigerator to help a person who might struggle with suicidal thoughts.

“The plan can have support people to call and emergency numbers like the police, suicide hotline, or poison control,” she explained. “Everything is written out in a place that’s easily seen, so when someone isn’t thinking straight and their thoughts are all over the place, they don’t have to think about what to do — it’s right there.”

 

Stay Connected

Though we might feel alone in our thoughts, Burgess encouraged people to reach out to those they are comfortable with to talk about their feelings.

“What’s profound about the pandemic is that it’s a collective experience everyone is going through,” she said — and one that no one should have to confront alone.

Health Care Special Coverage

An Anxious Transition

While the economic reopening is being called the ‘new normal,’ things aren’t back to normal, really — at least not by pre-pandemic standards. With COVID-19 still lingering, developments like the loosing of mask and gathering rules and a growing call for employees to return to the office have only ratcheted up the stress and anxiety among a broad swath of the population. In other words, for many, returning to the world as they knew it will be a gradual process.

By Mark Morris

In these unique times when COVID-19 is still active but in decline, we all have lots of questions about how to navigate daily life.

For example, if you have been vaccinated, should you continue to wear a mask? Why does the CDC say you can go without a mask, yet many public places still require one?
Should we still socially distance and sanitize in certain situations?

And, importantly, how much anxiety are such questions causing these days?

Answers can come from many places. Lauren Favorite, assistant program director with Behavioral Health Network, noted that, while information can be good, an overload of messages from different sources results in confusion.

“When we are bombarded with a plethora of information, it’s difficult for people to make a singular choice that will be the right one for them,” Favorite said. “Too much conflicting information can create anxiety.”

“Because so many people are not sure what to do, they will hold on to behaviors even when they no longer serve their intended purpose.”

BusinessWest spoke with several behavioral-health professionals who said much of the stress people are feeling right now is rooted in their concerns about how safe it is to go back into the world. Despite the May 29 reopening of Massachusetts, allowing everything from restaurants to sports arenas to fully welcome the public, Alane Burgess, clinic director for MHA’s BestLife program, said many people still do not feel safe going to the supermarket.

Alane Burgess

Alane Burgess says it’s always easier to learn how to be afraid than to unlearn that mindset.

“It’s always easier to learn how to be afraid than it is to be unafraid,” Burgess said. “Even when we’re told everything is OK, people still have questions.” As COVID-19 is a relatively new virus and scientists are still learning about it, continued concerns about personal safety are not surprising.

A recent research article looked at the trauma experienced by refugees after they emerged from a war-torn country. Favorite said their experience serves as a metaphor for these times.

“In the war zone, they had to develop certain habits and routines as a way to survive,” she said. “Once they escaped and reached a safe place, they held on to those behaviors because they didn’t know how else to act.”

All behaviors have a motivation, she continued, and the ones we followed to stay safe during the pandemic served us well. As we move beyond the pandemic, however, it’s time to examine if those behaviors are still serving us.

“Because so many people are not sure what to do, they will hold on to behaviors even when they no longer serve their intended purpose,” Favorite said. “I think many people will be in a sort of in-between place until we start to see a critical mass of vaccinations.”

 

Baby Steps

For many, entering back into the world needs to be a gradual process. Kathryn Mulcahy, clinic director for Outpatient Behavioral Health Services at the Center for Human Development, encourages her clients to start small.

“Instead of trying to do everything at once, I remind people it’s OK to take baby steps,” Mulcahy said. “You might not be ready to go out to the movies, but you can start getting back into the world by taking a walk in your neighborhood.”

As an incentive to go out again, Burgess advises her clients to make a bucket list of activities they are excited about doing again. “Making a list reminds people of what brought them joy before COVID and can help motivate them to get back to doing those things again.”

lauren favorite

Lauren Favorite

“I think many people will be in a sort of in-between place until we start to see a critical mass of vaccinations.”

COVID also had a significant impact on the nature of work. Depending on the occupation, some people reported to work every day during the pandemic, while others followed a more hybrid approach of working at home some days and at the office other days. A third group has been working from home since last March.

Employers have begun asking Joy Brock, director of the CONCERN Employee Assistance Program, how to proceed as we move toward the end of the COVID era.

“Companies are struggling with how to translate all the different mandates,” Brock said. “They are having as much anxiety as their employees.”

According to the Massachusetts Attorney General’s Fair Labor Division, employers are allowed to ask if an employee has been vaccinated. In some cases, they can require vaccination in order to report to work. Exceptions are allowed for those protected by legal rights, such as individuals who have disabilities or those with sincerely held religious beliefs.

Brock said even those distinctions beg more questions. “What if I’m vaccinated, but the person next to me isn’t? How is that going to work with masks, social distancing, and other considerations?”

When there is no clear-cut direction, individuals usually figure out how to keep themselves safe. Brock said even modest steps to take control over one’s health can help reduce anxiety. “If that means you are the only one in the office wearing a mask, that’s perfectly fine.”

Finding a comfort level at work and in the world ultimately depends on the individual. Burgess emphasized that everyone is on their own journey, and it’s OK to move at a different pace than others.

“I advise people to be patient with themselves and not make any self-judgments just because their comfort level is different than their friends or co-workers,” she said.

One clear demand Brock has heard from workers involves flexibility in work schedules.

“For the most part, people have enjoyed working from home because it makes child care easier to manage, they have been able to match or exceed their productivity, and many report lower stress levels,” she said.

With that in mind, many employers are looking at a hybrid model and trying to figure out the right mix between working at the office and from home.

Kathryn Mulcahy

Kathryn Mulcahy

“Instead of trying to do everything at once, I remind people it’s OK to take baby steps. You might not be ready to go out to the movies, but you can start getting back into the world by taking a walk in your neighborhood.”

A return to the office also means remembering how to be a colleague. Even if co-workers talk remotely every day, Mulcahy said people can get out of the habit of face-to-face conversations.

“As silly as it sounds, practicing an in-person conversation with someone outside your bubble is one more way to prevent that overwhelming feeling of being thrown back into the workplace,” she explained.

Beyond water-cooler discussions, Burgess said a successful transition back to the office also requires companies to be tuned in to the apprehensions their employees may have. “It will be important for people to have an open dialogue with their employers about any anxieties or concerns they may be feeling.”

Added Favorite, “as a supervisor in the workplace, I’m having conversations with my staff to assuage their fears about coming back on site.”

 

Talk About It

One key to putting COVID behind us is recognizing what everyone has gone through since last March.

“For the past 14 months, we’ve lived in a world full of trauma,” Burgess said. “The idea that we can suddenly go back to the way everything was is an impossible task.”

Mulcahy said she has heard from people who are embarrassed because they feel stressed and anxious about returning to a more normal life.

“They feel like they should be happy and excited that people are vaccinated, but instead they just feel worried,” she noted. “I want people to know they are not alone and they can reach out for help to navigate these feelings; that’s why we’re here.”

Burgess also pointed out that life was different during the pandemic, and we should accept that we are not the same people we were before.

“Our life has changed, and we have changed in some of the ways we think, how we feel, and what feels safe,” she said. “It’s important to respect who we are today because that, too, is part of the process in getting back into the world.”

When everyone was forced to suddenly deal with a pandemic, it created anxiety for many. Now, as the pandemic (hopefully) nears its end, that creates anxiety, too. Those who spoke with BusinessWest agree that talking about this stress, and letting people know their feelings are valid, will go a long way to easing everyone’s anxiety.

After all, Favorite said, “we’re still learning how to be in a world where we don’t have to worry all the time.”

Health Care

Disrupting the Cycle

 

The past year has been a difficult one in many ways, Dr. Alisha Moreland-Capula said.

“It’s been a tough time with COVID. We’ve had a lot of uncertainly, a lot of loss, and we’ve also had a rise in racial tension and a disruption in the relationship between law enforcement and the community,” the psychiatrist and author of Training for Change noted.

But when addressing an issue like urban violence, what many people — even those working to solve the problem — often don’t understand is the impact of fear. Not occasional fear, but long-term, lived-in fear.

“If you can imagine a life that is completely consumed and shaped by fear, then it is not absolutely outside the realm of possibility to understand how toxic that can be on someone’s life,” Moreland-Capula said.

The occasion for her words was the keynote address of a virtual forum last month hosted by Roca, an organization that aims to disrupt incarceration, poverty, and racism by engaging young adults, police, and systems that impact urban violence.

Fear can be a positive, she noted, when it heightens one’s senses in order to escape a dangerous situation or seek help.

However, “being afraid is meaningful until it’s not,” she said — when it’s a constant presence in a young person’s life, due to stressors like racism, poverty, and violence. That’s why Roca aims to tackle the issue of violence by addressing the causes of other traumas first — engaging not only with young people, but with the systems that impact them, from education to law enforcement to child welfare.

Gov. Charlie Baker

Gov. Charlie Baker

“Roca has been a relentless force in disrupting incarceration, poverty, and racism by engaging young adults, law enforcement, and systems at the center of urban violence and relationships to address trauma, find hope, and drive change.”

“We know from brain science that the external environment around us impacts who we are and who we become,” Moreland-Capula explained. “What Roca says is that we have to work with those environments, change the systems, and help to change the trajectory of the young adults we seek to serve.”

Mike Davis, vice president of Public Safety and chief of Police at Northeastern University, as well as a Roca board member, understands that concept.

“We have before us a moral imperative to be better as individuals and collective members of society,” he told forum attendees, adding that, too often, people lose hope because change hasn’t happened fast enough or, worse, believe working for change is someone else’s responsibility.

“Both of these thoughts are not only wrong, but but if they serve as the guidance for our behavior, they will guarantee failure,” Davis went on. “Substantive change is everyone’s responsibility, without exception. What needs to animate our actions now is a sense of urgency based on a vision for what is possible.”

Roca has such a vision, he explained, based on the premise that all people have intrinsic value and potential to contribute something unique to their society — and has not only helped steered young people away from prison and toward better outcomes, but also worked with police to see their roles differently.

“The loss of life to homicide or prison not only not only impacts that individual, that community, or that city, it impacts all of our society,” Davis said. “Loss of life is loss of possibility.”

In a brief address to the forum, Massachusetts Gov. Charlie Baker noted that “Roca has been a relentless force in disrupting incarceration, poverty, and racism by engaging young adults, law enforcement, and systems at the center of urban violence and relationships to address trauma, find hope, and drive change. I’ve seen firsthand that Roca and its programming works.”

 

Fear Factors

Fortunately, Moreland-Capula said, Roca has been ahead of the curve in paying attention to the relationship between root traumas and their societal impact.

“They understand that, for whole communities to heal, for people to heal, there has to be keen attention paid to specific things like community violence, like trauma.”

Some of the chronic fear she mentioned earlier stems from a lack of basic needs, from food and water to shelter, safety, even love and belonging. By helping young people access education and employment, those cycles can be broken as well, she noted. “We know there are complex and structural challenges that require a complex and structural approach.”

Molly Baldwin, Roca’s founder and CEO, said the proliferation of drugs, violence, and guns in communities requires innovative approaches.

“Our old methods won’t work. Incarceration is expensive and a failure. Jobs and GED programs are not enough, and even the most credible messenger cannot convince a young person to do differently if that young person is living in a state of fight or flight and cannot access the thinking part of their brain for healthy decision making,” she said. “If we don’t address the impact of lived trauma, we can’t hope for healing and change.”

That philosophy is behind the recent establishment of the Roca Impact Institute, which works with communities and institutions that have a clear commitment to addressing violence by working with young people who are at the center of local incidents and trends.

Molly Baldwin

Molly Baldwin

“Even the most credible messenger cannot convince a young person to do differently if that young person is living in a state of fight or flight and cannot access the thinking part of their brain for healthy decision making.”

Unlike a typical training approach, the Roca Impact Institute is an intensive coaching approach that works with police departments, criminal-justice agencies, and community-based programs in sustained, collaborative partnerships over a 12- to 24-month period. Experienced Roca leaders engage these partners to learn new, trauma-informed strategies and apply them in their local context.

The idea, Baldwin said, is to change together. “If we hope for change for young people, we must change, too.”

At the virtual forum, Baldwin presented Roca’s James E. Mahoney Award to Peter Forbes, commissioner of the Massachusetts Department of Youth Services (DYS), which has implented some of the concepts Roca promotes. Back in the 1990s, he noted, juvenile justice was in a different place, using terms like ‘predator’ and ‘offender,’ and concepts like boot camps and scared-straight programs.

But those thing didn’t work, he said, instead generating poor outcomes for individuals and communities. “Since that time, our work at DYS has evolved. We’ve embraced the principle that young people can make positive change in their lives, that we as an agency can be part of that change, and that our investment in youth development actually contributes to community safety.”

He cited national studies demonstrating that therapeutic approaches to justice-involved youth drive lower recidivism than punishment strategies. “If we run a coercive system, we actually run the risk of young people being worse off for their contact with the system.”

It starts, Forbes said, with meeting young people where they are. “People who work with adolescents see disrespect, non-responsiveness, impulsivity, defiance — behaviors that are typical of adolescents. Those are not descriptors of juvenile delinquency; that’s typical adolescent behavior. So it’s really important, as adults working with young people, that we respond to the behavior, but not overreact.”

 

New Beginnings

The event featured a brief address by former U.S. Rep. Gabby Giffords, who has been an ardent gun-control advocate following her assassination attempt in 2011. Her message struck a different, more activist tone than the rest of the program.

“These are scary times — racism, sexism, lies, coronavirus. It’s time to stand up for what’s right. It’s time for courage,” she said. “We must do something to stop gun violence and protect our children, our future … to make our country a safer place, a better place.”

It will be a better place, Baldwin said, through the kind of relationship building, mutual understanding, and personal accountability that lie at the heart of Roca.

“We are humbled and honored to work with the young people at the center of urban violence — those who are traumatized, full of distrust, and trapped in a cycle of violence and poverty that traditional youth programs alone can’t break,” she said. “Today is a celebration of those who make this work possible, from young people to Roca teams and our partners committed to sparking new thinking about working with young people who are traumatized and stuck.”

Getting unstuck is a decision, she noted, offering a George Bernard Shaw quote: “Progress is impossible without change, and those who cannot change their minds cannot change anything.”

Roca is doing its part to create change, Baldwin said, but it can’t achieve its goals alone. “There is an opportunity for all of us to begin again.”

 

Joseph Bednar can be reached at [email protected]

Health Care Special Coverage

Youth in Crisis

Let’s face it — the past year of COVID-19 has probably been tough on you, in any number of ways that weigh on your peace of mind. But what about your kids? How are they doing? And … do you even know? That might seem like a flip or aggressive question, but a group of local teenagers who have been talking to public-health leaders about the issue say their parents aren’t fully hearing them when it comes to the impact of the pandemic. And that impact, in many cases, has been worrisome.

 

Alane Burgess began by stating the obvious.

“It’s not normal for kids to be home all the time.”

As clinic director of the BestLife Emotional Health & Wellness Center, a program of MHA Inc., Burgess is one of many healthcare professionals keenly invested in how the COVID-19 pandemic has impacted young people. And the picture is worrisome.

“They like to be out. They like to socialize. Most kids like to be with friends,” she said. “COVID forced isolation on a lot of people; they haven’t been able to go to school, to socialize, to be involved with activities they once loved, like sports. Community spaces haven’t been open.”

It’s not surprising, she added, that this isolation has contributed to an uptick in anxiety, depression, frustration, and a tendency to act out in negative ways.

Indeed, according to the Centers for Disease Control and Prevention, between April and October 2020, hospital emergency departments saw a rise in the share of total visits from childen for mental-health needs. Nationwide numbers on suicide deaths in 2020 are still unclear, but anecdotal evidence suggests an uptick.

“Kids are excited to go back and see their friends and have some sense of structure, to be in society again. But there are definitely a lot of adjustments to be made.”

But here’s the less obvious reality, Burgess noted: while the pandemic may be (and that’s may be) on its last legs and schools and other gathering places are slowly opening back up, that doesn’t mean the stresses of the past year will just fade away.

“Kids are excited to go back and see their friends and have some sense of structure, to be in society again,” she told BusinessWest. “But there are definitely a lot of adjustments to be made.”

When COVID struck, she noted, the shifts were quick and unplanned — kids were suddenly learning at home, and many of their parents were suddenly working there. It has been a challenging time, particularly for working parents with young children who need help with school.

But transitioning back to whatever will pass for the new normal poses its own challenges, she said. “It was originally going to be two weeks, and weeks turned into months, and months became a year. Now, they’re going back out into a world that’s changed; it’s not going to be the same — there will be masks and social distancing and limitations on clubs and activities.”

Tamera Crenshaw says barriers to accessing mental healthcare are myriad.

Tamera Crenshaw says barriers to accessing mental healthcare are myriad.

Socially, certain young people — those with a more introverted personality — found they thrived in the remote setting, and are anxious about returning to campus, Burgess added. Others found the home setting to be an escape from bullying, and are palpably fearful about going back.

Meanwhile, some students, depending on how rigorous their remote-learning experience was, might find themselves overwhelmed or feeling academically behind as teachers play catch-up. Many students report coasting to passing grades, even very good grades, while feeling they haven’t been learning much.

And the economic struggles affecting many families who lost income or jobs — a definite stressor on kids — certainly aren’t over.

Tamera Crenshaw, a clinical psychologist and founder of Tools for Success Counseling in Longmeadow, said she’s especially passionate about mental health in minority populations, a demographic disproportionately affected by mental-health issues — because, again, those issues tend to be exacerbated by factors like economic stress, which have also landed hard on those populations during COVID-19.

Even remote learning has been a greater problem for communities of color because of issues of technological access and family strife over financial matters, she added. “Home isn’t necessarily the most conducive learning environment — and COVID just exacerbated it.”

An uptick in suicidal ideation is especially concerning, Crenshaw said. “Someone can have a baseline of thought, but when kids are actually expressing a plan or intent, it’s scary. And we’re definitely seeing an increase.”

Some of the factors are typical stressors on teens in any given year, but despondency has certainly been driven by greater economic instability, which can raise tension and anxiety in the home, as well as two competing factors: a longing to end a year of isolation and get back to school, and health fears about the safety of doing so, especially for kids who know someone who has died of COVID.

“These kids have not been forgotten, but even with a vaccine, they’re going to be vaccinated last,” she noted. “I can’t imagine there’s not a fear of going back into the school environment when they haven’t been vaccinated.”

The issues are deep and complex, and solutions aren’t easy. But, like most others in the mental-health field, Crenshaw says the first step to helping young people take charge of mental-health issues is clear and simple.

“You’ve got to name it.”

 

Start the Conversation

That means breaking through societal stigma surrounding these struggles.

“My mission is to destigmatize mental health,” Crenshaw said, noting that several factors contribute to that stigma and the resulting reluctance to seek help. “I want to help debunk that stigma.”

Beyond attitudes toward mental health, another barrier is financial — the challenge of accessing insurance that will pay for treatment, or, for those who don’t have it, navigating out-of-pocket costs while already struggling economically, she added.

“It was originally going to be two weeks, and weeks turned into months, and months became a year. Now, they’re going back out into a world that’s changed; it’s not going to be the same — there will be masks and social distancing and limitations on clubs and activities.”

A third factor is religious belief, specifically a belief by some churchgoers that mental-health professionals are at odds with faith, or that faith makes such help unnecessary. “We’re trying to educate churches and knock down that barrier,” she said. “I’m a woman of faith myself.”

Another factor is the simple fact of how few therapists of color are working today. Crenshaw’s team is largely women of color, but her practice is an exception — which is unfortunate because she knows people of color will often have an easier time trusting someone right off the bat when they can relate to them or see themselves in them.

This last factor might be a long-term struggle to overcome, she added, noting that she teaches classes in her field at Westfield State University, and none of the 17 students currently in one of her classes is a woman of color.

