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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.

Health Care

Leveling the Playing Field

Spiros Hatiras

Spiros Hatiras says the Massachusetts Value Alliance has created what he called a “virtual system” for the state’s independent hospitals.

Spiros Hatiras was asked about the Massachusetts Value Alliance and, more specifically, how it improves the buying power of its members, including the one he serves as president and CEO — Holyoke Medical Center (HMC).

He handled the assignment by referencing the hospital’s ongoing work to implement a new electronic medical record (EMR) system, and with an analogy that puts this concept in its proper perspective.

“Let’s say you went to Ford and asked them to build you a car, but told them that, instead of putting the power-switch buttons on the window side, you wanted them on the center console — the cost to customize the car the way you wanted it would be enormous,” he explained. “It’s the same with EMR; what hospitals used to do, and still do, is go to an EMR vendor and ask them to come in and build and install a system for that hospital.”

The Massachusetts Value Alliance, or MVA, as it’s called, is a coalition that is enabling its members to depart from that expensive scenario.

Indeed, several members of the alliance, which now includes 14 community hospitals, have come together to order an EMR system that will be customized for a group — with minor tweaks for each specific facility — and not one hospital. The savings will be substantial — in fact, Hatiras pegs the cost at roughly $5 million for HMC, close to half of what the cost might have been.

“Instead of us individually customizing, we get three hospitals to come together and say, ‘what are the features that make sense for all of us, and let’s build it one time and implement it in three locations.’”

“Our patients are not that different; in fact, they’re not different at all from the other hospitals, and the processes that we use are very similar — the order set, the treatment protocols, are all very similar,” he told BusinessWest. “So, instead of us individually customizing, we get three hospitals to come together and say, ‘what are the features that make sense for all of us, and let’s build it one time and implement it in three locations.’”

This is the very essence of the MVA, which was formed three years ago by founding members Emerson Hospital in Concord, Sturdy Memorial Hospital in Attleboro, and South Shore Health in South Weymouth. It has added new members steadily since then, and the alliance now also includes HMC, Berkshire Medical System, Harington Healthcare System, Heywood Healthcare, Lawrence General Hospital, Signature Healthcare, and Southcoast Health.

These are smaller, independent hospitals that enjoy the benefits of being independent and the ability that gives them to be focused on the needs of their respective communities, said Dr. Gene Green, president of the MVA board of trustees and president and CEO of South Shore Health. But they don’t enjoy the buying power and other cost-saving benefits of being in a larger healthcare system.

Dr. Gene Green

Dr. Gene Green says the MVA gives its members a very potent commodity in these challenging times — buying power.

The MVA, operating under the slogan “Health Care Is Better When We Work Together,” was created to level the playing field in at least some ways.

“There’s always greater bargaining power with numbers,” Green explained, adding that the MVA has helped its members reduce the cost of everything from laboratory services for their patients to health insurance for their employees. “Although a lot of people do group purchasing on common things, there are other things, especially within hospitals and healthcare systems, that are specialized, and so the question was, ‘how do we help each other bring our numbers together and help each have more bargaining power with third-party vendors?’”

The MVA was the answer to the question. It was in many ways inspired by a similar system in Connecticut called the Value Care Alliance (VCA), said Green, and today, the two alliances are collaborating to create additional economies of scale.

For this issue, BusinessWest takes an in-depth look at the Massachusetts Value Alliance and at how it is benefiting its members across the state during what remains a very challenging time for all hospitals, but especially the smaller, independent institutions.

Group Rates

Hatiras told BusinessWest that he was approached by the president of Sturdy Memorial not long after the MVA was created and encouraged to become part of the new group.

As he recalls the conversations, it wasn’t a very hard sell.

That’s because the value — yes, you’ll be reading that word a lot during this discussion — was readily apparent. And value is something these hospitals certainly need.

“We were quick to join — we’ve been a member almost from the beginning,” said Hatiras. “This is something we ought to be doing because, as independent hospitals, our resources are much more limited.

“This was a way to bring these hospitals together and join forces in terms of acquiring resources without merging assets or governance,” he went on, recounting two of the obvious downsides to becoming part of a large healthcare system. “We’re creating an almost virtual system.”

And within this virtual system, there exists that all-important commodity of businesses of all kinds, but especially hospitals that purchase a seemingly endless array of products and services — buying power. The alliance uses it with everything from laboratory services — there’s a contract with Quest Diagnostics — to elevator services, Green explained.

“The question was, ‘how do we help each other bring our numbers together and help each have more bargaining power with third-party vendors?’”

“It was a way for us to help each other find cost reductions and efficiencies to help drive down the cost of care, hopefully — unfortunately, revenues are declining at the same time we’re doing the cost cutting — and serve our communities.”

Hatiras agreed.

“We don’t have the benefits of a, quote-unquote, system,” he said, referring to the independent hospitals in the MVA. “But we replicated a lot of the those benefits with this alliance.

“We don’t have a mothership that can come to the rescue if one of its members isn’t doing so well — we don’t have that backup,” he went on. “But aside from that, all the other benefits of a system are there — the sharing of information, the sharing of best practices, collaboration, shared negotiation on resources, and more.”

And the alliance enables its members to enjoy greater buying power while also remaining independent, meaning decisions are made locally, a quality these hospitals covet.

“As independents, we’re very focused on our communities, and we’re very proud of that,” said Green. “That’s one of the reasons we came together — to see how we could help one another through cost-effective measures to be able to carry on our missions. We all have the same mission and focus on patient care, patient experience, and high quality.

“All of us are good at partnering with people in our own communities,” he went on, “which made us naturals to be able to partner with one another.”

Green said the group will collectively decide where opportunities to collaborate may exist, and then individual members have the opportunity to opt in or not, an operating mindset that provides members with a good deal of flexibility.

“We didn’t want to force anyone into doing something,” he explained. “If you had a contract that was good for five years, when that expires — and we have one — you can opt in, or you can stay with your own, depending on the relationship.

Which brings us back to that example of EMR that Hatiras mentioned. It’s a perfect example of just how and why the alliance works.

This is a project that involves HMC, Harrington Healthcare System, and Heywood Healthcare, all working with EMR-system designer Meditech.

“This allows to take advantage of tremendous economies of scale because we work on a common build and share common resources, which allows to do this build at a significantly lower cost than if we did it alone,” said Hatiras, adding that HMC will go first, with the other hospitals to follow, with an August 2020 ‘go live’ date for the system.

Bottom Line

Green told BusinessWest that, as reimbursement rates for care decrease, or hold steady, and as the price of technology and everything else hospitals buy continues to increase — the savings generated by the MVA are even more important.

“They enable us to stay afloat,” he said in a voice that clearly conveyed just how challenging these times are for all hospitals, but especially those who have chosen to remain independent.

That choice has left them without a safety net, if you will, but in the MVA, they have something that replicates a system in so many ways.

As that chosen slogan suggests, healthcare is better when people work together.

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

Health Care

Implanted Thoughts

Dr. David Hirsh

Dr. David Hirsh says mini dental implants can hold a bridge or crowns in place without requiring surgery and months of recovery.

Early in his career, Dr. David Hirsh used to perform dental work for the then-Springfield Indians, and even back then, there was a clear generational divide among hockey players — one measured by how many teeth they had.

“Everybody used to talk about hockey players having no teeth,” he told BusinessWest. “But the young players grew up with helmets, facemasks, and mouthguards, and they came to the office here, and they had beautiful teeth. Their older counterparts would smile, and there would be nothing there.

“It was a matter of education,” he went on, comparing it to how today’s athletes have a better understanding of concussions for the same reason.

But that focus on education holds true among all dental patients, Hirsh added, not just athletes. Simply put, dentists are seeing people make it past their childhood and young adulthood with healthier teeth than in decades past. “We see a tremendous difference in the younger population, which is very satisfying.”

Since launching his practice in downtown Springfield in 1981 — he has expanded the Bridge Street office four times since then — Hirsh has seen plenty of change in the way care is delivered, particularly in the realm of implants, especially the mini implants he has become known for regionally (more on that later). But some of that change has to do with improving habits.

“We’re here to restore teeth and fix teeth and help patients smile and look good. But we would much rather get these people when they’re younger — meaning children or young adults — and guide them and help them to maintain their teeth,” he explained.

“There’s no fun in making someone a denture,” he went on. “There’s no fun in having to restore a full arch with implants. We do it because there’s a need. But that’s not the goal of dentistry. The goal of dentistry is clearly prevention. My goal has always been having a strong hygiene program, a strong prevention program, and helping guide people — and helping parents guide their children — to better oral health so they won’t have to be in a situation where they need a root canal, bridges, partials, dentures. Those things aren’t the goal. That’s not what we want.”

“There’s nothing more satisfying to me than to have a patient come in missing teeth, and they leave here with a beautiful smile, and they have tears in their eyes.”

But because there will always be a need for restorative dentistry, Hirsh — who practices with Dr. Kelly Soares under the umbrella of PeoplesDental — has taken advantage of plenty of innovations in the world of implants, with the goal of restoring not only teeth, but quality of life to patients with less recovery time than ever before.

Tooth of the Matter

When implants first came on the scene a half-century ago, Hirsh said, they were designed differently, and didn’t exclusively use titanium as they do today, so a membrane would form between the metal and the bone, causing the implants to loosen up.

“Today, every implant system is based on titanium technology — all of them,” he explained. “Titanium is the only metal that fuses directly to bone without forming a membrane around it.”

Implants are typically a surgical procedure, placed into exposed bone after the gums are opened up. “A hole is drilled, the implant is tapped in or screwed in very gently, and then the gums are sutured closed, and you have to wait anywhere from six to eight months in the lower jaw — four to six months in the upper — for that titanium implant to fuse with the bone.”

While traditional implants do a good job of anchoring crowns, bridges, and other structures over the long term, mini dental implants, or MDIs, have been a game changer for Hirsh’s practice.

MDIs are solid, one-piece, titanium-coated screws that take the place of a tooth root. They are much thinner than traditional dental implants and were originally designed to hold dentures in place. However, they have other benefits, including the fact that they stimulate and maintain the jawbone, which prevents bone loss and helps to maintain facial features. In addition, they are stronger and more durable than crowns and bridges that have been cemented into place.

They were first used in the ’90s and have been approved by the U.S. Food and Drug Administration for long-term use for fixed crowns and bridges and removable upper and lower dentures.

PeoplesDental in Springfield is now certified among a group known as Mini Dental Implants Centers of America — the only one, in fact, in a region that stretches from the Berkshires to Worcester, and from Vermont to Hartford. The organization is associated with the Shatkin Institute, the largest training center in America for MDIs.

“For reasons I don’t understand, mini implants in this area in New England are not widely utilized,” Hirsh told BusinessWest. “I think we’re a little slower than other areas of the country to experiment and do new things. When we have something that works, we don’t like to change. When traditional implants began in the late 1960s, early ’70s, the biggest negative voices were from dentists themselves — ‘you can’t put metal in somebody’s bone.’ Then, all of a sudden, by seeing what could be done, they came around.”

The same may soon happen with MDIs, he went on. “More people around the country are learning that minis are a very, very good alternative to traditional implants. The mini implants are not shorter, they’re just narrower; the largest minis today are equivalent to the thinnest traditional implants. The difference is basically the placement of them and what’s involved from a patient perspective.”

Most notably, no surgery is involved. Rather, the dentist makes a small hole through the gum tissue and into the bone, and screws the implant in.

“It gets its retention from the screwing effect, so you don’t have to wait six to eight months,” Hirsh explained. “That very day, you take an impression and make your final crown or bridge or whatever you’ll use it for.”

He likened the procedure to drilling a thin screw into a piece of wood. “You drill a pilot hole first, then put a screw in that’s a little bigger than the hole, so it bites into the wood. The same thing happens here, except it bites into the bone. It’s about half the cost, it’s less invasive, and there’s less chance of infection and the many types of sensitivity and soreness afterward because that usually comes from the cutting and the stitching.”

Quality of Life

More important, however, is the impact of mini implants on patients’ quality of life, Hirsh said, particularly for those wearing lower dentures.

“Lower dentures float all over the place. Nobody’s ever happy with their lower denture. It sits on a ridge like a horseshoe, and their tongue hits it and lifts it up, and they use pastes and powders that are uncomfortable and taste bad. And at restaurants, they can only eat what their teeth permit them to eat.”

With mini implants, however, a dentist can place four implants into the arch and corresponding attachments into their denture, and the denture can snap into place that same day. When they are used to stabilize upper dentures, the palate portion of the denture can be cut away, which makes it more comfortable and improves the taste of food.

“They can take it out to clean it, but it’s not going to move around,” he said. “There’s no paste or powder, it’s cost-effective, and it changes their life. I’ve done commercials with patients who bite into apples or corn with dentures, and they feel it’s rock solid.”

That’s gratifying for someone who has spent nearly 40 years helping people find solutions to dental issues that stem from genetics, accidents, environmental factors, and plain old bad habits.

In his earlier days, he explained, before dental insurance became more widely accessible, it was more common than today for families to avoid the dentist because of cost — or, if a tooth went bad, just opt for an extraction over a root canal.

“They were in a bad financial situation, or they weren’t educated to take care of their teeth, or a combination of both,” he told BusinessWest. “One tooth goes bad, and they need a root canal to save it, but they don’t want to spend the money, or don’t see the value in it. So they have that tooth extracted, and a year later, another one hurts, and it’s the same thing. All of a sudden, you’re looking at half a mouth of teeth, and half a mouth can’t do the work of a full mouth.”

Sometimes it’s a long process — decades, perhaps — to get to that point, or perhaps something happened suddenly, like a car accident or being struck in the teeth, but without insurance, it can be a challenge for families to get the work they need, at a time when procedures have become less invasive, in many cases, and more cutting-edge.

That’s changing, he said, not just on the insurance front, but as the result of decades of education and advertising the benefits of healthy oral habits. “When I see today’s young people, I don’t think, in the future, we’re going to see the amount of restorative need we see today.”

Until then, Hirsh aims to continue fixing what he can and helping young people forge a path to a future without implants. He’s scaled back to three days a week as he approaches retirement, but says the leisure activities of those coming years may not make him as happy as his current work does.

“There’s nothing more satisfying to me than to have a patient come in missing teeth, and they leave here with a beautiful smile, and they have tears in their eyes,” he said. “I’m not a golfer, but I fully understand hitting a great golf shot is very satisfying — but no one can convince me it’s as satisfying as doing something like that for a patient.”

Joseph Bednar can be reached at [email protected]

Health Care

On the Front Lines

VA Hospital in Leeds, Mass.

Early aerial photo of the VA Hospital in Leeds, Mass.

Gordon Tatro enjoys telling the story about how the sprawling Veterans Administration facility in Leeds came to be built there.
The prevailing theory, said Tatro, who worked in Engineering at what is now the VA Central Western Massachusetts Healthcare System for 20 years and currently serves as its unofficial historian, is that the site on a hilltop in rural Leeds was chosen because it would offer an ideal setting for treatment and recuperation for those suffering from tuberculosis — one of its main missions, along with treatment for what was then called shell shock and other mental disorders.

And while some of that may be true, politics probably had a lot more to do with the decision than topography.

“President Warren G. Harding came out and said, ‘stop looking for places … we’re going to put it in Northampton,’” said Tatro, acknowledging that he was no doubt paraphrasing the commander in chief, “‘because Calvin Coolidge is my vice president and he lives in Florence, and we want it to be in or around Florence.’”

Nearly 95 years later — May 12 is the official anniversary date — it is still there. The specific assignment has changed somewhat — indeed, tuberculosis is certainly no longer one of the primary functions — but the basic mission has not: to provide important healthcare services to veterans.

Overall, there has been an ongoing transformation from mostly inpatient care to a mix of inpatient and outpatient, with a continued focus on behavioral-health services.

“We’re more of a managed-care facility now,” said Andrew McMahon, associate director of the facility, adding that the hospital provides services ranging from gerontology to extended care and rehabilitation; from behavioral-health services to primary care; from pharmacy to nutrition and food services. Individual programs range from MOVE!, a weight-management program for veterans, to services designed specifically for women veterans, including reproductive services and comprehensive primary care.

Andrew McMahon says the VA facility in Leeds is undergoing a massive renovation

Andrew McMahon says the VA facility in Leeds is undergoing a massive renovation and modernization initiative scheduled to be completed by the 100th anniversary in 2024.

“When this facility was established, the mission of the VA was much different than it is today,” McMahon told BusinessWest. “We were a stand-alone campus in a rural part of the state that had 1,000 beds and where veterans went for the rest of their lives.

“Now, we are one facility within a network of eight serving Central and Western Massachusetts. We have this beautiful, 100-year-old campus, but the needs of today’s veterans are changing — they need convenience, primary care, and specialty care, and we’re trying to establish those services in the areas where the veterans live, primarily Worcester and Springfield.”

Elaborating, he said that, as the 100th anniversary of the Leeds facility in 2024 approaches, the hospital is in the midst of a large, multi-faceted expansion and renovation project designed to maximize its existing facilities and enable it to continue in its role as a “place of mental-health excellence for all of New England,” as McMahon put it, and also a center for geriatric care and administration of the broad VA Central Western Massachusetts Healthcare System.

By the 100th-birthday celebration, more than $100 million will have been invested in the campus, known colloquially as ‘the Hill,’ or Bear Hill (yes, black bears can be seen wandering the grounds now and then), said McMahon, adding that an ongoing evolution of the campus will continue into the next century.

“President Warren G. Harding came out and said, ‘stop looking for places … we’re going to put it in Northampton, because Calvin Coolidge is my vice president and he lives in Florence, and we want it to be in or around Florence.’”

Round-number anniversaries — and those not quite so round, like this year’s 95th — provide an opportunity to pause, reflect, look back, and also look ahead. And for this issue, BusinessWest asked McMahon and Tatro to do just that.

History Lessons

Tatro told BusinessWest that, with the centennial looming, administrators at the hospital have issued a call for memorabilia related to the facility’s first 100 years of operation. The request, in the form of a flyer mailed to a host of constituencies, coincides with plans to convert one of the old residential buildings erected on the complex (specifically the one that the hospital directors lived in) into a museum.

The flyer states that, in addition to old photographs, those conducting this search are looking for some specific objects, such as items from the old VA marching band, including uniforms and instruments; anything to do with the VA baseball team, known, appropriately enough, as the Hilltoppers, who played on a diamond in the center of the campus visible in aerial photos of the hospital; any of the eight ornate lanterns that graced the grounds; toys made by the veterans who lived and were cared for at the facility; copies of the different newspapers printed at the site, including the first one, the Summit Observer; and more.

Collectively, these requested items speak to how the VA hospital was — and still is — more than a cluster of buildings at the top of a hill; it was and is a community.

The oval at the VA complex

The oval at the VA complex has seen a good deal of change over the years. Current initiatives involve bringing more specialty care facilities to that cluster of buildings, bringing additional convenience to veterans.

“It was like a town or a city,” said Tatro, noting that the original campus was nearly three times as large as it is now, and many administrators not only worked there but lived there as well. “There was a pig farm, veterans grew their own food, there were minstrel shows, a marching band, a radio station … it really was a community.

“In that era, everyone had a baseball team, and we played all those teams,” he said, noting that the squad was comprised of employees. “The silk mill (in Northampton) had one, other companies had them; I’ve found hundreds of articles about the baseball team.”

This ‘community’ look and feel has prevailed, by and large, since the facility opened to considerable fanfare that May day in 1924. Calvin Coolidge, who by then was president (Harding died in office in 1923) was not in attendance, but many luminaries were, including Gen. Frank Hines, director of the U.S. Veterans Bureau.

He set the tone for the decades to come with comments recorded by the Daily Hampshire Gazette and found during one of Gordon’s countless trips to Forbes Library on the campus of Smith College. “President Coolidge has well stated that there is no duty imposed upon us of greater importance than prompt and adequate care of our disabled. And every reasonable effort will be made in that direction. I consider it the duty of those in charge of the veterans’ bureau hospitals to bring about a management and an administration of professional ability in such a manner as to recover many of those whose care is entrusted to them.”

“It was like a town or a city. There was a pig farm, veterans grew their own food, there were minstrel shows, a marching band, a radio station … it really was a community.”

The facility was one of 19 built in the years after World War I to care for the veterans injured, physically or mentally, by that conflict, said Gordon, adding that the need for such hospitals was acute.

“There was a drive in Congress to get the veterans returning from World War I off the streets,” he said. “They were literally hanging around; they had no place else to go. Public health-service hospitals couldn’t handle it, and the Bureau of War Risk Insurance couldn’t handle the cost, and I guess Congress just got pushed to the point where it had to do something.”

That ‘something’ was the Langley bill — actually, there were two Langley bills — that appropriated funds to build hospitals across the country and absorb the public health-service hospitals into the Veterans Bureau Assoc.

The site in Leeds was one of many considered for a facility to serve this region, including a tissue-making mill in Becket, said Tatro, but, as he mentioned, the birthplace of the sitting vice president ultimately played a large role in where the steam shovels were sent. And those shovels eventually took roughly 12 feet off the top of the top of the hill and pushed it over the side, he told BusinessWest.

As noted earlier, the facility specialized in treating veterans suffering from tuberculosis and mental disorders, especially shell shock, or what is now known as post-traumatic stress disorder (PTSD). In the early years, there were 300 to 500 veterans essentially living in the wards of the hospital, with those numbers climbing to well over 1,000 just after World War II, said Tatro.

Gordon Tatro, the unofficial historian at the VA hospital

Gordon Tatro, the unofficial historian at the VA hospital, says the facility is not merely a collection of buildings on a hill, but a community.

With tuberculosis patients, those providing care tried to keep their patients active and moving with a range of sports and games ranging from bowling to swimming to fishing in ponds stocked by a local sportsman’s club, or so Tatro has learned through his research.

As for those with mental-health disorders, Tatro said, in the decades just after the hospital was built, little was known about how to treat those with conditions such as shell shock, depression, and schizophrenia, and thus there was research, experimentation, and learning.

This added up to what would have to be considered, in retrospect, one of the darker periods in the facility’s history, when pre-frontal lobotomies and electric-shock therapy was used to help treat veterans, a practice that was halted in the late ’40s or early ’50s, he said, adding that this is one period he is still researching.

Battle Tested

Over the past several decades, there has been a slow and ongoing shift from inpatient care to outpatient care, said McMahon, who, in his role as associate director, is chief of all operations. He added that there are still inpatient wards at the hospital, and it retains its role as the primary regional provider of mental-health services for veterans.

But there is now a much broader array of services provided at the facility, and for a constituency that includes a few World War II and Korean War veterans, but is now dominated by Vietnam-era vets and those who served in both Gulf wars.

Overall, more than 28,000 individuals receive care through the system, which, as noted, includes both Central and Western Mass. and eight clinics across that broad area. The system measures ‘encounters’ — individual visits to a clinic — and there were more than 350,000 encounters last year.

The reasons for such visits varied, but collectively they speak to how the hospital in Leeds has evolved over the years while remaining true to its original mission, said McMahon.

“We haven’t really downshifted in our inpatient mental health — that’s an area of strength for the VA, and we continue to invest in that area,” he explained. “But in geriatrics, we’re looking to expand our nursing-home footprint, and hopefully double the size of those facilities by the time the 100th comes around — we have 30 beds now, and we’re looking to add maybe 30 more.”

McMahon, an Air Force veteran, said he’s been with the VA hospital for more than seven years now after a stint at Northampton-based defense contractor Kollmorgen. He saw it is a chance to take his career in a different, more meaningful direction.

“To get over into this area and serve the veterans … it’s a job that has a mission behind it,” he told BusinessWest. “It’s more than a paycheck.”

That mission has always been to provide quality care to those who have served, and today, as noted, the mission is evolving. So is the campus itself, he said, adding that ongoing work is aimed at maximizing resources and modernizing facilities, but also preserving the original look of the campus.

Current projects include renovation of what’s known as Building 9, vacant for roughly 15 years, into a new inpatient PTSD facility, with those services being moved from Building 8, an initiative started more than two years ago and now nearing its conclusion.

The new facility will be larger and will enable the VA hospital to extend PTSD care to women through the creation of a dedicated ward for that constituency.

Meanwhile, another ongoing project involves renovation of a portion of Building 4. That initiative includes creation of a new specialty-care floor, a $6 million project that will include optometry clinics, podiatry services, cardiology, and more.

Set to move off the drawing board is another major initiative, a $15 million project to renovate long-vacant Building 20 and move a host of administrative offices into that facility, leaving essentially the entire ‘Hill’ complex for patient care and mental-health services.

“We’re going to get HR, engineering, and other administrative offices down to Building 20 and expand our mental-health facilities around the oval,” McMahon said, referring to the cluster of buildings in the center of the campus. “There’s $40 million in construction going on at present, and by the end the this year, we expect that number to be closer to $60 million.

“There’s a lot of construction going on right now,” he went on. “But things will look good for the 100th.”

That includes the planned museum. The search goes on for items to be displayed in that facility, said Tatro, adding that he and others are working to assemble a collection that will tell the whole story of this remarkable medical facility that became a community.

Branches of Service

Tatro told BusinessWest he’s been doing extensive research on the history of the Hill since he retired several years ago. He’s put together thick binders of photographs and newspaper clippings — there’s one with stories just from the Gazette that’s half a foot thick — as well as some smaller booklets on individual subjects and personalities.

Including one Cedric (Sandy) Bevis.

There’s a memorial stone erected to him in what’s known as Overlook Park, created with the help of that 12 feet of earth scraped off the top of the hill. Tatro found it while out on one of his many walks over the grounds, and commenced trying to find out who Bevis was (he died in 1981) and why there was a stone erected in his honor.

But no one seemed to know.

So Tatro commenced digging and found out that Bevis was a Marine officer who served in Vietnam as a helicopter pilot. He had been shot down more than once but survived. After attaining the rank of lieutenant colonel, he left the service in June 1971, married, and settled in the Florence area. As a Marine Reservist, he got involved with a Vietnam veterans organization called ComVets (short for Combat Veterans) at the VA Hospital and was elected its first president.

“He was honored for his impact on other Marines who were part of ComVets, and they initiated and obtained a plaque for him,” said Tatro, adding that the saga of Sandy Bevis is one of thousands of individual stories written over the past 95 years. And those at the VA facility are going about the process of writing thousands more.

The last line on Bevis’ plaque reads, “He served when called.” So did all those all others who have come to the Hill since the gates opened in 1924. That’s why it was built, and that’s why it’s readying itself for a second century of service.

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

Health Care

Combating ‘Hair Interruption’

By Mark Morris

Joan Quinn, coordinator of the Wig Boutique at the Cancer House of Hope in West Springfield.

Joan Quinn, coordinator of the Wig Boutique at the Cancer House of Hope in West Springfield.

When a cancer patient goes through chemotherapy treatment, feelings of nausea, fatigue, and hair loss are all common physical reactions. For women, loss of hair often adds an emotional element of humiliation and shame.

“I don’t call it hair loss; I call it hair interruption,” said Joan Quinn, coordinator for the Wig Boutique at the Cancer House of Hope (CHH) in West Springfield, who sees her mission as helping women look good and feel better about themselves while their hair grows back.

And she is passionate about her work, as will become abundantly clear.

The Center for Human Development (CHD) runs the Cancer House of Hope as a free community resource to provide comfort and support in a home-like atmosphere for anyone going through cancer treatment. Yoga classes and Reiki massage are among the many services offered there.

As for wigs … Joseph Kane, former director of the Cancer House of Hope (he left that position for another opportunity earlier this month), admits that, while they’ve always been available, they were often treated as an afterthought.

“If someone asked for a wig, we’d pull one out of a plastic tub, and it usually looked like it had bed head; it wasn’t ideal,” he said, adding that this important service has come a long way in recent years thanks to Quinn, who not only provided the drive to create and stock a boutique where there was none, but also staff it with volunteers, maintain a steady inventory, and raise needed funding to keep the operation thriving.

Our story begins with a visit to CHH by one of Quinn’s neighbors, who left her tour thinking that the wig service, such as it was, needed serious help, and that Quinn, a cosmetology-field veteran of more than 50 years who spent 26 years teaching the subject at Springfield Technical Community College, was just the person to provide that help.

“If someone asked for a wig, we’d pull one out of a plastic tub, and it usually looked like it had bed head; it wasn’t ideal.”

“My neighbor said, ‘oh, Joan, I know your standards, and this doesn’t meet them. You should stop in and see them.’”

She did, and this was, coincidentally, after an answered prayer left her looking for a way to give back — and in a big way.

Indeed, a few years earlier, Quinn’s son suffered from a heart condition that required a transplant. As he was living in Iowa City, Quinn flew there to help. “During that time, I prayed that he would receive a heart transplant and promised God that, if he lived, I’d give back tenfold.”

Her son did receive a transplant and is healthy today.

Feeling that she now had to deliver on her promise, Quinn had no idea how she could help the American Heart Assoc. But when the need for a better wig situation presented itself at CHH, she knew immediately she could make a difference.

And she has. Now in operation for more than three years, the Wig Boutique is currently booking appointments five days a week with three volunteer consultants. Quinn estimates the facility has provided more than 300 wigs for cancer patients since opening.

For this issue and its focus on healthcare, BusinessWest explores how the Wig Boutique came to be and why the services it provides are so important to women battling cancer.

Root of the Problem

As she retold the story of how the boutique was launched, Quinn noted that, under some health-insurance plans, cancer patients can purchase a wig and get reimbursed after the fact. In order to be covered under MassHealth, cancer patients must travel to its contracted wig provider located in Worcester.

When Kane learned that three wig providers in the area went out of business, the thought of a dedicated wig program began to sound like a viable idea.

“When I met Joan, she had a vision to make the wig boutique feel like a higher-end service,” Kane said. Likewise, Quinn credits Kane for what she called his “blind faith” that she could convert one of the rooms in the Cancer House of Hope into a boutique on a zero budget.

Volunteer Jan D’Orazio in the Wig Boutique.

Volunteer Jan D’Orazio in the Wig Boutique.

The energetic Quinn began by figuring out how many wigs CHH had and how to get them into presentable shape. Tapping into her network, she convinced her former teaching colleagues at STCC to open their cosmetology classrooms during summer break and made arrangements to have 110 wigs washed. “We even brought in people who didn’t know how to wash wigs, but we taught them.”

Now with a starting inventory, Quinn needed to purchase shelving material and clean lighting for the room. “It had to be organized, and it had to be cheerful,” she explained. “I could not envision people coming in to look through a tub of wigs.”

Before she even had shelves, Quinn approached local businesses and asked them to sponsor $20 shelf tags to be placed in front of each displayed wig. In a short time, she raised enough to pay for the building materials.

While planning the design of the room at the Home Depot, Quinn lamented that she had enough money for materials but not enough to cover labor. The Home Depot associate told her about a program the store sponsors where it would pay for the labor as a donation, a big step toward executing Quinn’s vision.

The finished room resembles a true boutique, displaying 59 wigs under clean lighting with a fitting chair and a full-length mirror. Kane said the boutique provides a unique experience for cancer patients.

“It gives someone who is losing her hair a chance to come in, meet with a professional, and leave with something that does not look like a wig — all for free,” he told BusinessWest. “It’s really powerful.”

When women first come in for a consultation, Quinn said, they are often reliving the horror of having cancer and confronting the reality of their hair falling out.

“Many of the women we see are depressed and fearful of taking off their head covering,” Quinn said. “While we can’t take away their fear, we reassure them that we work with many people in their situation and that this is a safe place.”

She added that the dozens of wigs displayed in the room help to shift the women’s focus away from themselves and onto which style of wig they might want.

“Current wig styles change quickly, so we’re always looking for new styles and quality wigs,” she noted, adding that she approached Sally’s Beauty Supply in West Springfield and left her name on a piece of paper to call if they ever had wigs they wanted to donate. The manager of Sally’s happened to pin Quinn’s contact information on a bulletin board, and one day, when the company discontinued its line of high-end wigs, Quinn got the call and filled two shopping carts with donated wigs. In addition to local donations, CHH receives wig and accessory donations from as far away as North Carolina and California.

Quinn told BusinessWest she is grateful for her network of volunteers and professionals, whom she refers to as her “angels.” She works with many salons in the area whose owners are often former students.

Quinn approached salons with a fundraising idea for the Wig Boutique called “Hang Cancer Out to Dry,” consisting of a small, desk-sized clothesline where customers can attach cash donations with miniature clothespins.

“In its first 17 months, this effort has raised more than $10,000,” Quinn said, adding that it’s not unusual for a salon owner to raise $300 from customer donations and then match it with a $300 donation of their own.

While Quinn pursues donations with great drive and enthusiasm, she also goes after volunteers the same way. Jan D’Orazio was shopping for Christmas decorations at Michael’s when Quinn approached her and asked if she was a hairdresser. D’Orazio replied that many years ago she was, but hadn’t done it in a long time.

“I must have been having a good hair day, because the next thing I knew, Joan was showing me pictures of the boutique on her iPad and encouraging me to join her,” said D’Orazio. “By the time I got to my car, I said, ‘what did I just agree to do?’”

Quinn freely admits she chased down D’Orazio and is glad she did. “Jan is very calm, and she makes people feel comfortable.”

Joni Provost also works with D’Orazio and Quinn as a volunteer coordinator for the Wig Boutique. The three women provide consulting services on selecting wigs. They do not cut or style the wigs, but encourage having that done at a hairdresser. Quinn said sometimes a woman brings along her hairdresser to the boutique. “We want people to feel this could be their hair and their length.”

A Cut Above

D’Orazio said one of the most rewarding parts of working at the Wig Boutique is seeing her clients change in demeanor.

She said many women who come in are feeling down and have what she described as a “cancer look.” The consultation helps to brighten their day and change their whole outlook.

“Last week, a lady came in who is fighting her third bout with breast cancer. When she was getting ready to leave, she was so happy and told me, ‘I feel like Cinderella; I don’t look like I have cancer anymore.’”

Those sentiments speak to how the boutique is providing not only hair and a certain look, but a chance for women to feel better about themselves as they confront perhaps the most difficult time in their lives.

Thus, it’s changing lives in a profound way.

Health Care

Under Pressure

A changing healthcare landscape has doctors feeling stressed, unsatisfied, and burned out like never before — and that could have dire effects on patient care. That’s why the industry is focused on diagnosing the problem and prescribing remedies.

Every day, patients rely on doctors to tackle their chronic health and wellness issues and make them feel better.

But what if it’s the doctors feeling miserable? Or stressed-out, anxious, and overwhelmed? Unfortunately, that’s happening constantly.

Burnout among physicians has become so pervasive that a new paper recently published by the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Mass. Medical Society, and the Mass. Health and Hospital Assoc. deems the situation no less than a public health crisis.

“A Crisis in Health Care: A Call to Action on Physician Burnout,” as the document is titled, includes a number of strategies aimed at curbing the prevalence of burnout among physicians and other care providers, including improvements to the efficiency of electronic health records (EHRs), proactive mental-health treatment and support for caregivers experiencing burnout, and the appointment of an executive-level chief wellness officer at every major healthcare organization (much more on all of these later).

But the report also details just how extensive the problem is, and why it should be a concern for patients. In a 2018 survey conducted by Merritt-Hawkins, 78% of physicians said they experience some symptoms of professional burnout — loosely described in the survey as feelings of emotional exhaustion, depersonalization, and/or diminished sense of personal accomplishment.

Physicians experiencing burnout are more likely than their peers to reduce their work hours or exit their profession. And that’s concerning in itself; the U.S. Department of Health and Human Services predicts a coming nationwide shortage of nearly 90,000 physicians, many driven out of practice due to burnout.

“The issue of burnout is something we take incredibly seriously because physician well-being is linked to providing quality care and favorable outcomes for our patients,” said Dr. Alain Chaoui, a practicing family physician and president of the Massachusetts Medical Society. “We need our healthcare institutions to recognize burnout at the highest level, and to take active steps to survey physicians for burnout and then identify and implement solutions. We need to take better care of our doctors and all caregivers so that they can continue to take the best care of us.”

Dr. Alain Chaoui

Dr. Alain Chaoui

 “We need to take better care of our doctors and all caregivers so that they can continue to take the best care of us.”

While some have pointed to the passage of the Affordable Care Act (ACA) in 2010 — the most significant recent change in the American healthcare landscape — as a stressor, the roots of the crisis date further back, the report notes. For example, EHRs, mandated as part of the 2009 Reinvestment and Recovery Act, have dramatically changed the way doctors allot time to their jobs. And the 1999 publication of the Institute of Medicine’s “To Err is Human” report, highlighting the prevalence of medical errors, directed new attention to the need for quality improvement, physician reporting, and accountability — and brought heightened pressure.

In the past, the report notes, some have proposed ‘self-care strategies’ — such as mindfulness or yoga — as a response to burnout and presented some evidence of limited success with such approaches. However, physicians typically don’t have time to fit such coping strategies into their routine. They also don’t really address root problems.

“Such an approach inaccurately suggests that the experience and consequences of burnout are the responsibility of individual physicians,” it continues. “This is akin to asking drivers to avoid car accidents without investing in repairing and improving hazardous roads. Simply asking physicians to work harder to manage their own burnout will not work.”

Digital Dilemma

As the report noted, a broad consensus has formed that a major contributor to physician burnout is dissatisfaction and frustration with EHRs, which have become ubiquitous in recent years. While the goal of transitioning to electronic records has been to improve quality of care and patient communication, the results have been mixed at best.

“The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients, contributing to a growing epidemic of physician burnout,” said Dr. Ashish Jha, a VA physician and Harvard faculty member. “There is simply no way to achieve the goal of improving healthcare while those on the front lines — our physicians — are experiencing an epidemic of burnout due to the conflicting demands of their work. We need to identify and share innovative best practices to support doctors in fulfilling their mission to care for patients.”

As Dr. Atul Gawande, a Massachusetts surgeon, writer, researcher, and CEO of the nonprofit healthcare venture formed by Amazon, Berkshire Hathaway, and JP Morgan Chase, recently described it, “a system that promised to increase physicians’ mastery over their work has, instead, increased their work’s mastery over them.”

That’s because the patient encounter is now dominated by the demands of the EHR, undermining the crucial face-to-face interaction that has long been at the core of a satisfying doctor-patient encounter, the report notes, adding that, “for many physicians, EHRs impose a frustrating and non-intuitive workflow that makes excessive cognitive demands and detracts from, rather than reinforces, the goals of good patient care.”

Dr. Ashish Jha

Dr. Ashish Jha

 “The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients.”

In addition, the quantity of mandatory documentation imposed by EHRs — due to regulatory and payer requirements — means physicians typically spend two hours doing computer work for every hour spent face to face with a patient, including numerous hours after work. And they’re frustrated by spending so much time on administrative tasks they feel have little to do with actual patient care.

One promising solution, according to the report, would be to encourage software developers to develop a range of apps that can operate with most, if not all, certified EHR systems.

Improved EHR usability is, in fact, required by law. The 21st Century Cures Act of 2016 mandates the use of open health care APIs (application programming interfaces), which standardize programming interactions, allowing third parties to develop apps that can work with any EHR. This would allow physicians, clinics, and hospitals to customize their workflow and interfaces according to their needs and preferences, promoting rapid innovation and improvements in design.

Another promising but less-developed approach to reducing the HER burden on physicians, the report notes, is the development of artificial intelligence (AI) technologies to support clinical documentation and quality measurements.

Mind Matters

The report spends plenty of time on mental health, and for good reason.

“It is clear that one can’t have a high-performing healthcare system if physicians working within it are not well,” it notes. “Therefore, the true impact of burnout is the impact it will have on the health and well-being of the American public.”

To that end, it calls on hospitals and other healthcare organizations to improve access to, and expand, health services for physicians, including mental-health services — while reaching out to doctors and encouraging them to take advantage of such services in order to prevent and manage the symptoms of burnout.

That’s easier said than done, of course, as a stigma still exists around seeking help for mental-health issues.

“Physician institutions — including physician associations, hospitals, and licensing bodies — should take deliberate steps to facilitate appropriate treatment and support without stigma or unnecessary constraints on physicians’ ability to practice,” the report argues.

Last year, the Federation of State Medical Boards (FSMB) adopted a policy reconsidering ‘probing questions’ about a physician’s mental health, addiction, or substance use on applications for medical licensure or renewal, as the existence of such questions may discourage physicians from seeking treatment. “To the extent that such questions are included,” the report says, “those questions should focus on the presence or absence of current impairments that impact physician practice and competence, in the same manner as questions about physical health.”

The FSMB is also calling for state medical boards to offer ‘safe-haven’ non-reporting to applicants for licensure who are receiving appropriate treatment for mental health or substance use. Such non-reporting would be based on monitoring and good standing with the recommendations of the state physician health program (PHP).

Speaking of which, Physician Health Services Inc. (PHS) — a charitable subsidiary of the Massachusetts Medical Society that serves as the PHP for Massachusetts physicians — intends to reach out in a broader way to physicians and hospitals to encourage doctors dealing with burnout and behavioral-health issues to seek appropriate and confidential care.

“Many PHPs in other states have expanded their outreach,” the report notes. “Hospitals and other healthcare institutions should complement and support this effort by acknowledging physicians’ concerns with seeking mental healthcare and clearly identifying avenues and opportunities to receive confidential care, particularly for residents and trainees, who are at a vulnerable stage of their careers.

Finally, the report calls for the appointment of executive-level chief wellness officers (CWOs) at all healthcare organizations. “CWOs must be tasked with studying and assessing physician burnout at their institutions, and with consulting physicians to design, implement, and continually improve interventions to reduce burnout.”

“Patients do not like being cared for by physicians who are experiencing symptoms of burnout, which is significantly correlated with reduced patient satisfaction in the primary-care context. Evidence further suggests that burnout is associated with increasing medical errors.”

The key responsibilities of the chief wellness officer, in addition to acting as an advocate and organizational focal point, may include studying the scope and severity of burnout across the institution; reporting findings on wellness and physician satisfaction as part of institutional quality-improvement goals; presenting findings, trends, and strategies to CEOs and boards of directors; and exploring technological and staffing interventions like scribes, voice-recognition technology, workflow improvements, and EHR customization to reduce the administrative burden on doctors, just to name a few.

CWOs could benefit physicians not just in hospitals, the report continues, but across health systems, and in affiliated practices. “Departments, units, and practices can survey for burnout, begin to identify their areas of focus and barriers to success, and collectively develop solutions. The CWO can help lead this process and provide best practices and other supports.”

Lives in the Balance

In the end, physician burnout is a problem with many triggers, which is why the authors of “A Crisis in Health Care” encourage a multi-pronged approach to counter it. But it’s also an issue with many potential consequences, not just for doctors and their employers.

“Patients do not like being cared for by physicians who are experiencing symptoms of burnout, which is significantly correlated with reduced patient satisfaction in the primary-care context,” the report notes. “Evidence further suggests that burnout is associated with increasing medical errors.”

Dr. Steven Defossez, a practicing radiologist and vice president for Clinical Integration at the Massachusetts Health and Hospital Assoc., said hospitals in the Commonwealth place a high priority on the safety and well-being of patients, so combating burnout will continue to be an area of focus.

“In particular, we recognize the need to further empower healthcare providers and support their emotional, physical, social, and intellectual health,” he said. “This report and its recommendations offer an important advance toward ensuring that physicians are able to bring their best selves to their life-saving work.”

Joseph Bednar can be reached at [email protected]

Health Care

Progressive Course

Laura Hanratty

Laura Hanratty says the number of BCBA students has probably doubled since 2012, a clear sign of growing need for such trained individuals.

In many cases, Alyssa Clark says, progress — in whatever way it is measured — comes slowly.

But in most all cases, it does come, and when it does, it quickly reminds her why she chose this career path — not that she ever really forgets.

Clark was talking about her work as a board-certified behavior analyst, or BCBA, as those with the requisite credentials are called. She works in a few area elementary schools with students in grades K-4. Some are on the autism spectrum, but all of them are defined with an industry term of sorts: social/emotional, which means they have behavioral issues, usually brought on by trauma in their backgrounds — poverty, divorce, or being in foster care, for example.

“Sometimes, progress is slow in coming, but even the little things you see … kids might have that one good day after several bad ones,” she told BusinessWest. “And to be able to see that and know that you could make a difference in that kid’s life and help them…”

She didn’t actually finish the sentence, because she didn’t have to. The satisfaction that comes with such work is clearly apparent. And it is one of many reasons why applied behavior analysis (ABA) is becoming an increasingly popular career path within the broad spectrum of healthcare, and also why programs such as the master’s in ABA program at Elms College in Chicopee, which Clark graduated from recently, were created and continue to see growth in enrollment.

“Every kid that we work with should go through an analysis to determine why problem behaviors are occurring, and then treatment based on that analysis helps address those behavioral concerns.”

But the biggest factor is growing need within the community, said Laura Hanratty, assistant professor and director of both the ABA and ASD (autism spectrum disorders) programs at Elms.

“It’s definitely a growing field,” she said, noting that, when she sat for the certification exam in 2012, there were roughly 10,000 BCBAs in this country; now, there are perhaps twice that number.

Why? The ever-growing number of people diagnosed with autism is a big factor, she said, adding that there are many theories surrounding this surge, but the prevailing one is that there is simply more awareness of the condition and, therefore, more early diagnosis.

But the nature of applied behavior analysis, and the tremendous rewards, as Clark described, are also a factor in the growing popularity of this profession.

When asked to elaborate, Hanratty said there is a good deal of science, some of it rigid in nature, in this field. But there are also large amounts of creativity, and this blend of ingredients appeals to many people looking to enter the broad realm of healthcare.

“What we try to teach our students to do is become a scientist practitioner,” she went on, adding that there is much that goes into that phrase. “Every kid that we work with should go through an analysis to determine why problem behaviors are occurring, and then treatment based on that analysis helps address those behavioral concerns.

“We know that attention and rewards help increase behaviors,” she went on. “So what our students do is take that science side, but then then get really creative and personalize with our kids.”

This ability to be creative is what appeals to Rachel Reyes, currently enrolled in the Elms master’s degree program and working part-time with young people through a company called Positive Behavior Supports Corp. (PBS). She has one client, a 4-year-old with autism she sees three times a week.

“I’m working one-on-one with a child a lot, and that’s what I love most about this work,” she said, adding that she aspires to become a BCBA. “I get to see them grow, I get to see their progress, and I get to know them; I build a relationship with them first so they they’ll trust me.”

For this issue and its focus on healthcare, BusinessWest takes an in-depth look at the ABA offering at Elms. In the course of doing so, we’ll explain why the program, and the careers it can lead to, have attracted people like Clark, Reyes, and many others.

Down to a Science

When asked how she got onto the path to becoming a BCBA, Clark said a single course on applied behavior analysis she was taking during her undergraduate work at the Elms opened her eyes and changed her career focus.

Alyssa Clark

Alyssa Clark, seen here at the Applied Behavior Analysis International Conference in San Diego earlier this year, says there are many rewards from her work as a BCBA.

“I was in the speech language pathology program,” she recalled. “They mentioned applied behavior analysis; that one class really stuck with me. I knew I always wanted to work with this population of kids, whether it was kids on the autism spectrum or kids with disabilities. So I looked into it more and I saw the behavior side of things, and I loved it.”

Reyes tells a somewhat similar story. She was doing undergraduate work at Westfield State University, studying special education. She had come to the conclusion that she didn’t want to teach and took an introductory course in ABA.

“Prior to creation of this program, there was a master’s in autism spectrum disorders, which was also behavior-analytics-focused, but a little more broad. What we found is that most people who are coming into the program are really interested in the behavior-analysis side, so that’s where most of our students are now.”

“The professor was great — when she would teach, everything was amazing,” she recalled. “I thought about things some more, went to her office, and asked if there were any graduate programs in the field, because I realized that this is what I wanted to do. She told me about Elms.”

Hanratty said many of the students now in the ABA program arrive via a somewhat similar experience, and this helps explain the creation of the master’s program, which accepted its first cohort in 2017.

“Prior to creation of this program, there was a master’s in autism spectrum disorders, which was also behavior-analytics-focused, but a little more broad,” she explained. “What we found is that most people who are coming into the program are really interested in the behavior-analysis side, so that’s where most of our students are now.”

Rachel Reyes, a student in the Elms ABA program

Rachel Reyes, a student in the Elms ABA program, says she enjoys working one-on-one with children.

Students enter the program with a wide diversity of backgrounds, she went on, adding that there are many with a psychology or communications sciences background, who took their undergraduate focus on speech disorders and shifted it to behavioral analysis.

But there are others with backgrounds in education, sociology, social work, and other fields.

“We also get some students who earned their bachelor’s degree in … whatever, and then found a passion for working with kids with autism,” she went on, adding that enrollment in the master’s program fluctuates, but it averages about 17. The smaller size of the cohorts — and the classes themselves — appeal to many students because of the one-to-one support from faculty members.

As she mentioned earlier, ABA is a blend of science and creativity that addresses a range of recognized behavioral issues in people of all ages.

“ABA is based on basic science principles,” Hanratty explained. “We take the basic principles of behavior and apply them to promote changes in behavior among children with autism or behavior concerns. Our students get to take that science and apply it.”

Practitioners use reinforcement — giving some kind or reward or positive contingency — for appropriate behaviors, as well as strategies for reducing inappropriate behaviors.

When asked for an example, she cited a research project she worked on with several of her students, including Clark. Together, they gave a presentation on their work at the Applied Behavior Analysis International Conference in San Diego earlier this year, and also at the Berkshire Conference for Behavioral Analysis.

The project involved one young person exhibiting problem behaviors, said Hanratty. “We did an analysis and found that kids were engaging in severe problem behavior usually to gain some control over their environment — they want to take a break from adult-led activities and just have time to do their preferred activities.

“We taught the kids to ask for control, and then we would reward that, with them being able to have ‘their-way’ time,” she went on. “We gradually started saying, ‘you can’t have your way right now; it’s adult time, and you need to do X,Y, and Z.”

Eventually, the students would come to understand that they can’t always have ‘their-way’ time when they asked for it, and would acquiesce to adult-led activities without immediate reward or reinforcement.

Such progress was noteworthy, because these were students who were engaging in severe problem behaviors, said Hanratty, adding that they would (note the past tense), when asked to do an instruction, aggress toward adults and engage in self-injurious behaviors.

“We were making really impactful outcomes for families,” she told BusinessWest. “It was very rewarding work.”

And just one example of how to blend science and creativity, she went on, adding those attracted to this work now have a number of attractive career options.

These include work in school systems and specifically in special-education classrooms, but also, and increasingly, in the home, working with both children and their families. Others open their own private practices or conduct research. With a doctorate, which some go on to attain, they can teach in the field.

Meanwhile, many students, like Reyes, are finding work in the field, or, in this case, the home, as they’re earning their master’s degree.

“I’d love to stay in the home; I love the home setting,” she said, adding that she enjoys working with not only the child, but the family as a whole.

Bottom Line

Such sentiments, such passion for this demanding yet rewarding work, help explain the growth of the ABA field and programs like the one at Elms.

As Hanratty and her students noted repeatedly, applied behavior analysis is indeed an intriguing blend of science and creativity, a rare mix that is gaining the attention of people from diverse backgrounds and putting them onto the path of becoming a BCBA.

And also opening doors to a wide mix of fulfilling careers.

Health Care

Healthy Development

Baystate Health & Wellness Center in Longmeadow held a grand-opening and ribbon-cutting ceremony on Feb. 25. The $11 million, 54,000-square-foot medical office building offers primary and specialty care, as well as services like Baystate Reference Laboratories and Baystate Radiology and Imaging.

State legislators present Baystate leaders, including President and CEO Mark Keroack (center), citations on the grand-opening occasion

State Sen. Eric Lesser and Keroack share a moment before the event

State Sen. Eric Lesser and Keroack share a moment before the event

The ribbon-cutting ceremony

The ribbon-cutting ceremony

Dr. Elizabeth Boyle chats with state Rep. Angelo Puppolo

Dr. Elizabeth Boyle chats with state Rep. Angelo Puppolo

The back entrance to the new facility at 21 Dwight Road

Health Care

Game Plan

By Mark Morris

James Ferry, certified aging life care manager at Coaching Caregivers Inc.

James Ferry, certified aging life care manager at Coaching Caregivers Inc.

Many adults take on the role of caregiver for an aging parent, but few are prepared for what’s actually involved in taking on that all-important assignment.

What starts out as a trip to the grocery store or a ride to the doctor’s office can, and very often does, become overwhelming when the parent has a medical crisis or other event where their needs suddenly change.

“It often begins with a hospitalization,” said James Ferry, who manages Coaching Caregivers Inc. in Northampton. “Let’s say your mom is admitted for a urinary-tract infection. After a short stay at a skilled-nursing facility, your family is told that she can no longer stay home alone.”

If the family is local, he went on, an adult child, usually a daughter, typically tries to be the caregiver. But as she tries to balance her mother’s care needs with holding down a job and taking care of her own family, burnout inevitably sets in.

And that, unfortunately, is the time when many families usually reach out for help.

“They come to me when they’re exasperated,” said Ferry, a certified aging life care manager with more than 25 years of experience and an advanced degree in social work. He sees his role as someone who helps navigate the complexities of elder care to relieve the family’s burden and develop a course of action that provides a quality life for the elder parent.

He’d rather get involved before people become exasperated, but human nature often precludes that from happening. Regardless of when he does get involved, the goal is the same — to come up with a care plan that works for both the elder parent and the caregiver.

It’s an art and a science, he says, that brings many rewards.

The Big Picture

In order to develop a plan, Ferry starts by doing an assessment.

“I’ll visit the elder in their home and ask them to tell me their family story,” he explained. “At the same time, I’m listening for what’s going on emotionally and with their mental processing. Then we might take a tour around the home to see how they maneuver in that environment, how safe it is, and how realistic is it for them to remain in the home.”

After the assessment, Ferry develops a care plan to best meet the elder’s needs. The plan can range from a few basic services on an as-needed basis to a more substantial plan that provides daily services.

Arranging for help with even simple tasks can provide great relief for the family, he added. “There’s a big difference between having nothing and having a person in place for grocery shopping, doctor’s appointments, or just to walk the dog.”

For more intensive needs, Ferry will often recommend a plan that functions like assisted living, but takes place in the person’s home and still allows for family to be involved.

He refers to this type of plan as a “split-shift approach” in which a caregiver arrives in the morning around 8 a.m. to help the elder client with bathing, getting dressed, and eating breakfast. Then the caregiver will make lunch, clean up after lunch, and leave. The client has the afternoon to themselves to watch TV, catch up with friends, or take a nap. The elder can be alone during this time because they will have a lifeline-type device in the event of an emergency.

A second caregiver arrives around 5 p.m. to prepare dinner, do the cleanup afterward, and help get the client get ready for bed.

“With a plan like this, you can cover the whole day with only seven or eight hours of care,” he explained. “This approach is much less expensive than an assisted-living facility and provides a much higher quality of life for the client.”

This type of plan reflects the current trend of ‘aging in place,’ where services that were once provided in a facility are now delivered in the home. In recent years, home-healthcare agencies have seen strong growth because their services can cost much less than an admission to a long-term-care facility. In addition, studies have shown that people enjoy better quality of life when they can stay in their home and follow their own schedule.

In addition to health concerns, caring for an aging parent also involves financial, legal, and other issues. During this time, family dynamics can bring out a whole new level of stress. “If a family member has a resource agenda, such as the parent’s house or some cash, they could potentially subvert a plan of care because they see it as less going to them.”

Ferry’s role in these situations, he explained, is to be a facilitator who helps the family reach common ground and remind everyone of what’s best for their parent.

Age-old Concerns

The need for the services provided by Coaching Caregivers and similar businesses is sure to increase as more people than ever before are living longer in retirement. According to the U.S. Census Bureau, a 65-year-old couple has a 50% chance of one of them living to age 93, and a 20% chance that one of them will reach age 97.

“I work with a lot of people in their 90s who need some help, but clearly do not need a nursing home,” Ferry said, noting that, 25 years ago, far fewer people lived past age 90.

When an aging parent is living a vital and independent life, it’s easy to avoid an elder-care discussion, but he said that’s the time to do it. As difficult as it is to start the conversation with a healthy parent, Ferry said it’s much easier than waiting for a crisis when significant decisions about care must be made under stress.

“When people are desperate for help, they don’t have the capacity to shop around. Instead, they listen to the first person who can offer a solution,” he noted, which may not be in the elder’s best interest.

Ferry counsels people to ask many questions before selecting a caregiver. “Try to get a sense of their reputation. Are they looking out for your parent, or are they steering you to the business they are in?”

There are many professionals who consider themselves care managers, he added, but may represent the interests of an agency or an insurance company. His advice, simply put, is to look for someone who will objectively represent the client’s interests. Once a care plan is in place, he explained, he then takes on the role of ‘consumer advocate’ for the client to make sure they get the services they were promised.

“Professionals like me have no bias for a particular course of action,” he told BusinessWest. “I have relationships with many home-care and assisted-living agencies, as well as other professionals I can recommend. My only interest is what’s best for my individual client.”

Health Care

Lean — But Not Mean

Mark Fulco in the ‘Mission Control’ room at Mercy Medical Center.

Mark Fulco in the ‘Mission Control’ room at Mercy Medical Center.

‘Lean.’ ‘Six Sigma.’ ‘Gemba walks.’ These are terms and phrases, used traditionally on manufacturing shop floors, in relation to continuous improvement initiatives and efforts to take waste out of processes. Today, they’re being heard more in the healthcare realm, and especially at Mercy Medical Center, where efforts are ongoing to improve efficiency without impacting quality of care.

The sign on the door says ‘Mission Control.’

That’s a play on words, obviously. There’s a definite nod to NASA and its famous control room, where decisions were made, and moonshots were choregraphed. But that word ‘mission’ takes on a different, higher meaning at Mercy Medical Center, part of Trinity Health Of New England. The hospital was founded more than 125 years ago by the Sisters of Providence, and its mission to care for the region’s population, and especially those who are traditionally underserved, has been paramount and in most ways more important than the bottom line.

But these days, the mission is being carried out in a different way, said Mark Fulco, president and CEO at Mercy, who recently marked a year at the helm. He noted that, in many ways, the hospital, and the Trinity system on the whole, are taking cues from the auto industry and other business sectors and taking a Six Sigma approach to healthcare — a lean approach, one that manifests itself in a number of ways.

But the major focus is on making the medical center more efficient in ways that will reduce costs without sacrificing quality.