In fact, the mental-health and social-work fields in general are in need of more talent, said Jessica Collins, executive director of the Public Health Institute of Western Massachusetts (PHIWM). She agreed about the access issue as well, noting that mental health should be a basic support, not something available only for people who can pay for it — especially when families who can’t pay are often in greater need of those supports.

Recognizing the importance of these issues among young people, before the pandemic even began, the Public Health Institute facilitated the formation of a youth mental-health coalition in Springfield — one that brings to the table direct service providers like BHN and Gándara, Springfield Public Schools, local therapists, and, critically, a group of 11 teenagers who meet regularly.

The question at the center of the initiative is simple, Collins said. “How do we best support kids? It might sound basic, but it’s fairly new; there has not been an emphasis on the mental health of kids except in extreme cases, where the kids have to go into inpatient care.”

One takeaway so far is that teens don’t feel fully heard by the distracted adults in their lives.

“What we’re hearing, loud and clear, from our young people is, when they talk to adults, adults are not skilled at supporting them,” Collins said. “Adults are stressed, adults are stretched, and that just adds to this epidemic of young people feeling hopeless and alone and unsupported.”

That’s why the Public Health Institute is talking about what kind of training adults — those who work in preschool and school programs, but also parents — might need to learn how to better listen to young people and work through and respond to what they’re hearing.

Jessica Collins

Jessica Collins says parents sometimes get so stressed, they don’t realize how stressed their kids are, too.

“These big direct-service providers are really competitive, so to get them in a room to talk about how can we work together to better support families, instead of just competing for them, that’s fairly new,” Collins said, adding that Daniel Warwick, Springfield’s superintendent of Schools, has also been on board with efforts like this for a long time.

For example, when he saw a 2017 report by PHIWM about the hopelessness felt by local teens who don’t identify as heterosexual, “he was so upset about that, a few years ago, he mandated some training for all Springfield public-school adults to better support kids who are LGBTQ+.”

 

Take It Seriously

That’s a good example of listening to young people and then taking them seriously — which is one way to normalize mental-health needs, Collins said. “If you can’t talk about it, you can’t figure out for yourself what you need.”

And one thing young people need right now is reconnection. While many kids are tired of the technology-only avenues for connecting with friends, Crenshaw said, Zoom calls, text chats, and the like have been an overall positive in staying in touch. But she also encourages kids and families to take opportunities to see friends and loved ones in person, in a safe manner, when possible.

“You can go to the park; you can go outside with a soccer ball, wear your mask, and connect. Some families have said, ‘we can’t do this alone,’ and became part of each other’s bubble, taking turns doing homeschooling. We encourage these ways of connecting with each other.”

And don’t give up on trying to talk to your kids, Burgess said, even when they don’t feel like talking back.

“The most important thing any parent can do during these times is open a dialogue with their children and allow kids to have open communication,” she said. “What are they thinking? What are they feeling? Then we can guide them and help them through their own resiliency and make adjustments.”

Families can help combat their kids’ isolation, she said, by planning quality family time, even if it’s just having dinner together, around the table, every night, or scheduling a family game night every week. Those moments, she noted, can naturally help kids let their guards down.

“You want to have that quality time, that open communication to talk and listen to your kids and ask, ‘how are you feeling? What’s going on? What can I do to help make things easier?’ Sometimes, as a parent, we’re not able to say ‘yes’ to everything, but we can look for compromises and help kids make some of the decisions.”

The problem in identifying signs of distress, Crenshaw said, is that teenagers, even on their best days, often prefer to be isolated, or present a sullen demeanor. So how can parents separate normal teen ‘attitude’ from real warning signs?

“Are they communicating as much with you, or are they isolating in their rooms moreso than normal? Are they eating normally?” she asked. “Even prior to COVID, parents would say, ‘I didn’t know there was a problem — I thought that’s how kids are.’”

It doesn’t hurt for parents to simply ask their kids, directly, how they’re feeling, what’s working or not working in their lives, how school is going, and if they’re feeling more anxiety than usual. “If a teen is isolated in their room, that could be typical teen behavior, but maybe not.”

Physical signs may be visible, too, Crenshaw said, noting that cutting — what’s referred to in her field as ‘self-injurious behavior’ — and eating disorders are more common than some parents think.

But more often, the signs are subtler. “It’s just really knowing their disposition and what they’re involved in.”

Burgess said it’s important for parents not to go it alone if their gut tells them something is truly wrong.

“If you notice your kid struggling with severe signs of depression — really isolating, really struggling — definitely seek professional help. If your kid is talking about suicide or even just having a hard time getting back into interacting or adjusting, seeking professional help is always key.”

In the end, coming out on the other side mentally healthy — and that goes for parents and children alike — will take patience and resilience, Burgess added.

“There’s no guidebook for this. There’s no ‘COVID for Dummies’ book. We’re all doing the best we can to adapt. We’re all just going through an unprecedented time.”

 

Joseph Bednar can be reached at [email protected]

Health Care

Mental Block

The health anxieties, economic stresses, substance abuse, and feelings of isolation exacerbated by COVID-19 aren’t exactly new, Dr. Barry Sarvet says. And they won’t fade when the pandemic does.

“Prior to the pandemic — and it’s easy to forget this now — we had an enormous amount of stress in our communities related to poverty, homelessness, economic struggles … people just facing an enormous amount of stress in their lives,” said the chair of Psychiatry at Baystate Health. “We had underemployment, unemployment, an opioid epidemic. It’s a very distressed community with a lot of long-term struggles, a lot of psychosocial stress. Every psychiatric disorder is influenced by environmental stresses, and those aren’t getting better. We need to pay more attention to them after the pandemic.”

Well before COVID-19, Sarvet noted, the region’s mental-health needs laid bare a shortage of inpatient beds for patients who need more help than outpatient visits can provide. It’s why Baystate announced a joint venture with Kindred Behavioral Health last summer to build and operate a $43 million behavioral-health hospital for the region, set to open in 2022. The hospital will be located on the former Holyoke Geriatric Authority site on Lower Westfield Road in Holyoke.

Dr. Barry Sarvet

“Every psychiatric disorder is influenced by environmental stresses, and those aren’t getting better.”

Holyoke Medical Center (HMC) had revealed a similar proposal in March 2020 to build a $40.6 million, 84-bed behavioral-health facility on its campus. But when Baystate’s plans came online, and the threatened closure of 74 inpatient beds at Providence Behavioral Health Hospital were saved by a change in ownership, HMC reverted to an earlier plan, to repurpose two of its existing units for behavioral health.

“We were concerned about providing a solution to get beds online as the state was developing guidelines for all hospitals to incentivize an increase in behavioral-health beds,” said Spiros Hatiras, president and CEO of HMC and Valley Health Systems.

The process of converting two units to behavioral health — an adult unit and one with a likely geriatric focus — began in October and will be finished by late April, and will add 34 new beds to the existing 20 at the hospital, more than doubling the total to 54. In doing so, it provides a more immediate solution to regional bed shortages, avoiding the need for a lengthy construction period (HMC’s new hospital was also expected to open in late 2022).

The internal repurposing of units had been conceived as a stopgap measure, but when Trinity Health announced the sale of Providence to Health Partners New England (HPNE), which committed to keeping inpatient beds open — and Baystate moved forward with its project — the stopgap made sense as a longer-term solution, although HMC could revisit a standalone behavioral-health hospital at some point in the future, Hatiras said.

Baystate’s project, meanwhile, will include 150 beds — 120 of them part of the original plan. The system has also contracted with the state Department of Mental Health to operate a 30-bed, long-term continuing-care unit for chronically mentally ill people who need a longer time in the hospital to stabilize before returning to the community, Sarvet explained.

This state-funded program, not accessible to regular referrals, was launched after the closures of Northampton State Hospital and other facilities like it. “Some patients need longer-term care, and this offers a length of stay to support people who don’t benefit from short-term hospitalization,” Sarvet said, adding that the DMH unit will be physically connected to the new hospital, but offer its own unique resources.

“New beds will be needed over the long term,” he said, speaking of the project as a whole. “We have had quite a shortage for many years, prior to the potential closure of Providence and prior to the pandemic. This substantial increase in needs is reflected in emergency-room visits from patients with a mental-health crisis. And we certainly see evidence that this isn’t a short-term blip, but part of a longer-term trend that predated the pandemic.”

 

Multiple Pivots

The prospect of any additional behavioral-health beds in the region is certainly a turnaround from a year ago, when Trinity Health announced it would close 74 inpatient beds at Providence Behavioral Health Hospital.

However, two months ago, the health system sold Providence to HPNE, which provided some management services at the facility from 2011 to 2014, and will operate the facility under the name MiraVista Behavioral Health. In doing so, it will resume operations of numerous outpatient programs, as well as including up to 84 inpatient psychiatric beds.

Spiros Hatiras

Spiros Hatiras

“We were concerned about providing a solution to get beds online as the state was developing guidelines for all hospitals to incentivize an increase in behavioral-health beds.”

“At the time we put forth the plan to build a new behavioral-health hospital, everyone else had pretty much abandoned any behavioral-health expansion,” Hatiras told BusinessWest. “People were shrinking programs; Providence was closing down their campus, and Baystate had put their plans on hold indefinitely. We decided we needed to do something to service the region. Since then, Baystate resurrected their plan to develop the old Geriatric Authority site.”

The recent moves come as no surprise at a time when state health officials have been incentivizing hospitals to open up behavioral-health beds in the wake of a sharp increase in cases due partly to the pandemic.

However, “we had a concern that what seemed like no beds could potentally become too many beds,” Hatiras explained. He disagrees with Marylou Sudders, secretary of Health and Human Services for the Commonwealth, who has said there can never be too many beds because the state has so many needs. Rather, he noted, “demand may be greater now than it will be a year from now as we move away from the pandemic spike; we might see demand go down.”

Two other factors, both geographic, also played into the decision to scale down HMC’s behavioral-health expansion. One is that HMC, Baystate, and Providence would have been providing around 225 beds within a three-mile radius of each other, and though the need for services is great statewide, there’s only so far patients and families will be willing or able to go to seek access to treatment — not to mention the difficulty of recruiting more physicians, nurses, and ancillary staff to such a concentrated area.

“We might find ourselves very quickly in a situation where we might not be able to staff those beds. Can we attract staff to this area? That’s always been difficult for Western Mass.,” Hatiras said, another reason why a smaller-scale project makes sense right now.

“I’m optimistic about the units we’re building coming online quickly and providing some relief,” he said. “It’s a good project, and we have a good track record in behavioral health. We know we can run it well, and the state has been very enthusiastic about it. I think we’re in really good shape.”

While the standalone hospital proposal is ‘parked’ for the moment, not abandoned completely, HMC has to be sure something of that scale would be both necessary and practical before moving forward, Hatiras added. “We’re a small community hospital. A project can’t be something that may or may not succeed financially; we can’t take a $45 million risk.”

Baystate currently has 69 behavioral-health beds at three of its affiliate locations: 27 at Baystate Wing Hospital, 22 at Baystate Franklin Medical Center, and 20 at Baystate Noble Hospital. When the new facility opens next fall, these three locations will close. A fourth location, the Adult Psychiatric Treatment Unit at Baystate Medical Center (BMC), which accommodates up to 28 medically complex behavioral-health patients, will remain open. Kindred Healthcare will manage the day-to-day operations of the behavioral hospital.

Sarvet firmly believes Baystate will able to fully staff the new venture.

“We do have a nursing shortage, so this will present a challenge, but I don’t think it’s insurmountable,” he told BusinessWest. “We’ll work very hard to include people from the region and hire locally, but we might need a wider net to bring people in. We are very confident we’ll be able to be successful.”

 

Not Waiting Around

In fact, all the local players in the inpatient realm of behavioral health need to be successful, Sarvet noted. For example, suicide rates are increasing, as are instances of anxiety and depression, including in young people (see story on page 4). Meanwhile, the workforce of psychotherapists and clinicians in outpatient settings haven’t been operating at full capacity — again, partly due to the pandemic and the shift to remote treatment settings.

Like HMC, Baystate isn’t waiting for a new building to expand certain aspects of behavioral care. It will open a 12-bed child unit at Baystate later this month, which will expand to a 24-bed unit in the new hospital next year, in response to a shortage of beds specifically for that population. “We see a large number of kids taken care of on medical floors, waiting for beds, up to several weeks,” Sarvet said.

All this movement is positive, Hatiras noted, though he does wish that leadership from HMC, Baystate, and Providence had engaged in deeper conversations about the region’s long-term behavioral-health needs and how to meet them before the recent rush of project launches and changes, bed closings, and ownership transitions.

“Let’s talk as a regional team and determine what makes sense for the region,” he said. “That still has purpose now. Let’s decide what makes sense in these areas before we build 250 beds and can’t staff them, or half of them sit empty.”

For his part, Sarvet agrees that the meeting the region’s inpatient behavioral-health needs is not a solo effort. “We don’t want to win the battle; we want all hospitals to be staffed. We’re in a friendly competition, and we want everyone to win.”

 

Joseph Bednar can be reached at [email protected]

Health Care

The Next Step

By Mark Morris

 

Jack Jury

Jack Jury says today’s joint-replacement patients experience less pain and a shorter rehab than in the past.

As we age, it’s not unusual for our joints to become worn down from decades of use. For most people, their knees, hips, or shoulders will develop painful arthritis and need some kind of attention.

When a patient suffers from especially severe joint pain, doctors usually begin treatment by recommending physical therapy, as well as pain medications or an assistive device such as a cane or a walker. When these non-operative approaches work, they can provide relief and delay an eventual surgery.

However, “if the pain, function, and quality of life do not improve for the patient, that’s when we recommend joint-replacement surgery,” said Dr. Ben Snyder, an orthopedic surgeon at Cooley Dickinson Health Care.

Nearly 1 million Americans undergo joint-replacement surgery every year, with around 600,000 for knees and 300,000 for hips. According to Snyder, this safe and effective surgery is proliferating because, as people age, they want to remain active through their later years.

In the past, surgeries were often held off until patients were in their 70s because older-model replacement joints would not hold up for more than 10 or 15 years. “But improvements in joint-replacement techniques and technology have increased the longevity of joint-replacement surgery,” Snyder said. “Because of that, we’ve seen a big increase in patients who are 55 to 65 years old.”

A key to success for joint-replacement surgery involves getting patients out of bed and walking on the same day of surgery, Snyder noted. “We find that mobilizing patients early promotes faster recovery, less pain, and fewer complications.”

Andrea Noel-Doubleday, assistant director of Rehabilitation Services at Cooley Dickinson, has been a physical therapist for 25 years. In that time, she said, helping patients with their rehab has improved greatly because it has become a much less painful process for the patient.

Dr. Ben Snyder

Dr. Ben Snyder

“We find that mobilizing patients early promotes faster recovery, less pain, and fewer complications.”

“Joint-replacement surgeries have evolved and become so good that we just guide patients through their exercises,” she said. “For most patients, there isn’t the high level of pain in a rehab like there used to be.”

Less pain also translates to a shorter rehab process. Jack Jury, lead physical therapist at the Rehabilitation Hospital at Mercy Medical Center, said a full knee replacement for many patients is a day-stay surgery.

“They come in in the morning, have their knee replaced, work with us for couple sessions of physical therapy, and then go home the same day,” he explained.

While home exercises and outpatient rehabilitation remain essential, he noted, even they are taking less time. “A few years ago, it was not unusual for our patients to see us for 12 weeks of outpatient therapy. Now, four to five weeks is a long time to work with someone.”

 

Transition Game

Both Jury and Noel-Doubleday pointed out that rehabilitation hospitals play a key role in the healing process for patients who are not yet ready to move from the hospital directly to their home.

Those patients see people like Nick Rizas, inpatient therapy manager with Encompass Health Rehabilitation Hospital of Western Massachusetts. Rizas explained that patients are usually referred to Encompass because they have chronic conditions (such as obesity, diabetes, and active tobacco use) that make healing more challenging. He also works with patients when they decide to have both knees replaced at the same time.

“When a person is in pain because their knees are giving them trouble, getting both done means they only have to go through the process once,” he said, quickly adding that “this procedure would only happen after a discussion with the surgeon to determine that this is the best course of action.”

Andrea Noel-Doubleday speaks with a joint-replacement patient.

Andrea Noel-Doubleday speaks with a joint-replacement patient.

On occasion, physical therapy plays a role before surgery when doctors recommend patients for a program known as ‘prehab.’ Noel-Doubleday explained that prehab allows patients to increase their strength and become familiar with the exercises they will need to perform to properly heal after surgery.

“It can be hard to go through the exercises when you aren’t feeling great, but it’s worth it,” she said. “By being stronger before the surgery, patients can get back to their normal activity sooner.”

When Rizas does prehab work to help patients build strength in their leg or hip before surgery, he said, “it gives them a running head start on their rehab program.”

Healthy muscles around the joint play an important role in protecting it as well, he added, noting that the hips have a deep socket with lots of muscle surrounding them, while the shoulders have less muscle mass protecting them.

“By being stronger before the surgery, patients can get back to their normal activity sooner.”

“The shoulder socket is more like a golf ball on a tee; it’s much more delicate,” Rizas said. “We have to be more careful when treating a shoulder because the muscles surrounding it aren’t as big as in the hips and legs.”

If a patient needs prehab but has trouble walking, therapists now have the AlterG, an anti-gravity treadmill that supports a person’s weight so they can exercise and build their strength prior to surgery. Noel-Doubleday said the treadmill also helps after surgery.

“If a patient is having difficulty getting their normal walking pattern back, the anti-gravity treadmill helps them get more comfortable and confident with their walking and with their movements before their full body weight is on the joint,” she explained, noting that equipment like this was not available even 10 years ago.

 

 

Playing Catch-up

One year ago, when COVID-19 infection rates began to overwhelm hospitals, joint replacements, along with other elective surgeries, came to a halt. Elective surgeries have since resumed, and doctors continue to catch up with what Snyder described as “innumerable joint-replacement surgeries” that were put on hold due to the pandemic.

One sign that joint-replacement procedures are back in business, Jury noted, was the recent addition of two new orthopedic surgeons at Mercy Medical Center.

The joint-replacement rehab areas have all beefed up their screening process as well as implemented all the necessary safety protocols to continue to see patients, Noel-Doubleday said. “COVID changed our routine, but it hasn’t stopped us from doing our jobs. We might work with patients in a different space or alter things slightly, but overall, we’ve made the necessary adjustments.”

As the world starts to emerge from pandemic times, many people are concerned about the “COVID 15,” a popular expression for the weight gained as a result of less activity during a year of being stuck inside. Maintaining a proper weight provides many health benefits, and lessening the wear and tear on the joints is one of them. Physical therapists say it’s a simple matter of biomechanics: the more weight we carry, the more stress we put on our joints.

Snyder recently authored a whitepaper on treating knee arthritis and discussed the relationship between weight and our joints. In the data he cited, for every pound a person loses, the force on the knees is reduced by five to 10 pounds.

Physical therapist Steve Markey

Physical therapist Steve Markey works with a patient on the AlterG anti-gravity treadmill.

Jury said carrying too much weight over time can also throw off structural alignments in the body, which exacerbates the stress on the joints. “We haven’t yet seen the impact from recent weight gains during COVID, and it will probably be years from now until we do.”

When joint-replacement surgery is necessary, Noel-Doubleday makes it a goal to educate patients before the procedure so they know what is involved. Jury makes sure his patients understand what he termed as “a couple important things” to know about joint replacement.

“First, it’s not an easy rehab, by any means,” he said. “But if the patient puts in the effort at physical-therapy appointments and, more importantly, at home with their independent program, they will most likely have a successful outcome.”

He noted that the success rate based on standard outcomes is much better today than it was even five years ago. In turn, most joint-replacement rehab patients these days expect to resume their activities at high levels after surgery. “If you look at walking, the goal is more than comfortably getting around, it’s being able to take a three-mile walk for exercise every day like they’ve done in the past.”

Noel-Doubleday said identifying specific activities patients want to return to is a change from past rehabilitation practices.