“It’s been a watershed for us, because it has changed our work and has helped us focus on key metrics to drive efficiencies.”

“It’s been a watershed for us, because it has changed our work and has helped us focus on key metrics to drive efficiencies,” said Fulco, adding that the hospital’s efforts to become leaner are reflected in everything from reduced wait times in the ER to an increase in the number of discharges over last year by staffing up more beds; from reducing the overall cost of each discharge by roughly $1,100 to cutting back on travel by using videoconferencing technology.

Overall, Mercy and the Trinity system are eliminating waste whenever possible, creating efficiencies in every department, and constantly looking for ways to improve service without impacting quality of service.

This work extends all the way down to the medical center’s printers and copiers, the number of which has declined noticeably over the past year or so.

“We’ve gone very much paperless,” Fulco explained. “We had two big meetings this morning, and instead of printing out huge packets of information, we did it electronically and on large monitors.

“It’s unbelievable what a color copy costs these days, and when you produce lots of color copies with charts and graphs, it costs a lot of money,” he went on. “So we’ve actually taken printers away and put codes on some of our printers so departments are accounting for every color copy they make.”

This focus on lean practices and accountability brings us back to the room behind the door bearing the sign that says ‘Mission Control’ and its co-called ACE (achieving clinical excellence) boards that track progress in specific areas.

They are part of what is now known as the Trinity Health Management System, or lean daily management, an operating philosophy, if you will, that we’ll explore in greater detail later.

It also brings us to the large conference room, also known as the Patient Safety and Flow Room, a few hundred paces away. Here, each day at 8 a.m. (no one is typically late, because if they are, they have to walk into a room filled with people who were on time), as many as 50 people gather for what are known as ‘huddles.’

These are strategy sessions where issues are discussed, problems are identified, and solutions generated, said Fulco, who offered an example.

“We have several huddles every morning, and one of them is our ‘tier 3 huddle,’ where we bring together leaders from across the entire hospital,” he explained. “The very first thing we talk about is patient safety or problems that came up the night before, or safety catches — like if something was a near-miss — because we want to know, first and foremost, what we need to do to be better and keep patients safer.

“That’s our early-warning system,” he went on. “And at the meeting, if we have a detected infection, we report it, and then we talk about what we can do to prevent another case like that from happening.”

For this issue, BusinessWest looks at Mercy’s broad efforts to employ the principles of Six Sigma and become, in keeping with its mission, lean but certainly not mean, at least in a very literal sense.

Work in Progress

They’re calling it the ‘29-minute pledge.’

That number is significant because of its specificity, meaning it’s not the ‘30-minute pledge,’ a much rounder number to be sure.

It refers to the maximum time it will take for someone visiting Mercy’s Emergency Department to see a physician or physician’s asistant, and this pledge is due to be launched in the coming weeks and announced with billboards and other forms of advertising.

“We’re pledging a door-to-provider time, in our emergency room, of 29 minutes,” Fulco explained, adding that the program has essentially been rolled out already, but the billboards won’t be going up for another few weeks. “We chose 29 minutes because it represents an average of what we can hold out as a pledge; there are times when we’ve averaged 16 minutes.”

The 29-minute pledge is a another example of Mercy’s efforts to improve quality of service while also becoming more efficient and taking cost out of the equation, said Fulco, noting that it is one of many initiatives put in place during what has been a very intriguing and challenging (he would use that word early and quite often, and usually with at least one ‘really’ in front of it) first year at the helm — and year for all those who provide healthcare.

He would sum it all up, sort of, by saying, “I knew what I was getting into — I knew it was challenging; it’s just been more work than I expected — not in a bad way, but in a good way, because it’s been a labor of love.”

What he was getting into is a very demanding climate for not just Mercy but all healthcare providers, one in which reimbursements for services provided, especially from public payers including Medicaid and Medicare, do not really come close to covering the cost of those services.

This disparity is especially large in the broad realm of behavioral health, Fulco noted, adding quickly that, through its facilities at Providence Behavioral Health Hospital, the Trinity Health system is the region’s leading provider of such services.

And these are services that are, from a purely bottom-line perspective, losing propositions, again because the cost of care is not being met by those paying for it. And while Providence and the Trinity system have always been mission-driven, there comes a point where the losses being incurred cannot be sustained, said Fulco, adding that this reality explains why there were inevitable cutbacks at Providence, and in other departments under the Mercy/Trinity umbrella as well.

Mission Control is part of an effort to bring the principles of Six Sigma to Mercy Medical Center.

Mission Control is part of an effort to bring the principles of Six Sigma to Mercy Medical Center.

“We had to make some tough decisions — the status quo simply doesn’t work,” he explained, adding that among these decisions were staffing reductions at Providence (most employees were offered other positions within the system) and cutbacks within or elimination of some departments at Mercy, including the Hearing Center.

While the cutbacks and staff reductions garnered the largest headlines regarding the Mercy system in 2018, a considerable amount of work going on behind the scenes to make the system more efficient, more responsive, and, yes, leaner — efforts like the 29-minute pledge — were perhaps more newsworthy.

As he talked about them, Fulco said these initiatives accurately reflect a system-wide operating philosophy being implemented by Trinity Health Of New England’s recently appointed CEO, Dr. Reginald Eddy, a former emergency-room physician.

“He really gets it,” said Fulco. “He gets it from a care perspective, and he has a strong sense of urgency that he’s really instilled in us in terms of doing it right, doing it well, and doing it quick, not just from a patient perspective, but from a business sense.”

Tracking Improvement

As he talked about the Trinity Health Management System, Fulco said it is focused on quality metrics, or what he called ‘people-centered metrics,’ which are carefully monitored with an eye toward continuous improvement.

As an example, he cited the infection rate, a key issue — and major challenge — for all hospitals.

“Our infection rate has remained below target and below what’s expected for a hospital like Mercy, and is, in fact, one of the 20 lowest infection rates across all the 94 or 95 Trinity hospitals,” he said, using infections from urinary catheters as an example of how Mercy tracks issues and addresses problems.

“Our goal is to be an ‘A,’ and we’re not stopping until we get there, and then we have to stay there, which becomes progressively more difficult.”

Steps such as these have a trackable impact on quality, as measured in a number of ways and by a number of entities, said Fulco, noting that Mercy’s Leapfrog score — its rating based on surveys undertaken by the Washington, D.C.-based Leapfrog Group, improved from ‘C’ to ‘B’ in 2018.

“Our goal is to be an ‘A,’ and we’re not stopping until we get there, and then we have to stay there, which becomes progressively more difficult,” he explained. “But we’ve improved by one whole grade, which is a significant step forward.”

But while quality is certainly an important benchmark, so too is cost, said Fulco, adding that the ultimate goal is to not only improve the overall level of quality but reduce the cost of providing care as well.

“On the cost side, because we’ve been more efficient and we’ve tried to tease out unnecessary expense — and there are several buckets of expense, from labor to non-labor — we have reduced the cost per case by more than $1,100 from last November [2017] to this November,” he said. “And when you multiply that by the 1,400 or so discharges we had, that’s a savings of more than $1.5 million.”

With that, he went to his desk to retrieve the current average cost per discharge, $6,850, a number he had handy, and for a reason — it is carefully tracked, and its downward movement is a source of pride within the system.

It’s been accomplished through a number of means, he said, starting with staffing changes (none at the bedside) that result from consolidation in some areas, such as billing, that are made possible by synergies with the regional Trinity team, thus reducing overhead costs.

Further savings have been achieved on supplies, he said, returning to efforts to go paperless when possible, and also such things as travel expenses.

“We work with people; if they’re printing too much, we take steps to reduce that volume,” he said. “It doesn’t sound like much, but it adds up when you’re saving 50 cents or 75 cents on a print; it adds up over time. And it doesn’t contribute anything to patient care, so we’d rather put the money into patient care than into paper.”

As for travel, it has been cut back as well, he said, noting that meetings between the Mercy team and the system team are now staged electronically. “Instead of having our people drive to Hartford or their people drive here, we’re using technology,” he told BusinessWest.

Huddling Up

As he offered a tour of the Mission Control room, Fulco started by referencing several large charts, called A3 charts, on the wall. Each one outlines an individual’s primary strategic aims, and they are part of the hospital’s lean daily management system.

“An A3 is putting our key objectives and measures all on one page,” he said, referencing his own A3, while noting that the charts track progress toward meeting those specific aims and goals, as laid out in an action plan. “We track this every week; we look at this every week. Every member of the leadership team has one of these.”

And when problems arise at those huddles, as he noted several times, everything is measured.

That goes for efforts to address recognized problems or issues as well, he went on, referring to other charts and the four letters ‘P,’ ‘D,’ ‘C,’ and ‘A,’ which stand for ‘plan,’ ‘do,’ ‘check,’ and ‘act,’ the four stages of tackling a problem, as Fulco identified them.

“This is flowing constantly; it’s changing every day,” he said, adding that the PDCA cycle, as it’s called, was created to generate action on a specific matter and keep things moving.

From Mission Control, the tour moved to the Patient Safety and Flow Room, where there was a comparatively small huddle going on (this was late afternoon). For the 8 a.m. huddles, those assembled have an agenda and start with safety, and move on to a daily operating summary and then performance reports — how well the hospital is doing with patient satisfaction, for example. Next is a round-robin session, at which feedback is sought on problems that have been identified.

But the tier 3 huddle is actually the second step in the process, said Fulco, noting that there are huddles on the departmental level as well. Matters arising at those sessions then come before the larger group, and there is then a Gemba walk. That’s a Japanese term that translates, loosely, into going to the front lines to see what’s going on, to hear from the people involved and come to understand the problem; it is similar in many ways to the concept known as MBWA — managing by walking around.

“A Gemba walk is daily rounding — we’re not sitting in our office or around a conference-room table; where going to see things where they really happen. We’re talking to people who are doing the work, and we’re doing some accountability checks,” said Fulco. “From 8:30 to 9:30 we take that walk, and from there we go to the Mission Control room and do an accountability huddle.

“It’s about getting close to the people,” he went on, “and finding out how we, as leaders, can help them.”

To emphasize these points, he concluded the tour in the Emergency Department, where are charts similar to those in both Mission Control and the Patient Safety and Flow Room.

They track things like wait times and numbers of patients who left without being seen — presumably because the wait times were too long — said Fulco, adding that subsequent huddles and PDCA charts identified the causes of those problems and tracked the success of steps taken to address them.

Healthy Outlook

Gemba walks. PDCA cycles. Huddles. A Mission Control room. These names, acronyms, and places all help explain how, while the mission hasn’t changed at Mercy Medical Center and Trinity Health Of New England, the process of carrying out that mission certainly has.

The emphasis today is on continuous improvement and being lean — without impacting the quality of care being provided at the bedside. As Fulco said repeatedly, in this environment, everything is measured, or charted, and progress is marked daily.

There is considerable work still to be done — this process never actually ends, he said — but progress can be seen in the ER, on the bottom line, and on the charts in the Patient Safety and Flow Room.

It could be seen as paper as well — only they’re using much less of it these days. That’s just part of the process of running lean.

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

Health Care

A Widening Problem

Steve Conca says it can be difficult for people to ask for help losing weight and getting fit, especially if they’re discouraged by all the attempts that didn’t work.

Steve Conca says it can be difficult for people to ask for help losing weight and getting fit, especially if they’re discouraged by all the attempts that didn’t work.

It’s gratifying, Steve Conca said, when people ask for help managing their weight — especially if nothing has worked before.

“When people come to us, they have a laundry list, and sometimes we’ll even write it on the whiteboard — ‘tell me all the stuff you’ve tried that didn’t work,’” said Conca, who owns Conca Sport and Fitness in West Springfield.

“They go on and on about different things, whether it’s a training method or a diet — you name it, they’ve tried it, and it didn’t work. And we draw the line and say, ‘we don’t to be the next thing on that list of 15 things that didn’t work. It stops right here.’”

But that’s easier said than done, he told BusinessWest, because weight loss is more than a numbers game — even when the numbers seem so overwhelming.

“It’s a lifestyle change. It’s mindset, it’s accountability, it’s exercising the right way. It’s eating healthy again and not just counting points. You’ve got to take it one step at a time and get your mind right.”

“It’s a lifestyle change. It’s mindset, it’s accountability, it’s exercising the right way. It’s eating healthy again and not just counting points,” he said. “You’ve got to take it one step at a time and get your mind right — and make sure the effort and exercise you’re going to put in are designed for you specifically, and will work for your body and your metabolism.”

Even people who lose weight, whether through traditional diet and exercise or surgery, often have trouble in the months and years following their initial success, said Dr. Yannis Raftopoulos, director of the Weight Management Program at Holyoke Medical Center.

“The challenge is, how do they maintain this weight in the long run?” he said. “Most practices today aren’t looking to change the person. That’s what we do here, and we have a higher success rate and a better chance to maintain the weight loss. But that’s hard to do. We have seen great successes, but it’s labor-intensive, time-consuming, and a lot of resources are needed.”

And it starts with a decision to take that first step, Conca noted.

“When someone calls and says they need help, that’s a vunerable position they put themselves in. When they come in and sit down, that’s one more big step that can also be another vulnerable spot,” he said. “We take that very seriously that you’re looking to trust us with your health, fitness, and well-being. That’s a huge responsibility, and we take it seriously.”

Wrong Direction

It’s an important responsibility, too, in a country that’s been going in the wrong direction, fitness-wise.

“There’s something that’s dramatically not right,” Conca said. “As a people, we’re getting less active, and we’re eating a much poorer grade of food than we did 20 or 30 years ago.”

Those trends are starting at an early age. According to the latest data from the National Health and Nutrition Examination Survey, produced by the Centers for Disease Control and Prevention (CDC), the percentage of children ages 2 to 19 who are obese increased from 14% in 1999 to 18.5% in 2015 and 1016. In the Pioneer Valley, 25% of children are considered obese.

Dr. Yannis Raftopoulos says treatments for obesity are myriad, and crafted on a patient-by-patient basis.

Dr. Yannis Raftopoulos says treatments for obesity are myriad, and crafted on a patient-by-patient basis.

“That means they have a body-mass index that puts them at increased risk as they enter adulthood for diabetes, high cholesterol, heart disease, gallbladder disease, asthma, and bone and joint problems. Already, we are seeing more and more youngsters developing type II diabetes, which is commonly developed by overweight adults,” said Dr. Chrystal Wittcopp, medical director of Baystate General Pediatrics, who oversees the Pediatric Weight Management Program at Baystate Children’s Hospital.

“The growing rate of childhood obesity in our country is alarming. Being overweight poses a serious threat to the health of America’s children, and as a society, we must make a concerted effort to decrease its prevalence not only in the Springfield area, but across the country,” she added, noting that obesity carries psychosocial consequences that can also hinder these children academically and socially.

Of even greater concern, there was a large increase in obesity — up to 14% from 9% — in the youngest population of those 2 to 5 years of age.

“My philosophy is, I try to change the patient’s lifestyle. If you want any chance to be successful, you have to change the logistics, how they operate every day.”

Conca sees it, too. “Overall, kids are moving not as efficiently as they were years ago. When we were growing up, kids were outside crawling, jumping, running around, and their bodies developed much differently than the kids now if they’re not forced into a structured activity. Instead, many of them are glued to a phone or a tablet. It’s a generational thing, and we’re seeing it not only on the activity level but the nutrition level as well. Kids don’t appreciate their bodies as much as they should because things like exercise and sleep and nutrition aren’t talked about.”

He recalled talking to an older woman whose infant grandchild’s first word was ‘Dunkin’ Donuts’ — which isn’t as odd as it sounds because the child’s parents were always making fast-food runs.

“She’s distraight about it because it’s not the way she wants her grandkids to be raised, but it’s something that, culturally, a lot of kids are embedded in. And they’re so impressionable at that age.”

When parents choose to eat right and be physically active, Wittcopp added, children are more likely to take note and make those same healthy choices. She said families could encourage each other by walking around the neighborhood together, going on a bike ride, or playing basketball at the park, while limiting time spent in front of the TV and video games, and cooking healthy meals with fresh vegetables, fruits, and whole grains.

“The severe consequences of obesity underscore the critical importance of children and teens to participate in physical activity and to engage in healthy eating habits,” she noted. “Childhood obesity is entirely preventable, and it is up to adults to encourage these healthy habits.”

Plenty of Options

For individuals who are well past those foundational years and frustrated by an inability to get fit, there are plenty of treatment options, Raftopoulos said.

“There are different levels of obesity, and different methods are available based on that,” he told BusinessWest. “For someone mild obesity, surgical options are usually not recommended, though there are some exceptions to that.”

Less drastic options range from classic diet and exercise to medications that restrict appetite, although Raftopoulos isn’t personally keen on those, as they can be expensive, come with side effects, and are not a long-term solution.

“My philosophy is, I try to change the patient’s lifestyle. If you want any chance to be successful, you have to change the logistics, how they operate every day.”

A more dramatic, yet still non-surgical, option is a gastric balloon that is swallowed, inflates, and suppresses the appetite until it’s removed after a few months. Holyoke Medical Center is currently involved in a clinical trial of a more advanced balloon that needs no endoscopic removal, but rather passes into the stool after it deflates.

Then there are the surgical options, specifically gastric bypass and sleeve gastrectomy, both of which drastically reduce the size of the stomach. But, no matter how effective a treatment is, whether surgical or non-surgical, patients face the same challenges afterward.

“Surgery will reduce the portion of the stomach and how much you can eat, but you can gain weight even with a small stomach,” Raftopoulos said. “If surgeons don’t provide the support to change the fundamentals of the patient — if they don’t help you change how you live your life — nothing will be very effective, and you can gain the weight back.”

For people who have struggled with obesity, he noted, there’s a psychological component to maintaining a healthy weight, and one that can be frayed by the stresses of everyday life, from work schedules to parenting obligations to caring for sick parents. That’s why his team works with patients on managing their entire lifestyle — through education and support services — to stay on the right path.

“The problem with how medicine is done today is not seeing the patients holistically,” he said. “Everybody is focused on one thing — ‘oh, your ear hurts? Let’s fix the ear.’ But the ear is connected to something else. And that fragmented mentality affects the patient’s results.”

But when something clicks, Raftopoulis gets excited — not just for that one patient, but for others who may be inspired by their example.

“The more practices do this the right way, and the better results they have, the more people will believe we can help them,” he said. “We need to have more practices do the right thing because there’s a great need.”

Reaping the Rewards

Conca understands the frustration of trying to make a change, and, after a few weeks of poor results, becoming discouraged.

“What they’re doing isn’t working, and after a few weeks, they’re tired and frustrated, and they quit again. Rightly so — if you’re doing something and not getting results, you’re going to stop doing it,” he said.

That’s why he touts his practice’s ‘Fit in 42’ program, an immersive, six-week experience that aims to change not just the number on a scale, but a mindset, through both serious exercise and an emphasis on accountability through activities like daily journaling and connecting with other members, both at the gym and on a private Facebook page.

“That sense of community and connection is so powerful — it’s more powerful than anything we could throw at them exercise-wise,” he went on. “So we have the community component, plus training that works, plus nutrition — there’s no diet, you’re just going to eat good, healthy foods for your body type — and then you see results. We have to show them results.”

It’s a great feeling, he said, when someone trusts him to make a change when nothing has worked before.

“When someone comes in, they have to have a why. From a business perspective, we try to preach that as well. Why are we doing what we’re doing?” he said, before answering his own question.

“People come in, and they’re down in the dumps and just throwing in the towel, saying, ‘I just want to play catch and not hurt, or just roll around on the ground with my kids.’ And it’s really cool to give somebody that. It’s really rewarding.”

Joseph Bednar can be reached at [email protected]

Health Care

The Eyes Have It

Dr. Camille Guzek-Latka

Dr. Camille Guzek-Latka shows a patient an image of her eye and any signs of disease that might be present.

When people think of diabetes, they might think of complications like cardiac disease, but they may not consider what elevated blood-sugar levels can do to their eyes over time. In truth, regular vision exams are a must for diabetics, who are at higher risk of certain conditions, including diabetic retinopathy, that can seriously damage one’s vision. Like diabetes itself, the key to minimizing the risk is often simply diligent lifestyle management.

It’s no secret that diabetes is a growing problem in the U.S., with more than 30 million Americans suffering from this condition that affects blood-sugar levels and leads to a host of complications, from heart disease and stroke to kidney disease, foot ulcers, and eye damage.

It’s that last one that often catches people off guard, said Dr. David Momnie of Chicopee Eyecare.

“A few red flags do go up when we examine patients with diabetes,” he said, explaining that a diabetic eye exam always includes a careful examination of the retina through a dilated pupil, looking for a condition known as diabetic retinopathy (more on that later).

“We also carefully examine the iris for tiny vessels that don’t belong there. We call this condition neovascularization. And we also also look for changes in the lens of the eye, called cataract, and for signs of glaucoma, as both of these conditions occur more frequently in people with diabetes.”

According to the American Diabetes Assoc., about one-fourth of people with diabetes are undiagnosed, which is problematic on many levels, one of which is that diabetics need to have their eyes checked more often — at least once a year — than the general population.

“What’s alarming to us is seeing more young adults and people in their 20s and 30s with type 2 diabetes. The culprit is invariably weight. It’s a global phenomenon as people are spending more time indoors and less time being physically active.”

And, as noted, it’s a condition that’s becoming more prevalent. In Massachusetts alone, diabetes incidence has risen from 3.9% of all residents 25 years ago to about 9% today.

The day BusinessWest visited Chicopee Eyecare early in the afternoon, Dr. Camille Guzek-Latka said she had already seen four patients that day with diabetes — unsurprising because, as a practice that has been around for decades, many patients are older.

“People are living longer, so it’s not surprising to see more people in their 70s, 80s and even 90s diagnosed with diabetes,” Momnie said. “But what’s alarming to us is seeing more young adults and people in their 20s and 30s with type 2 diabetes. The culprit is invariably weight. It’s a global phenomenon as people are spending more time indoors and less time being physically active.”

Yet, not all overweight people develop diabetes, he added, so there are obviously other factors involved — in some cases, there are genetic reasons why the beta cells of the pancreas stop producing enough insulin.

Dr. David Momnie says a key part of seeing diabetic patients is educating them about lifestyle factors that go into their eye health.

Dr. David Momnie says a key part of seeing diabetic patients is educating them about lifestyle factors that go into their eye health.

“Since the likelihood of developing complications of diabetes like cardiovascular, kidney, and eye problems increase over time,” he added, “young people developing diabetes are more likely to have these problems down the road.”

But with early detection, Guzek-Latka said, patients have a good chance of holding off many of the complications, including eye damage, because they can get a head start on controlling their blood sugar with medications and lifestyle changes.

“We tend to spend a little more time with our diabetic patients,” Momnie added, “because we need to have a frank discussion about lifestyle changes like weight control, a well-balanced diet, and quitting smoking.”

I Can’t See Clearly Now

When diabetes does cause eye damage, it’s often in the form of a disease called diabetic retinopathy, which is caused when too much sugar circulating in the blood damages the tiny retinal blood vessels in the retina, which is like the film of a camera.

“Elevated glucose levels cause damage to blood vessels. The most vulnerable vessels, the ones that show the earliest damage, are the smallest ones that lie farthest from the heart, such as those that supply the fingers, toes, kidneys, and eyes,” said Dr. Andrew Lam, an ophthalmologist at New England Retina Consultants, as well as an attending surgeon at Baystate Medical Center.

Diabetic retinopathy, he explained, is the leading cause of blindness in adults aged 20 to 74. “Treating this condition can be one of the most fulfilling, and frustrating, conditions that a retinal specialist encounters.”

“Elevated glucose levels cause damage to blood vessels. The most vulnerable vessels, the ones that show the earliest damage, are the smallest ones that lie farthest from the heart, such as those that supply the fingers, toes, kidneys, and eyes.”

The two most common eye problems that result from diabetic retinopathy are vitreous hemorrhage and macular edema. Vitreous hemorrhage, or bleeding in the eye, typically results from the formation of neovascular blood vessels in the retina.

“The growth of these vessels is actually the eye’s natural response to the lack of normal blood supply in diabetic eyes, but they are bad because they are apt to leak and bleed,” Lam said, noting that doctors can try to stop the proliferation of neovascular vessels with a laser treatment, and sometimes with injections of a medicine called Avastin.

“But when major bleeding in the eye does occur, it can severely affect a patient’s vision — sometimes taking away almost all the vision,” he went on. “The good news is that our techniques performing vitrectomy surgery to remove the blood are very good, and some of our most grateful patients are those whose vision has been restored after a vitreous hemorrhage has been cleared.”

Diabetic macular edema can be a more frustrating condition to treat, Lam said. This occurs from leaking blood vessels causing swelling in the macula of the eye, the part of the retina responsible for detailed central vision. This in turn causes vision loss and distortion.

Dr. Andrew Lam says diabetic retinopathy is the leading cause of blindness in adults aged 20 to 74 — and it’s increasing in prevalence.

Dr. Andrew Lam says diabetic retinopathy is the leading cause of blindness in adults aged 20 to 74 — and it’s increasing in prevalence.

“If we can reduce or eliminate the edema, the patient’s vision often improves, but this is sometimes hard to do,” he explained, noting that weapons in the battle can include eye injections with medicines such as Avastin, Eylea, or steroids, or even laser treatments.

“But the problem is that these treatments don’t always work that well, or for very long,” he went on. “Some patients respond quickly and do well, but others have persistent macular edema and blurry vision, even after repeated treatments.”

Guzek-Latka noted that 7.7 million people in the U.S. had diabetic retinopathy in 2010, a number projected to double to 14.6 million by 2050. Because diabetic retinopathy is progressive and does not cause symptoms until vision loss occurs, she stressed that annual exams are recommended, with more frequent follow-ups if retinopathy is detected. Her practice sends reports on ocular health to the patient’s primary-care physician and schedules appointments with a retinal specialist, like Lam, when necessary.

“One of our problems is that we cannot cure the underlying disease: diabetes,” Lam said. “Still, we fight diabetic retinopathy as diligently and as well as we can. I tell my patients to consider this a life-long battle that requires constant vigilance and sometimes many treatments over time. They must also strive to maintain the best blood-sugar control they can.”

Indeed, he noted, diabetic retinopathy can be managed — and sometimes vision loss can be regained — with treatments, but there is no cure because there is no cure for diabetes itself.

“Early detection, monitoring, and treatment of diabetic retinopathy certainly improve the chance that a patient will enjoy good vision throughout their lifetime,” he continued. “It is important that all diabetics have at least an annual eye exam to detect early signs of retinopathy before it becomes vision-threatening.”

Momnie and his team often use a digital retinal camera to take a picture of any diabetic retinopathy that they find, especially if it’s progressing — and not just because it’s beneficial to them in diagnosing and treating it.

“We also want to get the patient involved in managing their diabetes,” he said. “Seeing the actual damage to their retina is often an incentive to better manage their blood sugars.”

Guzek-Latka agreed. “I find it helpful to show people these pictures because, if you show a person a picture of what’s going on for them, it’s like night and day. It’s a powerful tool not only to document what they’ve got, but to educate them.”

Another instrument for tracking people with diabetic retinopathy is an OCT, which stands for optical coherence tomography, which is a scan that produces a cross-section image of the retina, so they can tell if there is any macular edema. “Any time a diabetic patient has reduced vision, we need to rule out diabetic macular edema, and the OCT gives us that information.”

Early Detection Is Key

Lam said there are many other possible manifestations of diabetes in the eye, including cataracts, neovascular glaucoma, tractional retinal detachment, and optic nerve swelling. These are treated in various ways, sometimes surgically. As the only retina practice in Western Mass., he noted, New England Retina Consultants sees many patients with diabetic retinopathy every day.

Momnie stressed that diabetic eye conditions don’t always present with dramatic symptoms at first. “There are some potentially blinding eye conditions that can develop in people with diabetes without symptoms like blurred vision. And yet, these conditions are treatable if caught early enough.”

Tight blood-glucose control is the key to significantly reducing the incidence and severity of diabetic eye disease, he went on, adding that people with diabetes should discuss with their primary-care physician how to keep their levels in an acceptable range.

Like diabetes itself, some people are at increased risk for developing diabetic eye disease, including women with diabetes who are pregnant, people who have had diabetes for a long time, and cigarette smokers those who simply don’t have their blood sugars under control. African-Americans and Hispanics are also at a greater risk of developing diabetic retinopathy.

Eye appointments for diabetic patients can run slightly over the expected time, Momnie told BusinessWest, but it’s not the exam itself that takes longer. “It’s the time we spend talking to the patient at the end of the exam. We want to discuss prevention with lifestyle changes and the importance of knowing certain numbers like their hemoglobin A1C.”

The A1C is a three-month average of a diabetic’s blood sugar; a reading between 5.7 and 6.4 typically indicates prediabetes, and higher indicates diabetes. “We don’t like to see it above 7.0,” Momnie said. “Generally, the lower the A1C, the better.”

As part of lifestyle changes, Momnie discusses with patients what is known as the glycemic index of carbohydrates, which ranks carb-laden foods by how quickly they break down into simple sugars in the body. Carbohydrates with a lower glycemic index, like oatmeal and whole-wheat pasta, take longer to break down, and are better than foods like potatoes and bread, which have a higher glycemic index. It’s all part of a series of decisions diabetics need to make, he said, to keep their numbers down and complications — like eye damage — at bay.

“Early detection, optimal glucose control, appropriate follow-up care, and timely treatment of diabetic eye disease are key to guarding against loss of vision,” Guzek-Latka said, adding that, occasionally, she will look at someone’s eyes and detect diabetic retinopathy, and then begin asking about other symptoms, and it turns out the patient wasn’t aware they were diabetic. Once they know, however, they can do something about it.

“If you know, you have so much control over what you can do,” she said. “But there are so many people that don’t know they have it that are walking around. If we can catch some of those and steer them in the right direction, that’s a big deal for that individual.”

Joseph Bednar can be reached at [email protected]

Health Care

In the Club

Adam Malmborg says kids don’t usually enjoy going to the dentist

Adam Malmborg says kids don’t usually enjoy going to the dentist, but he’d like to make the experience a little more fun.

Going to the dentist may never rise to the level of fun for most kids, but one local practice is making it a little more enjoyable, by using a point system and prizes to motivate young patients to take care of their teeth — and improve their lives in other ways as well.

Adam Malmborg was a teacher before his current role at Flagship Dental in Longmeadow, so he knows a little something about motivating kids.

“I love working with kids,” said Malmborg, the practice’s hygiene coordinator and marketing assistant, whose mother, Katie, is Flagship’s practice manager and marketing manager. “She wanted a kids club — something to get kids more interested in coming.”

So he did some research — lots of it, in fact — into what dental practices around the country were doing to motivate their young patients to get serious about their dental health — a topic that many, understandably, aren’t that enthusiastic about.

“I used to be a teacher, so I know what kids like,” he told BusinessWest. “Basically, what I created is a points system; they can earn points here in the office, at home, and even at school.”

Indeed, the Flagship Dental Young Explorers Club, as the new program is called, assigns point values to dozens of achievements, from losing a baby tooth (five points) to scoring a cavity-free visit (25 points) to coordinating a dental presentation at their school (a whopping 500 points). Every 50 points wins a $5 gift card from a store or restaurant chain of their choice.

“It helps them get excited about coming to the dentist, because I know a lot of kids are afraid to come to the dentist,” Malmborg said. “I was, too. I hated coming to the dentist. Any type of medical office, I hated even the smell of it.”

His mother, who has worked in dental offices for more than 40 years, notices the difference in attitude.

“They’re happy to come to the office, and that doesn’t always happen. It’s a good little reward for them,” Katie said. “I do the marketing for the office, but Adam has taken on the job of getting kids invested in their dental treatment and getting them motivated. They can earn points for coming in, for their report cards, and for things they can do in the community as well. It’s pretty cool.”

Since the program began in March, a few participants have already scored enough points to win a gift card — the options range from Starbucks, Red Robin, Subway, and Dunkin’ Donuts to Walmart, Target, Amazon, GameStop, and many others — while others have banked their points in a quest for a bigger reward. Either way, Malmborg said, they’re having fun making healthy choices.

“I remember being younger, and it’s like, what do I get for having great teeth?” he asked. “Really, nothing. I get a pat on the back and a new toothbrush. My mother was huge on dental care, so she was like, ‘good job, congratulations.’ But coming from a dental office, that ‘congratulations, you’ve worked really hard, we want to reward you’ makes a bigger impression.”

How It Works

Members of the Young Explorers Club are given a membership card — showing it at an appointment earns two points — and a colorful badge; wearing this to the office earns five points, and uploading a photo onto social media wearing the button at school picks up another 10.

Being on time for an appointment is worth five points, a dental cleaning earns 10 points, X-rays get 15, and, as noted earlier, a cavity-free visit earns 25. “That pushes a lot of the kids to brush their teeth and floss,” Malmborg said.

And good works outside of school are rewarded, too, such as an A grade on a report card (two points), straight As (15 points), celebrating a personal achievement by sending Flagship a photo (15 points; one patient recently snapped a picture of her new puppy), and volunteering for community service (five points per hour). And those are just the tip of the iceberg.

“I just want to show the kids we’re supporting them,” Malmborg said of the community and school aspects of the program, adding that anything that gets children thinking about the dentist in a positive way, even peripherally, is a plus.

Some Tips to Ease
a Child’s Dental Visit

Are your kids reluctant to visit the dentist? The American Dental Assoc. recommends the following tips to make the experience less like — well, pulling teeth.

• Plan ahead. “If families want to avoid the rush to go back to school in August,” said ADA spokesperson Dr. Mary Hayes, “then plan on getting appointments for the beginning of the summer.”

• Encourage age-appropriate dental habits at home. To make cleanings easier, parents should encourage their kids to brush twice a day for two minutes and floss once a day.

• Timing is everything. Avoid cramming in a dentist appointment right after school or camp. “If the child has already been exhausted or had a bad day or had tests, they just don’t have the stamina to make it through the appointment successfully,” Hayes said.

• Make one child a model. If you’ve scheduled back-to-back appointments for your children, there’s a simple way to decide who goes first: choose the child who’s had the most positive experiences at the dentist. “You generally want the ones first who are more successful because the others get to see how it goes,” Hayes said.

• Hungry doesn’t equal happy
. Feed your child a light meal before the appointment. “Hungry people are grouchy people. You want them to be comfortable,” Hayes said. Oh, and bonus points if your child brushes before an appointment. That’s just polite.

• Leave your anxiety at the door. If your heart races at the very thought of the dentist, your child can probably tell. “Kids pick up on parents’ anxiety,” Hayes said. “It’s important with kids, especially at 4, 5 and 6, because I believe the phobic adults are the ones who had bad experiences when they were that age.”

• Keep cool if your child won’t cooperate
. If your child gets upset during her visit, the worst thing you can do is swoop them out of the chair and leave. “The next visit is going to be harder. You still have to help them get through part of the visit,” Hayes said. “Give the dentist every opportunity to turn the visit around.”

He’s not done adding to the reward list, he noted; for example, he intends to add points for getting a cavity filled. The rationale? The cavity may not have been an ‘achievement’ worth celebrating, but doing something about it certainly is. “I’m just trying to give the kids more chances at points.”

During each visit, the hygienist fills out a report card based on the child’s account of school and home activities, which is used to add points to his or her total. The patient also gets a second report card, this one based on the results of the cleaning.

“Parents can take this home and have a discussion with their kids — ‘oh, I see you have moderate amounts of tartar or plaque. OK, what do you think we can do better?’” Malmborg noted. “It’s all about the communication at home between the parents and kids. It’s the same as a school report card — it’s important that parents have something to go by.”

Speaking of school, the reason coordinating a dental presentation at a school is worth so many points is because it’s an opportunity to spread these messages about proper dental hygiene to as many kids as possible.

“When we meet with the kids at school, we give kids the tools they need to properly take care of their teeth, because some kids don’t have that — they don’t know what to do, or some parents might not be focused as much on it. That’s why we go in and do that.”

Something to Chew On

The Young Explorers Club is a significant aspect of a shift at Flagship to attract more families with children — a change that’s evident just walking into the waiting room, which features a tepee to climb in, a brightly lit fishtank, an interactive selfie station, and pencil-and-crayon activities lining the walls.

“Our patients are primarily older people, and we did the waiting room with the kids in mind,” Malmborg said. “I don’t want to say they have fun going to the dentist, but we want to get kids excited.”

The activities — word searches, coloring contests, and other brain games — earn three points each, and kids are allowed to do three per visit. “It just gets them doing something in the office, because sometimes in the waiting room, anxiety happens, so as long as folks are doing something fun, they’re not as nervous.”

So far, he told BusinessWest, the points program and other kid-friendly touches are working and getting children thinking more about their dental health.

“They come in, proudly wearing their button and showing their membership card. They’re like, ‘Mr. Adam, I did this.’ I say, ‘don’t worry, I’ve got your points.’ We’ve had a couple of kids turn in their points for gift cards, and they’re already ready for their next one.”

As a program that’s fun for the younger set and keeps them focused on good decisions, Malmborg thinks Flagship has settled on a winner. And he’s glad it’s simple to manage, because, while he’s seen other practices outsource a similar program, that isn’t his style.

“It’s a lot of fun,” he said. “It’s more personable when we can communicate with the kids. This way, they’re not getting rewarded by an outside company; they’re getting it from someone they know.”

Joseph Bednar can be reached at [email protected]

Health Care

Recovery Mission

Michael, a three-time resident of Goodwin House

Michael, a three-time resident of Goodwin House, feels he has finally found the strength and resolve to stay on the path to recovery.

Chantal Silloway started using substances at age 12 and eventually battled her way to sobriety at 25; she’s been clean for 32 years. With her background, she knows full well that no two people take the same path to substance use, and likewise, no two take the same path to recovery. This is the mindset, and operating philosophy, she brings to her role as director of the Goodwin House in Chicopee, a place where young men try to piece their lives back together.

Michael (policy allows use of his first name only) remembers that not long after his family moved while he was in middle school, he started “looking up to the wrong people.”

This was a development that would have consequences he says he couldn’t have foreseen.

He told BusinessWest that his descent into substance abuse began when he started drinking with these individuals and smoking some weed, as he put it. Things would only escalate from there.

“I started doing percocets and slowly became addicted to those,” he recalled. “Then I couldn’t afford them anymore, so I was introduced to heroin, and soon developed a real problem … I wasn’t feeling good when I wasn’t using it, and when I was using it, I felt fine.

“I hated life. It was like … I wasn’t even enjoying the fact that I was super young and had so much to look forward to. I didn’t really care anymore, because all I needed was that drug.”

“Eventually, I turned over to the needle, and once I started shooting it, it became a whole different ballgame,” he went on. “It became my life — that became my top priority every day. I eventually spiraled out of control; I dropped out of high school, I started stealing from friends, family … anything I could do to get that fix.”

Michael was offering these flashbacks while sitting down with BusinessWest on the front porch of Goodwin House, a large home on Fairview Avenue in Chicopee. This unique facility, the only one of its kind in the Commonwealth, is a 90-day program providing substance-abuse treatment for males ages 13-17, operated by the Center for Human Development (CHD). Michael says he feels at home here, and he should; this is his third stint here and also his last.

He’ll be aging out of the program soon, but, more importantly, he feels he has, through the help of those at Goodwin House, found the strength and resolve to stay on the path to recovery, with his next stop hopefully being a so-called ‘sober house’ for individuals over 18.

“This is a great success story — we’re very excited for him,” said Chantal Silloway, program director at Goodwin House and someone who can, like many in positions like hers, speak from experience when it comes to substance abuse and recovery.

“I started using substances starting at age 12, and became clean at age 25; I’ve been sober for 32 years,” said Silloway, who has worked for CHD since 2004 in various capacities involving substance-abuse programs. “It’s long been my goal to lead a program like this one.”

With her background, Silloway knows that no two people take the same path to substance use, and, likewise, none take the same path to recovery. Thus, this 90-day residential recovery program focuses on the uniqueness of each young man that arrives at its door, with a view to self-empowerment and the future they choose.

Chantal Silloway says no two people take the same path to substance abuse, or to recovery.

Chantal Silloway says no two people take the same path to substance abuse, or to recovery.

Elaborating, she said that young men are referred to Goodwin House from a variety of sources, including detox facilities, hospitals, the Department of Children & Families, the Department of Youth Services, and parents and guardians themselves. But where they were referred from is not really important, she said. What is, however, is that they arrive with a willingness to help themselves.

Without that, recovery is simply not attainable, she went on, adding that Michael is a good example of this, as we’ll see, and also an example of why many residents make return visits to this facility.

At Goodwin House, a team of clinicians and recovery specialists use evidence-based programs to help residents find and maintain sobriety. Treatment programs include assessment and treatment planning, individual and group therapy, recovery school and/or educational tutoring, vocational and employment-search assistance, recovery meetings, and after-care services and resources.

Often, said Silloway, the path to recovery means getting family members deeply involved in the process, so there is a family-therapy program as well.

Success at this facility is measured in different ways, she went on, adding that while residents do “graduate” from this program and there is a ceremony to commemorate that, there are other milestones, such as ongoing care, accomplishing specific goals that residents have set, and simply becoming ‘stabilized,’ a significant goal in itself.

For this issue, BusinessWest paid a visit to Goodwin House and talked at length with Silloway and Michael. And it is through his eyes, and his thoughts, that we came to understand what happens at this unique facility and how it is helping others change the course of their lives.

Strong Dose of Reality

Flashing back again to those days when heroin was dominating his life, Michael said he needed five to 30 bags of the drug a day, meaning he needed $20 to $80 a day to fuel his habit. And, as he said, he would do anything he had to do to come up with that cash.

Addiction caused him no end of legal problems, and it strained relationships with family and friends to the tipping point and beyond, he went on. But the actual toll was much, much higher.

“I hated life,” he said. “It was like … I wasn’t even enjoying the fact that I was super young and had so much to look forward to. I didn’t really care anymore, because all I needed was that drug.”

Most all of the people who come to Goodwin House are there because they arrived at the same place that Michael did, said Silloway — a place where they probably hated life and didn’t really care anymore. And they needed a way out and a path to a better life.

Helping to provide all that was the motivation for Goodwin House, a facility named after Jim Goodwin, long-time director of CHD. It opened its doors in May 2017.

“Eventually, I turned over to the needle, and once I started shooting it, it became a whole different ballgame. It became my life — that became my top priority every day. I eventually spiraled out of control; I dropped out of high school, I started stealing from friends, family … anything I could do to get that fix.”

The program operated there was created from the ground up by Silloway, and modeled loosely on a similar facility for young girls ages 13-17 in the Worcester area called Highland Grace House.

Residents must have a substance-abuse disorder, and the substances range from marijuana to alcohol to opioids, said Silloway, adding that a resident’s journey there begins with a referral, usually after a stint in detox.

This is a treatment facility and a next step after detox, she told BusinessWest, adding that Goodwin House can accommodate up to 15 young men at a given time. There are a handful there now, and there could and should be more given the state of the opioid crisis in this state and this country, she went on, but there is still a powerful stigma attached to addiction, and this is, unfortunately, keeping many from seeking the help they need.

Residents — that’s the term used to describe those participating in the program — come from across the Commonwealth, noted Silloway. They arrive, as she noted earlier, under different circumstances and with unique backstories.

But the common denominator is that successful recovery must begin with admitting that one has a problem, and possessing a willingness to do something about it — ingredients that are very often missing from the equation.

“We focus on them wanting to be here as opposed to being mandated, and some can be mandated to come,” she explained. “When they get here, they need to have a willingness to work on themselves.”

At Home with the Concept

Indeed, Michael said his first visit to Goodwin House was triggered by his arrest on various charges (he didn’t want to get into any great detail) in November 2017, followed by a stint in detox.

“I was sent here,” he said, putting heavy emphasis on that word ‘sent.’ “I came here for all the wrong reasons; I wasn’t coming here for myself at first, I was coming for the courts.”

With the benefit of hindsight, he believes that first time in detox and his initial visit to Fairview Avenue ultimately saved his life. But he knows now that he when he first arrived, he just wasn’t ready to change — as in change his friends, the places he hung out at, or, most importantly, himself as a person.

This residential treatment program for males ages 13-17 is the only facility of its kind in the Commonwealth.

This residential treatment program for males ages 13-17 is the only facility of its kind in the Commonwealth.

He started using again while he was at Goodwin House, got kicked out of the program, went back to detox, came back to Goodwin House, used again after only a few weeks, and was again kicked out of the program. He went to detox yet again and then to a halfway house in the Boston area, where he was discharged for using. The frustrating cycle continued with one more trip to detox and his third referral to Goodwin House. This time, though, things were different.

Silloway told BusinessWest that those addicted to substances like heroin, other drugs, and even alcohol are essentially in recovery for the rest of their lives. Recovery is a journey, and very often a long and difficult one, she went on, adding that is why it is not considered a failure to relapse and return to Goodwin House a few times, as Michael has.

“As someone’s leaving,” she said, “we say, ‘we hope we don’t see you back here, but if you need us, we’re here.’”

Michael still needed them, and they were there for him when he checked back in over the summer. Only this time, he arrived with a different attitude.

“When I went to detox for the fourth time, I decided I was sick of living that way and knew I needed to make some changes,” he recalled.

And over the course of the past 10 weeks or so, he has made some, and, with the help of the large support network at the Goodwin House, Michael is ready to do something he was never ready to do before — live without drugs.

“I feel like I wanted to make a change — I just didn’t know how,” he said. “But then, I started second-guessing whether I wanted to make that change. I got through that second-guessing, but I’m addict; I’ll always want to use. But now, it’s a matter of what will happen if I use. Am I going to die? Am I going to have more legal issues?

“Now, I’m happy,” he went on. “Before, I didn’t have any emotion — I just got through the day. Now, I can take in the memories that I have; every day, something can happen, and it can turn into a good memory or a bad memory.”

When asked about the long term, Michael said he doesn’t think in such terms. In fact, he doesn’t even take things one day at a time.

“I’m locked in on thought-by thought, minute-by minute,” he explained, “because that last thought can bring you right back to where I was.”

Positive Steps

On Oct. 18, Michael will turn 18. As noted, he will then officially age out of Goodwin House. He’s hoping that his next short-term address will be a sober house, which will be what he called “another stepping stone on the journey to living without drugs.”

He admits to being somewhat nervous, but not scared.

“The way I was brought up was to always want more out of life, to achieve something greater than you’ve already achieved,” he explained. “I want to keep putting one foot in front of the other every day, because I don’t want to take one step forward and two steps back. I did that for such a long time … I don’t want to start this all over again.”

Getting to this point has been a long struggle, but Michael has found the will to change and keep moving forward. The Goodwin House has played a huge role in that, and the goal moving forward is to write more success stories like this.

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

Health Care

Deep Dive

Stacey Kronenberg (right), operations manager at Achieve TMS East

Stacey Kronenberg (right), operations manager at Achieve TMS East, demonstrates the dTMS technique with technician Sara Pittman.

With data in hand showing that its signature treatment — known as deep transcranial magnetic stimulation — has a strong track record in battling depression, Achieve TMS East has seen significant growth in the region. Now it has further reason to be excited, with the technique showing great promise in treating OCD.

Margie Pierce understands the difficulty — and, yet, the importance — of tackling the problem of depression.

“It’s the leading cause of disability worldwide right now,” said Pierce, a licensed clinical social worker and director of operations at Achieve TMS East, a fast-growing chain of behavioral-health practices that employ an innovative approach to treating depression known as deep transcranial magnetic stimulation, or dTMS.

“We’ve had people who were chronically depressed for 20 years have a fabulous response to this, and we’ve had people chronically depressed who have not had a great response,” she told BusinessWest. “We can’t pigeonhole people when they come in, whether they’re going to respond or you’re not. It’s kind of hit or miss, just like with medications. Some people respond to certain medications, and others don’t.”

That said, however, dTMS has proven remarkably effective in most people who undergo it — in many cases, people who have tried a seemingly endless string of medications and therapies with little success. That explains why the organization has grown to 11 offices across Western Mass., with broader geographic expansion planned.

“We can’t pigeonhole people when they come in, whether they’re going to respond or you’re not. It’s kind of hit or miss, just like with medications. Some people respond to certain medications, and others don’t.”

Deep transcranial magnetic stimulation, or dTMS, is a non-invasive technique that applies a series of brief magnetic pulses to the brain, by passing high currents through an electromagnetic coil placed adjacent to a patient’s scalp. The pulses induce an electric field in the underlying brain tissue and activates underactive areas in the brain associated with depression.

Dr. John Zebrun, senior medical officer with Achieve TMS East, said transcranial magnetic stimulation (TMS) was developed in Europe in the 1990s, and the first machine to receive FDA approval in the U.S. was the Neurostar machine, in 2008, which reached two to three centimeters into the brain, unlike dTMS — developed by an Israeli company called BrainsWay — which reaches six to seven centimeters in, and earned FDA approval in 2013.

“It enables you to get deeper into the brain tissue, so the volume of brain tissue is larger,” Zebrun told BusinessWest. “We don’t miss the target, ever, and there’s more stimulation in that area.”

The developers of the original TMS technique, he explained, wanted to discover if there were circuits or networks in the brain tissue they could stimulate to ease clinical depression. They targeted the left prefrontal area, which imaging scans suggested were underactive in patients with depression.

“The thought was to stimulate that area first and get it closer to a normal activity level, and that would help with depression — and it did. And that still is the primary target,” he said, noting that the device produces a magnetic field, not an electric current. “It’s getting groups of neurons in the circuit to fire together. As they get used to firing together, they’re more connected to each other.”

After a standard treatment of 36 sessions, he went on, those neurons become trained to fire normally. Treatment statistics show that 51% of patients who undergo the entire protocol get all the way to remission, while 75% get at least halfway to their goal. About one-third will need repeat, ‘booster’ treatments down the road, while two-thirds don’t.

Dr. John Zebrun says deep transcranial magnetic stimulation gets deeper into the brain than traditional TMS

Dr. John Zebrun says deep transcranial magnetic stimulation gets deeper into the brain than traditional TMS — and shows great promise for OCD as well.

In short, those are great numbers for a depression treatment, Zebrun said, and that success explains why Achieve has grown so rapidly across the region — and promises to become a more widely known name across the Northeast.

Long Time Coming

The breakthrough in TMS occurred in 1995, Zebrun said; that was when researchers first demonstrated that a magnetic field could stimulate the right neurons and get a response.

“So it’s been around a long time,” he said. “It varies from machine to machine, but they’re all operating within a certain range and certain power level to get the antidepressant effects.”

FDA approval was only one key development, however; insurances companies still needed to pay for the treatment if doctors hoped to reach a wide market. Medicare accepted it in 2015, and other payers soon came on board.

The FDA originally approved TMS for patients who had failed to find relief with another antidepressant treatment. “But insurance companies added extra layers, expecting to see about four medication and psychotherapy trials before they give this approval,” Zebrun said. “But a lot of people out there have already been through years of treatment and tried several medications.”

Dr. Thomas Bombardier, an ophthalmologist turned businessman, was involved with launching a chain of Achieve TMS businesses in California, Pierce told BusinessWest, and when he saw the benefits and how patients were responding out west, he decided to bring the model to his Western Mass. stomping grounds, teaming with two other owners to open Achieve TMS East.

Patients are referred to Achieve by their primary-care doctors, therapists, and psychiatrists, and some self-refer after hearing about the practice through social media or friends or family members.

“We’re very open to however they can get into the door to get the help they need,” Pierce said, noting that, while the majority of people who seek out tDMS are good candidates for it, some aren’t, due to medical contraindications, recent seizures, or even metal in the head that could heat up during the treatment. Everyone also gets a psychiatric consult to see if the treatment will be appropriate.

Stacey Kronenberg, operations manager at Achieve TMS East, demonstrated the dTMS technique for BusinessWest on Sara Pittman, a technician with the practice, although at a very low power level. Pittman put on a soft cap followed by the dTMS helmet, and Kronenberg set the device to a single-pulse mode, moving centimeter by centimeter until she found the motor area for Pittman’s hand, which twitched. From this process of ‘mapping,’ she could locate the right area to target for treatment.

The power setting isn’t uniform for each patient, and can be altered by the thickness of the skull, how much sleep the patient got the night before, even how much coffee they drank that morning. The process involves 36 ‘taps’ in two seconds as the neurons are stimulated, followed by a 20-second break, then another 36 taps in two seconds, then a 20-second break — a cycle repeated 55 times, totaling just over 20 minutes.

Initial treatments are run at lower power than later treatments to desensitize the patient to the sensation, which Pittman described as more of an annoyance — like a woodpecker tapping at her head — than anything. “It’s a tolerable discomfort,” Zebrun added. “I wouldn’t say it’s a breeze, but it’s tolerable.”

Margie Pierce

Margie Pierce says some people have come in after battling depression for 20 years — and finally found relief through dTMS.

Some patients pass the time by chatting with the technician, while others choose something to watch on Netflix, on the big TV hung on the wall beside the treatment chair.

“A lot of people, at the end, are like, ‘oh, I’m done already?’ They’re enjoying their conversation or their show,” Kronenberg said. “I think we should work for Netflix. A lot of people come in and are like, ‘I want to get Netflix.’”

That’s because they’re at the office often enough to binge a lot of TV — five days a week for six weeks, in fact, which is how long it takes to train the brain. “A lot of patients don’t want to leave when it comes to the end of their treatment,” she said. They tell us, “I’m so used to coming and seeing you. Who can I talk to now?’”

Beyond Depression

For starters, they can talk to their loved ones, in most cases, about how effective the treatment was. And depression isn’t the only use for dTMS. The FDA recently approved it as a treatment for obsessive compulsive disorder. In fact, dTMS has been successful in trials for OCD in ways that traditional TMS cannot be, because the target area of the brain is deeper than for depression.

“The surface coils [of TMS] would need so much energy to get that deep, it would hurt. The surface area would get too much stimulation rather than area you’re targeting, and you’d risk a seizure. That wouldn’t happen with dTMS,” Zebrun explained.

He said he hopes to reach people who don’t find standard cognitive treatment for OCD effective. “It can devastate one’s life. You can get wound up into some of these compulsions, or your mind can be so caught up and obsessed with obsessive thinking that you can’t focus on anything else. You can’t get through a planned project because there’s too many interruptions from your loops of thought that come in. There’s a wide range of those obsessions and compulsions.”

Even milder symptoms of OCD can really bother people, he added. “They wish they could get rid of these images popping into their head that started from nowhere and have no relation to anything in their lives and are disturbing to them.”

“They’ll say, ‘why wouldn’t you try this? What do you have to lose, except maybe your depression?’ … For most people, it’s going to help.”

Kronenberg also hopes dTMS makes an impact on the lives of these patients, noting that OCD is one of the most thorny issues that therapists tackle. And, much like depression, she added, OCD can be a “hidden” disease because there’s some stigma and shame associated with it.

But there shouldn’t be, Zebrun said, especially when something like dTMS exists, with its strong track record and its minimal side effects, which may include facial muscle contractions and headaches, which are both temporary. Fewer than one patient in 1,000 may experience a seizure — a risk similar to that of taking an antidepressant medication at the maximum dose.

Because it’s tolerable, he added, patients can do it before or after work, or during their lunch break, and return to their normal activities.

And maybe a normal life.

“People who for 20 years were depressed say it’s life-changing for them,” said Anita Taylor, marketing director at Achieve TMS East. “When we hear those kind of stories, we’ll ask them, ‘what would you say to someone thinking about this?’ They’ll say, ‘why wouldn’t you try this? What do you have to lose, except maybe your depression?’ It’s worth it to give it a try, go in wholeheartedly, and, for most people, it’s going to help.” u

Joseph Bednar can be reached at [email protected]

Health Care

In Search of Empathy

Catherine Williamson

Catherine Williamson says empathy is at the heart of the dementia-friendly movement.

Empathy is a quality America can always use more of — and that’s especially true, Catherine Williamson said, when it comes to families struggling with dementia.

“What attracted me to the dementia-friendly movement is being able to help individuals adjust to what’s going on in their lives,” she recently told a group of business leaders, who met for lunch at the Student Prince in Springfield for a presentation by the Springfield Dementia Friendly Coalition.

“It’s about empathy, and some of us are not great at being empathetic,” she went on. “Our lives are fast-paced, and we’ve got a lot going on — kids, jobs, husbands and wives, volunteering. We’ve got so much going on that, sometimes, we forget to stop and think about someone else not being able to move as fast as we can, or understand things the way we can.”

Williamson, a certified dementia practitioner and gerontologist with SilverLife Care at Home, said a goal of the dementia-friendly movement is to educate the community, and even the loved ones of people with dementia, about how daily experiences differ for individuals with that condition — everything from going to the library to visiting a doctor; from having a financial-planning meeting with an attorney to simply eating out at a restaurant.

To demonstrate, she led the lunch attendees in a virtual ‘dementia experience,’ in which participants use common objects to block or hinder their eyesight, hearing, range of hand motion, and other faculties, then try to communicate with each other — again, as a way to create empathy and reinforce the need for dementia-friendly changes in society.

“People with functional limitations are dealing with this constantly,” she said. “Imagine how much this impacts their daily lives, their relationships, getting around, even wanting to be out in the community. If you felt like this all the time, in this impaired state, you’d probably want to stay home, too. We need to think about how to make our communities and businesses and public spaces a little easier to navigate.”

The business leaders at the lunch shared their professional and personal experiences with dementia and learned about what it would mean to make Springfield a dementia-friendly community — a designation that an increasing number of Massachusetts cities and towns have been pursuing, one in which businesses, municipal departments, and other entities make a collective effort that help people who are memory-challenged to function in the community and live independently for as long as possible.

“Sometimes, we forget to stop and think about someone else not being able to move as fast as we can, or understand things the way we can.”

“What can we do as a community to improve the quality of lives?” asked Anna Randall of Greater Springfield Senior Services, one of the coalition members. “Being dementia-friendly means different things to different communities, depending on their populations and what resources they already have. We’re here to ask businesses what we can do to help your clients and make this community dementia-friendly.”

At a Loss

Nearly 5.1 million Americans age 65 and older are living with Alzheimer’s disease, the most common form of dementia, and the number is expected to reach 7.1 million in the next decade. Nearly 60% of people with dementia live in their own communities, and one in seven live alone, creating an urgent need, dementia-friendly advocates say, for communities to support people with dementia and their caregivers. 

Attendees of the recent Springfield Dementia Friendly Coalition

Attendees of the recent Springfield Dementia Friendly Coalition lunch underwent a virtual ‘dementia experience’ to get a small taste of what’s it’s like to navigate the world with cognitive impairment.