“For example, many patients want to resume playing golf or tennis, so we structure the rehab to help them do that again,” she said. “It’s been interesting to see how rehab has evolved like this, and it’s a lot of fun to be a part of it.”

Coronavirus Health Care Special Coverage

Forward Thinking

A rundown of the big issues facing healthcare 20 years ago would, in some ways, be similar to the same list today, encompassing persistent challenges like hospital finances, staffing shortages in certain specialties, strategies to tackle substance abuse, and diseases like cancer and Alzheimer’s.

Yet, the solutions to those issues have certainly evolved. For example, hospitals have seen a dramatic shift to accountable care, a model in which disparate providers work together and are paid for patient outcomes, not how many procedures they order up. And patients are increasingly active participants in their own care, as are senior-living residents and their families.

Technology has exploded as well over the past two decades, from robotic and minimally invasive surgery to increasingly targeted cancer treatments and rapid advances in prosthetics — not to mention the IT revolution, and the shift to electronic health records, patient portals, and, of course, everyone’s favorite pandemic-driven technology, telemedicine, which, most doctors agree, will continue to play a key role post-COVID-19.

Education has expanded as well. Stroke survival rates are higher these days, partly because people better understand the signs, and so are cancer survival rates, with the public more aware of the importance of screening. In fact, one huge story over the past 20 years has been the rise of preventive wellness and patient education — and keeping people out of the hospital as much as possible.

So, yes, many decades-old concerns of patients remain key concerns in 2020 (along with that whole pandemic thing that has dominated this unusual year). But the way we tackle those issues — with new ideas, new technology, and new facilities — is dramatically different.

To better paint that picture, we asked area health leaders what the next 20 years might hold in the areas of hospital administration, behavioral health, cancer care, and health education. On the following pages are their intriguing perspectives.

What’s Next for Hospitals

What’s Next in Behavioral Health

What’s Next in Cancer Care

What’s Next in Health Education


Health Care

What’s Next for Hospitals

By Spiros Hatiras

The year is 2020, in the midst of an unprecedented pandemic, and the subject is the U.S. healthcare system — more specifically, the average U.S. hospital. Is it alive and well, or is it ailing?

I will argue that all is not well with our healthcare system, and that the average U.S. hospital is facing tremendous challenges now and for the foreseeable future.

It is important to establish that, while the healthcare-delivery model has been shifting to less hospital-centric models, the acute-care hospital remains solidly in the center of our delivery system and, in my opinion, will continue to do so. Any notion of a more decentralized model with less emphasis on hospitals has been pushed many years into the future, in part as a result of the COVID-19 pandemic. Despite the accelerated growth of telemedicine during the pandemic, the need for hospital bed capacity, specialized equipment, and personnel — including the ability to ‘surge’ when needed — has all but ensured that the trend toward a smaller hospital footprint will slow down if not entirely reverse.

Shouldn’t that be good news for the future of hospitals? Well, not quite. While we may have a new appreciation for the need of readily available inpatient hospital care, we have also not solved any of the problems that hospitals have been facing for many years. In fact, the pandemic laid bare one of the most fundamental problems facing the industry, especially for smaller community hospitals. At the very onset of the pandemic, it was immediately clear that many hospitals, suffering from years of underfunding, faced immediate financial threat and would not be able to survive without a financial bailout, while private insurance companies reported record profits.

“I will argue that all is not well with our healthcare system, and that the average U.S. hospital is facing tremendous challenges now and for the foreseeable future.”

Why is this the case in a country where healthcare demands the highest per-capita expenditure of all developed countries? According to a study published in January 2019 by the Johns Hopkins Bloomberg School of Public Health, the U.S. topped the ranking of healthcare spending among developed countries in 2016 at $9,982 per capita per year, a figure that is more than double the median of $4,033.

The reason for this disconnect is that most of that money is spent not on actual care, but on administrative costs. A recent study by the Center for Medicare and Medicaid Services found that, of the $3.5 trillion spent on healthcare in 2017, 33%, or $1.1 trillion, was paid to hospitals. Unfortunately, a significant portion of that money covered unnecessary costs to process bills and get paid by insurance companies, meaning the total spent on actual hospital care was far less. The same is also true for doctors’ offices.

In a study published in 2017 in Annals of Internal Medicine, Steffie Woolhandler and David Himmelstiein noted that the administrative cost of our healthcare system was estimated to be $1.1 trillion, of which the vast majority is excess and unnecessary spending. We are spending vast sums of money on a deliberately confusing and complex insurance system.

Trying to navigate the onerous billing requirements, denied-claims management, pre-authorization requirements, and a host of other administrative hurdles unique to the U.S. healthcare system is wasteful and frustrating to hospitals, doctors, and patients alike. We spend more money administering the system than we spend on care. This should alarm each and every one of us and prompt us to look a little more carefully at proposals for a single-payer system.

It is time to ignore private insurers who portray a single-payer system as the boogeyman, or the end of healthcare as we know it, and recognize their argument for what it really is: a reluctance to part with huge profits being made from a broken system at the expense of our health.

 

Spiros Hatiras is president and CEO of Holyoke Medical Center.

Health Care

What’s Next in Health Education

By Marie Meckel, Kathleen Menard, Susan McDiarmid, and Theresa Riethle

Despite the complexities that COVID-19 has brought to healthcare education, the trajectory from traditional models to hybrid or virtual experiences was inevitable. Today’s technology allows healthcare educators to transcend geography, which widens access to health education in all segments of the population despite location, economic status, and race. The pandemic also revealed the vulnerabilities of underrepresented minorities.

These challenges caused many educators to pause to re-evaluate and readapt to how we teach and develop medical curriculum. Incorporating technology through virtual learning experiences while focusing on how social determinants of health impact patient care and outcomes are two areas of focus in the future of healthcare education.

Health programs can integrate in-person and remote simulation experiences; these include the traditional simulation lab consisting of realistic mannequins where learners can develop clinical skills in a safe setting without patient harm. Additional virtual experiences include a wide array of interactive patient-encounter portals where learners can conduct histories, perform physical examinations, order and interpret diagnostic tests, develop assessments and treatment plans, all while documenting patient records and receiving coaching and feedback every step of the way.

“By incorporating technology into healthcare education, medical learners will be better prepared for clinical practice.”

Live rounding with certified medical providers has also enabled learners to experience traditional hospital rounding from wherever they are in an interactive manner. Even surgical experiences can be supplemented with high-definition surgical videos and medical lectures from subject-matter experts.

While none of these experiences will replace the need for traditional hands-on learning, they can provide learners with unique education experiences that directly correlate to what is seen in clinical practice. With the increase in telehealth visits, medical learners are now equipped to adapt to these visits, delivering care in a better and more effective manner.

Technology is intertwined into healthcare today as seen with diagnostic imaging, robotic surgery, and electronic health records. By incorporating technology into healthcare education, medical learners will be better prepared for clinical practice. The virtual experiences will also develop independent and critical thinking, thus making it easier to adapt to innovations and changing patterns of illness and health systems.

In order to provide equitable, high-quality healthcare to all patients, we must include social determinants of health in the curriculum. These include socioeconomic status, education, neighborhood and physical environment, employment, and social-support networks, as well as access to healthcare.

This charge became more evident with the pandemic, as we have seen its profound impact on underrepresented minorities. It would be a disservice to future providers to ignore the current healthcare disparities in these populations. Addressing these determinants is not only important for improving overall health, but also for reducing health disparities that are often rooted in social and economic disadvantages.

Healthcare providers of the future will not necessarily be those who have a traditional classroom education, but will be those who know how to use, implement, and apply technology in healthcare systems and provide high-quality healthcare to all patients.

 

Marie Meckel, MS, MPH, MMSc, PA-C; Kathleen Menard, MS, PA-C; Susan McDiarmid, MS, PA-C; and Theresa Riethle, MS, PA-C are physician assistant faculty members at Bay Path University.

Health Care

What’s Next in Cancer Care

By John Sheldon, M.D.

Cancer is the second-leading cause of death in the U.S., but we continue to make significant advances in reducing its toll.

John Sheldon

John Sheldon

Key developments have included targeted drug therapies resulting from genomic profiling of tumor samples, which determines the molecular ‘fingerprint’ of the tumor; immunotherapy, which allows the body’s own natural immune system to better attack tumors; more sophisticated radiation-delivery technologies, which allow for more precise targeting of tumors and better sparing of adjacent normal tissues from radiation dose; and newer combination or ‘multi-modality’ treatment regimens, taking advantage of a combination benefit effect of different ways of attacking and killing tumor cells.

In lung-cancer treatment, for example, we now have drugs to target a variety of specific mutations that may be present, such as EGFR, ALK, ROS1, MET, RET, BRAF, or NTRK. Immunotherapy has been shown to provide a survival improvement in both stage-3 and stage-4 lung cancer. For earlier and smaller lung cancers, highly targeted radiation treatment can be delivered in a short regimen of just three to five sessions, as an alternative to surgery for patients who are not good surgical candidates. And for other patients, combination regimens of radiotherapy and chemotherapy followed by immunotherapy may be the preferred approach.

Even newer types of drugs are now available called antibody-drug conjugates, or ADCs, which target with high affinity a particular protein expressed on the surface of tumor cells, attach to the target, and then deliver a toxic payload to kill those particular tumor cells. This type of treatment was just approved by the FDA in April for metastatic ‘triple-negative’ breast cancer (a more aggressive type of breast cancer), and another drug in this category was approved last December for locally advanced or metastatic bladder cancer.

Molecularly targeted radiation delivery is another category of treatment that is advancing. Also known as peptide-receptor radiotherapy (PRRT), it consists of a radioactive particle, or radionuclide, linked to a protein, and this protein seeks out and targets its intended receptor, which is overexpressed on certain tumor cells. Once the protein-receptor binding takes place, the radionuclide is internalized into the tumor cell — and destroys the tumor cell. This treatment is currently being utilized for neuroendocrine tumors of the abdomen (the type of cancer that afflicted both Steve Jobs and Aretha Franklin), and it is being investigated for the treatment of metastatic prostate cancer.

Quality of life is an ongoing focus of cancer care, and while we always aim to increase survival, we simultaneously aim to optimize quality of life for patients under our care. In the realm of radiation treatment, shorter course regimens are more frequently being used (supported by evidence from clinical trials) in order to increase convenience for patients. Such regimens are now commonly used in the treatment of breast cancer, for early-stage lung cancer (as mentioned above), for some brain-tumor patients, and for some patients with prostate cancer. For the latter, radioactive seed implants into the prostate gland may be an option for a one-visit outpatient treatment.

In short, we continue to push forward strongly in the treatment of a broad range of cancers.

 

Dr. John Sheldon is medical director, Radiation Oncology at the Mass General Cancer Center at Cooley Dickinson Hospital.

Health Care

What’s Next in Behavioral Health

By Barry Sarvet, M.D.

As a science-fiction fan, I would love to be able to travel in time to see into the future of psychiatry. But, of course, the future isn’t really knowable and depends in large part on the choices we make. A more useful and realistic approach is for us to envision a possible future based on our awareness of the most urgent needs in the field, and to assume linear progress from the current state of our scientific knowledge and discovery.

Barry Sarvet

Barry Sarvet

In my opinion, the two most compelling needs within the field of psychiatry are the need for more effective, safe, and reliable treatments for the subset of psychiatric patients who don’t respond optimally to current treatments, and the need to make psychiatric care more accessible and equitable for everyone who suffers from mental-health conditions.

Depression is one of the most common psychiatric illnesses, affecting 7.1% of all adults and 13.3% of adolescents in the U.S. Severe depression is a potentially deadly illness, and suicide is a leading cause of death in this country. Although we already have a host of effective treatments for depression, between 10% and 30% of patients do not respond favorably to treatment. However, ongoing advances in our understanding of the neurobiology of mental illnesses in recent years have led to a number of novel biological treatments for treatment-resistant depression and other psychiatric conditions.

One recently developed treatment that has shown great promise with treatment-resistant depression is repetitive transcranial magnetic stimulation (rTMS). Available at Baystate, rTMS is a non-invasive procedure in which focused pulses of electromagnetic energy are applied to specific regions of the brain resulting in increases in blood flow and metabolic activity. rTMS belongs to a branch of psychiatric treatment referred to as psychiatric neuromodulation. We expect to see further development of this branch in coming years, particularly because of the encouraging observations of clinical effectiveness and safety of this type of treatment for patients whose conditions have not responded to conventional medications.

Other biological psychiatry advancements on the horizon include the development of medications targeting receptors for neurotransmitter systems (such as glutamate and NMDA) which have recently been implicated in the pathophysiology of depression and other psychiatric illnesses. We are also seeing a renaissance of research activity studying the use of so-called psychedelic drugs in combination with talk therapy to induce states of consciousness in which patients may find it easier to change well-worn patterns of thinking associated with psychiatric illnesses such as PTSD, anxiety, and depression.

Lastly, on the biological front, advances in the understanding of genetic variability in metabolism and responsiveness of the nervous system to psychiatric medications promise to usher in an era of personalized medicine in psychiatry, allowing psychiatric clinicians to select effective and tolerable medication treatments for patients without having to go through a trial-and-error process.

Even more important than advances in biological psychiatry is the need for progress in making psychiatric treatment more accessible to everyone who needs it. Currently, a majority of patients with mental illness do not receive any treatment at all, and for many more, treatment is delayed. In fact, many patients with untreated mental illness, disproportionately persons of color, end up in the criminal-justice system because of a lack of access to care.

In recent years, we have seen steady reduction in stigma surrounding mental illness and increased acknowledgment of the importance of mental health across society. Baystate’s recently announced plan for the development of a new, state-of-the-art psychiatric hospital facility for our region reflects the growing recognition of the importance of improving access to behavioral healthcare.

This new facility is just one component of a comprehensive strategy which needs to be executed in partnership with the whole community to improve access to all levels of mental healthcare and address persistent racial and socioeconomic disparities in access to care. Some of the components of this strategy includes work we have been doing at Baystate to embed mental-health services into our primary-care services. In addition, our development of new training programs for psychiatrists and child and adolescent psychiatrists have established a pipeline for enhancing the psychiatric workforce in our region.

We also will see continued use and improvement in telehealth models of psychiatric practice, which, of course, have dramatically grown in response to the pandemic, and have proven to be an important tool in reducing geographic barriers to access to care.

 

Dr. Barry Sarvet chairs the Department of Psychiatry at Baystate Health.

Health Care Special Coverage

Critical Condition

Guy DiStefano

Guy DiStefano says the non-urgent procedures that were shut down in March typically support the rest of what hospitals do, leading to major revenue shortfalls this spring.

Back in March, when COVID-19 was just starting to crest, hospitals took steps to brace for a potential surge of patients. But while COVID-19 surged, revenues slowed to a trickle.

“Early on, we realized we needed to build capacity for a surge of patients so we didn’t get overwhelmed like they did in New York City, so we shut things down early in March — which blew a hole in everybody’s finances,” said Mark Keroack, president and CEO of Baystate Health. “We’ve been gradually returning to prior operations. We always remained open, of course, but it was only a week or two ago that we resumed more elective kinds of cases.”

Many hospitals are doing the same, but the overall losses to the state’s hospital industry are, as Keroack put it, “staggering” — expected to total between $5 billion and $6 billion by the end of the fiscal year on Sept. 30. “It’s a big stress test, if you will, for hospitals. And some have been hit more than others.”

All area hospitals have taken a financial blow.

“This has been very challenging, with the reduction in services,” said Guy DiStefano, vice president of Finance at Mercy Medical Center. “All our outpatient services — what are termed non-urgent cases, which usually help feed and support what a hospital does in its normal, day-to-day business — has been shorted, leaving us with a great revenue shortfall.”

At the same time, he added, “we still have all our expenses in place, just like any other business. Look at restaurants — the doors were closed, but they still had rent, utilities, all the other expenses, and the employees.”

Through May, Mercy saw a $25 million reduction in revenues due to pandemic-related reductions in services — and plummeting volume in the ER, a development that surprised hospital officials nationwide. At Mercy, daily Emergency Department cases dropped from a typical average of between 225 and 250 to around 100 to 120.

“Those slowly crept back up — we’re at 150 to 180 on a daily basis, so we’re not at full capacity, and there’s a lot of pent-up demand. Our business is coming back, but we lost a lot of revenues.”

“All our outpatient services — what are termed non-urgent cases, which usually help feed and support what a hospital does in its normal, day-to-day business — has been shorted, leaving us with a great revenue shortfall.”

Joanne Marqusee, president and CEO of Cooley Dickinson Hospital, said the hit has been significant. Through May, the facility recorded a loss of $18 million, partly due to COVID-related costs, but mostly because of lost volume. That number would be worse if not for $5.5 million in federal support.

“But that in no way covers our losses,” she added, noting that Cooley Dickinson Health Care could see a revenue shortfall of well above $30 million for the fiscal year ending on Sept. 30.

“We’re now planning for a fiscal-year 2021 budget and considering a number of measures to mitigate some of this — things like hiring freezes and reducing a lot of discretionary expenses. Everywhere we can hold off on spending, we have,” she went on, noting that service hours could be temporarily curtailed in some services, while employees making more than $26.50 per hour will forgo raises for the time being.

While that move shaves some costs while protecting lower-paid employees, it doesn’t make nearly enough of a dent, Marqusee noted. “So we’re looking at ways to further reduce expenses. But the work we’re doing already will certainly have an impact.”

DiStefano said Mercy has also had to take steps like furloughs and reducing hours to mitigate the losses. “We did everything we could to help employees keep their benefits in place. But employees are the number-one cost of a typical hospital — about 50% to 60% of the cost structure.”

Holyoke Medical Center has been losing roughly $6.5 million per month since services were curtailed back in March, President and CEO Spiros Hatiras said. But the community hospital did take some steps early on to gird against the damage.

“We were probably the first hospital in the area to furlough folks; we didn’t hold off because we saw it was absolutely important to be financially viable because we don’t have a parent company to spot us money,” he told BusinessWest, adding that many furloughed employees took advantage of the $600 federal boost in unemployment and wound up bringing in more than they did while working.

Joanne Marqusee says she hopes patient volume returns

Joanne Marqusee says she hopes patient volume returns not because of the revenue issue, but because patients shouldn’t forgo necessary care.

“That helped reduce expenses significantly,” he added, noting that almost 170 of 250 furloughed employees were back at the start of July, with another 80 to 90 expecting to return at month’s end. “Then MassHealth stepped in and allocated $11.8 million over four months to cover some of the losses, and we got a one-time payment from the feds of about $3 million. Add it all up, and through May, our losses were roughly $3 million — not insignificant, but we were able to survive it.”

Dollars and Sense

Baystate is surviving, too, Keroack said, emphasizing the importance the health system has not only on its 12,000 employees, but on the region, where it has an annual economic impact of some $4.2 billion.

When the fiscal year ends on Sept. 30, he expects Baystate to have lost about $160 million in revenues due to volume losses, but the system was able to secure about $75 million in federal relief and another $23 million state aid.

“The rest of that will likely be covered by reserves,” he added, noting that Baystate is fortunate to have both reserve funds and a broad service model.

“The smaller hospitals that have cash-flow problems got hit very hard because they didn’t have much in the way of reserves, but the other group is bigger hospitals that are highly specialized, like Mass General, where their revenues really depend on that elective surgical volume. Hospitals that are jacks of all trades and have good size, like Baystate, were hit less hard. Not to say it was pleasant what we’ve been through.”

Calling a $160 million revenue loss a ‘less hard’ hit may speak in some ways to the financial clout of the healthcare industry as a whole; it’s certainly one of the Commonwealth’s key economic drivers. And as patient volume continues to ramp back up, hospitals will be on safer ground when it comes to budgeting.

“At Baystate Medical Center, we’re at 80% to 90% capacity, so I would say people are mostly back.” Keroack said, noting that, while patients are returning gradually for routine care and procedures, current volume is still affected by social-distancing and sanitization measures that have slowed the pace of treatment. “In the community hospitals, they’re a bit further behind — more like 60% of former volume.

“In the long run, the question is, will volumes be permanently depressed?” he went on. “We’ve tried to convince people you really don’t want to put off stuff you know is worthwhile — you don’t want to ignore symptoms that might be serious. We have seen a number of people lately whose illness is much more serious than it would have been in pre-COVID days.”

Cooley Dickinson Hospital’s Emergency Department has seen a 100% increase from its COVID lows, during the height of the pandemic locally, when it was handling 35 to 45 patients per day. Now, ED providers are seeing 70 to 80 patients per day, which is still about 20% below the organization’s typical ED volume.

“We are seeing people with chronic illness who have waited too long to seek medical attention and are sick,” Emergency Department Nurse Director Sara McKeown said. “We have also seen an uptick in people seeking mental healthcare; patients presenting with substance-use issues and trauma are also increasing.”

Patient volume is bouncing back at Holyoke Medical Center and its community-based practices, but ED visits still lag, Hatiras said. “Anecdotally, we’ve heard of people putting off heart conditions and other things, and that can lead to bad outcomes. People shouldn’t stay home with serious conditions.”

That said, “I don’t blame the government for being overly cautious with closing down elective surgeries,” he added, noting that the elimination of many procedures over the past two months was, more than anything else, about preserving beds to treat an unpredictable pandemic.

“We’re now planning for a fiscal-year 2021 budget and considering a number of measures to mitigate some of this — things like hiring freezes and reducing a lot of discretionary expenses. Everywhere we can hold off on spending, we have.”

Now that the infection rate is being effectively controlled, he explained, hospitals are trying to communicate the message that they are safe places to visit — with plenty of strict protocols in place, from masking to social distancing to constant sanitizing — for patients who need to be seen.

DiStefano said the challenge has been ramping services back up — and bringing back furloughed workers — to match what is proving to be pent-up demand, but in a measured way. “It’s a delicate balance — how do we do this to best serve the community?”

It’s a long road back from the volume lows of the spring, when physician revenue dropped by 50. They’re now back around 65%, and inpatient beds are at about 80% of capacity. But people with serious health concerns should not put off care, he stressed, especially since the hospital has been diligent about infection protocols and keeping COVID-suspected patients separated from the rest.

“We take great pains to keep this environment safe,” he said. “The message to the community is, ‘if you are hurt, if you have a condition, this is a safe place to come.’” It helps, he added, to be affiliated with a larger system, Trinity Health, and while Mercy has rarely seen the kind of financial deficit it faced this spring, its leaders are still doing what they can to meet community health needs.

“We are the fabric of the community; there are no concerns about Mercy’s future,” DiStefano told BusinessWest. “We are going to be here for many years to come. Fortunately, we have the backing of a larger organization, and that helps a lot.”

Distance Learning

If there is an upside to navigating the pandemic, he said it might be the growing importance of telehealth, which became not just a convenient tool for providers and patients over the past few months, but a critical one — and one that seems to be on track to be covered by insurance payers in the future much more consistently than before.

“This has become more of a platform that allows us to reach out to patients,” said DiStefano, whose background in telemedicine goes back to the 1990s. “I hope it’s a bigger part of healthcare going forward. Obviously, you have to do some testing in the office, but you can do preliminary or follow-up appointments with telehealth, and that reduces the volume of patients in the waiting room and the physical office, which allows us to have a much cleaner, COVID-free environment to keep those people safe.”

In short, it’s a way to boost volume — and revenues — while making patients who do go to the hospital feel more secure.

Hatiras agreed. “We had to switch on the fly to do more telehealth, but what we saw was care being delivered even more efficiently,” he said. “We saw no-show rates completely drop. So it’s an effective way to provide care, and there will certainly be more pressure on insurers to reimburse appropriately for telehealth.”

Indeed, Marqusee added, “what has been stopping us from doing more telehealth has been reimbursement; I hope we never go back to the days when we were so underpaid for telehealth. It has been a terrific model.”

In the meantime, she sees volume slowly returning to Cooley Dickinson — perhaps reaching 90% of a typical season come October. “But the reason we welcome those numbers is because people need to get care — it’s not because we need the volume. We know from national studies and anecdotally that people have been afraid, and they’re forgoing care, and that can really have health impacts for people.”

That’s why her facility, like the others BusinessWest spoke with, is not only maintaining strict protocols around infection control, but is communicating what it’s doing with the community.

“People have to believe that and feel confident. It’s really important that people don’t stay home in pain with issues that will just get worse. People aren’t coming with heart attacks, or appendicitis, or they power through a head injury, and it turns out they had a brain bleed. People need to come for care, and they should know this is a place they can come and feel comfortable.”

Not so comfortable, however, that they neglect the behaviors that have reduced infection rates in Western Mass. and allowed hospitals to increase their non-COVID-19 services.

“We’re in a good place; there isn’t a high level of COVID in our community. But that can change quickly,” Marqusee said. “I want people to always remember the reason we have low levels of COVID is because of the efforts everyone is making to social distance, wear masks, and practice hand hygiene. We shouldn’t take the reopening as a sign they we don’t need to do those things, but to do it even more. That allows us to provide needed care to all our communities.”

Keroack says he expects some patients to enthusiastically return to care providers, while others will be stragglers who need more convincing — while others will continue to embrace telehealth as the best option.

“We may not return to our former volumes until we have a vaccine and everyone feels totally comfortable,” he told BusinessWest. “I think it’s going to be a process.”

Joseph Bednar can be reached at [email protected]

Health Care

Improved State

Dr. Andrew Artenstein

Dr. Andrew Artenstein says the state’s slow, cautious reopening has effectively blocked some of the paths COVID-19 might take, thus slowing transmission of the disease.

In many respects, Dr. Andy Artenstein says, the COVID-19 virus acts like water in the home in that, if there are leaks, it can go where you don’t necessarily want it to go and cause major problems.

“Water will always find a path,” Artenstein, chief physician executive and chief academic officer at Baystate Health, told BusinessWest. “But if you block off all the paths, you have a chance; it’s the same with the virus.”

With that, he worked to explain why it is that Massachusetts, more than most of the other 50 states at this particular moment in time, is seeing the number of hospitalizations and deaths stemming from the virus decline sharply. In short, and in his view, the residents of the Commonwealth are essentially, and somewhat effectively, blocking off the paths the virus might take.

“We live in a society where there’s free mobility — that’s one of the things we love about our society. But it’s also one of the things that puts us at risk when there’s a transmissible agent rooted in this society,” he explained. “And this one is clearly here; it’s clearly transmitted in our community. It has not gone away; it’s just that, if viruses don’t get transmitted from person to person … if the virus has nowhere to go, it puts a wall from that root of transmission. You start to block off transmission paths.”

This was Artenstein’s way of explaining why, as one looks at a map of the country charting cases, hospitalizations, and deaths from the pandemic, Massachusetts is colored or tan or pink, while so many other states, especially in the South and Southwest, are dark shades of red, indicating they are hot spots.

Robert Roose, chief medical officer at Mercy Medical Center, gave essentially the same account.

“Massachusetts, along with a few of the other states here in New England, like Connecticut, New Hampshire, and a few others, seem to be solid, if not shining, examples of how a state encompassing multiple different communities can effectively slow down the rate of transmission of the coronavirus,” he said. “More than 40 other states are seeing significant increases in numbers of new infections, while here, over the past several weeks, we have not seen that increase; rather, we’ve seen a plateauing at a very low level.”

“Massachusetts and other states now doing well have been cautious in giving guidance to residents about limitations on travel and quarantining of individuals who have come from other states where there are increasing numbers of infections.”

He punctuated those comments with some statistics from his facility. Indeed, he noted that hospitalizations stemming from COVID-19, which numbered in the 50s daily on average in April, the height of the surge in this region, were down in the 20s in May, then the single digits in June. Starting in early July, there were several days when there were no hospitalizations.

Clearly, the state is doing something right, or several things right, when it comes to blocking paths for the virus, and we’ll get to those. But this begs a number of questions — especially, ‘is this sustainable?’

The quick answer, said Roose and Artenstein, is ‘yes.’ But there are a number of caveats, especially as more segments of the economy reopen in more cities, including Boston, and as the new school year is poised to begin. In their view, the Commonwealth has acted prudently in not opening too much of the economy too quickly. Staying that course is essential, they said, adding that it appears the state is committed to the slow, steady, and safe method.

Meanwhile, travel is another key factor in this equation, both people from this state traveling to others and people from other states coming here — actions that create paths for the virus, rather than block them.

“Massachusetts and other states now doing well have been cautious in giving guidance to residents about limitations on travel and quarantining of individuals who have come from other states where there are increasing numbers of infections,” Roose said. “To me, that is likely to be the most significant factor going forward, because of the rates of infection in other parts of the country; interstate travel represents one of our most significant risks in terms of keeping our rates of transmission is this local community low.”

Dr. Robert Roose

Dr. Robert Roose says caution regarding travel will be one of many factors that will determine if the Bay State can continue its pattern of falling hospitalizations as a result of the pandemic.

But the biggest factor might be fatigue.

“It’s exhausting — for all of us; I’m not just talking about the healthcare side, I’m talking about life,” said Artenstein. “There are certain things that you just miss having as social human beings. But the longer you can sort of wait this out and stretch this out, the better off we’ll be.”

In other words, people can’t relax or think for a moment that maybe it’s time to start talking about the pandemic in the past tense.

As they talked about the state’s current status as a … let’s call it a cold spot for the virus, both Roose and Artenstein praised the Commonwealth’s approach to reopening, which has been described by both those supporting and criticizing it as slow and careful.

Pain Threshold

Artenstein had another word for it.

“It’s painful, because we all want to get back to a sense of normalcy,” he explained. “It’s exhausting that you can’t do what you like to do the way you used to do it, and eventually we will be able to. But this approach has paid dividends; you get used to a little bit of a new normal, but you also know that you’re moving toward something.”

Roose agreed.

“What I think Gov. Baker and the Executive Office of Health and Human Services have done very well is be cautious, rely very clearly and directly on the key data points, and move slowly but consistently through a phased reopening,” he explained. “In other states, governors had moved much more quickly, and we’re seeing the effects of that now; in many states, they’re seeing such significant increases that they’re moving backward and rolling back some aspects of their reopenings.

“It’s not to say that this same type of thing couldn’t happen here,” he added quickly. “But relying consistently on key data and reinforcing consistently the important public-health and safety strategies that we know are effective in reducing transmission — that has not wavered, and I think that has sent a very consistent and strong message to residents to continue to wear masks, be cautious with increasing your social circle, practice hand hygiene, and quarantine when you’re sick.”

As a result of the slow reopening plan and diligence with things like mask wearing, contact tracing, social distancing, and testing, the Commonwealth has effectively moved past the first wave of the pandemic — while other states have clearly not, said those we spoke with. It is now in what Artenstein called a “window,” where, he said, residents must be diligent about not backsliding when it comes to mask wearing, hand washing, keeping one’s distance, and other preventive measures, while also preparing for the second wave that most say is almost certain to come in the fall or winter.

“That’s just historically what pandemics do,” he explained. “They don’t all do that, but statistics will tell you that there will be at least a second wave if not more waves.”

What will those waves be like? It’s difficult to say at this point, said Roose and Artenstein, adding that a number of factors will dictate the level of infections and how well the healthcare community can respond to the next surge.

But in the meantime, and while still in this window, the state’s residents and business owners alike must continue to stay the course, the experts said.

“We still could do better in terms of how often people wear masks in pubic and follow the public-health recommendations,” said Roose, adding that state leadership must continue to reinforce those messages. “We know that when we give those recommendations and that guidance and it’s clear and connected to science, it helps, and it’s certainly important to be consistent about it, or people will have less inclination to follow them.”

Meanwhile, as the state proceeds with phase 3 of its reopening plan and eyes phase 4, testing will be another critical key to closing off paths the virus might take.

“I believe strongly that adequate capacity and widespread testing are critical for us to continue to move forward into phase 4 and into a state where the community is engaging as fully as it can,” Roose said. “That allows us to ensure that, if we do identify infections, we can mitigate the spread; widespread testing is really critical, and we’re not yet where we need to be, as state and as a country. We still could be doing more, and I think the ways we do testing will continue to get easier and more readily available, and that will help quite a bit.”

Artenstein agreed, but quickly noted that all the steps people have been taking — and hopefully will continue to take — only serve to slow or inhibit the spread of the virus. The virus is still there, and it will remain there until a vaccine is developed.

“You can temporarily shut down or limit transmission,” he said, “and then you have the chance for other things to kick in, such as therapies and better approaches to diagnosis and treatment. Those things take time, but they can get a chance to take root once you’ve already established those public-health principles.

“It’s pretty obvious that limiting public gatherings and staying the course has helped,” he went on, returning to the thought that, however painful and exhausting the last few months have been, the strategy moving forward for the state and all its residents has to be to continue to wait it out and, as he said, “stretch it out.”

Bottom Line

Turning the clock back 100 years, to the so-called Spanish flu, Artenstein said the second wave of that pandemic was more severe than the first in many parts of the country simply because communities eased off on restrictions and returned to what life was like before it struck.

“A lot has changed in 100 years — science, technology, people, etc.,” he told BusinessWest. “But one thing that hasn’t changed that much, in my opinion, is behavior. We may be able to further mitigate any future surge, just as we mitigated this surge, by adhering to public-health guidelines. If we can keep that up, and then get some help with testing, better contract tracing, better therapies, which will happen, and maybe a vaccine…”

He didn’t completely finish the thought and instead stressed that this ‘if’ is a very large one, and there are really no certainties when it comes to this strategy.

But the very best strategy at the moment, he stressed, is to string this out and close off those pathways the virus can take.

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

Health Care

Life on the Front Lines

Dr. Andrew Artenstein

Dr. Andrew Artenstein, chief physician executive and chief academic officer for Baystate Health.
Photo courtesy of Baystate Health

Dr. Andrew Artenstein isn’t the first to notice the lack of cars on the roads, but he’s certainly among those most invested in those open roads.

“When I leave work, I’m used to traffic, and there’s no traffic,” said the chief physician executive and chief academic officer at Baystate Health. “Every day feels like Sunday out there. The streets are a lot quieter. Hospitals don’t have visitors, so the hallways are quieter.”

Fewer people out and about means the social-distancing movement has largely taken hold in Western Mass., meaning fewer transmissions of the novel coronavirus and fewer cases of COVID-19 than would be present if people weren’t staying home. The question is, how much difference will it make in the end?

“I can tell you that I don’t know the effect, but I do know anything will help,” Artenstein told BusinessWest. “It’s the right thing to do, and it will hopefully blunt the peak. It will not prevent it totally, but if you can blunt the peak, flatten the curve, we can possibly manage the surge.”

What that surge will represent wasn’t clear at press time, when the state had tallied close to 17,000 cases of COVID-19 — a number that may be much higher as you’re reading this.

Based on expert estimates, Gov. Charlie Baker said Thursday that coronavirus hospitalizations in the state will likely peak between April 10 and April 20, with the total estimate of coronavirus cases in the state ranging from 47,000 to 172,000 over the course of the epidemic, or about 0.7% to 2.5% of the population.

“It appears the community has done a really good job of generally heeding the recommendations from our national and state public-health experts, which is, if you’re not sick, don’t come to the hospital,” Artenstein went on. “People still need other types of care; people still have cardiac issues or lung issues or kidney issues. That’s not going to stop. But people who don’t need emergency or hospital-level care, for the most part, are finding care in other ways, which is what they’re being told to do. That keeps people from transmitting infection in hospitals, and keeps them away from other patients who might be sick.”

That means patient volume for non-urgent matters is indeed down at Baystate, with some of that work being moved to telephone or telehealth platforms (more on that later), as well as outpatient clinics and urgent-care centers, all of which are also trying to enforce social distancing as best they can.

What is on the rise in the emergency room are cases of respiratory illness, fevers, and coughs, with many of those being admitted and testing positive for coronavirus.

“It appears the community has done a really good job of generally heeding the recommendations from our national and state public-health experts, which is, if you’re not sick, don’t come to the hospital.”

“There’s clearly a lot of transmission going on in the community, which is exactly what you’d expect from a pandemic,” he said. “If you look at the data, the vast majority of people [with the virus] are not sick enough to need to go to the hospital, but they’re still infectious and potentially transmitting it if they’re not isolating themselves.”

Artenstein should know all about the effects of isolation on pandemics. He founded and directed the Center for Biodefense and Emerging Pathogens at Brown University for more than a decade before arriving at Baystate, so “I have a fair amount of experience with these things. But this is a unique experience … a 100-year event.”

It’s an event that has seen Mercy Medical Center, like Baystate, shift from a strategy prioritizing preventive wellness to one that focuses on readiness and the immediate response to coronavirus — and an expansion of capacity where possible, said Dr. Robert Roose, the hospital’s chief medical officer.

“At this point, we have been heavily focused on increasing our available beds and staffing to continue to respond to the needs of the community, and we have been seeing increasing numbers of patients infected with COVID — and the acuity of those cases continues to increase,” he told BusinessWest.

That increase in the number of patients requiring hospitalization reflects what Mercy’s leaders are tracking on a national level, and he expects the trend to increase over the coming weeks.

HCC Police Captain Dale Brown stacks boxes

HCC Police Captain Dale Brown stacks boxes of personal protection equipment for delivery to area hospitals.

“In regard to our local preparedness, we have a robust surge plan that identifies three different levels of escalation to increase our capacity to treat increasing numbers of patients,” he explained. “We’re also coordinating with other local and regional hospitals on a surge-capacity plan in the event we need to share resources among different hospitals in the region.”

Testing, Testing

What would help predict and manage the coming surge is a more robust array of testing resources, but local hospitals are still hampered by a limit on how much is available at the state level.

“At the present moment, we’re prioritizing testing patients who are symptomatic and in need of care in the Emergency Department, as well as healthcare workers and first responders,” Roose said. “We’re prioritizing those groups per the CDC, and as testing capacity increases, then we’ll be able to offer more testing as it becomes more readily available.”

Artenstein reported the same protocol for priority test groups: patients hospitalized with symptoms, employees showing symptoms, and some first responders who are symptomatic. “We know it’s not in our control; it’s a national issue, and we’ve been severely limited in our ability to test. It’s starting to improve because of a tremendous effort by people at Baystate and some of our government officials to help us get more testing and more capacity and more rapid turnaround time. We’re starting to see an improvement, but it’s still not where it needs to be.”

As for the coming surge, Baystate began preparing for that in a number of ways over the past few weeks, including the construction of a rapid-response triage facility just outside the entrance to the ER. It holds around 40 chairs — each of them six feet apart — for individuals entering the ER.

“There’s community transmission of the virus at this point,” said Dr. Niels Rathlev, chair of the Department of Emergency Medicine, when the project was announced last month. “And we really are preparing for more patients showing up for screening. This is not to expand testing; the real issue is to try to keep patients that don’t require admission to the hospital — acute emergency care — and screen them rapidly out here.”

Construction of the triage center is a step that mirrors what is happening in other parts of the country, Rathlev noted, adding that some areas, such as the state of Washington, established such centers weeks ago in anticipation of a surge in visits to the ER and the critical need to triage those coming in. Meanwhile, field hospitals are being created at sites like Worcester’s DCU Center and the Boston Convention and Exposition Center.

Capacity concerns also cross over into the realm of protective equipment like masks and gloves. Roose said Mercy is working aggressively with suppliers to make sure it has what it needs. “I will say we have supplies, but I don’t think any hospital around here feels particularly comfortable with the amount they have because there may be a large influx of patients at any time.”

It’s a problem that has required some creativity. Earlier this month, Patriots owner Robert Kraft sent a team plane to China to pick up 1.2 million N95 masks. In all, Kraft partnered with the state to purchase 1.4 million masks for Massachusetts, and purchased another 300,000 protective masks for New York.