Meghan Lemay, regional manager in the Springfield office of the Alzheimer’s Assoc., said Alzheimer’s disease is a true epidemic, currently the sixth-leading cause of death in the U.S. and the only major disease that has been increasing in incidence — by a 123% rate since 2000, in fact. At the same time, incidences of diseases like cancer and heart disease have been falling.

In addition, she noted, Alzheimer’s is the most expensive disease in America, expected to cost the healthcare system and caregivers some $277 billion in 2018 alone.

“It’s something we have to address on multiple fronts,” Lemay said. “We know it impacts families directly and has a significant emotional impact, but there’s also a significant financial impact for individuals and our communities.”

Springfield, in fact, is disproportionally affected, with a higher rate of dementia than other Massachusetts communities on average. Demographically, meanwhile, the condition affects African-Americans and Latinos at a higher rate than whites.

While individual communities seek the dementia-friendly designation, a state-level organization known as Dementia Friendly Massachusetts is supporting those efforts. On the community level, Randall noted, businesses who go through dementia-friendly training can then display that fact, “to say this company has gone the extra mile to show they care about their community and want to be more inclusive for people caring with dementia.”

“It’s something we have to address on multiple fronts. We know it impacts families directly and has a significant emotional impact, but there’s also a significant financial impact for individuals and our communities.”

Williamson noted that such steps by businesses could include modifying entryways, altering lighting, or changing the ways they interact with customers. And the changes don’t have to be dramatic. For example, a coffee shop in Boston became more dementia-friendly when it complemented its chalkboard menu with large-print menus at the register. “It’s little things like that — different types of things you can do.”

One attendee of the recent lunch in Springfield noted that some businesses have gone the opposite route, citing the increasing use of automated ordering kiosks at McDonald’s and the dominance of self-checkout lanes at Stop & Shop as two developments that can be problematic for certain individuals.

However, on the plus side, many restaurants have embraced the Purple Table training program designed to help visitors with dementia, autism, PTSD, hearing or vision impairment, or other conditions benefit from a more predictable environment and additional accommodations when dining out.

When families make a Purple Table reservation, participating restaurants provide accommodations that work best for that diner, along with extra patience and attention from staff who have been trained to understand different needs and how to best meet them. Those steps might differ depending on the visitor, but the underlying philosophy of empathy and understanding is the same.

Law and Order

The recent lunch gathering was funded by a dementia-friendly capacity-building grant from the Massachusetts Council on Aging under a service incentive grant from the Massachusetts Executive Office of Elder Affairs, allowing the coalition to hold focus-group meetings with local government and public officials, first responders, and members of the business community.

The goal is to make them aware of the issues facing individuals living with dementia, their friends, family, and care partners; to give an overview of the movement; and to elicit their thoughts and engagement in the initiative. In addition, the group will meet with those living with dementia and their care partners.

The coalition chair, Synthia Scott-Mitchell from Springfield Partners for Community Action, noted that “a dementia-friendly community is defined as one that is informed, safe, and respectful of individuals with dementia and their families, and provides supportive options for improved quality of life.”

But legislators can make a difference, too, and recently did, by passing a first-of-its-kind bill — subsequently signed into law by Gov. Charlie Baker — that aims to make life a little easier for individuals with dementia and their families, through a multi-pronged approach.

More than 130,000 people are currently living with Alzheimer’s disease in Massachusetts, and being cared for by more than 337,000 family and friends. According to the Alzheimer’s Assoc., in 2018, Massachusetts will spend more than $1.6 billion in Medicaid costs caring for people with Alzheimer’s.

“Alzheimer’s is the single largest unaddressed public health threat in the 21st century, and we remain on the front lines of this crisis every day here in the Commonwealth,” said Daniel Zotos, director of Public Policy & Advocacy of the Alzheimer’s Assoc., Massachusetts/New Hampshire Chapter. “This legislation follows in the tradition of Massachusetts being a national leader in healthcare, and we commend the governor and Legislature for ensuring everyone impacted by Alzheimer’s gets the quality care and support they deserve.”

Among its mandates, the bill:

• Establishes a comprehensive state plan to address Alzheimer’s disease within the Executive Office of Health and Human Services, while also establishing a permanent advisory council to help coordinate government efforts and ensure that public and private resources are maximized and leveraged;

• Requires curriculum content about Alzheimer’s and other dementias be incorporated into continuing-medical-education programs that are required for granting the renewal of licensure for physicians, physician assistants, registered nurses, and licensed nurse practitioners;

• Ensures proper notification of an Alzheimer’s or dementia diagnosis to the family or legal guardian and provides information on available resources to both the patient and family;

• Requires state hospitals to implement an operational plan for the recognition and management of patients with dementia or delirium; and

• Establishes minimum training standards for social workers in elder protective services, to ensure protection from abuse and exploitation for elders with Alzheimer’s and dementia.

Small Steps, Big Impact

When it comes to making communities more navigable and manageable for people with dementia, every effort helps, Williamson said, noting that the dementia-friendly movement also seeks to raise awareness — often through workplace presentations — of resources available to help families grapping with Alzheimer’s, when they’re not always willing to seek them out because of shame or stigma.

“If we go into your workplace and address your employees, we’re reaching folks that might need help,” she said. “It’s not just about doing the right thing for your customers, but also for your staff — folks who are taking care of their loved ones, but might not want to come forward.”

As the statistics show, those folks are legion. Increasingly, Williamson and her fellow coalition members hope, they are starting to find their communities a little friendlier, in some very important ways.

Joseph Bednar can be reached at [email protected]

Health Care

‘We Are a Different Place’

Shriners Hospitals for Children – Springfield is in a much healthier place than it was nearly a decade ago, when its parent organization seriously considered shutting its doors. A move in 2011 to accept third-party insurance — although free care is still provided to those who need it — stabilized the national network, and canny decisions to introduce new services have helped the Springfield facility not only survive, but thrive and grow stronger: the same goal it has for each young patient.

George Gorton recalls a conversation he had with the parent of a child who nearly drowned — and then required months of intensive rehabilitation to regain full function, both physically and mentally.

Unfortunately, the only two pediatric inpatient rehabilitation units in Massachusetts are located in Boston.

“There was nowhere in Western Massachusetts to bring him back to maximum function level,” Gorton told BusinessWest. “She couldn’t transfer her family to live in Boston for two months to get the care she needed.”

That has changed, however, with last month’s opening of a new, 20-bed Inpatient Rehabilitation Unit at Shriners Hospitals for Children – Springfield.

“Now, everyone in Western Massachusetts who needs that kind of support can come here rather than figure out how to maintain their family 90 miles away,” said Gorton, the hospital’s director of Research, Planning, and Business Development. “It made sense; we had this excess capacity and didn’t need to do a lot of renovation work. It seemed like a natural fit, so we worked to get it set up.”

That excess capacity is due to a trend, increasingly evident over the past two decades, toward more outpatient care at Shriners — and hospitals in general. But despite the space being in good shape, it still needed to be converted to a new use and outfitted with the latest equipment, and that necessitated a $1.25 million capital campaign, which wound up raising slightly more.

George Gorton, left, and Lee Kirk

George Gorton, left, and Lee Kirk say long-standing support from Shriners, their families, and community members — reflected by this display in the lobby recognizing donors — has been a major reason why the hospital provides care regardless of ability to pay.

The new unit is an example of both the community support Shriners continues to accrue and the hospital’s continual evolution in services based on what needs emerge locally.

Specifically, Gorton said, the hospital conducts a community-needs assessment every three years, and out of the 2013 study — which analyzed market and health data and included interviews with primary-care providers and leaders in different healthcare sectors — came a determination that an inpatient pediatric rehab clinic would fill a gaping hole.

When H. Lee Kirk Jr. came on board as the facility’s administrator in 2015, he and his team honed that data further, spending the better part of that year reassessing the hospital’s vision and putting together a strategic plan. They determined that continued investment in core services — from neuromuscular care and cleft foot and palate to spine care and chest-wall conditions — was an obvious goal, but they also identified needs in other areas, from fracture care to sports medicine to pediatric urology, as well as the new rehabilitation unit.

“After a traumatic injury — a brain injury, serious orthopedic injury, it could be spinal injury — a child might have some functional deficits, even though they are not in a medically acute situation,” Kirk told BusinessWest. “So they come to this program and spend anywhere from two to eight weeks with intensive rehabilitative services, which is physical therapy, occupational therapy, and speech therapy, and also physician care and nursing care.”

Under the supervision of a fellowship-trained pediatric physiatrist, patients admitted to the unit will receive a minimum of 15 hours of combined physical, occupational, and/or speech therapy per week, added Sheryl Moriarty, program director of the unit. “Using an individualized, developmental, and age-appropriate program model, our Inpatient Rehabilitation team will manage medically stable children and adolescents with a variety of life-altering and complex medical conditions.”

That evolution in services makes it even more clear, Gorton said, that the landscape is far different than it was in 2009, when the national Shriners organization seriously considered closing the Springfield hospital.

“We’re stronger in every sense of the word,” he said, “from our leadership to the quality of the employees we have to the diversity of programs we have to the financial strength behind all this. We are a different place.”

First Steps

When a boy named Bertram, from Augusta, Maine, made the trek with his family to Springfield in February 1925, he probably wasn’t thinking about making history. But he did just that, as the hospital’s very first patient.

“While Shriners opened hospitals primarily to take care of kids with polio, Bertram had club feet,” Kirk said — a condition that became one of the facility’s core services.

After the first Shriners Hospitals for Children site opened in 1922 in Shreveport, La., 10 other facilities followed in 1925 (there are now 22 facilities, all in the U.S. except for Mexico City and Montreal). Four of those hospitals, including one in Boston, focus on acute burn care, while the rest focus primarily on a mix of orthopedics and other types of pediatric care.

As an orthopedic specialty hospital, the Springfield facility has long focused on conditions ranging from scoliosis, cerebral palsy, and spina bifida to club foot, chest-wall deformities, cleft lip and palate, and a host of other conditions afflicting the limbs, joints, bones, and extremities. But that’s the tip of the proverbial iceberg.

“This is along the lines of a community service, and our athletic trainers are working with school systems and private sports clubs in the community, to participate from a preventive point of view, but they certainly can attend games as a first responder and then follow up with treatment.”

“There’s some consistency in services, but each of the hospitals has adapted to the needs that present themselves in that community,” he went on, noting specialties like rheumatology, urology, and fracture care in Springfield, as well as a sports health and medicine program that brought on two athletic trainers and is currently recruiting a pediatric orthopedic surgeon with training in sports medicine.

“This is along the lines of a community service, and our athletic trainers are working with school systems and private sports clubs in the community, to participate from a preventive point of view, but they certainly can attend games as a first responder and then follow up with treatment.”

In all, more than 90% of care provided in Springfield is outpatient, reflecting a broader trend in healthcare, Kirk added. “We have always had, and still have, the only pediatric orthopedic surgeons in Western Massachusetts.”

Jennifer Tross stands in a hallway of the new Inpatient Rehabilitation Unit.

Jennifer Tross stands in a hallway of the new Inpatient Rehabilitation Unit.

After its clinical work, he noted, the second part of the Shriners mission is education. Over the past 30 years, thousands of physicians have undertaken residency education or postgraduate fellowships at the children’s hospitals.

“We have a lot of students here in a lot of healthcare disciplines, particularly two orthopedic residents who come on 10- to 12-week rotations from Boston University and Albany Medical Center. We have nursing students, nurse practitioners, physical and occupational therapists — a whole cadre of individuals.”

The third component of the mission is research, specifically clinical research in terms of how to improve the processes of delivering care to children. That often takes the shape of new technology, from computerized 3D modeling for cleft-palate surgery to the hospital’s motion-analysis laboratory, where an array of infrared cameras examine how a child walks and converts that data to a 3D model that gives doctors all they need to know about a child’s progress.

More recently, a capital campaign raised just under $1 million to install the EOS Imaging System, Nobel Prize-winning X-ray technology that exists nowhere else in Western Mass. or the Hartford area, which enhances imaging while reducing the patient’s exposure to radiation.

That’s important, Kirk said, particularly for children who have had scoliosis or other orthopedic conditions, and start having X-rays early on their lives and continue them throughout adolescence.

It’s gratifying, he added, to do all this in a facility decked out in child-friendly playscapes and colorful, kid-oriented sculptures and artwork.

“It’s truly a children’s hospital when you look around the waiting areas and the lobbies,” Kirk said, noting that ‘child-friendly’ goes well beyond décor, to the ways in which the medical team interacts with patients. “This is a happy place, and it’s a privilege for me to be part of such a mission-driven organization. I’ve been in this business for 35 years, and this is the most mission-driven healthcare organization I’ve ever been associated with — and I think others feel that way too.”

Joint Efforts

Jennifer Tross certainly does. She’s one of the newest team members, coming on board as Marketing and Communications manager earlier this summer. “I felt the commitment as I was being recruited here,” she said. “It’s an honor to be a part of it, really.”

It’s not that difficult to uphold the hospital’s mission when one sees the results, Kirk added.

“Our vision is to be the best at transforming the lives of children and families, and that’s what we look for every single day,” he told BusinessWest. “You see how their lives are transformed, and how, regardless of their situation, they’re treated like normal kids here. That helps them to evolve and have confidence to function normally at home, at school, and in their communities.”

There’s a confidence in the voices of the hospital’s leaders that wasn’t there nine years ago, following a stunning announcement by the national Shriners organization that it was considering closing six of its 22 children’s hospitals across the country — including the one on Carew Street.

“Our vision is to be the best at transforming the lives of children and families, and that’s what we look for every single day. You see how their lives are transformed, and how, regardless of their situation, they’re treated like normal kids here. That helps them to evolve and have confidence to function normally at home, at school, and in their communities.”

In the end, after a deluge of very vocal outrage and support by families of patients and community leaders, the Shriners board decided against closing any of its specialty children’s hospitals, even though the organization had been struggling — at the height of the Great Recession — to provide its traditionally free care given rising costs and a shrinking endowment.

To make it possible to keep the facilities open, in 2011, Shriners — for the first time in its nearly century-long history — started accepting third-party payments from private insurance and government payers such as Medicaid when possible, although free care is still provided to all patients without the means to pay, and the hospital continues to accommodate families who can’t afford the co-pays and deductibles that are now required by many insurance plans.

“That was a very good strategic move,” Kirk said, noting that, regardless of the change, 65% of the care provided last year to 11,501 children was paid for by donors, the Shriners organization, and system proceeds.

If a family can’t pay, he noted, the hospital does not chase the money, relying on an assistance resource funded by Shriners and their families nationwide. “One of the largest causes of personal bankruptcy is healthcare. It’s unfortunate that all healthcare can’t be delivered in the Shriners model. But I don’t disparage my colleagues — they don’t have a million-plus Shriners and their families around the world who are incredibly passionate about raising money to take care of kids.”

As a result of this model, “Shriners Hospitals for Children is a net $10 billion business with no debt. And one of the things we try to minimize is the support we require from system proceeds, other than our endowment,” he noted. “And we’ve been very successful here. It’s kind of an internal competition — which hospital requires the least support from the system.”

In the past three years, the Springfield facility has ranked second on that list twice, and third once. And that’s despite actually growing its services significantly. In 2016, Gorton said, the hospital grew its new patient intakes by 44%, followed by 26% the following year and a projected 20% this year. “So we serve a lot more children across the diverse set of services we provide.”

He noted that the outpouring of community support in 2009 — which included a sizable rally across the street — was an awakening of sorts.

“They said, ‘hell no, don’t go, we need you; stay here,’” he recalled. “Since then, we’ve done everything we could to identify what it was that the community wanted from us and recreate ourselves in that image. I think we’ve been largely — more than largely … exceptionally — successful on that.”

The hospital saw a lot of turnover in the years following 2009, Gorton added, “but the people who stayed are committed to the mission and vision of transforming children’s lives. The people who have joined us since then sense that the one thing we don’t compromise on is our mission and our vision.”

Best Foot Forward

When asked where the hospital goes from here, Kirk had a simple answer: Taking care of more children.

That means making sure area pediatricians, orthopedists, and hospitals are aware of what Shriners does, but it also means bolstering telehealth technology that allows the hospital not only to consult with, say, burn experts at the Boston facility, but to broaden outreach clinics already established in Maine, New York, and … Cyprus?

“We go to Cyprus every year — for 37 years now,” Kirk said of a connection the organization made long ago with the Mediterranean island. “We’ll see 300 kids in four days of the clinic, and over the course of a year, 10 to 20 will come to Springfield and stay in the Ronald McDonald House here while they receive care — typically surgical care.

“We’ve had an ancient telehealth connection with Cyprus, and we’re now updating that to the latest technology, so we can have telehealth clinics with Cyprus four to six times a year in addition to going over there,” he went on. So we’re going to focus on taking care of more kids.”

That is, after all, the core of the Shriners mission.

Joseph Bednar can be reached at [email protected]

Health Care

A Different Kind of Health Crisis

Dr. Gaurav Chawla

Dr. Gaurav Chawla describes suicide as “a very unfortunate, tragic outcome of a complex set of circumstances.”

It’s a common, but certainly not universal, refrain when an individual takes his or her own life.

Friends and relatives will say they didn’t see any signs that this was coming, said Kate Hildreth-Fortin, program director, Emergency Service & Mobile Crisis Intervention with Behavioral Health Network (BHN). Or they’ll say that they could not see any apparent reason for this outcome, that the individual in question seemed outwardly happy and was enjoying life.

That’s what people said about celebrity chef Anthony Bourdain, designer Kate Spade, comedian Robin Williams, and countless others, famous and not at all famous.

“But almost always, there are warning signs, and there are reasons,” said Hildreth-Fortin, one of many who spoke with BusinessWest about a subject that is timely, immensely complicated, and a true healthcare crisis probably on the same level as the one involving opioid addiction.

“If you think about the cost society pays due to undiagnosed mental-health conditions, due to emotional crises and stressors leading to loss of function and ultimately to suicide, and how many lives are directed affected by suicide … when you think about all that, this is a public health crisis.”

Timely not just because of those celebrity suicides several months ago — although they always help bring attention to the problem — and not just because of a recent report from the Centers for Disease Control and Prevention on the growing problem.

It’s timely because the numbers continue to rise, as does the overall toll from suicide, which goes well beyond the individuals who take their own life, said Dr. Gaurav Chawla, chief medical officer at Providence Behavioral Health Hospital, part of Trinity Health Of New England, who estimated that six lives are directly impacted by each suicide.

“If you think about the cost society pays due to undiagnosed mental-health conditions, due to emotional crises and stressors leading to loss of function and ultimately to suicide,” he went on, “and how many lives are directed affected by suicide … when you think about all that, this is a public health crisis.”

Getting back to the numbers, they are eye-opening and quite alarming:

• The most recent surveys show there are 45,000 completed suicides in the U.S. every year;

• That number has steadily risen since the start of this millennium, with suicides up a total of 28% since 2000;

• Massachusetts has the third-lowest suicide rate in the nation, but the rate of suicides in the Bay State has increased 35% since 1999, well above the national average;

• Women attempt suicide at a higher rate than men, but men complete suicide at a higher rate than women;

• Firearms are used in more than 50% of suicide attempts;

• Middle-aged white men (those in their 40s to mid-50s) have the highest suicide rate, particularly when they are single, but there is another peak involving individuals over 84; and

• Among individuals ages 14-34, suicide is the second-leading cause of death after accidents.

Perhaps as disturbing and frustrating as the numbers themselves are the forces behind them. They are numerous, often difficult to see, and very difficult to combat.

But there are common denominators of a sort. For starters, suicide usually results from a combination of factors, not one in particular, said Chawla, who summed things up succinctly, noting that “there is never one reason for someone to take their life; suicide is a very unfortunate, tragic outcome of a complex set of circumstances.

Kate Hildreth-Fortin

In almost all cases, Kate Hildreth-Fortin says, there are warning signs with someone contemplating suicide.

“You will often see the assumption that undiagnosed mental illness or inadequately recognized or treated mental illness is the cause,” he went on. “However, that is a myth; 50% of the suicides do not have a diagnosed mental illness behind them.”

As for what is behind them, that list is obviously quite long, said Hildreth-Fortin, and could include biological and genetic factors, increasing stresses of life, relationship crises, financial and occupational stressors, poor coping styles, increased substance use, and many others.

Another common denominator is that those contemplating suicide generally feel trapped in a life that does not bring them happiness or make them fulfilled, said those we spoke with, adding that this descriptive phrase can be applied to people at every age, every income bracket, and every walk of life.

Slicing through it all, such individuals need a way out of that trap and can’t find one or are unwilling to try, said Chawla.

“Suicide is a confluence of circumstances that lead one to conclude that they’re trapped in a hopeless circumstance, sometimes without purpose, in a painful existence from which there is no other way out,” he told BusinessWest.

Meanwhile, providing a way out, especially to those suffering from behavioral-health issues (and that’s a large percentage of those who contemplate or complete suicide) is made more difficult by the persistent stigma attached to seeking help for such conditions, and then finding help in a system plagued by a shortage of resources.

These are the reasons why this is a healthcare crisis, even if the same politicians who are quick to give such a label to the opioid epidemic are mysteriously reluctant to do the same with suicide.

For this issue, BusinessWest takes a long, hard look at suicide, going beyond the numbers in a quest to explain why they continue to rise, and also looking at how area professionals are helping those who are in that aforementioned ‘trap’ and need a way out.

A Failure of the System

Hildreth-Fortin, like the others we spoke with, said that, while it is somewhat regrettable that it often takes celebrity suicides like Bourdain’s and Spade’s to bring heavy media attention to the problem of suicide, she’s happy for the attention and a chance to bring the conversations to the forefront, instead of the background, where they have been for too long.

That’s because a brighter light needs to be shone on this crisis to bring about any kind of change in the current trends. With that attention, she said, there is hope that the stigma attached to mental-health issues and seeking help for them might be diminished; hope that more resources might be brought to bear to address the crisis, as has happened with opioid addiction; hope that friends and loved ones might become aware of the warning signs — what to do when they see and hear them; and hope that those feeling trapped might be more persistent in finding a way out.

That’s a lot of hoping, but in this battle, those fighting it will take whatever help they can get, especially with regard to that stigma concerning mental health.

“Suicide is a word we use every day; it’s something we deal with every day,” said Hildreth-Fortin, whose program handles roughly 1,300 assessments a month, and 70% of these individuals, in her estimation, have suicidal thoughts. “There’s a lot we can do with prevention; we need to reduce the stigma, improve education, and treat suicide the same way we would diabetes — ‘what can we do to help someone?’”

Chawla agreed, and said the stigma attached to both suicide and mental illness and seeking help for it often contributes to a lack of understanding concerning why someone commits suicide.

That is certainly the case with celebrities such as Bourdain, Williams, and others, he went on, adding that, to most of the rest of the world, these people seem happy and content with their lives.

But it’s not the world’s perception of these individuals that matters; it’s how they view themselves, and this is true of people across all income levels and social strata.

“It’s about perceptions of who you are, how you fit in your world, and how meaningful you find your existence,” he said. “That’s what ultimately leads to or doesn’t lead to such acts.”

But while suicide is seemingly an individual act, it isn’t, and each act represents more than one person choosing that tragic outcome.

“Suicide is taken as one event by one individual, and that’s not what it is,” said Chawla. “It is the final outcome of the failure of the system. Along the way, there are many lives affected, there’s a lot of loss of function, and there is opportunity that’s missed.”

Hildreth-Fortin and others at BHN agreed, and said one huge key to perhaps reducing the number of suicides is to seize opportunities rather than miss them.

And there is quite a bit that goes into this equation, she noted, listing everything from proper training of police officers, teachers, and others to being aware of the many warning signs; from knowing what questions to ask those at risk (and asking them) to knowing how to respond to the answers to those questions.

And this means not overreacting or underreacting, and, above all, connecting people at risk with services that provide help, said Hildreth-Fortin, who, like Matthew Leone, assistant program director of the crisis unit at BHN, is trained in something called QPR, which stands for question, persuade, refer — the three basic steps in suicide prevention.

“This is training given to anyone in recognizing the risk factors, how to persuade the person to get help, and how to refer that person for help,” Leone explained, adding that, in his role, he does a lot of training in the community on how to recognize suicide.

Which brings him to those warning signs. There are many to watch for, some subtle, some most definitely not, he said.

“This is training given to anyone in recognizing the risk factors, how to persuade the person to get help, and how to refer that person for help”

They could and often do include people saying ‘goodbye’ or ‘nice to know you’ on Facebook and other platforms, individuals giving away possessions, young people suddenly drawing up a will, people losing interest in things they enjoy doing, a decrease in performance at school, and many others.

“A more overt sign might be when they start stockpiling medication or another means of following through on their plan,” Leone went on, adding that, in addition to these warning signs, which are clearly red flags, there are also risk factors.

And there are many of those, he said, starting with being a middle-age male. Others include financial distress, depression, divorce, loss of a job, being given a terminal diagnosis, and, of course, a combination of some of these.

Questions and Answers

The next part of the equation is knowing what to do when warning signs are recognized, or with someone who outwardly seems at risk, said Hildreth-Fortin.

She acknowledged that having a conversation with such an individual and asking the questions that need to be asked is awkward and often very difficult (some fear that just asking the questions can help promote a suicidal act) but it needs to be done.

“A big piece of QPR training is teaching people how to ask the question, to get someone comfortable with asking someone if they’re suicidal,” she said, adding that this training is often given to first responders and educators, but parents, spouses, friends, and employers also fall into the category of individuals who need to ask questions and need to know how to ask and also how to respond.

Questions should focus on what thoughts people are having, how often they’re having them, and whether they’ve acted on these thoughts in any way before, said Hallie-Beth Hollister, assistant program director, Community Relations for BHN, adding that the answers will generally reveal just how at-risk someone might be.

Jenni Pothier

Jenni Pothier says those working with those contemplating suicide need to create a comfortable, non-judgmental, open space for dialogue to occur.

One key, she went on, is not asking leading questions that would enable the individual to give the answers the questioner might be looking for.

“Don’t say, ‘you’re not thinking of killing yourself, right?’” she said by way of example.

But, as noted, recognizing warning signs and asking the right questions are only parts of the equation. Responding to the signs and the questions to the answers is another big part, said Leone, adding that that many people balk at asking questions, or especially difficult and specific questions, because of anxiety about the answer.

“‘What do I do if the answer is yes?’” is a question that unnerves many, he went on, adding that there’s a reason for this; the response can be complex.

“We talk with people all day who mention that they’ve having suicidal thoughts,” he explained. “Some have the intent to follow through, others do not; some have vague suicidal ideation where there’s no real plan to it.”

Which is why overreaction is possible and should be avoided.

“Many times, with suicide, when someone says they’re having those thoughts, instead of starting a conversation, it ends the conversation,” he explained. “People will jump in and say, ‘we need to get them to the hospital, we need to get them help now,’ when the person is just reaching out to talk about it for help.

“And this overreaction can have a negative effect to it because then the next time the person is experiencing those thoughts, they may not say anything,” he went on, adding that the key is generating the proper response given the individual’s risk factors, warning signs, the strength of the connections in his or her life, and other factors.

Jenni Pothier, director of the Tenancy Preservation program for Springfield-based Mental Health Associates, agreed. In the course of her work, which involves helping individuals who are at risk of homelessness — a stressful situation to say the least — the subject of suicide often comes up.

“Because we know that suicide includes risk factors like poverty, experiencing potential homelessness, and a lack of access to resources, people are in crisis,” she explained. “So we’re assessing people regularly for suicide.”

And those assessments involve asking those questions mentioned above, asking them in an effective way, and responding in the appropriate manner.

“As practitioners and clinicians in the community, you need to create comfortable, non-judgmental, and open spaces for dialogue to occur,” she explained, “so people can express to you how they’re feeling without the fear of the stigma or that you’re going to instantly call 911 to get them hospitalized if they say they’re contemplating suicide or having suicidal ideations.”

Bottom Line

As she talked with BusinessWest about suicide and, more specifically, the problems many have with asking the questions that must of asked of someone at risk, Hildreth-Fortin related the story about an educator who, during a QPR training session, admitted not only that she would have difficulty asking such questions, but also that she would be upset if someone put those questions to her child.

“I had a real hard time responding to her, because it spoke so greatly to the stigma attached to this,” she said. “If your child had a stomach ache, you wouldn’t have a problem with him going to the nurse. You talk about what hurts, what kind of pain it is … we have to treat suicide the same way we would any medical symptom. We have to talk about it.”

It will take a confluence of factors and a great deal of resources to reverse the current trends on suicide, but getting people to talk about it and respond to the talk is the big first step, said Chawla, adding that only by doing so can those missed opportunities he mentioned become real opportunities to do something about a true healthcare crisis.

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

Health Care Sections

Mindful Connections

Allison Baker (right, with Cheryl Moran)

Allison Baker (right, with Cheryl Moran) says everything from the Atrium’s programs to its physical layout caters to individuals with cognitive impairment.

Over the past few decades, assisted-living facilities have increasingly opened dedicated memory-care units, and for good reason — a booming senior population is set to spawn sharp increases in Alzheimer’s disease and other dementias. These facilities stress safety, but more than that, they aim to keep residents active and engaged with life, while giving their loved ones much-needed peace of mind.