Locally, institutions have stepped up enthusiastically to meet the need. Springfield Technical Community College’s (STCC) School of Health and Patient Simulation donated personal protective equipment — including surgical masks, isolation gowns, and exam gloves — to Baystate Medical Center, Mercy Medical Center, Holyoke Medical Center, and Cooley Dickinson Hospital, in addition to emergency medical services personnel in the West Springfield Fire Department.

“We recognize there is a critical need for personal protective equipment at hospitals and medical centers,” said Christopher Scott, dean of the School of Health and Patient Simulation at STCC. “By donating our supplies, we are doing what we can to protect the healthcare workers who are running short on masks and other protective equipment. The community needs to work together to ensure we defeat this pandemic.”

Holyoke Community College donated similar equipment from its health-science programs to area hospitals. HCC Police Captain Dale Brown spent a day last month conducting an inventory of collected supplies — including boxes of isolation gowns, exam gloves, masks, goggles, hand sanitizer, and microbial wipes — at the Campus Police station. A representative from the Massachusetts Emergency Management Agency picked everything up to coordinate delivery to area hospitals.

“At this point, we have been heavily focused on increasing our available beds and staffing to continue to respond to the needs of the community, and we have been seeing increasing numbers of patients infected with COVID — and the acuity of those cases continues to increase.”

Even Dakin Humane Society pitched in, donating its in-house supply of disposable surgical gowns and booties, along with other personal protective equipment, to Baystate.

“We’ve seen news stories about the need for protective equipment being faced by those in human healthcare, so we reached out to Baystate Medical Center because they’re local,” said Karina King, Dakin’s director of Operations. “We anticipated that human health workers would need these supplies soon, so we recently stopped using disposable items at Dakin and found alternative equipment, including smocks that could be laundered and re-used instead of being disposed of.”

A researcher from UMass Amherst contributed in a different way, with a dose of data. Richard Peltier, a professor in the university’s School of Public Health and Health Sciences, partnered with Dr. Brian Hollenbeck, chief of Infectious Disease at New England Baptist Hospital in Boston, to test in his lab whether used N95 facemasks were still effective at blocking infectious particles after sterilization. They determined that, yes, masks could be safely sterilized and reused.

“While these are ordinarily disposable protective devices for medical workers, these are not ordinary times,” Peltier said, “and this science shows that sterilized face masks will protect our healthcare providers who are working under extraordinary conditions.”

Across the Distance

In short, there’s a lot going on to both help hospitals prepare for the surge and to reduce non-critical traffic as much as possible. To that end, a number of institutions have stepped up their telehealth efforts, including Valley Health Systems, which includes Holyoke Medical Center, Holyoke Medical Group, and River Valley Counseling Center.

“We are expanding our capabilities to meet the needs of our patients, especially those with ongoing health concerns that need to be treated and in contact with their healthcare providers,” said Spiros Hatiras, president and CEO of HMC. “It is important for everyone to maintain their health and safety regarding pre-existing conditions, as much as it is to protect from COVID-19.”

Behavioral Health Network (BHN) introduced a new program, BHNTeleCare, that allows individuals to continue counseling sessions with their therapists from the safety of their own homes.

According to Katherine Wilson, president and CEO of BHN, “this innovation in the way we provide therapy and counseling services is groundbreaking and allows us to render services where people are. This is particularly critical as a result of the needs that have emerged due to the spread of COVID-19. It allows a counseling avenue for those suffering anxiety and in need of support during this time of crisis affecting individuals and families.”

Meanwhile, MHA also introduced its new TeleWell virtual service delivery, which allows mental-health clinicians and their clients make virtual connections using a smartphone, tablet, or computer.

“With social distancing now part of daily life, people who receive therapy for emotional support, or who would like to, may experience uncertainty when it comes to making and keeping office-based appointments,” said Sara Kendall, vice president of Clinical Operations for MHA. “TeleWell provides another option by enabling people to keep their appointments virtually. Every day, more BestLife clients are using this option.”

All these efforts — including simply staying at home to avoid transmission — are helping, Roose said.

“I cannot stress enough how important the efforts of the community are in ensuring that our healthcare providers and resources adequately meet the needs of this crisis,” he said. “Physical distancing, diligent hand washing, isolating and quarantines when appropriate — those are the efforts that will flatten the curve and lessen the impact of this disease, and ensure that our healthcare providers have what they need to provide the care the community needs.

Meanwhile, Mercy’s incident command center continues to keep in contact with the entire Trinity Health system every day. “And every single day, I stress the importance of efforts we can all take to impact this disease. It’s something we all have the power to impact if we take proper precautions and follow the guidelines around physical distancing and quarantines. I can’t stress that enough.”

Those community efforts don’t guarantee Massachusetts won’t become as strained as New York City, Artenstein said, but they help.

“My feeling is that April is going to be very challenging in Western Massachusetts, and after that, I don’t know,” he told BusinessWest. “It quite possibly could extend well into May. I don’t think we’ll be completely out of the woods, and I do think, if you look at epidemics and pandemics, there are second and third waves sometimes.”

For example, he explained, the Spanish flu of 1918 saw a second wave late that year, and an even worse third wave arrived the following spring. COVID-19 has the potential of following a similar track because it’s new, and people haven’t built up the blanket of underlying immunity that keeps seasonal flu, while dangerous as well, under control.

“With each passing day, it becomes clearer we’re living in an unprecedented time, and with that comes uncertainty,” Roose added. “As this pandemic evolves, we are all called upon to learn quickly, work collaboratively, and constantly change how we do things. This is a community crisis, and it takes involvement and the efforts and support of everyone in our community.”

Ready for the Surge

Roose emphasized that he greatly appreciates those efforts, not just in the community, but from the selfless healthcare workers on the front lines.

“I could not be more inspired and impressed by our teams of providers, clinicians, nurses, everyone showing a commitment to putting patients first and responding to the needs of the community,” he said. “In a crisis like this, people show their true character, and it’s clear to me we’re much stronger together, and our teams are rising to this challenge.”

Artenstein agreed.

“I’ve never seen a group of more dedicated, committed, and compassionate people than I’ve seen here,” he said. “They’re working hard in adverse conditions.”

At the same time, he added, “they’re nervous, scared for their familes, and scared for themselves — and they have the right to be scared. But our people are true to their mission to provide excellent, compassionate care.”

No matter what form the April surge may take.

“This is a very unique point in our history — one that, hopefully, we’ll look back on and not have to relive.”

Joseph Bednar can be reached at [email protected]

Health Care

A New Normal

By Mark Morris

Dr. S. Lowell Kahn

Dr. S. Lowell Kahn says he feels an obligation to the community to offer his services because it’s so difficult for people to get healthcare right now.

At a time when COVID-19 is dominating everyone’s attention and resources, people are still experiencing other urgent health issues such as heart attacks, strokes, and any number of other medical conditions that require treatment.

During the last few days of March, BusinessWest spoke with several area physicians about the challenges they are confronting in trying to serve the needs of their patients who require medical attention that is not related to the coronavirus.

The doctors BusinessWest spoke with have all reduced their normal business activity and only see patients for emergency or medically necessary reasons. They all said they closely follow the guidelines from the Centers for Disease Control and Prevention (CDC), notices from Massachusetts Gov. Charlie Baker, as well as information from their respective medical societies.

“It’s a challenging environment, to say the least,” said Dr. S. Lowell Kahn, president of New England Endovascular Center.

Kahn said he feels an obligation to the community to offer his services because it’s so difficult for people to get healthcare during these times. The procedures he is doing are non-elective, and in many cases essential for patients, as well as their doctors.

“People with cancer still need chemotherapy, and those with bad peripheral veins need a biopsy first,” he explained. “If we don’t provide that biopsy, the oncologist can’t properly treat them.”

Dr. Stephen Jacapraro, a dentist with Family Dental Care, is only opening his office when someone has a dental emergency. He said moving from reduced hours to closing up completely was a fast transition.

“We are filling a need because my patient doesn’t want go to the emergency room, and the ER staff doesn’t want him there at this time.”

“Back on March 16, the Massachusetts Dental Association recommended that we start limiting hours; then, on March 19th, the state became more stringent, and since then, we shut down completely except for emergencies,” said Jacapraro. “If someone has severe pain or swelling, I can diagnose it, but even in normal circumstances, I would refer the patient to the proper specialist, such as an endodontist or dental surgeon.”

Dr. Christopher Peteros, a podiatrist with New England Foot Specialists, is limiting his practice to seeing post-surgical patients who need follow-up attention, diabetics with foot issues, and others with medically urgent foot conditions.

“If I have a diabetic patient with an infection in his foot, I don’t want to send him to the emergency room at this time,” Peteros said, adding that there is less risk involved in taking care of the patient in his office than sending him to the hospital. “We are filling a need because my patient doesn’t want go to the emergency room, and the ER staff doesn’t want him there at this time.”

Not Business as Usual

Even fairly routine procedures that are usually done in a hospital setting have become more difficult due to hospitals preparing to be overwhelmed with coronavirus cases. Replacing a dialysis catheter for patients would normally be handled in a hospital, but Kahn has been doing them in his office.

“Even though this isn’t considered an emergency procedure, for dialysis patients, it really needs to get done,” he noted, adding that patients prefer to go to his office these days rather than risk exposure to COVID-19 at the hospital.

Dr. Christopher Peteros

Dr. Christopher Peteros is seeing patients with urgent issues for two reasons: because they need care right away, and to keep them out of hospitals.

All three doctors spoke of following the latest protocols for constantly wiping down their offices, as well as screening patients more carefully before they arrive. They all said that, if there is any reason to believe a patient has been exposed to the coronavirus, they are kept away from the office.

In the interest of social distancing, the doctors are spreading out appointment times to prevent more than one patient from being in the waiting room at any time. Kahn has taken it one step further, and offers patients the option of waiting in their car until they are ready to be seen.

“We used to let family members come in and sit with the patient in our recovery area after their procedure, said Kahn. “We don’t allow that anymore.”

The safety of their teams is an obvious priority for all three doctors as well. Kahn said all his staff wear masks the entire time they are in the office.

“We screen ourselves every single day using screening questions issued by the CDC,” Kahn said, noting that they go through the entire list of questions to check every staff member for a fever, cough, shortness of breath, etc.

“People are scared these days. It’s not fun being a healthcare worker like it was before,” he told BusinessWest.

Jacapraro said one of his concerns is that he and his staff are “toward the older, more vulnerable age group,” so one upside of seeing only emergency cases is that it limits his staff’s exposure to the public. He also mentioned that, with masks and gloves in such high demand, the limited hours allows him to conserve his supplies.

“We’ve been cohesive as a team, trying to keep each other healthy both physically and mentally. We’re staying strong through it to make sure we can stay open to help patients who need us.”

“Our suppliers are taking care of the hospitals first, as they should,” he said, adding that, even with limited supplies, he has enough in stock to handle emergencies.

With his primary supplier unavailable, Jacapraro has been using a secondary supplier for masks whose price is four times higher. Jacapraro doesn’t believe the supplier is jacking up the price, but that it’s more likely a cost difference between suppliers. “When you’re not making any money, however, you still have to pay them four times as much.”

Back in mid-March, the U.S. surgeon general asked doctors to stop all elective procedures, a move that has proven almost self-regulating as the doctors have said patients are more reluctant to seek services at this time.

“Some of my patients are asking me to push off appointments, and I’m asking the others to do so as well,” said Peteros.

Jacapraro added that, once social distancing was being encouraged, the Massachusetts Dental Assoc. recommended stopping all elective treatments. “Obviously, we have to get closer than six feet to help our patients.”

Some of the most common procedures are being seen in a different light in the environment of the COVID-19 pandemic. The Society of Interventional Radiology (SIR) issued a reminder to doctors about a basic procedure that Kahn had done many times in his office.

The procedure involves inserting a feeding tube through the skin and into the stomach. Before doing that, however, the doctor inserts a catheter into the patient’s nose, through the esophagus, and into the stomach to determine the best location for the feeding tube. When the catheter is being inserted into the patient’s nose, it is common for them to have a gag reflex. The SIR cautioned that the gag reflex could aerosolize the COVID-19 virus, and recommended that, unless the doctor and staff wear N95 masks and full headgear, they could potentially expose themselves to the virus.

“This has always been a quick and safe procedure, but we’ve had to rethink it,” Kahn said. “And for the time being, we have backed off on doing feeding tubes, per these recommendations.”

Carrying On

The doctors who spoke with BusinessWest have all based their COVID-19 protocols on information from the CDC, and they advise consumers do the same.

“There’s a lot of bad information out there on social media, where suddenly, everyone thinks they’re an epidemiologist,” said Kahn, adding that consumers should get their information from reliable sources.

Early on, as they understood the significance of the coronavirus, Kahn met with his staff to allow everyone to voice their concerns about practicing medicine at this time. By the end of the meeting, he noted, everyone was on board with how they needed to proceed.

“We’ve been cohesive as a team, trying to keep each other healthy both physically and mentally,” he said, while seemingly speaking for everyone in the industry. “We’re staying strong through it to make sure we can stay open to help patients who need us.”

Health Care

Back to Basics

By Ashley Tresoline

The World Health Organization has declared COVID-19 a pandemic. We are all trying to navigate through figuring out what is best for ourselves and our families in these uncertain times. As we all stock our homes with extra food, hand sanitizer, and the toilet paper we waited four hours for at the store, we need to be thinking about how we can keep ourselves healthy too: not just by preparing our homes, but by preparing our bodies as well. All of us are facing a new normal for the foreseeable future.

We need to refocus and go back to basics of everyday living to help us support our immune systems. Here are some tips to do just that.

Get enough sleep. I know your latest binge-worthy Netflix show is calling your name, but you still need to be trying to get seven to nine hours of sleep a night. When we are sleep-deprived, we are more likely to get sick. When we sleep, we make proteins called cytokines, which help regulate the immune system.

Stay hydrated. Drinking water seems so simple. Drinking plenty of water ensures that your blood will carry plenty of oxygen to all the cells of your body. This means all of your body’s systems will function properly, because they’ll be getting plenty of oxygen. Your immune system functions best when your muscles and organs are functioning best. If the taste of plain water is hard for you to stomach, add a little lemon, lime, or cucumber.

“Drinking plenty of water ensures that your blood will carry plenty of oxygen to all the cells of your body. This means all of your body’s systems will function properly, because they’ll be getting plenty of oxygen.”

Stay as active as possible. It is so easy to sit around more than we usually do because we are in our houses and don’t have many social activities. Make your workout a priority for your mental and physical health. There are so many gyms and studios that are offering online training and classes for you to do in your own living room. Being active will help you feel less stressed and help keep your immune system functioning in tip-top shape.

Eat your greens. Do you remember when your mom used to tell you to eat your broccoli because it would make you big and strong? Well, guess what? She was right. When you want to boost your body’s immune system, you can do it naturally by eating the most nutritious foods. Dark, leafy greens and cruciferous veggies are recommended by dietitians because these foods contain high levels of minerals, antioxidants, and vitamins. Broccoli is considered one of the most versatile vegetables to buy because you can consume it in a variety of ways, such as raw in salad, steamed, or sautéed.

Eat other foods that help with your immune system. These include citrus fruits such as oranges, limes, and lemons to help with vitamin C, ginger to protect against bacteria and inflammation, sweet potatoes, green and black tea for the amino acids, mushrooms rich in B vitamins and minerals, yogurt for the probiotics and vitamin D, spinach because of its vitamin C and iron, and turmeric for its anti-inflammatory properties and flavonoids to help fight off countless infections.

Avoid alcohol and processed sugar. I know these are difficult times and drinking in moderation in most cases is OK, but an increase in your alcohol intake can increase a person’s exposure to bacterial and viral infections. Processed sugar can weaken the immune system, and we all know we should limit our processed sugar on a normal basis. Realistically, we all will have a treat or two every now and then, but processed foods are nutrient-poor. When we eat a lot of sugar, the immune system is habitually deprived of nutrients. We need nutrient-dense food to help our immune system fight off colds and viruses.

Incorporate supplements and vitamins. A lot of us take a daily multi-vitamin, which is a good way for us to help get the recommended vitamins and minerals we need in our diet. There are many other supplements that claim they can help you boost your immunity but be careful, as they can load you up with vitamins and minerals your body can’t absorb. Loading up on some minerals and vitamins in large doses can cause you to have other health problems, such as nausea, vomiting, dizziness, kidney problems, headaches, and many more serious conditions, depending on your health situation.

There are a few natural cold supplements that aren’t all bad to add to your health regimen, such as elderberry syrup and zinc lozenges. Elderberry contains natural substances called flavonoids, which can help reduce swelling, fight inflammation, and boost immunity. Studies have shown elderberry can ease the symptoms of the flu, bacterial sinus infections, and bronchitis. The benefits seem to be most effective when started 24 to 48 hours after symptoms begin. (However, never consume a product made with raw elderberry.) Zinc lozenges can also help reduce cold and flu symptoms, but they come with the risk of overwhelming your body with too much zinc. If you take too much, you may be at risk for nausea, vomiting, stomach upset, copper deficiency, and risk of suppressing the immune system. Be sure to speak to a healthcare professional before adding any supplements to your healthcare regimen. Some supplements can react with prescription medications and over-the-counter medications you are taking.

Your body is working hard to keep you healthy. Help your body by eating right, getting proper sleep, staying hydrated, and keeping active. Health is a cumulative thing, so keep up your best health and wellness practices while we are in this difficult time — and, of course, wash your hands!

Ashley Tresoline is the founder of Bella Foodie, LLC; [email protected]

Health Care

Vision 2020

Few industries change as rapidly — and as dramatically — as the broad, multifaceted realm of healthcare. From oncologists’ use of cancer fingerprinting and gene therapy to facial transplants for accident victims; from cutting-edge protocols to save the lives of stroke and heart-surgery patients to a dizzying array of new treatments to improve vision … the list is seemingly endless, making it impossible to paint a full picture of where healthcare has come in the past decade.

But we at BusinessWest wanted to try anyway — and, at the same time, look ahead at what the next decade might bring. So, appropriately, here at the dawn of 2020, we invited a wide range of healthcare professionals to tell us what has been the most notable evolution in their field of practice in the past 10 years, and what they expect — or hope — will be the most significant development to come in the next decade.

The answers were candid, thoughtful, sometimes surprising, but mostly hopeful. Despite the many challenges healthcare faces in these times of advancing technology, growing cost concerns, and demographic shifts, the main thread is still innovation — smart people working on solutions that help more people access better care. After all, healthcare is, at its core, about improving people’s lives, even when they seek it out during their direst moments.

Innovation and promise. That’s what we believe a new decade will bring to all corners of the healthcare world — that is, if these leaders, and countless others like them, have anything to say about it.

Administration

Joanne Marqusee

President and CEO, Cooley Dickinson Health Care

Joanne Marqusee

The most significant recent development in healthcare administration has been a recognition of the role patients play in their own healthcare. “Crossing the Quality Chasm: A New Health System for the 21st Century,” published in 2001 by the Institute for Healthcare Improvement, called for a massive redesign of the American healthcare system. Specifically, it provided “Six Aims for Improvement,” five of which focused on safety, effectiveness, timeliness, efficiency, and equity. Not talked about as much, the sixth aim was to make healthcare ‘patient-centered.’

While we still have a ways to go to truly be patient-centered, we have witnessed a sea change in the past decade in this regard. Patients are increasingly active participants in their care, questioning their doctors and other providers to ensure that they understand their options, using electronic medical records to engage in their care, and speaking out about what they want from treatment or forgoing treatment at the end of life. The best healthcare providers — both organizations and individuals — embrace these changes, welcoming patients as more than recipients of care, but rather active partners in their own care and decision making.

My hope for the most significant development over the next decade has to do with providing universal healthcare coverage while controlling healthcare costs. While we almost have universal coverage in Massachusetts, too much of the nation does not. A hotly debated topic, universal healthcare has many benefits, including increasing access to preventive and routine medical care, improving health outcomes, and decreasing health inequalities.

Surgical Technology

Dr. Nicholas Jabbour

Chairman, Department of Surgery, Baystate Medical Center

Dr. Nicholas Jabbour

The most significant development in surgery over the past decade has been the move toward less invasive surgical approaches made possible through advanced technology. These approaches include robotic and minimally invasive surgery, including intraluminal surgery in areas such as gastroenterology, cardiology, and neurosurgery — for exemple, the passage of an inflatable catheter along the channel inside of a blood vessel to enable the insertion of a heart valve instead of making a large opening in the chest. As a result, we have seen a big shift from inpatient to outpatient surgery with shorter hospital stays and improved post-op recovery.

In the next decade, we foresee these innovations in less invasive surgery will be enhanced by better computing and software integration. This interaction will include the merging of radiological and potentially pathological information — which is currently available in a digital format — with real-time visualization of anatomical structure during surgery. This will offer surgeons the opportunity to improve the accuracy and speed of a surgical procedure while minimizing the risks.

The next decade will also see major innovation in the area of transplantation with the development of tissues or whole organs through bio-engineering manipulation of animal or a patient’s own cells. The integration of this bio-engineering manipulation with currently available technology, such as 3D printing and 3D imaging, will provide patients with the needed tissue or organ — including valves, bone grafts, hernia mesh, skin, livers, and kidneys — in a timely manner. This development will revolutionize the field of transplantation and surgery in general.

Behavioral Health

Karin Jeffers

President & CEO, Clinical & Support Options Inc.

Karin Jeffers

Over the past 10 years, we’ve seen a growing adoption within the behavioral-health and medical fields of holistic treatment models. While the two disciplines were once treated as different animals, the entire health field is now moving to treat both the body and the mind — together. The next 10 years are likely to bring these two fields even closer.

Today, you’re seeing behavioral-health clinicians being hired into physical health practices. Likewise, physical health providers are cross-training to better understand behavioral issues. Whereas, a decade ago, a behavioral-health client might be assigned a therapist or a psychiatrist, they are now gaining access to more robust set of supports, including nursing, case management, recovery coaching, and peer support from those with lived experience. Government mandates and payment model changes are forcing outcomes-based integration, too. Pediatricians, for example, must now do behavioral-health screenings of all youth under 21. In the mental-health space, you’re seeing clinicians ask about weight, exercise, and other physical factors.

We’re seeing significant movement on both the state and federal levels to value outcomes over volume. It’s reflected in the criteria set by the Excellence in Mental Health Act for certified community behavioral-health clinics, a designation CSO has earned, and in the work we have done with the Substance Abuse and Mental Health Services Administration. Our ability to tailor programs, like our grant-funded work at the Friends of the Homeless shelter in Springfield, has literally saved lives among those experiencing homelessness and co-occurring conditions, like substance-use disorders.

In the coming years, we hope to see integrated care models become even more mainstream. Things appear headed in the right direction, but government action establishing payment reform within the behavioral-health field needs to be taken — and the integrated models need to be appropriately funded. Such changes would affirm overall health and wellness to include both physical and behavioral health.

Weight Management

Dr. Yannis Raftopoulos

Director, Holyoke Medical Center Weight Management Program

Dr. Yannis Raftopoulos

Weight management is a rapidly evolving field, and I am fortunate to be part of it. One of the most significant innovations this field has experienced in the last 10 years was the development of a new gastric balloon. Packaged in a small capsule and swallowed with water, the Elipse balloon provides satiety while requiring no procedure or anesthesia for its placement and removal. Together with its excellent safety profile, the Elipse balloon is the least invasive and yet effective weight-loss modality available today. Elipse is manufactured in Massachusetts by Allurion Technologies.

I had the opportunity to be an investigator in the European trial which led to the Elipse market approval in the European Union in 2016. Recently, Holyoke Medical Center was among 10 U.S. sites in which an FDA-regulated trial was conducted. The trial was completed successfully, and Allurion has submitted data requesting FDA approval to market Elipse in the U.S. The balloon’s use in Europe shows that patients can lose more than one-fifth of their initial weight.

A New England Journal of Medicine study reported that 107.7 million children and 603.7 million adults, among 195 countries, were obese in 2015. High body-mass index accounted for 4 million deaths and contributed to 120 million disability-adjusted life-years. Obesity is a chronic disease, and its management requires long-term guidance and close patient-physician communication. Successful collaborations between existing best practices with technology innovations that will allow delivery of effective weight-management care on a massive and global scale could be the most significant evolution in the field in the next 10 years.

Cancer Care

Dr. Hong-Yiou Lin

Radiation Oncologist, Mercy Medical Center

Dr. Hong-Yiou Lin

The advent of new medical oncology drugs has improved control of microscopic and, to a lesser extent, macroscopic disease, allowing local treatments, such as surgery or radiotherapy, to increase survival. To cure cancer, we need to eliminate cancer cells where they started, as well as any microscopic cells traveling through the body. The idea of using immunotherapy to fight cancer has been around for decades, but bringing this idea to the clinic has been hampered by the cleverness of cancer cells knowing how to evade detection by our immune system. Recently FDA-approved immunotherapy either takes away that ‘invisibility cloak’ or wakes up our dormant immune cells to start fighting cancer.

The biggest development in oncology in the next 10 years will be personalized precision medicine, which allows the oncology team to tailor treatment to each patient’s unique cancer biology and life circumstances. Meanwhile, improvements in cancer diagnosis will come from novel PET radiotracers and new MRI sequences that allow for more accurate staging and identification of the best site to biopsy. Pathologists will use novel tools such as genome sequencing to supplement traditional microscopy to subclassify the specific type of cancer within a certain diagnosis instead of grouping into broad categories.

Surgical, medical, and radiation oncologists can then use the above information to decide on the best sequencing between surgery, systemic therapy, and radiotherapy to minimize side effects and maximize cure. Medical oncologists will be able to offer more drugs that target new mutations, overcome drug resistance, increase specificity to a mutation, or better fine-tune immunotherapy, targeting only cancer cells by enlisting gene modification as well as natural killer cells. Radiation oncologists will have new radiomic and genomic tools to personalize the radiation dose and volume, and when to offer radiotherapy.

In short, over the next 10 years, cancer care will continue to move away from the traditional one-size-fits-all model toward a more personalized approach.

Allergy and Immunology

Dr. Jonathan Bayuk

Medical Director, Allergy & Immunology Associates of New England

Dr. Jonathan Bayuk

There have been incredible and exciting advances in allergy and immunology in the last two years. However, the unmet needs of allergic and autoimmune-disease-afflicted patients has grown dramatically in the last 20 years. In response to the increasing prevalence and acuity of allergic diseases and autoimmune diseases, the world has launched products to help address these very severe patients. These medications are indicated for many conditions and work very well. They are generally safe, but are very expensive. These medicines are different than traditional pharmaceutical drugs as they are not chemicals, but biologically derived medicines designed to augment or modify the immune response. As such, they are call biologic medications.

In the field of allergy and immunology, we can now dramatically treat and potentially cure many diseases that in the past were very challenging to manage. The biologic medicines that we have now treat asthma, eczema, allergic disease, and hives. The patient selection is based on severity of their condition, and these medicines are only for moderately to severely affected people. If, as a medical profession, we were to place as many people as possible on these therapies, the cost would be astronomical and not sustainable.

However, is it fair to deny any of these patients access to these treatments who truly need them? I would argue that choice is a very difficult one to make, and as physicians, our primary goal is healing at whatever cost. As a nation, we have a dilemma. Can we afford the medicines we have or not? It is unclear that any serious legislative body is willing to tackle that question. For now, the use of these medicines is changing lives dramatically, and it is an exciting time to be able to use these newer tools to help our patients live better lives.

Eye Care

Dr. David Momnie

Owner, Chicopee Eye Care

Dr. David Momnie

What are the most significant advancements in eye care in the last decade? It depends on whom you ask. Retinal ophthalmologists would probably say it’s the treatment of wet macular degeneration, a leading cause of blindness, with anti-VEGF injections. Cataract surgeons would most likely cite small-incision surgery and new lens implants that often leave patients with 20/20 vision. Glaucoma specialists might tell you it’s the development of MIGS, or minimally invasive glaucoma surgery. These operations to lower the pressure in the eye use miniature devices and significantly reduce the complication rate.

Primary-care optometrists and ophthalmologists would no doubt talk about the advances in optical coherence tomography, a remarkable instrument using light waves that gives cross-sectional pictures of the retina. The technique is painless and non-invasive and is becoming the gold standard in eye care because it has revolutionized the diagnosis and treatment of glaucoma and macular degeneration. For optometrists specializing in contact lenses, using newly designed scleral lenses to restore vision in people with a corneal disease called keratoconus has been a major development. There are many other specialists in eye care, including LASIK surgeons, that have seen remarkable changes in technology.

What will the next decade bring? Artificial intelligence (AI) is becoming more accurate for screening, diagnosing, and treating eye conditions. AI systems can increasingly distinguish normal from abnormal pictures of the retina. Where there is a shortage of ophthalmologists and optometrists, AI screenings combined with telemedicine, providing remote care using communications technology, may be able to find and treat more people who are falling between the cracks of our healthcare system. The term 20/20 is the most common designation in eye care, and the year 2020 will probably usher in another decade of remarkable developments in our field.

Information Technology

Teresa Grogan

Chief Information Officer, VertitechIT

Teresa Grogan

From the perspective of technology that enables healthcare, the biggest game changer of the last decade has been the iPhone — and now, essentially any smartphone.

Steve Jobs introduced the first iPhone in 2007 (a little over a decade ago), and physicians embraced it quickly. It started as a simple tool for doctors (applications like the PDR, or Physicians’ Desk Reference) for looking up drug interactions. Today, it’s a portable EMR, a virtual visit facilitator, and a remote-monitoring device for many healthcare providers, as many patients have embraced — and insisted on — this technology to improve access to care. As the cost decreases and cellular bandwidth improves, the rapid growth of the IoMT (Internet of Medical Things) will place smartphones at the center of the next wave of healthcare technology breakthroughs.

Looking forward, I’d like to see complete elimination of passwords to access electronic information. While there has been some movement toward this with ‘tap and go’ badges and fingerprint readers, a single standard is needed that would work regardless of the software program used. I hope there are greater strides in the creation, deployment, and adoption of other biometric technologies, like iris, face, or voice recognition, so that a healthcare professional could walk into a patient room — or into a hospital — and the computer systems would know his or her identity in immediate and secure fashion. If access to the data needed by a healthcare provider were as easy as turning on a light switch, the improvements in quality of life and efficiency in work for that provider would translate to improved patient outcomes.

Cardiovascular Care

Dr. Aaron Kugelmass

Vice President and Medical Director, Heart and Vascular Program, Baystate Health

Dr. Aaron Kugelmass

We have seen many improvements in cardiovascular care over the last 10 years, but the development, approval for clinical use, and dissemination of transcutaneous aortic valve replacement (TAVR) stands out as the most dramatic. This new technique allows cardiologists and cardiac surgeons, working together, to replace the aortic valve without opening a patient’s chest or utilizing heart-lung bypass, which has been the standard for decades. This less invasive approach is typically performed under X-ray guidance and involves accessing a blood vessel in the leg and guiding a catheter to the heart.

The TAVR procedure was first approved for clinical use in November 2011. It was initially limited to very sick patients, who were not candidates for traditional surgery because of the risk it posed to them. TAVR allowed patients who otherwise could not receive life-saving valve surgery to have their valves replaced with improvement in longevity. With time and experience, the procedure was approved for lower-risk patients as well, and more recently has been approved for the majority of patients, including those with low operative risk. TAVR has been shown to be equivalent or safer than traditional aortic valve-replacement surgery, and is quickly becoming the procedure of choice for most patients who require an aortic valve replacement. Since the procedure typically does not require open-heart surgery, recovery time is much shorter, with some patients going home within a day or two.

In the next 10 years, we expect that similar less-invasive procedures with shorter recovery time will be developed for other heart-valve conditions in patients who otherwise could not receive therapy.

Memory Care

Beth Cardillo

Certified Dementia Practitioner and Executive Director, Armbrook Village

Beth Cardillo

During the last 10 years, neuroscientists have been researching the causes of Alzheimer’s disease. There has been much discussion about which comes first — the amyloid plaque or the fibrillary tangles that develop in the brain, which are roadblocks to cognition, thus causing the difficulties with Alzheimer’s and other related dementia. That question has not been answered yet. Researchers were able to isolate the APOE gene, which is a mutant gene that is found in familial Alzheimer’s disease, helping us to better diagnose it. We have also better understood how diet, exercising both body and brain, and lifestyle contribute to the disease. Currently there are 101 types of dementia, with Alzheimer’s accounting for 75% of cases.

The next 10 years will result in more preventive actions. One major action will be to help people avoid developing type 2 diabetes, which may be labeled the next cause of Alzheimer’s (this type of Alzheimer’s is already being called type 3 diabetes). There has been a major link between sugar in the hippocampus and Alzheimer’s disease. Though there is no cure yet for Alzheimer’s, we are finding more information based on genetics, diet, and PET scans, which can show shrinkage in the brain.

Every year, researchers are more hopeful that a new drug will be developed to eradicate the disease. The last new drug from Biogen was looking hopeful in clinical trials, but that turned out to be not the case. Prevention continues to be at the forefront, as well as participating in clinical trials. More people who do not have dementia or mild cognitive impairment are desperately needed for clinical trials so comparisons of the brain can be made.

Nursing Education

Ellen Furman

Director of Nursing, American International College

Ellen Furman

As in all healthcare, the one thing that can be ascertained is constant change. The same can be said in nursing education today. No longer is the instructor-led lecture method of teaching considered best practice in education, but rather the shift to using class time to apply learned concepts. One way this is done is through the ‘flipped classroom.’ Using this educational modality, students study the concepts being taught preceding the class, followed by class time where students apply these concepts in an interactive activity, thereby developing students’ abilities to think critically, reason, and make healthcare judgements based upon the application of knowledge.

Another change in nursing education is an expanded focus away from pure inpatient (hospital-based) clinical education to outpatient (community-based) clinical education. While hospital-based education remains essential, the realization that most healthcare provided is in outpatient settings has broadened the clinical experiences required to prepare the graduate registered nurse for care provision.

Additionally, with healthcare as complex as it is, nursing students are being taught to be prepared for entry into practice. Education regarding the use of evidence-based practice, how to apply for the licensure examination, preparation to be successful on the National Certification Licensure Exam, nurse residency opportunities, interviewing techniques, transitioning from student nurse to registered nurse, etc. are all taught using a variety of educational modalities based upon the current best available evidence in nursing education.

As we forge ahead in healthcare, nurse educators will continue to evolve to meet healthcare needs through the education of nursing students so as to prepare them to provide care to meet the needs of those we serve well into the future.

Orthotics and Prosthetics

James Haas

Co-owner, Orthotics & Prosthetics Labs Inc.

James Haas

Advances in prosthetic technology have clearly been the most significant development in my field over the past decade. From knees and feet that adapt to different walking speeds and terrains to hands that send sensations of touch to the brain, every aspect of patient care has changed and continues to change at a rapid pace.

Prosthetic feet, knees, and sockets have been greatly impacted. Once made from multi-durometer foams and wood, the prosthetic feet of today are made from carbon, fiberglass, and kevlar laminated with modified epoxy resins. They store energy and adjust to uneven terrain and hills. Microprocessor knees have on-board sensors that detect movement and timing and then adjust a fluid/air control cylinder accordingly. These knees not only make it safer for a person to walk, they also lower the amount of effort amputees must use, resulting in a more natural gait. Sockets once made from stiff materials are now incorporated with soothing gels and flexible adjustable systems that allow a patient to make their own adjustments to improve their comfort.

As for the next decade, I hope to see national insurance fairness. Devices typically last about three to five years. Some people make them last longer, but others, especially growing children, need replacements more often. Many private insurance plans have annual caps and lifetime limits on coverage for orthotics and prosthetics. The Amputee Coalition of America authored insurance-fairness legislation and has lobbied for its implementation for over a decade. This legislation has been ratified in 20 states, including Massachusetts. The Fairness Act requires all insurance policies within the state to provide coverage for prosthetics and orthotics equal to or better than the federal Medicare program and have no coverage caps and lifetime restrictions.

Dental Care

Dr. Lisa Emirzian

Co-owner, EMA Dental

Dr. Lisa Emirzian

The most significant development in the field of dentistry over the past decade has been the integration of digital technology into our daily practices. There are three components of digital dentistry: data acquisition, digital planning, and, finally, the manufacturing of the restoration to be created. Data acquisition today is accomplished with digital radiographs, paperless charting, intra-oral scanners, cone-beam 3D scanners, and video imaging. For the planning process, we now have the ability to merge the data with software that enables computer-aided design and digital smile design, allowing dentists to perform complex procedures, including guided surgical treatments and smile designs, with optimum results. Fabrication and execution of the final restorations can be done in the office or, more often, in laboratories with highly sophisticated digital milling machines, stereolithography, and 3D printing.

In the next decade, we will see data fusion to ultimately create the virtual patient. The next-generation digital workflow will merge intra-oral 3D data with 3D dynamic facial scans, allowing dentists to create 3D smile designs and engineer the dentofacial rehabilitation. The integration of scanners and software will expedite the delivery of ‘teeth in a day.’ In addition, multi-functional intra-oral scanners will allow for early detection of carious lesions and determine risk levels for different patients.

Above and beyond this foreseeable future, artificial intelligence (AI) will be the next paradigm shift. Companies are already looking for big-data collection and deep machine learning to help the practitioner in their everyday chores of diagnosis and treatment. AI cloud-based design platforms will input data, and AI engines in the background will aid in all parts of dental treatment, including diagnosis, design, and fabrication of final restoration.

Let us not forget one thing: the future is all about us — people utilizing technology to enhance the human connection between doctor and patient.

Rehabilitation

John Hunt

CEO, Encompass Health Rehabilitation Hospital of Western Massachusetts

John Hunt

A significant rehabilitation development from the past includes one that may surprise you. Time. A luxury we once knew, time meant patients could recover in a hospital longer after a surgery, an accident, or an illness. Nurses had more time to assess patients to know exactly what they needed. Insurance companies approved longer patient stays through lengthy consideration. Ten years ago, a stroke survivor could recover for two weeks in a hospital and then join us for a rehabilitation stay that would last several weeks.

Today, a three- to five-day stay in the referring hospital, followed by a two-week stay in rehabilitation, is the norm. We are seeing significant decreases in the age of stroke survivors as well as an increase in the number patients who survive with cognitive and physical disabilities. Yet, we also see medical breakthroughs, including the discovery of tissue plasminogen activator (TPA) — nothing short of a miracle. TPA actually reverses the effects of an evolving stroke in patients when used early on, making recoveries easier.

With new advanced technologies being introduced every year, rehabilitation continues to progress at a rapid speed. Looking into the future, evidence-based research will continue to grow to help us make knowledgeable decisions that ultimately impact patient outcomes. Increased clinical expertise will lead to higher functional gains in shorter amounts of time. As a result, acute inpatient rehabilitation will impact the lives of patients like we’ve never seen before.

Hearing Care

Dr. Susan Bankoski Chunyk

Doctor of Audiology, Hampden Hearing Center

Dr. Susan Bankoski Chunyk

The most common treatment for hearing loss is hearing aids. Although digital processing has been available in hearing aids since 1996, the past 10 years have offered great leaps in technology for people with hearing loss. Each generation of computer chip provides faster and ‘smarter’ processing of sound. Artificial intelligence allows the hearing-aid chip to adjust automatically as the listening environment changes, control acoustic feedback, and provide the best speech signal possible. People enjoy the convenience of current hearing aids’ Bluetooth streaming, smartphone apps, and rechargeable batteries.