The guilt often associated with ‘putting mom in a home’ has never really gone away, even when the move makes sense, and those ‘homes’ — especially those which focus on memory care — aren’t what they used to be.

“It seems like a last resort sometimes,” said Allison Baker, director of Community Relations at the Atrium at Cardinal Drive in Agawam. “But what we’re able to provide in this community is care that is centered around their cognitive needs.”

Atrium — one of 56 communities in the Benchmark chain, which focuses solely on memory care — is celebrating its 20th anniversary this year, which allows its leaders to take a long view of how residential memory care has evolved.

“We care for individuals who have some form of cognitive impairment,” Baker explained. “Some of our residents are milder in terms of cognitive impairment, while some have end-stage, advanced dementia. We care for residents through the entire spectrum.”

It’s no secret that, as the senior population in America swells, so have instances of dementia. Alzheimer’s disease alone affects more than 5 million Americans — and, barring a cure, that figure might soar to 16 million by 2050, according to the Alzheimer’s Assoc.

That puts residences that specialize in memory care in a sort of sweet spot when it comes to meeting a growing need. In fact, that goes for assisted living of all kinds.

“The reality is, we’re all going to need help in the future,” Baker said. “It’s not something everyone wants to think about, but it’s reality. We try to educate families and provide them with guidance, whether or not someone moves into our community. Healthcare is not easy to navigate, but when families do come in, they see we’re not an institutional setting, but a homelike environment — yet, we can still meet their care needs.”

While giving BusinessWest a tour of Armbrook Village in Westfield, Executive Director Beth Cardillo noted the small size of the rooms in its Compass memory-care neighborhood, but there’s a reason for that — smaller spaces are easier to psychologically navigate, and residents spend most of their time outside the room anyway.

“Memory care is a smaller life in terms of space, but what we do there is no different than what we do in the rest of the building,” she said.

There are a few main reasons why families choose memory care, she noted. The first is that their loved one may be a flight risk, and families are worried their they might wander out of a building at 3 a.m. if the unit isn’t secured. “So, safety is obviously the number-one concern,” Cardillo said.

“The other piece, what people often don’t realize, is that, as someone’s world gets smaller, what we provide is a safe but very caring, normalizing environment. It’s a smaller world that’s a safer world. Often, people move to traditional assisted living and realize the world at large in this building is too big for them; they can’t negotiate the space. Sometimes less is more.”

Loved ones come to realize this too, she added. “When people move into memory care, for a lot of reasons, their families breathe a big sigh of relief, and it feels like a burden has been released off their shoulders. I always hear, ‘why didn’t I listen to you? It took me a while to get on the same page with this, but you were so right.’”

Kelly Sostre, executive director of Keystone Commons in Ludlow, which also boasts a dedicated memory-care neighborhood known as the Cottage, agreed that it can be difficult for families to come to terms with a growing need for help.

“It’s a hard hurdle for a child to get over, knowing her mom needs to be in memory care,” she told BusinessWest. “I definitely have to hold their hand through that process and explain the benefits of being in memory care.”

However, she went on, “just a week or two after they’re here, they’re like, ‘this is the best thing ever.’ They don’t have to worry anymore — they can come in and have a quality visit with mom, not worrying about medications or bathing her. They’re engaged, not tired, because they’re sleeping at night.”

Active Lives

Baker said the layout of Atrium is purposeful, catering to individuals with cognitive impairment.

“We don’t have long hallways with a lot of rooms coming off them, which can be confusing for residents,” she explained. “Instead, there are two wings with different neighborhoods in each wing, where apartments open into a common area.”

Beth Cardillo says families often find it difficult to choose memory care for their loved ones, but are typically relieved once they do.

Beth Cardillo says families often find it difficult to choose memory care for their loved ones, but are typically relieved once they do.

Meanwhile, each apartment is decorated with a shadowbox out front, which families can decorate however they wish, telling a story about their lives and interests and reaffirming the idea that the residents are individuals. But, as Cardillo said, the idea is to get residents out of those rooms.

“In our model of memory care, we don’t want residents sitting in their room alone,” Baker explained. “Part of the reason someone moves into a community like this is that engagement. Someone with cognitive impairment may not feel comfortable around those without cognitive impairment, but here, in a comforting space, they feel free to express themselves — we’ve seen that time and time again.”

Executive Director Cheryl Moran noted that, whenever a resident is admitted, the family is interviewed to learn about their interests, past hobbies, favorite foods, and more.

“That way, we can program our care and activities to what they enjoy,” Baker noted. “Some residents may enjoy playing bingo, while others may prefer trivia or want to join a garden club or a baking club. There are always multiple programs going on, so residents have the ability to decide whether to actively participate or just socialize and observe.”

The emphasis on personalizing the experience stems from an acknowledgement that these are people with long histories who led rich lives, and want to continue living. “Some were homemakers, some were doctors, some were journalists. It runs the gamut, so it’s about finding what each resident enjoys doing so they can have the highest quality of life they deserve.”

With residents ranging in age from 60 to 97, Baker noted — with birth years spanning almost four decades — even what music residents enjoy varies wildly, with tastes ranging from the 1920s to the 1970s.

“It’s about finding what each resident enjoys and appreciates,” Baker said. “And we count on families and caregivers to provide a lot of that information — and, to some degree, our residents. We want them to feel as they have control, making their own decisions on things and letting us know what programs they like and don’t like.”

With a packed daily calendar of activities like word games, reminiscing, Zumba, tai chi, yoga, art, and music, Sostre said, Keystone also tries to offer something for everyone. Shuttle trips into the community are especially popular, and they’re also a chance to educate establishments like restaurants — which are contacted in advance — on how to accommodate people with memory loss.

Back on campus, many Keystone activities are enjoyed by an integrated group, with residents from independent, assisted, and memory-care neighborhoods gathering together for exercise programs or a chef’s club in which they prepare and enjoy a meal together.

“The road to Alzheimer’s is different for each individual here, and we try to program for that individual. Sometimes their needs might be different than the general group,” said Grace Barone, director of Community Relations, adding, however, that Keystone tries to strike a balance between meeting individual needs and encouraging group interaction.

Good Nights

Many times, dementia affects sleep patterns, which means some residents keep odd hours, but that’s no problem in a unit that’s staffed 24/7.

“If I walked in here at 1 in the morning, I wouldn’t be surprised to see a resident or two in the common area having coffee with the care manager or doing a puzzle together because their sleeping patterns do get mixed up,” Sostre said. “But we have staff here, so if that happens, it’s OK.”

Kelly Sostre, left, and Grace Barone say many of Keystone’s activities integrate its independent-living, assisted-living, and memory-care residents.

Kelly Sostre, left, and Grace Barone say many of Keystone’s activities integrate its independent-living, assisted-living, and memory-care residents.

Cardillo agreed. “If you want to be up at 3 in the morning and have a cup of tea and toast, that’s fine. Want to dance in the living room at 4 in the morning? That’s fine, too. I don’t want to say anything goes, but the reason they’re here is not only to keep them safe, but to give them a robust life, not just keep them alive.”

Reminiscing is a big part of the activity program, she said, especially with a program called Reconnections, which is simultaneously a chance to learn new things and to generate conversation about the past.

“They remember going to USO dances or getting married the week before shipping out to war, or the Andrews Sisters singing ‘Boogie Woogie Bugle Boy.’ They’ll talk about art or where they went on their honeymoon. It brings up so much conversation.”

Such reminiscing has a clinical benefit, she added. “It keeps the synapses going — it’s a spark that increases dopamine in the brain. To see them sit and have discussions, it’s beautiful to watch.”

Music is a critical element as well — “it’s a window to the soul; it can bring you to your high-school prom or anyplace, really” — not to mention sensory activities from dancing and yoga to gardening. “It’s the regular world in a smaller place.”

And it’s often a place that remains meaningful to the family long after their loved one is no longer there, Moran said.

“The wife of a gentleman who passed came back to visit me maybe a month ago. She said she has a connection here and she likes to come visit, and she’s thinking about volunteering in our programs, which is very touching,” she told BusinessWest.

“It’s about love — when you walk in, I hope you feel a real sense of connection and family.”

Joseph Bednar can be reached at [email protected]

Health Care Sections

Out of the Darkness

Daniel Zotos characterizes H.4116 as a workforce-training bill more than anything else.

Daniel Zotos characterizes H.4116 as a workforce-training bill more than anything else.

When Carolyn Mutcherson’s mother was diagnosed with Alzheimer’s disease, her family decided to care for her at home, even though they all worked full-time. It was a team effort, with family members alternating taking time off from work to give others a break.

“No one can care for someone, no matter what the illness is, alone,” Mutcherson told the audience gathered at a recent legislative breakfast of the Massachusetts/New Hampshire Chapter of the Alzheimer’s Assoc. “My sisters and I, along with our children, grandchildren, and spouses, helped care for my mother around the clock because she was home and my father wanted her to be home. She was our mother, but his wife. So whatever he asked us to do, we did.”

Mutcherson’s mom died at age 81, in her family’s care, but that care was often difficult, she recalled. She reached out to the Alzheimer’s Assoc. and to Baystate Health, where she worked, for help, but said too many family caregivers don’t know where to turn.

“We were fortunate to have a close-knit family, and as time went on, we found more resources in the community,” she said. “It’s very difficult caring for someone 24 hours a day when you don’t have resources or don’t know where the resources are.”

It’s a story playing out increasingly often in Massachusetts and across the U.S., as the senior population swells — around 10,000 Baby Boomers hit age 65 every day — and, with it, the number of Americans with Alzheimer’s and other dementias. In Massachusetts alone, about 130,000 residents age 65 and up have Alzheimer’s today, and that figure is expected to soar to 150,000 by 2025, a 15.4% increase.

It’s why advocates for a piece of legislation known as the Massachusetts Alzheimer’s and Dementia Act — unanimously approved by the state House of Representatives in January and now in the Senate Ways and Means Committee — are acting with a sense of urgency, said Daniel Zotos, director of Public Policy & Advocacy for the local Alzheimer’s Assoc. chapter.

“It’s always important to pay attention to these facts and figures and see where these numbers are going,” he told the local legislators, caregivers, and others at the April 27 breakfast. “We’ve been very active on the federal level and working with our members of Congress on Alzheimer’s disease research funding.”

On the federal level, Alzheimer’s research received a $414 million boost this year, bringing the total outlay to $1.8 billion — roughly quadruple what spending was in 2011, just seven years ago.

“Knowing we’re doing this advocacy work on the federal level is so important, but we’re also focused on people living with this disease now and families impacted by dementia, and that’s where I really see the state-level work — on the front lines of what is really a health crisis,” Zotos said.

Carolyn Mutcherson says caregivers often get frustrated and overwhelmed, and need to know where they can access resources and help.

Carolyn Mutcherson says caregivers often get frustrated and overwhelmed, and need to know where they can access resources and help.

The seeds of the bill known as H.4116 were sown at an event on Beacon Hill in October, featuring expert panels talking about Alzheimer’s disease from different perspectives — such as industry, research, and the care community — and that conversation went on for about five hours between two joint committees, he explained.

“The result of that conversation was a comprehensive bill that packaged together a lot of existing bills within the Alzheimer’s Association legislative platform, as well as other initiatives,” Zotos said — and the legislation has only picked up momentum since.

What’s in the Bill?

The Massachusetts Alzheimer’s and Dementia Act features four main components. First, it creates an integrated state plan within the Executive Office of Elder Affairs, and establishes a permanent advisory council to coordinate government efforts and ensure that appropriate resources are maximized and leveraged.

The second part deals with education and training, specifically requiring medical providers, including primary-care doctors, nurses, and physician assistants, to earn continuing-education credits in Alzheimer’s and dementia as a condition of license renewal.

The rationale, Zotos noted, is that an estimated 45% of individuals with Alzheimer’s are actually diagnosed, and far fewer are offered information and options. Patients with cognitive impairments going into variety of healthcare settings, he argued, need to be diagnosed and treated correctly.

State Rep. John Scibak, who serves the 2nd Hampshire District and has been heavily involved in Alzheimer’s issues, told breakfast attendees that this is a particularly critical part of the bill, even though doctors have told him they don’t support the additional mandatory training.

“They say, ‘we’re doctors. We went to medical school. We don’t need to be educated.’ Well, surprise. You now have to. I think it’s absolutely essential.”

The bill’s third element deals with dementia in the acute-care setting, ensuring that hospitals are better prepared to treat patients with cognitive impairments when they arrive for some other health issue. Statewide, individuals with dementia have a 22.5% readmission rate within a month of visiting the hospital — the sixth-highest rate in the nation.

“You can come at this disease from the heart, the impact there, but also the head when you think about the cost to the state,” Zotos said. “We can work to improve the experience in that setting. We’ve been having some really good conversations with hospitals about this.”

Finally, the bill establishes new protections from abuse and exploitation, including provider training with social workers from Elder Protective Services, and proper family notification, consistent with federal and state privacy guidelines, about incidents of abuse in care facilities.

Mutcherson says that element of the bill is not an attack on caregivers, but an acknowledgement that frustration is part of the daily experience. She said there were times she raised her voice inappropriately to her mother, only to be calmed down by family members.

“You do get frustrated, you do get angry; this is why you can’t do it alone,” she said, noting that even doctors sometimes don’t know how to communicate with patients with dementia and become flustered. “So education everywhere needs to take place — not just in hospitals, but in doctor’s offices and dental offices as well.”

Zotos said he characterizes H.4116 as a workforce-training bill more than anything else.

“If we focus on training our doctors and clinicians in recognizing Alzheimer’s and dementia, knowing the signs, it can really lend to improving that rate of diagnosis and getting folks into care-planning services much sooner,” he noted. “It’s a care-planning issue, it’s a financial-planning issue, and it’s also just a dignity issue to know you have a disease when you have it.”

One Step at a Time

Zotos said the bill, if passed, would be one development — albeit a significant one — in a long string of actions to improve quality of life for those with Alzheimer’s and other dementias in Massachusetts.

Those include legislation in 2012 mandating mininum dementia care standards in skilled-nursing and assisted-living facilities, and the establishment in 2010 of a Silver Alert system to help locate individuals who wander. Most recently, the Alzheimer’s Assoc. secured an additional $100,000 in state funding for Alzheimer’s public awareness.

“We’ve really focused on being in the community and talking about this issue,” he added. “And this budget item has really helped us focus on underserved populations across the Commonwealth, especially African-Americans and Latinos, who more than two times more likely to develop Alzheimer’s.”

Zotos noted that his grandmother had Alzheimer’s disease, and when he saw the impact of the advocacy movement, it encouraged him to get involved as well, leading to his current role. “We’ve had a lot of success in Massachusetts with Alzheimer’s and dementia, improving quality of care within in the care setting.”

Grace Barone, who chairs the association’s advocacy committee and works as director of community relations at Keystone Commons in Ludlow (see story on page 11), said she’s sometimes overwhelmed by the stories she encounters.

“I can’t walk away from this disease. It’s not me today, but it could be tomorrow. It could be any of us in this room. We need to share these stories; we need to be a voice for those who cannot speak any longer and share their experiences.”

Part of that message is educating those who deal directly with individuals with dementia, Zotos, and that’s the promise the legislation holds. He admitted it doesn’t include dramatic benefits like tax credits or respite grants for caregivers, but he’s determined to put families at the table with decision makers to improve quality of life.

“There’s a lot of good happening, but we have never seen a bill on a state level approach Alzheimer’s disease and dementia like this,” he said. “Massachusetts has really been known for healthcare, and this bill would put Massachusetts on the map in terms of helping families and reducing cost — but also helping our neighboring states get moving with legislation like this.

“This bill isn’t perfect; no bill is,” he concluded. “But the conversation continues; the fight continues. It’s a big step.”

Joseph Bednar can be reached at [email protected]

Health Care Healthcare Heroes Sections

Nominate a Healthcare Hero

Only a few minutes into the first meeting of an advisory board created by BusinessWest and its sister publication, BusinessWest, to provide needed insight as they launched a new recognition program called Healthcare Heroes, the expected question was put forward.

“How do you define that word ‘hero?’ asked one of the panel’s members, addressing the magazines’ decision makers.

The reply, and we’re paraphrasing here, was something to the effect of ‘how we define ‘hero’ is not important — it’s how you define it.’

And by ‘you,’ Kate Campiti, associate publisher of the two publications, essentially meant anyone who would nominate an individual or group to be named a Healthcare Hero in one of seven categories that first year.

Those who did so came up with their own definitions, used to highlight the nominations of a unique class of individuals and groups that would include Sr. Mary Caritas, SP, former president of Mercy Medical Center, in the Lifetime Achievement category; Dr. Michael Willers, owner of the Children’s Heart Center, in the Patient/Resident/Client Care Provider category; Dr. Andrew Dobin, an ICU surgeon, in the Innovation in Health/Wellness category; and the Healthy Hill Initiative in the Collaboration in Health/Wellness category.

“Generally, ‘hero’ means someone or some group that stands out and stands above others in their profession, in their service to others, and in the way their passion for helping those in need is readily apparent,” Campiti said. “And we saw this in our first class of honorees. If there was one word that defined all of them, beyond ‘hero,’ it was ‘passion.’”

A panel of judges will be looking for that same passion as they weigh nominees for the class of 2018.

Nominations are currently being accepted, and will be until the end of the day on June 15. Nomination forms can be found on both publications’ websites — www.businesswest.com and www.healthcarenews.com.

Nominations are being accepted in the following categories:

Those nominating individuals and groups are urged to make their submissions detailed and specific, giving the judges who will review them all the information they need.

The honorees will be chosen this summer and profiled in the Sept. 4 edition of BusinessWest and the September edition of BusinessWest.

The Heroes will then be honored at a gala set for Oct. 25 at the Starting Gate at GreatHorse in Hampden.

Rounding out the class of 2017 are:

Lifetime Achievement: Sister Mary Caritas, SP;

Patient/Resident/Client Care Provider: Dr. Michael Willers, owner of the Children’s Heart Center of Western Massachusetts;

Emerging Leader: Erin Daley, RN, BSN, director of the Emergency Department at Mercy Medical Center;

Health/Wellness Administrator/Administration: Holly Chaffee, RN, BSN, MSN, president and CEO of Porchlight VNA/Home Care;

Community Health: Molly Senn-McNally, Continuity Clinic director for the Baystate Pediatric Residency Program;

Innovation in Health/Wellness: Dr. Andrew Doben, director of the Surgical Intensive Care Unit at Baystate Medical Center;

Innovation in Health/Wellness: Genevieve Chandler, associate professor of Nursing at UMass Amherst; and

Collaboration in Healthcare: The Healthy Hill Initiative.

For more information on Healthcare Heroes, visit www.businesswest.com or www.healthcarenews.com.

Health Care Sections

Sound Reasoning

Susan Bankoski Chunyk

Susan Bankoski Chunyk, here displaying a hearing aid, says new research provides some compelling reasons why individuals should not wait to do something about suspected hearing loss.

Susan Bankoski Chunyk has been quoting the same statistic for years now — because the numbers, to her consistent dismay, haven’t changed appreciably.

The average delay from when someone notices a hearing loss to when that same individual decides to actually do something about it is five to seven years, Bankoski Chunyk, a doctor of audiology practicing in East Longmeadow, told BusinessWest.

The basic reason why hasn’t changed, either. There is a serious stigma attached to hearing aids, she explained, adding that these ever-improving devices have always been associated with age and weakness.

“I’ve had people in their 80s and 90s tell me, ‘I don’t want to look old; those are for old people,’” she said when asked if this stigma was alive and well in the 21st century, noting that such sentiments should certainly answer that question.

What has changed in recent years, however, she went on, are some of the arguments for not waiting five to seven years and instead doing something as soon as hearing loss is noted.

Before, the basic arguments involved quality of life as it related to hearing, both for those suffering the hearing loss and the loved ones and friends coping with it. By way of explanation, Bankoski Chunyk, the region’s first doctor of audiology (more on that later), said she would often quote the line on a bumper sticker used by one of the hearing-aid manufacturers in some of its promotional material, especially as those devices became smaller and less obtrusive: “your hearing aid is less obvious than your hearing loss.”

But in recent years, research has provided Bankoski Chunyk and others like her with more powerful arguments, ones that she believes are already changing some attitudes when it comes to hearing health.

Indeed, numerous studies have linked hearing loss to dementia, depression (especially in women), isolation, loneliness, anxiety, insecurity, paranoia, poor self-esteem, and increased safety risk.

“There’s been a connection established between untreated hearing loss and earlier onset of dementia,” she explained. “The research is going on in multiple sites around the world, and I’m not saying there’s a cause and effect between hearing loss and dementia, but people who have hearing loss and don’t do anything about it are at increased risk of dementia.”

Bankoski Chunyk uses the information from such studies for what has always been a very important part of her practice and is now even more so — education, about everything from the health risks from hearing loss to what causes that condition, meaning everything from diabetes to smoking to noise exposure.

There are many misperceptions about hearing health and hearing loss, as well as that troubling stigma about hearing aids, she said. Overall, there is a general lack of urgency when it comes to hearing and its importance to one’s overall health and well-being, she told BusinessWest, adding that this is true not only for individuals with possible hearing loss, but also their primary-care physicians and the insurance companies that don’t cover hearing aids.

In many cases, hearing loss is often seen as part of the normal aging process, a nuisance rather than a health condition — something to be ignored rather than dealt with directly.

She draws a direct comparison to eye care. “Just because hearing declines with age for some people doesn’t mean it should be ignored,” she explained. “Vision changes are not ignored, even though they are common with age.”

Susan Bankoski Chunyk says that, unfortunately, many misperceptions about hearing health and hearing loss remain

Susan Bankoski Chunyk says that, unfortunately, many misperceptions about hearing health and hearing loss remain, as well as a troubling stigma about hearing aids.

Presenting such arguments and, more importantly, treating those who choose to do something about their hearing loss — hopefully not after five to seven years of waiting for it to get worse — has become a rewarding career choice for Bankoski Chunyk on a number of levels.

More than 30 years after first entering the field, she said she gains great satisfaction from changing someone’s life by enabling them to hear more clearly.

“When a person does come in, they usually kick themselves for waiting so long,” she said. “I love to make people’s lives easier, but I can only do it if they’ll let me.”

For this issue, BusinessWest talked at length with Bankoski Chunyk about her practice and her career, but mostly about some of that recent research she quoted, information she hopes will help change the dynamic when it comes to how people think about their hearing and how it relates to their overall health.

In other words, and as they say in this business, people should take a good listen.

A Positive Tone

Bankoski Chunyk said she first became intrigued by the broad field of audiology when she developed an interest in sign language when she was in high school.

“I got one of those cards with the manual alphabet on it and taught myself how to do all the letters of the sign-language alphabet while on a field trip one day in school, and I was hooked into the whole alternative way of communicating,” she explained, adding that audiology became a career focus in a roundabout way.

Indeed, she enrolled at the University of Connecticut (she’s a native of the Nutmeg State), intending to major in communication disorders with the goal of becoming a speech- language pathologist.

“I’d never heard of audiology before,” she recalled. “But once I started taking the coursework in audiology, I decided that’s where my heart belonged. And I got to combine the sign language for communication with profoundly deaf people with audiology, which covers the whole range of hearing loss.”

Back then, one needed a master’s degree to practice, but, like many professions within healthcare, audiology now requires practitioners to have a doctorate, said Bankoski Chunyk, adding that she earned hers online in 2004 (those who entered the field before the change were not grandfathered in) and thus became the first doctor of audiology in the region.

Her original plan was to get some experience in private practice and then go back to her native Middletown, Conn. and start her own practice there. However, while getting that experience with one of the first audiologists to start her own practice in this region, Kay Gillispie, she became attached to the region and a growing patient base.

The two operated a two-office practice for many years, with Gillispie working in the West Springfield location, and Bankoski Chunyk staffing the East Longmeadow facility. After Gillispie retired, the West Springfield office closed, and Bankoski Chunyk continued practicing in East Longmeadow, where she works with an associate, Jennifer Lundgren Garcia, also a doctor of audiology.

The two perform diagnostic evaluations on adults, fit patients with hearing aids when needed (and do the important follow-up work), and refer patients to specialists when other medical issues present themselves.

Over the years, Bankoski Chunyk said she has seen a great deal of change come to the science — and the business — of audiology.

With the former, she said she’s witnessed profound improvements in hearing-aid technology and ways to fit patients with them and then test and adjust to maximize outcomes.

And with that, she gestured to the something she called real-ear measurement equipment.

“This allows us to measure the sound in an individual’s ear canal without hearing aids in and then with hearing aids in,” she explained, “so that we can make sure that, for soft, medium, and loud sounds coming in, the device is doing the appropriate amount — not overemphasizing, but providing as much benefit as possible.

“By using this, we have a more objective measure than what we used to have,” she went on, adding this advancement, which came to the industry in the mid-’90s, is one of many that enable audiologists to bring real improvement in hearing, and thus quality of life, to patients.

As for the business side of the equation, Bankoski Chunyk said she’s seen it evolve and hearing aids become a commodity of sorts, now available at Costco and Walmart and on Amazon, and perhaps soon to be available over the counter in the same way that prescription eyeglasses are.

And this is where she draws an important distinction between the hearing-instrument specialists working in the Costco Hearing Aid Center and those who have ‘doctor of audiology’ written on their business card.

“A hearing aid is not a retail product; it’s a healthcare product — the FDA classifies them that way,” she explained. “And with hearing aids, there is a lot of review and adjustment and more review to make sure that the results they get are optimized.”

Volume Business

What’s of more importance to Bankoski Chunyk, however, is what hasn’t changed in this field of healthcare, especially that aforementioned lack of urgency and that alarming statistic concerning how long people wait before they call to do something about suspected, or even verified, hearing loss.

“Even physicians will think of hearing loss as ‘oh, you’re getting older, you’re going to have hearing loss,’” she told BusinessWest. “They’ll say, ‘you’ve got normal hearing for your age.’ We cringe when we hear that because there’s no such thing as ‘normal hearing for your age’; you either have normal hearing, or you have a hearing loss, no matter how old you are, and it should be treated.”

She has many concerns in this regard, including the commoditization of hearing aids and the fact that someone will soon be able to buy such equipment over the counter — with potentially serious consequences.

“People might go [buy over the counter] thinking that’s equivalent to what we have, which it won’t be; it won’t be nearly as sophisticated as what we have to offer,” she explained. “And then they’ll have a bad experience, throw it in the drawer, and say, ‘hearing aids don’t work,’ and then reset the clock and wait another five to seven years.”

Of more concern, however, is the recent research showing that those who wait those five to seven years, or longer, are not just missing lines from their favorite TV shows or asking family and friends to repeat themselves because they can’t hear them; they’re inviting other, potential serious health problems.

Indeed, Bankoski Chunyk cited one study showing that people with untreated mild hearing loss had twice the risk of dementia, while those with moderate loss had three times the risk, and those with severe loss had five times the risk of dementia.

“But the people in that study who used hearing aids had no greater risk than people who didn’t have hearing loss,” she went on. “We’re not saying that hearing loss causes dementia; we’re saying that use of hearing aids might help to postpone it, hopefully.”

Bankoski Chunyk said there are many conditions now linked to dementia, and the many reports can lead to confusion and frustration. But when it comes to hearing loss, the link to dementia makes sense.

“It’s been proven that lack of socialization is a big factor in cognitive decline,” she explained. “So we know that what happens with people who have hearing loss — because they’re not wearing hearing aids or they’re not fitted properly — is that they start to retract into themselves and they stop being social, they stop going to parties, they stop going to religious services, they don’t go to the movies, they don’t go out anymore. And that turns into depression, loneliness, anxiety, even to the point of paranoia.

“Gratefully, all this is making some people take things a little more seriously now because everyone is worried about winding up with dementia,” she continued, adding that the hope is that ‘some’ will become ‘most.’

Hearing Is Believing

Returning to the subject of that stigma surrounding hearing aids, Bankoski Chunyk said there used to be a stigma concerning eyeglasses.

“Years ago, glasses were a big deal; they used to call people ‘four-eyes,’” she recalled. “Now, people wear glasses as a fashion statement, and they have multiple pairs in different colors. It’s now cool to wear glasses.”

Hearing aids … not so much. And that picture is not likely to change anytime soon, although the technology continues to get smaller and even less noticeable than one’s hearing loss.

While she isn’t holding out hope that hearing aids can become a fashion statement, Bankoski Chunyk does have hope that more people will hear that message about hearing care equating to healthcare.

And not only hear it, but listen, and then act accordingly.

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

Health Care Sections

Seeing the Light

Dr. David Momnie tests a young patient’s vision.

Dr. David Momnie tests a young patient’s vision.

Dr. David Momnie was on a plane recently, sitting near a woman who dialed up a movie on her phone and stared at the screen for two hours. He doesn’t recall her looking up until it was over.

“That’s not good,” he said, but it’s far from rare. In fact, close-up viewing of electronic screens, whether to examine data on a computer at work or to watch YouTube videos or play mobile games on a smartphone, has become such common practice that the eye-care community is increasingly citing the trend to explain a troubling rise in myopia.

About 40% of the population is nearsighted, a problem that often develops in adulthood, but for children and teenagers, the number in the U.S. is more than 30% and increasing, while in Singapore, South Korea, and China, the myopia rate across all age groups is approaching 90% in some urban areas.