These features are ‘the icing on the cake,’ but the real ‘cake’ is preservation of the speech signal, even in challenging listening situations. Since the primary complaint of people with hearing loss is understanding in noise, new hearing-aid technology works toward improving speech understanding while reducing listening effort in all environments. This significantly improves the individual’s quality of life.

The negative effects of untreated hearing loss on quality of life are well-documented. Recent research has also confirmed a connection between many chronic health conditions — including diabetes, cardiovascular disease, kidney disease, balance disorders, depression, and early-onset dementia — and hearing loss. This research shows that hearing loss is not just an inevitable consequence of aging, but a health concern that should be treated as early as possible. My hope for the future is that all healthcare providers will recognize the value of optimal hearing in their patients’ overall health and well-being and, just as they monitor and treat other chronic health conditions, they will recommend early diagnosis and treatment of hearing loss.

Health Care

More Than a Gym

Dexter Johnson says people who work downtown are excited about having the YMCA nearby.

Dexter Johnson can rattle off the amenities found in any chain gym. Weights and cardio equipment. A sauna or pool. Perhaps a playroom for kids to hang out while their parents work out.

But the YMCA offers more than just fitness equipment and childcare for its members — it gives them a community, said Johnson, CEO of YMCA of Greater Springfield, which recently relocated from Chestnut Street in Springfield to Tower Square in the heart of downtown.

The nonprofit recently held its grand opening, and is well underway with programs, fitness classes, and more activities open to members.

The fact that Tower Square, Monarch Place, 1550 Main Street, and other surrounding offices are home to more than 2,000 employees in downtown Springfield is one of several benefits of the YMCA’s move, Johnson told BusinessWest. “The reception has been great. The people that work in this building or in the adjoining buildings have been excited about having us here.”

And it’s no secret why.

The new Child Care Center for the Springfield Y boasts a 15,000-square-foot education center, including classrooms, serving infants through elementary-school students. The Wellness Center continues its popular fitness and health programming with a new, 12,000-square-foot facility on the mezzanine level of Tower Square, complete with a group exercise room, state-of-the-art spin room, sauna, steam room, and walking track.

But Johnson knows the Y is more than just a gym — it’s a cause-driven organization that focuses on giving back to the community through youth development, healthy living, and social responsibility.

“We don’t call ourselves a gym, despite the fact that we have gym equipment,” he said. “We are a community organization, and this is just one of the ways that we serve the community.”

The Bigger Picture

One of the many programs the Y offers is LIVESTRONG at the YMCA, a 12-week personal-training program for adult cancer survivors offered without cost to participants. It also provides families with nearly $700,000 in financial scholarships every year — just two examples of how the Y is much more than just a gym, Johnson said.

“Our goal as an organization is to really make the Y stronger,” he noted, adding that the move to a new facility will greatly reduce costs to allow the organization to expand its services and impact. “The Y is looking to serve the community and to help from the spirit, mind, and body aspects of what people need.”

Before the move, Johnson anticipated the Y would lose about 20% of its members due to lack of a pool and change of location, but added that it has since gained new members and partners that are taking advantage of the services. About 50 new memberships were sold before the move into the new space, just because people knew it was coming.

“Nearly 2,000 people work in these three buildings, so we’re really hoping that those folks will understand the convenience of having something like this right here and not having to go to your car and drive elsewhere to meet your wellness needs,” he said.

Right now, the number of membership units, both families and individuals, is up to about 1,000. In order to increase these numbers, Johnson says the Y is giving tours, reaching out to local businesses and neighbors, and will be offering specials starting in 2020 to get people in the door.

“We’re hoping that we will get a good turnout of people that will give us a try,” he said, adding that a new sauna, steam room, and more than 40 group exercise classes a week are just some of the benefits.

While welcoming those newcomers, Johnson emphasized that the Y is also hoping its long-time members will enjoy the new facility as well.

“Despite the fact that we are heavily focused on the business population, we continue to serve the population as a whole, and we want our members to remember that part because that’s crucial for us,” he said. “We’re really looking to build upon the existing membership by moving here.”

A New Venture

While the new location has more limited space than the original, Johnson says he’s focused on making the most of the new location. That includes utilizing the parking garage by offering members free parking for up to three hours — as well as letting people know what other amenities exist in Tower Square, from retail and banking to UMass Amherst and numerous restaurants, most of them in the food court.

“We understand that the more activity and the more action taking place in this building, the better for everyone,” he said.

Overall, Johnson strongly believes this new facility will help serve the goals of the Y as a whole.

“We think this facility will stabilize the organization,” he said, “while we continue in our other efforts as they relate to our full service at our Wilbraham location, our childcare facilities throughout the city, and all the things the Y is involved with.”

Kayla Ebner can be reached at [email protected]

Health Care

Beyond the Ban

Call it a decisive response to a much less clear-cut problem.

While shop owners may seethe, Gov. Charlie Baker says the state’s four-month ban on selling vaping products is a necessary step while the medical community tries to figure out what’s causing a rash of pulmonary illness among e-cigarette users across the U.S.

“We do not know what is causing these illnesses, but the only thing in common in each one of these cases is the use of e-cigarettes and vaping products,” Massachusetts Public Health Commissioner Monica Bharel said. “So we want to act now to protect our children.”

On Oct. 1, the Massachusetts Department of Public Health (DPH) reported five additional cases of vaping-associated pulmonary injury — two confirmed, three probable — to the U.S. Centers for Disease Control and Prevention (CDC), bringing the statewide total of reported cases to 10. (Five of the cases are confirmed, and five are considered probable for meeting the CDC’s definition of vaping-associated lung injury.) At press time, 83 suspected vaping-related pulmonary cases have been reported to the DPH since Sept. 11.

“While no one has pinpointed the exact cause of this outbreak of illness, we do know that vaping and e-cigarettes are the common thread and are making people sick,” Bharel said. “The information we’re gathering about cases in Massachusetts will further our understanding of vaping-associated lung injury, as well as assist our federal partners.”

Some clarity may be emerging, however, particularly concerning the role of tetrahydrocannabinol (THC), an ingredient found in marijuana. According to the CDC, 77% of the people involved in the recent outbreak reported using products containing THC. In Massachusetts, five of the 10 cases involved THC, while another four vaped both THC and nicotine; just one of the 10 reported vaping nicotine only.

Based on this recent data, CDC recommends people consider refraining from e-cigarette or vaping products, particularly those containing THC.

“CDC is committed to finding out what is causing this outbreak of lung injury and death among individuals using vaping products,” said CDC Director Dr. Robert Redfield. “We continue to work with FDA and state partners to protect the nation from this serious health threat.”

More information is needed to know whether a single product, substance, or brand is responsible for the lung injuries, the CDC noted, adding that the investigation is particularly challenging because it involves hundreds of cases across the country, and patients report use of a wide variety of products and substances.

According to the CDC’s most recent national report, of the patients who reported what products they used, about 77% used THC-containing products, with or without nicotine-containing products; 36% reported exclusive use of THC-containing products; and 16% reported exclusive use of nicotine-containing products.

In addition, the report from Illinois and Wisconsin showed that nearly all THC-containing products reported were packaged, prefilled cartridges that were primarily acquired from informal sources such as friends, family members, illicit dealers, or off the street. THC use is legal and regulated in Massachusetts.

“The main theme seems to be illegal THC products. It’s a mix of chemicals in products to sell on the street that just don’t react that well with the lungs,” Dr. Nico Vehse, chief of Pediatric Pulmonology at Baystate Children’s Hospital, told BusinessWest.

He noted that vaping has posed lung issues since it first emerged in the early 2000s. “Back then, we had a recurrence of what they call popcorn lung. If you get fatty lipids into your lungs, your lung tries to fight it like pneumonia, and that causes a lot of lung damage.”

While much of the vaping news surrounds a lung illness, Dr. Nico Vehse says, nicotine addiction remains a persistent danger, particularly for young people.

Whether the current outbreak is a similar phenomenon or something altogether different is the subject of intense study, at the national level but also in Massachusetts. In mid-September, Bharel mandated that Massachusetts clinicians immediately report any unexplained, vaping-associated lung injury to the DPH. Of the 83 suspect cases reported at press time, 51 are still being investigated, with DPH officials collecting medical records and conducting patient interviews. Twenty-two cases did not meet the official CDC definitions, while the other 10, as noted, were reported to the CDC.

Off the Shelf

Baker went a big step further when, on Sept. 24, he declared a public-health emergency and a four-month statewide ban on sales of all vaping products in Massachusetts. The ban applies to all vaping devices and products, including those containing nicotine or cannabis.

The decision generated some pushback, and not just by retailers. Shaleen Title, commissioner of the state Cannabis Control Commission, assailed the ban in a tweet, posting that it is “purposely pushing people into the illicit market — precisely where the dangerous products are — and goes against every principle of public health and harm reduction. It is dangerous, short-sighted, and undermines the benefits of legal regulation.”

As someone who works with young people, however, Vehse understands the DPH’s concern. Of the 10 reported cases in Massachusetts, five are under age 20. Even absent concern over the current lung illnesses, many vaping products have a much higher nicotine concentration than traditional cigarettes, and some public-health officials are concerned an entirely new generation of young people may be falling prey to nicotine addiction. He noted that some products use salts instead of oils, which may not cause the same kind of lung damage as the oils, but deliver more nicotine.

“They improved on the perfect delivery system for addiction — cigarettes — and made it even more potent for nicotine addiction,” Vehse told BusinessWest. “Nicotine addiction is probably one of the hardest things to quit. I’ve always said you’ll have an easier time quitting heroin than quitting nicotine. It’s the most highly addictive substance we have, legally or illegally.”

As part of its public-health emergency declaration, Massachusetts implemented a statewide standing order for nicotine-replacement products that will allow people to access over-the-counter-products like gum and patches as a covered benefit through their insurance without requiring an individual prescription, similar to what the Baker administration did to increase access to naloxone, the opioid-reversal medication.

Other health organizations praised Baker’s decision, for a variety of reasons.

“In the absence of strong federal action, especially by the FDA, states are being forced to make decisions to protect the health of children and adults from a vaping-related public-health emergency,” said Harold Wimmer, president and CEO of the American Lung Assoc.

“While no one has pinpointed the exact cause of this outbreak of illness, we do know that vaping and e-cigarettes are the common thread and are making people sick.”

“Governor Baker’s announcement reinforces the need for the FDA to clear the market of all flavored e-cigarettes in order to address the youth e-cigarette epidemic,” he went on. “While the Centers for Disease Control and Prevention and state and local departments of health continue to investigate the hundreds of cases of lung injury from e-cigarettes, the American Lung Association once again urges all Americans to stop using e-cigarettes.”

Meanwhile, the Massachusetts Dental Society (MDS) also swung its support behind the ban.

“While vaping is believed to pose fewer health risks than smoking regular tobacco cigarettes — the leading cause of preventable death in the United States — it is by no means harmless,” said MDS President Dr. Janis Moriarty. “E-cigarettes still contain nicotine … which increases the risk of high blood pressure and diabetes. E-cigarettes also can have a significant impact on oral health.”

She cited a study supported by the American Dental Assoc. Foundation that determined that vaping sweetened e-cigarettes can increase the risk of cavities. “Additionally, the nicotine in e-cigarettes reduces blood flow, restricting the supply of nutrients and oxygen to the soft tissues of the mouth. This can cause the gums to recede and exacerbate periodontal diseases. Reduced blood circulation also inhibits the mouth’s natural ability to fight bacteria that can accelerate infection, decay, and other problems.”

Time to Act

The main story, however, remains the recent spate of lung illness. At press time, 805 confirmed and probable cases of lung injury associated with e-cigarette product use or vaping had been reported the CDC by 46 states and the U.S. Virgin Islands. Those cases included 12 deaths, but none in Massachusetts.

Bharel hopes her department’s reporting mandate will bear fruit in getting to the bottom of what has become a national concern.

“We are beginning to hear from clinicians about what they are seeing in their practice as a result of the health alert,” she said, adding that the mandate “establishes the legal framework for healthcare providers to report cases and suspected cases so that we can get a better sense of the overall burden of disease in Massachusetts. It also will allow us to provide case counts to the U.S. Centers for Disease Control and Prevention as they continue to try to understand the nationwide impact of vaping-related disease.”

In 2018, Baker signed a law that incorporates e-cigarettes into the definition of tobacco, making it illegal to vape where it is illegal to smoke and raising the minimum age to buy tobacco products, including e-cigarettes, to 21.

Still, the latest statewide data shows 41% of Massachusetts high-school students have tried e-cigarettes at least once. About 20% of them reported using e-cigarettes in the past 30 days — a rate six times higher than adults. Nearly 10% of middle-school students say they have tried e-cigarettes.

In the past year, DPH has conducted two public-information campaigns to raise awareness among middle- and high-school-aged youth and their parents about the dangers of vaping and e-cigarettes. The department promises to reprise both campaigns in the coming weeks and include resources for young people to assist them with quitting.

Vehse said it’s easier for teenagers to sneak a vape at school than to smoke cigarettes, which may contribute to their use. “It doesn’t smell; it doesn’t stay in the air. It’s completely covert. Now high schools have started to install some vaping sensors in bathrooms. As young as middle school, kids are vaping.”

He had no answer to why the usage numbers are so high among a population that shouldn’t even be able to purchase e-cigarettes, but deferred to the simple psychology of being young.

“Maybe it’s just because you’re a teenager and want to do something you’re not allowed to do. It’s all part of the teenager feeling indestrictible,” he said. “But whether you’re cigarette smoking or vaping, both are addictive, and you’re inhaling stuff you’re not supposed to.”

In many cases, they’re inhaling products flavored and packaged in such a way to appeal to kids, he added. “They pretty much make them look like candy bars on the shelves.”

Following a report from the CDC that 27.5% of kids are using e-cigarettes and that many are initiated with flavored products, the AMA’s Wimmer said, “we also call on the Massachusetts Legislature to pass a law prohibiting the sale of all flavored tobacco products.”

For now, Baker, Bharel, and other state officials will continue to assess their most recent moves as the national effort continues to learn more about — and prevent — vaping-related lung disease.

“One of the experts said that, ‘we don’t have time to wait. People are getting sick, and the time to act is now,’” Baker said when announcing the sales ban. “I couldn’t agree more.”

Joseph Bednar can be reached at [email protected]

Health Care

Cultural Shift

Michael Taylor and Teresa Weybrew say Christopher Heights of Northampton is striving to be ‘the place’ for LGBTQ seniors.

The average age of a Christopher Heights resident is somewhere in the 80s, says Teresa Weybrew, director of Marketing & Admissions at the assisted-living community in Northampton.

That’s an age group that grew up in a less-open time when it came to gender identity and sexual orientation — and members of that generation often still feel anxiety around their peers. But what’s more surprising, Weybrew said, is that, for many, that fear of being openly themselves is heightened when they move into senior-living communities.

“There’s a statistic that, of people who have come out and lived an authentic life in their sexual orientation, when they come into assisted living or skilled nursing, 86% go back in the closet out of fear,” she told BusinessWest. “They’re in an environment where they don’t know how safe they are because they have some memory loss or physical ailments — they’re already vulnerable because they’re not quite physically themselves — and then they have this added layer of anxiety. We want to help them understand that we get it, and they’re going to be OK here.”

Christopher Heights recently hosted a workshop for staff, residents, and public on LGBTQ (lesbian, gay, bisexual, transgender, queer) cultural competency in the senior-living setting. Presented by Rainbow Elders, an arm of LifePath in Greenfield, the event was also part of the process of being credentialed by SAGE, the nation’s largest advocacy organization for LGBTQ elders.

“I want our community to be accepting of other residents,” said Michael Taylor, the facility’s executive director, “but we also want employees to feel comfortable and respected. I see this as making it a welcoming place for both.”

Not all communities are. Angela Houghton of AARP Research writes that three out of four adults age 45 and older who are lesbian, gay, bisexual, or transgender say they are concerned about having enough support from family and friends as they age. Many are also worried about how they will be treated in long-term-care facilities and want specific LGBTQ services for older adults.

“I’ve been working with SAGE in a conversation for a couple months,” Weybrew added. “But as I got into it, I realized this isn’t just about having a plaque on the wall. We want to live and breathe and walk the talk and really be the facility that does the work and where people can come in and say, ‘yeah, they really do know what they’re doing, and I feel welcome,’ whether it be an employee or someone who comes to live here.”

Subtle Spectrum

For the recent workshop, Rainbow Elders brought in four people — representing gay, lesbian, bisexual, and transgender perspectives — to talk about gender, identity, orientation, and how none of those categories are black and white, but rather a spectrum.

“It was good educational background. Each talked about their personal story,” Taylor said, noting that Christopher Heights already employs a handful of LGBTQ individuals and aims to create a more welcoming environment for staff and residents alike — which is why hearing these perspectives shared aloud is important.

The demographics speak to the importance of this issue. By 2030, the population of American adults ages 65 or older is expected to surpass 70 million, according the U.S. Census Bureau. The National Gay and Lesbian Task Force puts the number of LGBTQ seniors in the U.S. at 3 million and notes that this figure is expected to double by 2030.

However, LGBTQ seniors frequently report concern over the possibility of encountering discrimination from senior-housing staff or other residents. According to SAGE, 48% of lesbian, gay, or bisexual couples experience “adverse treatment when seeking senior housing,” and transgender elders face such treatment at even higher rates.

Meanwhile, a 2016 report from Justice in Aging notes that 78% of LGBTQ residents in nursing homes, assisted-living facilities, and long-term-care facilities responded ‘no’ or ‘not sure’ when asked if they felt comfortable being open about their sexual orientation or gender identity to facility staff.

Then there are cases like Mary Walsh and Bev Nance, a Missouri couple whose housing application at a local senior-living facility was denied because of a cohabitation policy that defined marriage as between one man and one woman. They sued the facility, but their lawsuit was dismissed by a U.S. district judge in January.

Yes, that’s January 2019, not 1959. Clearly, the work of SAGE and like-minded organizations isn’t done. Cases like this certainly help explain why only 20% of LGBTQ seniors in long-term-care facilities are open about their sexual orientation, according to Justice in Aging.

Yet, attitudes have been shifting — and prejudices hopefully diminishing — over the decades when it comes to this population, and facilities should be welcoming them as an untapped market, notes a report by Sodexo titled “Why ‘LGBTQ-welcoming’ Will Soon Be a Hallmark of the Most Successful Senior-living Communities.”

“Developing a marketing strategy that attracts LGBTQ older adults is the right thing to do,” the report notes. “And it’s good business. Given the opportunity for senior-living operators to advance their growth agenda, developing a strategic plan that attracts and retains LGBTQ older adults and allies is a vital lever to business growth and to improve quality of life.”

To help facilities move in that direction, SAGE launched its credentialing program for retirement communities around the country aiming to create more understanding and resources for these marginalized groups. Its program addresses the specific difficulties LGBTQ older adults face, including abuse, neglect and hurtful comments.

“Most people work with older adults because they have a caring orientation,” said Tim Johnston, director of national projects at SAGE. “We are giving them the tools they need to help older adults feel more comfortable.”

Watch Your Language

In developing a culturally competent and welcoming environment, it is important to address a number of factors, including language, inclusive visuals in company materials, programming, and outreach efforts, according to the Sodexo report.

At Christopher Heights of Northampton, it begins with the application, which used to give only two options for gender — male or female. It may seem like a small thing, but it’s a detail that sets transgender and non-binary individuals on edge right from the start.

“If you’re trans, what do you put?” Weybrew said. “That’s your first exposure to us — and you’re already thinking, ‘all right, they expect me to be a man or a woman,’ when you don’t identify as that.”

She recently asked a resident from the LGBTQ community what might have improved her experience, and she did mention the application form, but she also stressed the importance of respectful communication.