“It’s a huge problem, and in Asian countries, it’s a growing concern,” said Momnie, president of Chicopee Eye Care. “It’s a global phenomenon. But where is it coming from?”

Part of the issue is, and always has been, genetic, he explained — nearsighted parents pass on a predisposition to the condition to their children. “But that doesn’t explain the rapid increase in the past 30 years. It’s increased so rapidly that it’s got to be about more than genetics.”

Increasingly, doctors are saying the screen culture bears some blame.

“Kids are looking at computers at a very early age — iPhones, iPads, and computers — more and more,” he told BusinessWest. “When I was a kid, when we were in the car, we played the license-plate game. Now, kids are on their phones or watching a movie on long trips. They’re getting three, four, five hours a day, or even more, of intense, concentrated near-point work, staring at a small screen eight inches away.”

Myopia, or nearsightedness, is a vision condition in which people can see close objects clearly, but objects farther away appear blurred. For example, people with myopia can have difficulty clearly seeing a movie or TV screen across a room, or the whiteboard in school.

According to the American Optometric Assoc. (AOA), people who have jobs or frequently engage in activities that require looking at something close up for long periods of time are at more of a risk of developing myopia. One such activity is screen time. Some people have even reported experiencing what is called ‘pseudo-myopia’ from staring at a computer or phone screen for too long. In short, they will develop all the effects of myopia, but for a short amount of time. As for permanent myopia, the only way to correct it is with glasses, contacts, or eye surgery.

A team from the University of Utah recently examined myopia’s rising tide and also pointed a finger at screens. They noted that, in 1984, 15% of children had access to a computer at home. Now, more than 80% of households in the U.S. have one, and most families have smartphones as well. While these technologies have various uses, from entertainment to education, they note, they also raise questions regarding proper usage and boundaries for children.

“There’s a lot more to this — pardon the pun — than meets the eye,” said Dr. Steven Squillace, an optometrist who practices at Somers Vision Clinic. He specializes in children and adults with eye-muscle and focusing problems, and has studied at length the effects of computers on the eyes.

“One of the hardest things in medicine is to make people make lifestyle changes, whether it’s smoking or high blood pressure or weight loss — or the amount of time they spend on devices like cell phones, tablets, or even laptop or desktop computers,” Squillace said. “With the evolution of the work world, more people have jobs that require employees to be on these devices, and the blue light emitted from the devices can be harmful.”

Doctors can do only so much, he added. Bifocals with blue filters and anti-glare properties filter off some of the blue light, “but it can still potentially damage the anatomy in the eye lens and macula over time.”

Close View of the Facts

While the exact cause of myopia is unknown, the genetic component is well-known. In fact, Momnie said, nearsightedness is the result of a complicated interaction between genetic predisposition and environmental exposures.

But those exposures can be significant. He cited a 1983 study on military recruits in Holland — well before computers and other devices were a ubiquitous part of life. But this study suggested the potential damage of long-term, close-up viewing of, well, anything. Specifically, 2% of recruits who came from a farming background were nearsighted, 15% with a merchant background had myopia, and 32% of those with advanced education suffered from the condition.

“So we know that people who do a lot of near-point work have a higher incidence of nearsightedness than people who work outdoors in construction, farming, and other activities,” he added.

In a more recent study, researchers in Italy recruited 320 3- to 10-year-olds and tracked how long the children spent in front of screens each day. They found that kids who spent more than 30 minutes a day playing video games were more likely than the others to suffer from headaches, eyelid tics, double vision, and dizziness, while 90% of the frequent video-game players had refractive vision problems such as myopia or farsightedness, particularly in their dominant eyes, compared with only half of the less-frequent players.

The World Health Organization predicts that, if current trends continue, half the world’s population will be myopic by 2050, and one-fifth of those will be at a significantly increased risk of blindness. And the WHO isn’t alone in its worry. “The AOA has long been concerned about the increased incidence of myopia and the impact of the increased visual stress caused by digital eye strain,” said Andrea Thau, the AOA’s immediate past president.

Dr. Steven Squillace has long been concerned about the effects of close viewing and ‘blue light’ from electronic devices.

Dr. Steven Squillace has long been concerned about the effects of close viewing and ‘blue light’ from electronic devices.

The AOA strongly encourages children to participate in outdoor activities and to follow the 20-20-20 rule: for every 20 minutes of reading, computer, or close work, take a 20-second rest break by looking at things at least 20 feet away. Thau, who has a primary-care practice with special emphasis on children’s vision and vision therapy in Manhattan, advises that doctors of optometry encourage young patients to engage in eye-hand coordination activities and to play sports and other outdoor activities.

Momnie agrees with the 20-20-20 philosophy. “It just refocuses the eyes, and it’s a reminder that prolonged staring at a short distance is a strain on the eyes.”

The AOA issued several other tips on screen use to protect eyesight. First, the user should be in a comfortable position when using a computer or any digital screen, sitting up straight with a flat back and forearms resting comfortably on the desk or table. The screen should be held away from the face and viewed at a slight downward angle. Other light sources should be minimized, to avoid glare on the computer screen, which can cause extra strain on the eyes. And users should consciously blink often, because staring at any light source can cause eyes to dry up faster and actually inhibit the urge to blink. If dry eyes are a particular problem, eye drops may be used periodically.

Another area of concern for the ADA is addictive screen use. The organization advises parents to establish clear rules when it comes to video-game use in particular, including both time limits and conditions such as being able to play only after all homework is completed. And it’s not just eyesight at risk; a recent German study suggests that overuse of electronic media by children is reducing their overall sleep quality.

“So, how do we stop it?” Momnie asked, before suggesting that a lifestyle that gets kids back outside could be a good start. “Studies have shown that being outdoors two hours a day causes a significant reduction in nearsightedness. In Singapore, they’re redesigning classrooms to let more light in, and making more time for outdoor recess.”

However, many American school districts, especially in the middle- and high-school years, are now requiring students to complete and submit their homework digitally, perhaps increasing their susceptibility to early-onset myopia.

Whatever the reason, the condition’s increasing prevalence among children could contribute to learning deficiencies as they struggle in school but don’t know why. “Eighty percent of learning is visual,” he said, “and they may not know they’re nearsighted.”

Digital Breaks

As for adults, Momnie went on, two decades ago, most people staring at a computer screen for eight hours were in financial services — such as banking and accounting — and perhaps customer service. Today, more and more jobs have fallen under the umbrella of heavy screen time.

Squillace said many employers, as an ergonomic measure, are encouraging employees to take ‘digital breaks’ by simply looking away from the screen for a half-hour, perhaps getting up to grab a cup of water and look out the window.

“There’s some value in that, not having the eye engaged for hours on end. You really need to take those visual breaks,” he told BusinessWest. “When we talk about limiting activity, it’s more managing it, taking those breaks, and mixing it up. Get off the screen and do some pencil-and-paper tasks. Do some math homework on traditional paper instead of working on a computer.”

At the very least, adults can set an example for their children in the way they handle their own screen time, Momnie said. And it’s OK to be firm.

“Parents can say, ‘you’re allowed one hour a day, and then you have to spend an hour or two outdoors.’ Kick them outdoors during the weekends, and they probably shouldn’t play on their devices during the evening. And for kids under 2, don’t even let them near one of these things. Even a video game on TV is better than looking at an iPhone or iPad.”

After all, he said, parenthood is a benevolent dictatorship, not a democracy.

“Computers aren’t going away, and trying to keep kids off computers isn’t easy to do,” he said. But preventing myopia — or at least pushing it well into the distance — makes the effort worthwhile.

Joseph Bednar can be reached at [email protected]

Health Care Sections

New Name, Evolving Mission

Jessica Collins and Frank Robinson say the organization’s mission to create a healthier community hasn’t changed, but is simply being honed and refocused.

Jessica Collins and Frank Robinson say the organization’s mission to create a healthier community hasn’t changed, but is simply being honed and refocused.

Partners for a Healthier Community recently initiates a rebrand, and is now known as the Public Health Institute of Western Mass., a name that officials say more accurately reflects what this agency has evolved into over the past 22 years and the critical role it plays within the region.

As she talked about a rebranding effort involving the agency now formerly known as Partners for a Healthier Community Inc. (PFHC), Jessica Collins said the project wasn’t initiated because the name chosen in 1996 didn’t convey what the nonprofit is or does.

Rather, it’s because the new name eventually chosen — Public Health Institute of Western Massachusetts — and its accompanying logo do the job much better.

Indeed, while the agency is a partner in a number of initiatives to improve overall population health in the region, the original name didn’t convey the full breadth of its portfolio of services, said Collins, its executive director. Nor did it really define just what the ‘community’ in question happens to be.

Most importantly, though, it didn’t fully communicate the agency’s role as a change agent when it comes to the overall health and well-being of the communities it serves and especially those populations that are underserved.

So last fall, PFHC, working in cooperation with the marketing and advertising agency Paul Robbins & Associates, went about coming up something more accurate and specific.

The new name, which was unveiled at an elaborate ceremony at the agency’s offices within the Community Music School building in downtown Springfield, was chosen for several reasons that we’ll get into shortly.

First, though, we need to elaborate on why a rebranding was necessary at this time. Indeed, such initiatives are time-consuming, expensive, and bring change, an always tricky proposition, into the equation.

For starters, PFHC joined the National Network of Public Health Institutes in 2014, Collins said, adding that, as part of the process of joining that organization, the agency needed to identify its core competencies.

And for PFHC, those are research and evaluation, convening and coalition building, and policy and advocacy.

“Given those three core competencies, it felt natural to go with the Public Health Institute of Western Mass., coming from that national perspective,” Collins explained. “Also, there was some confusion about our organization because there are several agencies in the Greater Springfield area that have the word ‘Partners’ already in their title.”

What’s more, a rebrand provides an opportunity for an agency or business re-emphasize its mission, how it is carried out, its history, and its plans for the future. Or “reintroduce itself,” as Collins put it, adding that, for many, the institute needs no introduction, while for many others, it does.

The unveiling of the new name was part of that effort, she said, but there will be other initiatives to build awareness of the overall mission as well as specific projects, such as:

• The Springfield Youth Health Data Project, a health survey among Springfield public-school eighth-graders in 2015 and 2017. The project is part of a larger initiative that includes the Youth Risk Behavior Survey, a tool developed by the Centers for Disease Control and administered to 10th- and 12th-graders in Springfield;

• Springfield Complete Streets, funded by a Robert Wood Johnson Foundation Policies for Action Grant. The initiative involves a study of Springfield’s Complete Streets policy and, specifically, policies that support roadways designed and operated for the safety of everyone using them — whether by car, bike, foot, or bus;

• The Healthy Homes Initiative, which brings together housing and healthcare providers to pay for home improvements in Springfield specifically related to asthma control — mold and moisture remediation, pest control, ventilation and air quality, and removal of carpeting that harbors dust and other allergens — with the goal of keeping asthma sufferers out of the hospital;

• Springfield’s Climate Action & Resilience Plan. The institute is leading the outreach and engagement of residents and key stakeholders around implementation of a plan to make Springfield a resilient, healthy city; and

• Age-friendly City, an initiative that will create a senior leadership program to train older adults to be effective age-friendly community advocates, conduct an environmental scan on housing and transportation, and work toward achieving an age-friendly status for Springfield.

As those projects indicate, the agency has taken even more of that change-agent role, while also becoming more focused on the collection and implementation of the data that is critical when it comes to everything from enacting health-policy changes to winning critical funding for initiatives to improve the health and well-being of neighborhoods, a city, or an entire region.

PFHC needed a new name and logo that brought that message home, and Public Health Institute of Western Mass. does just that.

For this issue, we’ll talk a little about this rebranding effort, and a lot about the institute and the critical work it is undertaking across the region.

Bright Ideas

As mentioned, the new name comes complete with a new logo.

Actually, it’s a remake of the old logo, imagery of a sun. The new look is larger, brighter, and the sun rays, if you will, are aligned to replicate the lines on a bar graph — a nod to the agency’s dual missions to collect data and put that data to use to improve quality of life in the region.

“We had always done the coalition and advocacy building, but over the past few years we’ve really dug deeper into bringing expertise around research and evaluation,” Collins explained. “The new name and logo bring a more academic framing to the work that we’re doing.

“We want people to understand that we’re the place to come to if they want health data — if they want data that is highlighting inequities and, therefore, identifies populations that are in need of more attention and resources and investment,” she went on. “We want people to come to us if they have policy issues and need us to organize and create advocacy strategies, and we want people to come to us, as they always have, if they have new and innovative ideas or if there are gaps and issues that need to be convened around.”

All of this comes across in the new name, where each word or phrase carries some significance: ‘public’ for obvious reasons; ‘health’ (it’s in red while the rest of the words are in black on the letterhead); ‘institute,’ which conveys research and data; and ‘Western Massachusetts,’ because the agency needs to make clear that its work extends well beyond Springfield.

Also, there is a subtitle, ‘Partners for Health Equity,’ which brings home the point that the institute partners with other entities on all of its initiatives, and that its work is focused on making sure that all those in the region have an equal opportunity for a healthy life, regardless of where they live.

While the words and the logo are certainly significant, what’s behind them is what the agency is working to emphasize with this rebranding.

And as we commence that discussion, it’s probably best to go back to the beginning. That was in 1996, when a group of area healthcare leaders, led by Sr. Mary Caritas, then retired from her role as president of Mercy Hospital (now Mercy Medical Center), sought creation of a new public entity focused on improving health and well-being in Greater Springfield.

The goal back then was to create a space where competing health organizations and other entities, including the city of Springfield, could sit at the same table and work together to make the community a healthier place, said Frank Robinson, vice president of Public Health and Community Relations at Baystate Health, who was one of those on the ground floor, if you will.

“With that ambitious agenda, the notion was, ‘what are the things that need to be changed? What’s interfering with a good portion of the Springfield population living healthy lives?’” Robinson explained. “That social-justice framework was at the root of the organization’s inception, and it has maintained that viewpoint.”

The mission has always been to create a measurably healthier community, he continued, putting heavy emphasis on that word. And while the mission hasn’t really shifted, what has happened over the past 21 years is that the focus and the interventions have become more precise, more targeted.

“And with that additional precision and targeting, we’ve become more of a specialist than a generalist,” Robinson explained. “The general work is still occurring, but the specialty work is really taking center stage.”

The agency’s broad role has shifted somewhat as well, he went on, from being merely a supporter of various coalitions to a being a change agent in its own right.

This is reflected in some of the success stories the agency has helped write over the years, including:

• The BEST Oral Health Program, which created a local system of education, screening, and treatment for preschools to decrease instances of oral diseases;

• The Pioneer Valley Asthma Coalition, created to improve asthma management and indoor air quality (two Springfield schools received national recognition for the program, and Holyoke Public Schools adopted similar policies in 2017);

• A “Health Impact Assessment on the Western Massachusetts Casino,” a 2013 study that highlighted the health impact of vulnerable populations and increased community understanding of these potential impacts;

• Live Well Springfield. Undertaken in partnership with the Pioneer Valley Planning Commission, the project is designed to improve access to health eating and active living opportunities. Signature projects undertaken as part of the initiative include the formation of the Springfield Food Policy Council, the sucessful, seven-year Go Fresh Mobile Farmer’s Market, and policies such as zoning, community gardens, and Complete Streets ordinances; and

•The YEAH! (Youth Empowerment Adolescent Health) Network, which engages diverse community stakeholders who work together to create a proactive, comprehensive response to adverse adolescent sexual health and adolescent sexuality. Between 2004 and 2015, there were significant reductions in teen birth rates in Springfield and Holyoke, and work continues to address inequities.

Data Driven

But it is in the collection and use of data that the agency has seen the greatest movement when it comes to its mission and how it has evolved over the past decades.

Indeed, as the nation, the region, and area healthcare providers continue a shift toward population health — keeping residents healthy as opposed to simply treating them when they are sick — data becomes critical, said Robinson.

Elaborating, he said providers, advocates, legislators, and, yes, foundations administering grant money use data to identify problems and where, specifically, they are occurring. But they also use it to create responses to the issues identified by this data.

The agency focuses on population data, which often comes from the state Department of Public Health, Collins explained, adding that it also works with the Springfield public schools to generate data on a large, diverse population.

“And we are able to tease out whether issues are at a block level, a neighborhood, a census track, a city, or county,” Collins explained. “We’re able to analyze data and create the story of what is going on in our region; we’re able to localize the data so people here can understand it and take action.”

Perhaps the best recent example of this is the so-called Healthy Hill Initiative, a broad-ranging effort to improve the health and well-being of those in Springfield’s Old Hill neighborhood, a program that earned the participating partners (and there were many of them) a Healthcare Heroes award (the new recognition program launched by BusinessWest and HCN) in the category of ‘Collaboration in Healthcare.’

“Their plan of action was driven by data provided to them around block groups within that neighborhood concerning health-status indicators such as asthma, obesity, public safety, and more,” Robinson explained. “Mapping that information helped to target the interventions and support the plan; the community organizing is data-driven in the sense that they’re using the data to inform both the intervention and whether they made a difference.”

Another example would the Springfield Health Equity Report, issued in 2014, said Collins, adding that the agency stratified data by race and ethnicity.

“So when you look at an issue like cardiovascular disease, or obesity, or teen-pregnancy rates, having this stratified data is critical,” she explained. “When you look at state-wide rates for teen pregnancy, for example, everyone’s thrilled because the state rate has come down considerably.

“But if you really look at the data and stratify it by race and ethnicity, you’ll see that the white-girl teen-pregnancy rates have gone down significantly, and so have teens of color,” she went on. “But you still see an incredible inequity and disparity between the two populations, and that’s what we try to lift up and shine a light on, so we’re not all clapping and saying ‘our job is done’ — there are still specific populations that need more resources and investment.”

The only way specific coalitions battling health issues ranging from asthma to obesity to teen pregnancy can determine if they are making an impact — and the desired impact — is through this data, Collins went on, adding that this reality not only explains the new name and logo, but, more importantly, where her agency’s emphasis will be moving forward.

Name of the Game

As Collins noted, there were several motivating forces behind this rebrand.

There was an effort to stem confusion given all the agencies with ‘Partners’ in their name, but also the need to better communicate just how much the agency had evolved into a true change agent since it was created in 1996.

But there was also that desire to reintroduce area residents, officials, and other constituencies to the important work it carries out, and to remind all of them that there is considerable work still to do.

So, to that rhetorical question, ‘what’s in a name?’ or, in this case, a new name? Plenty — and it is, for lack of a better term, a healthy exercise.

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

Health Care Sections

Secure Connections

The Baby Boom generation isn’t just marching into retirement — they’re positively surging into their senior years, with some 10,000 Americans reaching age 65 each day.

Yet, despite the fact that senior-living communities have become increasingly modernized, specialized, and resident-focused, nearly 90% of seniors want to stay in their own homes as they age, according to the American Assoc. of Retired Persons.

And technology is helping them do just that — everything from home-monitoring devices to GPS trackers (for loved ones with dementia); from medication reminders to automatic stove turn-offs, and more . All of it is intended to lend both security to seniors living alone and peace of mind to their loved ones.

Older Americans welcome the trend — according to the AARP survey, even if they begin to need day-to-day assistance or ongoing healthcare during retirement, 82% would still prefer to stay in their own homes. Yet, the stereotype often lingers of seniors being technophobes averse to change.

“Many Boomers disagree with that statement, finding it insulting or pessimistic or both,” writes Laurie Orlov, principal analyst for Aging in Place Technology Watch, a market-research organization that provides analysis and guidance about technologies and services that enable seniors to remain longer in their home of choice. “They will repeat plaintively that Baby Boomers are very different than their parents’ generation. They are comfortable with technology. See how many have smartphones — they text, use Facebook and YouTube. Many book travel online, read Trip-Advisor reviews, and even call for car pickups with an app.”

So why not embrace technology meant to improve quality of life and — just as important — independence? Especially, Orlov noted, when there are so many options, from a simple door sensor or a sophisticated whole-home automation and security system.

In the case of the former, simple technology can have profound results. “If an older adult is alone at home, enters a room, and does not return past the sensor, an alert is sent to a family member or other predefined organization, thus enabling an attempt to contact the older adult, and, if no answer, to dispatch help.”

Rachel Walker, an assistant professor in the UMass Amherst College of Nursing, has focused much of her research on addressing health disparities and the care of older adults with cancer and other serious illnesses. She’s also on the faculty for the Center for Personalized Health Monitoring (CPHM), one of three centers that make up the Institute for Applied Life Sciences at UMass Amherst, one that aims to accelerate the development and commercialization of low-cost, wearable, wireless sensor systems for personalized healthcare and biometric monitoring — but always with a focus on the human side of care.

“Oftentimes in the national news, there’s a lot of focus on the technologies — things like wearable sensors and home health monitors,” she explained. “A lot of clinicians and practitioners like myself work with individuals out in the community who experience these health challenges as they age, and there aren’t too many places that merge those two ends of the spectrum.”

Through the Wires

One reason technology isn’t an end-all, Walker said, is because, while 90% of older adults prefer to stay in place, it’s a bigger challenge in the more rural areas of Western Mass., where people may not have access to broadband and high-speed wireless service.

“That’s a sticky wicket. We’re embracing technology more and more, in this digital arena where people also expect to access their health record [electronically]; all these things are on the horizon, but we have whole communities in this region that have yet to get high-speed access.

“The team I work with, we would like to develop solutions that put control back in the hands of actual individuals and their caregivers,” she went on, adding that they’re using grant funds to develop a home-assessment tool that’s compatible with people’s smartphones. “Most users, even in places without high-speed wireless, have access to smartphones.”

Susan Keel, an aging-in-place specialist, recently told HGTV that a robust whole-home security system can be installed for the same cost as one month in an assisted-living facility. “With a system like this, you can remotely log in on a smartphone or the Internet, and, via the devices connected to the system, monitor your loved one’s activities.”

On a smaller scale, Orlov said personal emergency-response systems — wearable devices that can be used to alert outsiders of a health emergency or fall — is currently a $3 billion market that has evolved only slightly from its origins. But one important advance has been their use outside the home.

“The ‘I’ve fallen’ message is still inspiring families and seniors to acquire one. But 30% of the market’s sales are for mobile devices. This makes sense in this time of substantial life expectancy at age 65, when 46% of women aged 75+ live alone,” she notes. “Mobility demands mobile devices, which in turn boost confidence to be out and about. Consider walking the dog — since one-third of the 65+ population has one.”

The Center for Personalized Health Monitoring consolidates expertise from polymer science and engineering, computer science, kinesiology, and neuroscience as well as from other departments and collaborators, such as the UMass Medical School and industry, to develop solutions that consider the whole person, not just technology, Walker told BusinessWest.

For example, “we’re trying to better understand what specific exercises older adults can do to improve their lower-extremity balance and strength, so they don’t have as much risk for falls,” she explained.

At the same time, however, “we’re working on home sensor networks to determine how people are using the space, so we can optimize their environment. We’ve also focused on some of the data-security problems, to make sure information is kept secure from hackers.”

In short, Walker said, there’s plenty of room for technology to help people understand their environment and manage chronic conditions and symptoms, such as fatigue and sleep impairments that, if not addressed over time, can wear the body down and lead to other types of disability. “We try to avoid that so people can stay in their homes as long as possible as they continue to age.”

Human Touch

As amazing as it is, technology doesn’t have all the answers, writes elder-care specialist Michelle Seitzer at Care.com.

“It should never be used to supplement actual caregiving — only enhance it. Certain situations may require a caregiver’s assistance or physical presence (be it a family member, neighbor, or a senior-care aide) for a few hours a week, overnight, or most of the day.

“There may also come a time when it’s just not safe for your loved one to stay home — no matter how many webcams you install,” she continues. “If a senior doesn’t answer the phone, seems withdrawn, falls frequently, misses medications, or wanders off regularly, you may need to look beyond technology. Think about options like hiring a home-care aide or finding senior housing. Figure out what works best for your loved one and the situation, and be open to changes along the way.”

Walker said her team at UMass focuses on concepts of dignity, capability, and healthcare equity in the senior years, and not on technology for its own sake.

“Any time we start a new project, we ask if there is really a need for this technology or new device. Are we building something people really need? Secondly, how will it fit into the life of the person it’s designed for? Also, who’s been left out? A lot of technology is built for the upper middle class, and that’s certainly a need, but we need to make sure what we’re building doesn’t systematically exclude certain individuals like rural residents, with no high-speed wireless access.”

Then there are unintended consequences. “Are we making someone reliant on a device, so if something breaks on the device, they’re left without a safety net to get their needs met?”

It’s an important question to keep in mind as the worlds of elder care and technology continue to cross-fertilize in new, intriguing ways.

Joseph Bednar can be reached at [email protected]

Health Care Sections

Left to Their Own Devices

While residential care services have broadened in recent years for seniors unable to live independently, technology has emerged as well to help older people stay in their homes longer, if they so choose — while giving some peace of mind to their families. Here are a few currently available devices, and what the health-tech media is saying about them.

GPS Trackers

Individuals with dementia face specific challenges at home — particularly the possibility they might wander from that home. To counter that challenge, a number of trackers, many that operate with global positioning system (GPS) technology, have emerged on the market.

A solution to wandering from the Alzheimer’s Assoc., the Comfort Zone Check-In application ($10 per month) allows caregivers to use a small tracking device to monitor their loved one with dementia.

“Comfort Zone Check-In combines the latest technology with flexibility, allowing families to change devices and plans as a person’s disease progresses and monitoring needs change,” according to the Alzheimer’s Assoc. “Using GPS and cellular technologies with online mapping, the entire family can proactively determine the location of the person with Alzheimer’s. Families log into a secure, password-protected website similar to logging into most e-mail systems and proactively establish safety zones.”

“Comfort Zone Check In has the potential to give peace of mind, both to those who care for Alzheimer’s patients, as well as patients themselves, who can get frustrated or distressed when people will not let them do anything independently,” noted Health and Life in a review. “It is not an over-exaggeration to say that Comfort Zone Check In could have a dramatic impact on Alzheimer’s care, especially as research continues to unlock the complexities of the condition and we understand more and more about it.

A new cellular tracking device, iTraq3 ($149) uses cellular towers to determine location, allowing it to be used anywhere there is service. The device itself is as small as a credit card, and its location is reported through a mobile application which allows the user to view a map of locations and timestamps. Itraq also features a ‘guard mode’ where users can specify a radius on a map, then receive alerts if and when the itraq goes beyond the pre-set radius.

“iTraq is a remarkable cellular tracking device for iPhone or iPad,” iGeeksBlog notes. “Being developed as the most effective gadget to track your things, it is the world’s first global location device. As iTraq uses cellular towers to determine location, it can be located anywhere else in the world where cellular service exists.”

Meanwhile, Pocketfinder ($159), a small, waterproof GPS devices, allow users to not only view a GPS location, but also an address, distance from the address, and the speed the device is moving. The app provides updates at the touch of a button through e-mail and text notifications. It also provides an unlimited number of ‘geofences’ that send an alert when the GPS leaves a specified area.

“While there are several similar GPS technologies in the market,” Digifloor notes, “PocketFinder removes the complexities of modern wireless technologies and offers a simple and easy solution that helps people coordinate and communicate with people and things.”

In-home Sensors

Rather than track people outside the home, another class of devices helps people know what their loved ones are up to in their homes. Activity-based sensors can reassure that the resident is up and about, carrying out daily tasks — or not.

For example, Alarm.com’s Wellness independent living solution ($99) integrates a suite of sensors and devices, and applies machine-learning algorithms to the data they generate to detect changes that may suggest risks. Wellness can report about changes in activity levels, sleeping and eating patterns, bathroom-visit frequency, and medication adherence, as well as emergency situations like wandering out of the home or falls.

“Far from being a contemporary Big Brother, the system provides real-time info on your loved one’s whereabouts and well-being, all without the use of intrusive cameras,” Reviewed reports. “The system uses a combination of bed-presence monitors, motion sensors, and panic buttons to track movement and alert users and caregivers of any unexpected changes in routine.”

One of the newest devices is the Inirv React ($239), which connects the stove to a sensor in the home and a smartphone app. The sensor will automatically turn the stove off if it no longer detects motion around the appliance after a long period of time. The stove can also be turned off remotely using a smartphone.

“You can control individual burners through your phone, of course, but the real star of the show is a sensor that sits on your ceiling,” according to Engadget. “If it detects gas, smoke, or prolonged inactivity, it automatically shuts off active burners. You shouldn’t have to worry about sparking a house fire just because you forgot to switch the stove off before you left for the movies.”

Meanwhile, the iGuardStove Intelligent ($495) is a pricier way to shut off the stove if a loved one is away from the cooktop for too long. It automatically shuts off the stove if cooking is left unattended, thanks to a two-part system of a power box and motion detector.

“The built-in wi-fi can help keep you posted online about how often the system has to shut down off your stove and send you alerts if it’s happening a little too often,” CNET notes. “The iGuardStove Intelligent is a good product if you are concerned about yourself or a loved one leaving a stove unattended.”

LifeAssist Technologies has developed the Reminder Rosie ($99), a clock that allows the recording of personalized messages and reminders that will be broadcast at scheduled times for whomever is in the home — perhaps a reminder to take medication or that the grandchildren will be coming over for dinner.