“She said, ‘just ask.’ And we are afraid. We don’t want to offend anyone, and yet, in our fear, we are offending people by not asking them the questions. We want to connect, we need to connect, and that’s what I think this training will offer us — ways to have the conversation. Many people have lived their whole lives feeling either offended or accepted or some awkward in-between. It’s not like we’re going to do something that’s going to shock them.”

Sodexo’s report affirms that idea, noting that “one of the simplest ways to cultivate both understanding and respectful relationships with LGBTQ older adults is through appropriate use of language. Keep in mind, however, that some terms still used by older LGBTQ people may be seen as outdated by younger LGBTQ people. Become familiar with key terminology and pay close attention to how residents use terms and how they refer to themselves and others.”

Indeed, the report continues, “the LGBTQ community is not a monolith. This must be kept in mind when addressing the needs of LGBTQ older adults as well, who have a totally different set of life experiences than younger LGBTQ people. The former grew up in a time that was far less welcoming, when LGBTQ people guarded their sexual orientation and gender identity as a dangerous secret that could cause them to lose their homes, jobs, families, and freedom. They risked being labeled anything from criminal to mentally ill. That generation still carries a lot of this baggage today as they attempt to navigate issues related to housing and healthcare.”

That may be an understatement. SAGE notes that, just a few decades ago, homosexuality was still classifed as a mental illness by the American Psychiatric Assoc., not to mention a crime in some parts of the U.S. Housing, employment, and healthcare discrimination were common. As a result, many LGBTQ seniors remain fearful or distrustful of medical and social-service providers.

Weybrew has assembled an advisory board that will continue to meet regularly going forward and bring in educational opportunities for residents, staff, and the larger community.

“It won’t end. It can’t end,” she told BusinessWest. “We have to keep learning, and we have to say, ‘yes, we see you.’”

She knows she’s already dealing with a vulnerable population. “You’re talking about a potential resident who’s scared because they’re leaving their home of 40 years. Their spouse died, they’re losing their health, and they’re coming to a place where they don’t know us. I know what’s like because I did it with both my parents. Now you add that layer of sexual orientation. We want them to know, ‘yeah, it’s cool to be here because we’re going to treat you right.’

“We’re going to have our issues,” she went on. “We might get some pushback from an 88-year-old who says, ‘God says that’s a sin.’ It’s going to happen. And we’re going to learn how to manage that.”

Not Just Seniors

Senior-living facilities aren’t the only ones recognizing opportunities to boost cultural competency among their staffs. For example, Cooley Dickinson Hospital has been recognized as a 2019 Leader in LGBTQ Healthcare Equality by the Human Rights Commission (HRC), the country’s largest LGBTQ civil-rights organization. CDH is the only hospital in Western Mass. and one of only seven hospitals in the Commonwealth to earn this designation.

Among its efforts, Cooley Dickinson has recruited and trained clinicians who specialize in the care of LGBTQ people; implemented changes to electronic medical records that facilitate the use of the patient’s preferred gender, name, and pronouns; and collaborated with local gender-diverse community members, the Fenway Institute, and researchers from Harvard Medical School on the PATH (Plan and Act for Transgender Health) Project, a study that will inform the expansion of gender-affirming health services in Western Mass.

“This designation affirms Cooley Dickinson’s commitment to providing equitable, inclusive, and affirming care for LGBTQQ patients and their families,” said Cooley Dickinson Health Care President and CEO Joanne Marqusee. “We are proud to receive — for the third consecutive year — this honor and to continue our efforts to ensure that our local LGBTQ community has access to respectful, appropriate care.”

Sure, it’s easier for Northampton-based facilities like Cooley Dickinson and Christopher Heights to make these efforts, which are likely to meet with resistance in less progressive areas of the country. But it’s a start.

“We realize it’s going to be an ongoing process, but we as a company are committed to it,” Taylor said.

Weybrew said Christopher Heights is a corporate sponsor of the Out! for Reel film festival, which focuses on LGBTQ-themed films and recently kicked off its season. “I had a chance to get up and speak. The word is getting out that this is going to be a welcoming place, and it starts with us internally asking, how do we make it that place every day? How do we make people feel comfortable?”

The answer is an evolving one — and begins with asking the right questions of those who have felt marginalized for too long.

Joseph Bednar can be reached at [email protected]

Health Care

Baby Steps

Rachel Szlachetka, Jazz, and Cindy Napoli play in the kids’ room at the Center for Human Development facility on Birnie Ave in Springfield.

When looking at 2-year-old Jazeilis “Jazz” Jones, she seems like any normal toddler who loves to eat and play. But what you can’t tell from looking at her is that Jazz, born a month prematurely, has overcome several developmental hurdles to get to where she is today.

When Diany Dejesus gave birth to Jazz, she was already fighting her own battle with anxiety and depression. A newborn baby who wouldn’t latch to her breast or drink from a bottle only added to her stress and made it nearly impossible for Dejesus to sleep at night. After talking with her therapist, she was referred to the Early Intervention program at the Center for Human Development.

Today, Jazz could seemingly eat all day if you let her, and Dejesus is exponentially more confident as a mother.

This success story, like others similar to it but unique in some ways, wasn’t written overnight, but rather over time and through perseverance — as well a partnership, if you will, between the parent and the 22 staff members of the Early Intervention program.

Erinne Gorneault, a licensed clinical social worker and program director, explained how it works. She told BusinessWest that each child is unique and grows at his or her own pace. But sometimes a child needs help.

“It’s the best feeling in the world to feed your kid. Everybody should be able to have that joy in feeding, and it can be so stressful for our kids who are developmentally delayed or on the autism spectrum.”

With a caseload of 230 families, CHD’s Early Intervention program works with infants and children from birth to age 3 who have, or are at risk for, developmental delays. A CHD team can assess a child’s abilities and, if indicated, will develop an individualized plan to promote development of play, movement, social behavior, communication, and self-care skills. Staff members work with children and their families in their own environment.

The work is extremely rewarding, said Cindy Napoli, an occupational therapist and program supervisor of Early Intervention, who cited, as just one example, how the program can help give parents the gift of being able to feed their child.

“It’s the best feeling in the world to feed your kid,” she said. “Everybody should be able to have that joy in feeding, and it can be so stressful for our kids who are developmentally delayed or on the autism spectrum.”

For Jazz, her biggest challenge was with feeding. At one point, she was labeled as “failure to thrive,” meaning she was unable to grow or gain weight. Even when Napoli and other CHD staff found a solution by having her drink through a straw, she was still struggling. Now, Jazz is thriving, eating more than enough food to keep her healthy, and speaking in full sentences.

“She’s doing so great, I’m so amazed. At the beginning, it started off so slow, I was really afraid for her. I didn’t know what I was going to have to deal with, but she’s way ahead of herself now.”

Erinne Gorneault says that being receptive to parents’ wants and needs is a critical part of the early-intervention process.

For this issue, BusinessWest takes an in-depth look at CHD’s Early Intervention program and that aforementioned partnership between team members and parents to achieve life-changing results for both the child and the parents.

Food for Thought

Gorneault said parents often contact CHD’s Early Intervention program because they are concerned about their baby or toddler’s development in the areas of speech delays, or delays in walking or crawling.

The experienced team can assess the possibility of a delay and work with parents and their children to help them attain their milestones — essentially, to catch up — if that’s what’s needed.

Program staff members also work with children diagnosed on the autism spectrum, infants and toddlers with feeding concerns, toddlers with sensory issues, and infants and toddlers with medical needs. They support the family by providing education and improving developmental milestones through teaching parents to interact with their infant or child while building strong emotional relationship. In all cases, staffers work with families to connect them with other community services that might be helpful and provide several playgroups for both community members and CHD Early Intervention families to participate in without interactive team members.

Although the 22 staff members in the program may be the experts, Napoli said the most important part of their work is going at the parents’ pace and empowering them to be advocates for their child.

“It’s about enabling and empowering the parents to be the lead person and the specialist,” she said. “We believe the parents are the specialists. It’s about empowering them and teaching them how to be advocates.”

Gorneault agreed, adding that the trans-disciplinary approach used at Early Intervention allows them to guide parents effectively while also keeping them in the driver’s seat.

Diany Dejesus says that one of the most beneficial things that has come out of her participation in the Early Intervention program with daughter Jazz is that it has built up her confidence as a mother.

“We just help; the parents are the ones doing all the work,” she told BusinessWest. “They’re the ones working on the outcomes; they are making the difference.”

With occupational therapists, physical therapists, and speech therapists in the program, staff members use a trans-disciplinary approach to work with families and find the best way to help achieve milestones.

“You don’t go in there with blinders on, thinking, ‘I’m only here for feeding,’ or ‘I’m only here for walking,’” said Napoli. “It’s about where the child is at, where do we want them to go, what are the priorities of the family, and how can we all do it together?”

One of the most important aspects of this program, said those we spoke with, is that the specialists work with the families in their most natural environment, usually the home or a day-care facility, in order to get the most successful outcomes.

“Being in the home, you’re able to adapt the environment,” said Napoli. “You’re able to see what they’re cooking. I can’t say enough about the natural environment.”

One of the priorities during the hour-long sessions staged over several weeks is working on what is most difficult for the parents, said Napoli. Once staffers have made their suggestions, their goal — and their hope — is that parents continue to practice the suggested strategies on their own.

“You’re modeling in hopes to encourage the parent to do the same thing,” she explained.

This is important, she said, because while CHD staff see the child for only one hour a week and specialists may visit a family at different times, parents are with the baby daily, almost 24/7.

Gorneault agreed, adding that being receptive to the parents’ wants and needs is a critical part of the process.

“They run the show,” she explained. “We make recommendations, but if they’re not ready for that, we slow down and just stay at their pace and support them and build their confidence as parents.”

A Matter of Confidence

And a confidence boost was exactly what Dejesus needed.

“I started off doubting everything, due to the fact that I have anxiety and depression; it just made it so much harder for me,” she said. “Little by little, with a lot of help from here and from my therapist, I just got reassured more, and it made me that much more confident.”

Dejesus said the people she interacts with at CHD are like another family, and have helped her achieve the confidence she needs to be a great mother.

“Having more people that can help you and guide you, that really did help me a lot,” she said. “Now, I trust myself and my instincts as a mom when it comes to Jazz.”

Kayla Ebner can be reached at [email protected]

Health Care

Taking Important Steps

By Mark Morris

Dr. Christopher Peteros prepares a patient for laser therapy.

Dr. Christopher Peteros prepares a patient for laser therapy.

Spring weather in New England is a great time to shake off winter’s cabin fever and head outside to take a walk, go for a run, or play a sport. Spring also means an increase in foot injuries from people being too active, too soon.

While overdoing it can cause aches and pains in many areas of the body, it’s easy to overlook our feet, which support everything else and are key to overall quality of life. Those who specialize in this realm of care have a simple word of advice: don’t.

They stress the importance of taking care of one’s feet, listening to them when they are sore and need attention, and fully understanding how it’s not unusual for foot pain to be the cause or the result of other pain in the body.

“Sometimes foot pain causes knee, hip, or back issues, and by the same token, if someone has pain in their knees or back, it puts the foot in an awkward position, resulting in foot pain,” said Dr. Christopher Peteros, a podiatrist with New England Foot Specialists in Longmeadow, who stressed the importance of paying attention to pain, calling it our body’s early-warning system.

“If you feel pain in your foot, knee, or ankle, it’s telling you to stop what you’re doing,” he told BusinessWest. “It’s like the ‘check engine’ light in your car.”

When we walk or run, the foot’s natural movement is known as pronation (the inward roll of the foot) and supination (the outward roll of the foot), both of which move us forward while providing support, cushioning, and balance. Too much or too little of either pronation or supination can cause pain in the feet and other parts of the body.

“I’m not telling people to go walk in the middle of the street, but if you know of a neighborhood with a cul-de-sac or a circular street, those are better choices than sidewalks, which are a harder force on our bodies.”

Terrance McKeon, a physical therapist with Cooley Dickinson Health Care’s Rehabilitation Services in South Deerfield, refers to the foot as the ‘victim,’ because it’s often the one in pain while the culprits can be nearby or as far away as the hip or pelvis. To carry the analogy further, McKeon said that, when investigating the cause of foot pain, the calf muscle is often a prime suspect, because when the calf muscles are tight, the body adjusts by collapsing the foot.

“Your foot tries to maintain balance by unnaturally scrunching the toes,” he explained. “Then the fascia gets stretched, the Achilles tendon gets overstretched, and you may even wiggle your pelvis, all because your calf muscles aren’t letting you get over your foot.” 

Brianna Butcher, a physical therapist at Select Physical Therapy in Enfield, agreed. “When someone walks in with foot issues, the first thing I check is their hips,” she said, adding that, since the glute muscles tend to be weak in many people, it causes more strain to be put on the leg and foot to compensate and maintain balance.

For this issue, we take an in-depth look at what causes foot pain and discomfort and how to prepare your feet for activity.

Walking the Walk

Those who spoke with BusinessWest there are a number of factors that contribute to one’s overall foot health — or lack thereof. These include everything from the level of exercise to the type and condition of the shoes being worn, to the surface that people walk or run on.

Terrence McKeon demonstrates an orthotic insert for a patient.

Terrence McKeon demonstrates an orthotic insert for a patient.

People should be thinking about all of them and making smart decisions, said Butcher, who noted, for example, that serious runners opt for an asphalt road instead of a concrete sidewalk, because the asphalt surface is slightly less harsh on our bodies than concrete.

“I’m not telling people to go walk in the middle of the street, but if you know of a neighborhood with a cul-de-sac or a circular street, those are better choices than sidewalks, which are a harder force on our bodies,” she said, adding that, for those who live near a track, that’s an even better option than walking on the street.

While sidewalks can be too hard on our feet, Peteros said treadmills can create the opposite problem and result in repetitive-motion injuries.

“Some treadmills can be too soft, so as your foot sinks in, it creates an abnormal amount of repeated pronation while the person is walking, which can lead to tendinitis or plantar fasciitis.”

One of the most common causes of foot pain, plantar fasciitis affects the band of tissue that runs along the bottom of the foot from heel to toe. The plantar fascia acts like a shock absorber to support the arch of the foot. Too much strain on it leads to a stabbing pain in the heel.

Many factors can contribute to plantar fasciitis, but it often results from a change in activity levels that puts more stress on the heel. Peteros said likely candidates for plantar fasciitis include the person who hasn’t run in years and then decides to pursue it again, as well as the person who goes on vacation and does more walking than normal while wearing flimsy shoes.

Peteros said a person with plantar fasciitis tends to experience severe pain in the morning after just waking up. The pain subsides a little after moving around, and then, by the end of the day, it increases. He said the pain can move into a cycle that won’t easily go away.

“It’s a very difficult thing to treat in some cases,” he said, “because you’re using that sore foot for every other step you take, unlike a sore hand where you can just carry it around.”  

The first remedy Peteros suggests for plantar fasciitis and other foot injuries is the easy-to-remember acronym RICE: rest, ice, compression, and elevation. People can do this on their own, and in many cases RICE along with good, supportive shoes is enough to solve the problem. If that doesn’t work, he has a variety of treatments to further care for plantar fasciitis.

Anti-inflammatory medicines or cortisone shots are two possible treatment options. While cortisone can be effective for some, Peteros said, he cautions against its overuse because the shots can create ruptures in the plantar fascia instead of healing it.

For several years, he has used laser therapy to treat plantar fasciitis. As an alternative to anti-inflammatory medications, laser therapy uses a beam of light so it’s painless for the patient, works to reduce inflammation, and allows for faster healing. He said the success rate for healing injuries by laser therapy is about 80%.

“Depending on the injury, most patients will need between five and 10 treatments, which take about 10 minutes each. It may not always lead to a cure, but it speeds up the process,” he said.

For chronic foot issues, Peteros also uses shock-wave therapy, which treats plantar fasciitis with sound waves. He said it functions much like the technology that uses sound waves to break up kidney stones, adding that the same company makes the two machines.

When taken care of quickly, he said most people will get great results and no longer need treatment for their plantar fasciitis.

“Some patients may get an occasional flare-up, usually because they did something they shouldn’t have done. The key is to be aware of it, protect yourself, and stop as soon as you feel any pain.”

Getting to the Bottom of Things

That bit of advice applies to all aspects of foot care, said McKeon, who told BusinessWest that, overall, it’s best to best to be proactive and avoid the energetic enthusiasm of taking too much advantage of a nice spring day.

“Your brain says, ‘I used to run five miles a day,’ but when you’ve gone all winter without running even one or two miles, that’s breaking the 10% rule,” he said, explaining that the best way to prevent injury when approaching spring activities is to take it easy in the beginning and gradually increase activity levels no more than 10% a week.

Physical therapists have used the 10% rule for years, and recent studies have supported the idea that the body can react and get stronger from a 10% increase each week for nearly any activity.

“If you can obey the rule, especially for weight-bearing activities like walking and running, you’ll be fine,” said McKeon.

Brianna Butcher inspects a patient’s foot for injury.

Brianna Butcher inspects a patient’s foot for injury.

This can require some pre-planning, he added, noting that simple heel-raising exercises for the calf muscles are a good way to get ready for a walking or jogging routine.

“Strengthening calf muscles is easy because you just go up and down on your toes. Go up on your toes to hit full height, then back down, and do them until you get tired,” he said, adding that the yoga position downward-facing dog is an effective exercise for tight calf muscles. He then stressed that the 10% rule also applies to the stretches.

As essential as good conditioning is to prevent foot injury, these proactive steps can easily be undone by cheap or worn-out shoes — or the wrong kind. McKeon said serious runners should consider new shoes every six months because the foam in the shoe that absorbs the energy of running will lose its ability to bounce back with heavy use.

Peteros also emphasized the importance of protecting the feet with good hygiene and proper shoes. “Whether you are a runner, walker, or any type of athlete, good, supportive shoes are the foundation of healthy feet.”

Peteros recommends shoes designed for the specific activity in mind, with a stiff sole. “If you can bend the shoe in half, it’s not offering support.”

One of the best examples of warm-weather shoes that provide no support are the ever-popular flip-flops. Peteros did not condemn them, necessarily, but referred to them as “purpose-built.”

“If you’re sitting around the pool, or at the beach, or even on your back deck with an iced tea, they’re perfectly fine to wear,” he said, adding that problems arise when people continually wear flip-flops around town, because the feet have to work hard just to keep them on. “Your toes are scrunching as they’re trying to grip the flip-flop, and there’s just no support; they’re actually more trouble than they’re worth.” 

Peteros also mentioned the dangerous practice of people who wear flip-flops to mow the lawn, adding that yardwork is another place where good, supportive shoes matter.

“A lot of people retire their old, beat-up sneakers to wear in the yard, but when you’re doing yardwork, you’re often on uneven ground, when your feet need support the most.”  

A work boot or hiking boot is a great choice for yardwork, he said, because they are lightweight and supportive. Meanwhile, high-top or low-cut shoes are both fine, he noted, stressing that these shoes should be kept just for yardwork; don’t retire them to the yard only after they’ve worn out.

Because every foot is different, people with overly high arches or flat feet often need additional support from custom orthotic inserts. Peteros admits that some people can get good results with over-the-counter insoles and advised that, when shopping for inserts, firmer is better. When a custom orthotic insert is needed, he said the old methods to make them have given way to 3-D digital imaging that results in an orthotic that fits the exact contours of the person’s foot.

“We used to make casts and molds and have people step in foam. I haven’t done those things in at least nine years; it’s all digital now.” 

McKeon said finding the right footwear for those at one extreme or another can be tricky, while people whose feet are more in the middle range may be able to slowly build up strength in their feet and avoid using an insert.

“I tell people that, if they gradually increase their activity levels following the 10% rule, they can improve the strength in their foot,” he explained. “This works well with athletes who don’t like wearing orthotic inserts.”

So, before taking on outdoor activities this spring, remember supportive shoes, the 10% rule, and RICE. You’ll prevent injury to your feet and better enjoy the spring weather.

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