“Using revolutionary speech recognition technologies, Reminder Rosie announces multiple, loud, personalized reminder alarms at specific times daily, weekly, on a specific date, annually, in any language,” Caregiver Products reports. “Rosie can also tell the time, date, or today’s reminders to help organize each day. This talking alarm clock provides a simple solution to help users remember medications, appointments, household tasks, social activities, and other helpful information without touching any buttons. Reminder Rosie is a low-tech, stress-free memory aid that seniors or those with dementia, Alzheimer’s, or memory loss can actually use.”

Emergency pendants with fall detection serve a specific purpose, and have been around for longer than most other technologies in this article. Worn around the wrist or neck, they can be pressed in case of an emergency, such as after a fall, and a call is immediately made to 911 and/or pre-programmed numbers of family members.

Along with its lightweight and waterproof design, Philips Lifeline products are some of the more popular solutions on the market: HomeSafe, with autoalert fall detection (from $44.95 per month), works at home, while its GoSafe pendant, with autoalert and two-way voice (from $54.95 per month), uses up to six locating technologies, including GPS, to find someone in an emergency.

Medication Reminders

Then there are medication reminders, a field that has attracted plenty of innovation in recent years, with devices designed to remind, dispense, and manage medication.

Top5Reviews chooses as its favorite model the medSmart e-Pill automatic dispenser ($490), which comes with two keys, six daily alarms, a patient-compliance dashboard, and alarms that alert with sound and blinking lights.

“One buyer that we spoke to applauds its particularly deep medication compartments, compared to other models on the market,” the site notes. “One word of caution: it is a good buy only if the person taking the medicine is able to remember what the alarm signifies, is able to actually get the medicine out of the dispenser, and who are likely to take the pills right after removing them from the e-Pill.

For a budget option, Wirecutter, in its reviews of e-pill products, noted that the clock of the 31-day MedCenter System monthly pill organizer ($96) “was the easiest and most intuitive to program of any device we tested. If you can set a bedside alarm clock, you can set up this reminder device.

“However,” it went on, “you need to load the MedCenter’s pill trays, which each have their own plastic cover — individually, a task that can be a little arduous if you’re planning out a whole month. And you can’t individually lock the plastic pill caddies, which makes this model fine for a self-care situation or one where the patient is fully aware and not easily confused.”

Joseph Bednar can be reached at [email protected]

Health Care Sections

Screen Pass

socialmediadangerIn a nation where the vast majority of adults have a social-media presence, it’s not surprising that kids are clamoring to get in on the fun. But for teenagers, and especially the middle-school set, social media comes with its own set of additional traps, often magnifying and broadcasting incidents of peer pressure and bullying. There’s no real consensus on when kids should be allowed to use these ubiquitous tools, but experts agree that parents need to be involved in that decision — and well beyond.

Technology moves quickly, Dr. Bruce Waslick said. And young people are much better at keeping up with it than their parents.

“I’ve raised three kids, and the technology changed a lot from the time my first kid became a teenager to the time my third kid became a teenager,” said Waslick, chief of Child Psychiatry at Baystate Medical Center. “Things are moving so fast.”

Perhaps the most significant technological shift over the past decade — a seismic cultural shift, really — is the technology that almost 80% of all Americans are carrying in their pockets and purses: the smartphone.

nd make no mistake — it’s a tool that teens and tweens crave, particularly for access to the very public online realm of social media. But should they have that access? It’s a question doctors, parents, and tech experts have been grappling with for years, and still one without a definitive answer.

“So many kids now have access to smartphones and social media, and part of it can be great,” Waslick told BusinessWest. “People get connected to all kinds of information, and social media can be positive, helping kids communicate with each other and make relationships.

“The hard part is, kids are just so young, and they don’t know a lot about the world at that point, and they’re getting involved in very complex kinds of social-media functions they may not fully understand,” he went on, citing pitfalls from magnified self-image issues to cyberbullying. Online predators are another real concern, he said, because of the ease with which they can insinuate themselves into kids’ lives.

“In the old days, friends introduced you to friends, and vouched for them. Now, with a couple clicks, people get connected to people all over the country, and the world, with little filtering or regard for what they actually know about the people they’re connecting with.”

Melanie Hempe, a registered nurse and founder of Families Managing Media, a site that explores the hazards young people face in the online world, told Psychology Today that teenagers and pre-teens have a way of wearing their parents down with their desire to fit in to the Internet culture.

“Maybe because we’re exhausted from their constant begging for a phone, or because we think that all their friends have one, or because we want to upgrade ours to the latest model … we cave. We act on impulse. Our brain seems to regress like theirs, and we give them our old smartphone,” she explained. “And with that one little decision comes the world of social-media access — something we haven’t thought about and something none of us is prepared for.”

And she believes it’s a bad decision to give in, particularly before the high-school years. “Because the midbrain is reorganizing itself and risk-taking is high and impulse control is low, I can’t imagine a worse time in a child’s life to have access to social media than middle school.”

Specifically, she said, a tween’s underdeveloped frontal cortex can’t manage the distraction and temptations that come with social-media use. For example, “a tween’s ‘more is better’ mentality is a dangerous match for social media. Do they really have 1,456 friends? Do they really need to be on it nine hours a day? Social media allows — and encourages — them to overdo their friend connections like they tend to overdo other things in their lives.”

Dr. Bruce Waslick

Dr. Bruce Waslick

It’s a legitimate concern, said Dr. Yolanda Chassiakos, who serves on the executive committee of the American Academy of Pediatrics’ Council on Communications and Media. She cited a 2016 study showing that three-quarters of teenagers own a smartphone — close to the national average — and 24% of all adolescents report feeling “addicted” to their phone.

“Even parents young enough to be ‘digital natives’ themselves are worried about how to guide their children in this new digital media world and ensure the risks of media use and overuse are avoided,” she wrote, adding that increased sedentary media use usually corresponds to decreased sleep and a greater risk of obesity — as well as the psychological dangers Waslick and others have cited.

“Excessive media use has been associated with challenges such as isolation, victimization, depression, and Internet addiction,” she went on. “Unmonitored media use can leave children and teens vulnerable to online predators or allow them to make unwise decisions such as sharing inappropriate texts, videos, or photos.”

In other words, it’s a minefield. Just like the middle-school years themselves.

Not All Bad News

Waslick was quick to note the ways in which social media can exacerbate the social hazards tweens and teens already face.

“There’s a lot of peer pressure, as well as contacts with people posting inappropriate things online, disclosing personal details, getting into fights, a certain amount of cyberbullying,” he said.

The public nature of social media can take typical embarrassments and more serious incidents like bullying and magnify them, he added. “Sometimes, kids think when they type something, it’s like texting to somebody, but it’s being read by so many people. And one-on-one bullying is horrible enough, but bullying in front of large groups of people at the same time can be worse.”

However, not everyone who studies this issue comes to the same conclusions. Caroline Knorr is the Parenting editor of Common Sense Media, a website that exists to give parents a window into popular media in order to make good decisions for their kids. And she’s not convinced that online networking is the minefield some make it out to be.

“Yes, the risks of social media are real,” she said. “But new research is shedding light on the good things that can happen when kids connect, share, and learn online. As a parent, you can help nurture the positive aspects by accepting how important social media is for kids and helping them find ways for it to add real value to their lives.”

She identified a few ways in which social media can be a positive force, such as strengthening friendships, offering a sense of belonging, providing genuine support, and helping young people express themselves.

“Online acceptance — whether a kid is interested in an unusual subject that isn’t considered ‘cool’ or is grappling with sexual identity — can validate a marginalized kid,” she explained. “Suicidal teens can even get immediate access to quality support online. One example occurred on a Minecraft forum on Reddit when an entire online community used voice-conferencing software to talk a teen out of his decision to commit suicide.”

One other positive is the ability to do good, Knorr said. “Twitter, Facebook, and other large social networks expose kids to important issues and people from all over the world. Kids realize they have a voice they didn’t have before and are doing everything from crowdfunding for people in need to anonymously tweeting positive thoughts.”

One example of positive action using social media is an anti-bullying movement initially launched in Western Mass. that has spread across all 50 states and to more than 50 countries, with celebrities getting into the act. The core of the campaign is using the ubiquitous ‘selfie’ to spread an anti-bullying message on social-media platforms.

“The social-media effort was started by the kids of Unify,” said Edward Zemba, president of Unify Against Bullying, an organization based in East Longmeadow. “It was their way of bringing awareness to the silence of bullying. As parents, we all know that this issue is difficult enough to address when we talk about it. However, when children are left alone to deal with it in silence, things can get far worse.”

In January, the kids of Unify set a goal. By the end of the year, they wanted to have 50 celebrities participate in their selfie challenge. “Bullying is about trying to look cool,” said Zemba’s 14-year-old daughter, Julianna, one of the organization’s founders. “If celebrities send a message that bullying isn’t OK to kids, they’ll listen differently than if it’s from their parents, or even friends.”

With well-known figures such as Chris Evans, Zach Braff, and actors from series such as The Walking Dead, Game of Thrones, and Stranger Things participating, they are well on their way. Even athletes from NASCAR, the WWE, the Boston Bruins, the WNBA, and New England Patriots cheerleaders have posted selfies.

Chassiakos agrees that new media can provide a host of benefits and opportunities to grow in a positive way. “Because these platforms are interactive, children and teens can use them to learn, connect, and communicate with family and friends, and engage in creative activities. The key is moderation and balance; media use should not replace or displace other activities that promote healthy development and wellness.”

Parental Guidance Suggested

Unfortunately, Waslick said, there really is no hard-and-fast age when kids are ready to dive into social media.

“There may be kids who can appropriately use social media at an earlier age, although I don’t recommend that,” he told BusinessWest. “Others may be more fragile and shouldn’t be exposed to social media until they’re older, more mature, and able to handle certain things. I think parents should weigh this on an individual basis and then monitor how it’s going.”

That often includes insisting being a part of the teen’s social-media network — a Facebook friend, for example — even though they may not be crazy about the idea.

“Parents can be valuable ‘media mentors,’ guiding older children and teens on practicing online citizenship and safety, treating others with respect, avoiding cyberbullying and sexting, being wary of online solicitation, and avoiding communications that can compromise personal privacy and safety,” Chassiakos noted. “Parents also should be good role models by balancing their own media use with other activities.”

After all, Waslick said, even the best-intentioned kids end up with bad experiences online — not just bullying, but situations as simple as finding out about a party they weren’t invited to, or seeing a romantic interest cozy up to someone else online.

“These are normal things that happen during the middle-school years, but on social media, it plays out differently — more publicly,” he said. “While it’s an individual, case-by-case thing, parents should have a say in whether their kids are ready for it, and whether they understand what they’re getting involved in.”

He compared parental guidance in social media like learning how to drive. “That’s what a learning permit is for, so parents can supervise them while they learn to drive. I think getting involved in social media is like that; parental supervision is a good idea.”

Hempe insists that social media is an entertainment technology that doesn’t help kids raise their intelligence, develop socially in a healthy way, or prepare them for real life or a future job. She also feels it replaces learning the ‘work’ of dealing face-to-face with their peers, and often frays connections with family and real-world friends.

If they must partake, she suggests a few tips, including delaying access, following their kids’ accounts, allowing computer use only on large screens in the home, setting time limits for use, and planning non-tech family time together — in other words, replacing the screen with something positive and healthy.

“Don’t give that smartphone all the power in your home,” she said. “Help tweens choose healthier forms of entertainment. They have the rest of their life to be entertained by social media, but only a limited time with you.”

That’s advice few parents would argue against — no matter how much they trust their kids.

Joseph Bednar can be reached at [email protected]

Health Care Sections

Rewards Program

Dr. Matthew Richardson

Dr. Matthew Richardson, standing here in new outpatient space being readied at Baystate Medical Center, says working in pediatric oncology brings a broad mix of challenges and rewards.

When asked why he chose to direct his career toward work in pediatric oncology and hematology, Dr. Matthew Richardson flashed back to his time in medical school at the University of Rochester in New York and the rotations he was going through.

His recollections answered the question quickly and efficiently.

“I always thought I’d be an internist taking care of grownups,” Richardson, interim director of the Pediatric Oncology program at Baystate Medical Center, recalled. “But when I went through the internal-medicine rotation, I really didn’t like it. A lot of the time, the patients wouldn’t get better, and their problems derived from some sort of self-inflicted damage like smoking or drinking too much. But I really didn’t know what I was going to do if I didn’t like internal medicine.”

The next rotation happened to be pediatrics, and there, Richardson found an answer to that question — because he also found just about everything he didn’t find in internal medicine.

“You got to be goofy with the kids or play with the kids,” he told BusinessWest. “And they would get better; they would have illnesses that you would treat, and they would get better. Overall, as I used to say, and still do sometimes, a bad day with kids was still better than a good day with grownups.”

And in pediatric oncology, Richardson would find even more in terms of rewards, challenges, and everything else people get into the healthcare profession for. Indeed, the work involves treating the same patients for several years on average, and guiding them and their families through an experience that will test them in ways they probably couldn’t have imagined — and often to a full recovery and long life.

“When I see a child who’s now a young adult going off to college or in college, and they’re healthy, vibrant, and thriving, it’s incredibly rewarding,” he said.

At the same time, he and others with the Baystate program help introduce new treatment modalities through clinical trials, especially through Baystate’s affiliation with the Children’s Oncology Group, and, in the course of doing so, continue and even accelerate a remarkable pattern of progress that has marked the past several decades and Richardson’s entire career.

Meanwhile, the Baystate program, the only facility of its kind west of Worcester, offers an important level of convenience to patients and their families who would otherwise face of the prospect of battling cancer and having to drive halfway (or all the way) across the state repeatedly as they did so (more on that later).

Amid the many types of rewards and all that progress, however, there are still those times, said Richardson, when he must tell parents that there is nothing more than he can do for their child and that cancer will take their life.

Those conversations are, obviously, extremely difficult, he said, adding quickly that, with advancements made in recent years, there have been fewer of them, and as he looks forward, he is buoyed by the near-certainty that this trend will only continue.

For this issue and its focus on pediatrics, BusinessWest talked at length with Richardson about the state of pediatric oncology, the many of forms of progress being made in this realm, and about why, as he said, a bad day with children beats a good day treating adults.

Talking Points

As he talked with BusinessWest and posed for a few photos in the play deck at Baystate Children’s Hospital, Richardson noted, again, that many of the conversations he has with patients and their families in and around that facility are, indeed, difficult ones.

Starting with the first real talk — the one that comes after a cancer diagnosis.

“Someone’s world has just been completely altered — forever,” he said of the process involved with breaking that news, if you will. “It’s never the same conversation twice because each patient, each family, and each situation is different. Each child and each family deals with the news differently, so you have to be able to read the situation and determine how you think they might best respond to hearing news like that.

Richardson said he has become better at this art and science of ‘reading the situation’ over the years. He attributes this to “many years of learning on the job,” and he said breaking news to patients and families is merely one aspect of a much larger learning process that is ongoing — something else he likes about the specialty he’s chosen.

Richardson is one of three pediatric oncologists in Baystate’s program — actually there are two at the moment because a vacancy is being filled. Together, they see about 30 new patients a year, with almost all them living within 50 miles of the hospital, a catchment area that includes Western Mass., Southern Vermont, Northern Conn., and Eastern New York.

These patients have conditions that cover the full spectrum of pediatric oncology, he went on, adding that this phrase refers to everything from leukemias to brain tumors to kidney, liver, and bone tumors.

The ability to treat such cancers in this region is a huge asset for the region and the families that call it home, he went on, adding this convenience can reduce some layers of stress from situations where there are many.

“When you think about the time, the expense, the hassles, such as parking, parents having to take time off from work, children having to miss time from school … receiving care here is a real blessing,” he said. “A simple 20-minute doctor’s visit can turn into a whole-day affair if you have to go out to Boston, but if you can stay here, you might just have to take the child out of school a little bit early instead of them losing all of most of the day, and that’s important, because many patients have multiple visits every month, and sometimes several days in a row, depending on their treatment.”

And this convenience factor will only be enhanced in a few weeks, when the outpatient pediatric-oncology services currently located at the D’Amour Cancer Center are relocated to space at the Baystate campus on Chestnut Street, just a short elevator ride from the children’s hospital itself.

“It’s beautiful space, and it’s going to bring another level of convenience to patients and their families,” said Richardson.

Progress Report

Returning to his thoughts about why he chose pediatrics and pediatric oncology, Richardson said cancers (or most of them, anyway) are among the few conditions that can actually be cured.

“It’s not like you can take six cycles of hypertension medicine and your high blood pressure goes away,” he noted. “Or you take five cycles of insulin and your diabetes goes away. This [cancer] is a disease that we can treat, and treat successfully.”

And that process of curing children with cancer is extremely rewarding work, he went on, adding that his first experience with this came during his residency (also at the University of Rochester), when he cared for several children with cancer.

“These were kids that you would see over and over again throughout the year as they would come in for treatments, or you would see them in the office,” he explained. “And I liked that continuity, knowing the family when they came and knowing their history.”

Beyond this continuity, Richardson, no doubt speaking for all pediatric oncologists, said he also enjoys dealing with cancer on the many different levels it must be dealt with.

“Right down to the molecular, genetic level, and what mutation causes cancer,” he explained. “There’s also the cellular level — how does chemotherapy affect the dividing cell? — and the organ level: is this cancer affecting the kidney or the liver?

“And then, it goes to the personal level, and how the child is coping with the diagnosis and the treatment, as well as the family level and how the family is interacting with the healthcare system and dealing with the child’s illness,” he went on. “And if you really want to go the big picture, there’s the societal level, and how we as society try to do research on these rare diseases and come up with the best treatments and how we work together across the country to understand and treat childhood cancers.”

And, as he noted, in recent years, the ability to treat cancer and treat it successfully has only increased.

“It seems that every few years, there’s a new approach and a new modality available that seems to shift the paradigm of how we look at cancers and treat cancers,” he said while offering a quick chronology.

In the ’60s, ’70s, and ’80s, there was basically chemotherapy, which, as he noted, worked “some of the time, but not a lot of the time, and kids would get very sick with them.”

Improvements in chemotherapy coincided with better supportive care — more effective antibiotics and better nutritional support, and improved anti-nausea medications and other developments changed the landscape in the ’90s, he went on, adding that this was a time of what was known as “dose escalation,” because providers could better support children through the side effects.

Over the past 10 to 15 years, antibody therapies, developed to attack specific types of cancer, have become more prevalent, and with tremendous results, he said, adding that, most recently, specialists are taking the patient’s own immune system and training it to fight certain types of cancers.

Such advances have dramatically improved the survival rates for many childhood cancers, including leukemia, said Richardson.

“For some types of leukemia, the cure rate is 90%,” he told BusinessWest. “And for a disease that was once uniformly fatal, that’s pretty amazing.”

Bottom Line

In fact, the outlook is for continued improvement with those numbers and even greater ability to treat childhood cancers and treat them successfully, he went on, adding that he is looking forward to helping write these new chapters in the story of the fight against cancer.

Doing so will only add to an already long list of rewards that has come with joining a field where the work has more than its fair share of challenges, but also deep levels of progress and satisfaction.


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

Health Care Sections

A Matter of Compliance

The team at River Valley Counseling Center

The team at River Valley Counseling Center and local dignitaries cut the ribbon recently on the facility’s new in-house pharmacy.

It’s an easy concept to understand, Rosemarie Ansel said: medicine is useless if it’s not taken.

And prescription non-compliance is a common problem in the behavioral-health realm, said the executive director of River Valley Counseling Center. That can lead to rehospitalization in many cases, or worse.

“Whether it’s outpatient mental health or day treatment or services in schools, the idea is to provide support for people and help them manage their medical diagnosis so they remain in the community setting and not be hospitalized,” Ansel said. “Behavioral-health patients are a big part of who visits emergency departments. We try to provide services so it doesn’t get escalated to that level.”

That’s why she’s excited about River Valley’s new partnership with Genoa, the largest provider of pharmacy, telepsychiatry, and medication-management services for the behavioral-health and addiction-treatment communities. The company recently opened a pharmacy inside River Valley’s main clinic in Holyoke, Genoa’s fourth such location in Massachusetts and the first in the Greater Springfield region.

Genoa’s 380 pharmacies, all set in behavioral-health clinics across the country, serve than 550,000 individuals annually in 45 states, filling more than 13 million prescriptions annually.

“The focus is on behavioral-health medications, although they provide all medications for any of of our clients, their families, my staff, and my staff’s families,” Ansel said. “River Valley isn’t going to make any money on this; just a little bit of rent for the square footage in the building. It’s a partnership, in that the goal was to have the clients be more medication-compliant.”

A 2016 study published in the Journal of Managed Care and Specialty Pharmacy showed that integrated care models that feature on-site pharmacies produce higher medication adherence rates than community pharmacies, as well as lower rates of hospitalization and emergency-department utilization. In fact, Genoa’s consumers average more than a 90% medication-adherence rate.

And that’s the key, Ansel said. While there’s no guarantee patients will take their prescribed medications, compliance rates rise significantly once they have a prescription filled — which is much easier with a dedicated pharmacy on the clinic site than it is when they must visit a pharmacy off-site.

“One of the things we know in behavioral health is that clients pick up scripts and never fill them, or they don’t adhere to the recommended instructions, and they’re back in the hospital, and the cycle continues,” Ansel said. “We have a pharmacist who really understands the importance of being compliant and following their treatment plans to stay healthy.”

In addition, a pharmacist who specializes in the behavioral-health field, and who can easily communicate with a patient’s doctor if there are questions, makes it much easier to quickly answer questions, reducing confusion and further promoting compliance, she added.

For this issue’s focus on behavioral health, BusinessWest  spoke with Ansel about this new pharmacy partnership and how it’s just one part of a multi-faceted effort to increase access to behavioral healthcare for clients across the region.

Straight Talk

Ansel said River Valley had two ‘asks’ before taking Genoa on as a partner. One was that the pharmacist had to be bilingual in English and Spanish, as are about 75% of the practice’s 165 employees. “That’s a really important feature for us,” she said, considering the demographics of Holyoke. The pharmacist assigned to River Valley, Angel Marrero, fits the bill.

The second was that Marrero would be an active advocate with insurance companies, which often try to block certain medications, forcing practitioners to spend valuable patient time fighting with them.

“It’s time-consuming, it’s cumbersome, you’re on hold for a half-hour before talking to someone,” she explained. “This will free up our prescribers to see more clients. It’s a win-win for them.”

Rosemarie Ansel

Rosemarie Ansel says keeping clients compliant with medication instructions starts with making sure they actually fill the prescriptions.

After agreeing to both caveats, Genoa went to work over the winter in converting former waiting-area space into a pharmacy at the front of the clinic. After a soft opening in June, the pharmacy became the only one of its type in Western Mass.

River Valley’s clients — who receive outpatient care clinics in Holyoke, Chicopee, and Easthampton, as well as school-based sites in those three communities, as well as Granby and Springfield — run the gamut of age, demographics, and medical needs, Ansel explained.

For instance, the practice provides therapy in primary-care doctors’ offices, with licensed therapists assigned to the practice. The reason is that front-line providers are often the first to diagnosis a mental-health concern, and for many clients, their doctor’s office is the most comfortable environment for them to receive services.

In the elder-care realm, River Valley has contracts with both WestMass Elder Care and LifePath (in Franklin County) to provide mental-health services to the elderly, including in their homes.

For the younger set, school-based clinics in Holyoke, Chicopee, and Easthampton, as well as a few in Granby and Springfield, bring therapy services to students during the school day.

“Parents are overwhelmed, and the thought of taking the kid out of school and bringing them to therapy, then bringing the kids back — many times, that’s not going to happen. They’re working; they’ve got their own schedules. And transportation can be a huge issue. Even if the kid wants to go to therapy, he may not be able to get there. We go to the schools, which are considered satellites of our main clinic. Kids get taken out of non-core classes to see a therapist right at the school.”

Besides the therapeutic program, these school-based clinics provide a range of general health services, such as immunizations, physicals, dental screenings, and referral services to primary or specialty care. A similar program is offered at Springfield Technical Community College, again, so students can access therapeutic services without having to travel off campus.

Meanwhile, an employee-assistance program allows companies to access therapy services for their workers. “For example, an employee might be having a hard time at work, in their personal life, with finances, with their kids, and they need someone to reach out to. It could be financial problem, dealing with gambling problem, or it could be something that happened at a job site. If there’s a long-term therapy issue, they can link up with those services.”

The common thread with all these models of care? “We go to the clients in an effort to support them in the environment where they feel the most comfortable,” Ansel said. And comfort level is a bigger deal in the mental-health world than it is in other areas of healthcare.

“There’s a stigma around behavioral health. You need to make yourself as available as possible because, if there’s any kind of barrier, they don’t come. When we get just a little bit of snow, the cancellation rate skyrockets. Therapy is work. You’re not just chatting; you’re working on an issue, and that can be hard to face. If you can have it in an environment that’s more conducive, that causes less stress in your life, it makes it easier.”

Broad Reach

River Valley Counseling Center, which is part of Valley Health Systems and an affiliate of Holyoke Medical Center, has broadened its reach in other ways as well, such as with a day treatment program launched in Chicopee a few years ago.

“That’s for more chronically mentally ill clients, providing services during the work week with the goal of helping them become more independent and less dependent on such a structured program, so maybe they can get a job or start volunteering someplace and move on. People stay there anywhere from a couple months to a couple years, depending on their level of need.”

The practice also offers an HIV/AIDS support and treatment program, headquartered in Springfield, which provides assessment and referral services, case management, support groups, housing services, and other resources.

Considering all the ways River Valley strives to bring services to clients where they are, Ansel said, the partnership with Genoa, aimed at making medication compliance much easier, just makes sense.

“Everything is customer-friendly,” she said, right down to the bubble packaging Genoa uses to sort and clearly label medications by the dose and time.

“They really have a good, positive energy about their work,” she added. “They do things like send thank-you notes to all patients, hand-signed by the technician and pharmacist. Clients very much appreciate that personal touch. I just love this company.”

Joseph Bednar can be reached at [email protected]

Health Care Sections

The Best of Both Worlds

Dr. Lindsey Rockwell, left,

Dr. Lindsey Rockwell, left,  says the Mass General Cancer Center at Cooley Dickinson Hospital offers patients and their families the best of both worlds.

Opened almost two years ago, the Mass General Cancer Center at Cooley Dickinson Hospital is a stunning example of collaboration in motion, if you will.  The center brings a host of services together under one roof, but it also brings the vast resources of Mass General to CDH and the people it serves. The collaboration that created and designed the center is rock solid, but it also continues to evolve and add new layers to a unique partnership.

Dr. Lindsey Rockwell calls it “the gift that keeps on giving.”

As she spoke those words, she acknowledged that they form a somewhat old, well-worn cliché used, to one degree of effectiveness or another, in a wide array of forums.

But when it comes to the Mass General Cancer Center at Cooley Dickinson Hospital, it works, said Rockwell, a medical oncologist and hermatologist now affiliated with the center.

She told BusinessWest that when the center was conceptualized several years ago, it was envisioned as a facility where a host of specialists and services would come together under one roof, bringing higher levels of convenience and lower levels of stress to both patients and their families.

It was also blueprinted to become a truly unique asset for the region, one that would essentially make the vast resources of Massachusetts General Hospital and its oncologists available to individuals in this region — often without them having to travel to Boston.

And the center has become all of that and much more, said Rockwell as she talked about the facility nearly two years after it officially opened its doors. This is what she meant by that ‘gift that keeps on giving’ comment, before elaborating and reshaping her thoughts.

“Part of the beauty of this relationship is the idea of creating a new paradigm in oncology care where the patient can have their care in their backyard, with a world-renowned academic and research hospital at their fingertips when and if they need it,” she said. “And as a community oncologist, I believe this allows the patient to have the best of both worlds.

“They can have the intimacy and ease of a community hospital,” she went on. “And they can have access to the experts that are writing the data and doing the research in the field of their disease. They can get that here and not have to drive to Boston every week.”

 Dr. Lindsey Rockwell

Dr. Lindsey Rockwell

As she talked about the $5 million, 16,400-square-foot facility center and its first few years of operation, Rockwell came back repeatedly to that subject of stress — an all-important matters wen it comes to diagnosing and treating cancer — and how those at the center work collaboratively and effectively to reduce it.

“The patient doesn’t have to go see ‘A,’ ‘B,’ and ‘C’ — ‘A,’ ‘B,’ and ‘C’ come to the patient,” she went on. “And I think part of what that allows is for less stress. If the patient has a new cancer diagnosis, which obviously a terribly stressful time for them … by creating a system that works toward them, the intention is to alleviate the stress, their stress, and organize around them.”

For this issue and its focus on cancer care, BusinessWest talked at length with Rockwell about the center, the collaboration that created it and continues to fuel it, and this system designed to work for the patient.

Center of Attention

Rockwell said the seeds for the cancer center were planted perhaps as early as 2009, when a dialogue was generated with specialists at Mass General about what such a facility could and should look like — and how it would operate.

She called these the “courting stages.”

“Our go-to consultations to experts became our colleagues at Mass General,” she explained. “I think they had us on their radar for consideration for a satellite facility, and we had them on our radar for a replacement for Dartmouth Hitchcock (the former parent company for Cooley Dickinson Hospital).

“The oncology program was really the pilot program to establish a rapport with our colleagues in Boston,” she went on. “And it went really well.”

Elaborating, she said those both side of this pilot program developed a very fluid process of discussing patients, getting patients to Boston if they needed to be seen in Boston, and opening up a fast-track discussion of appropriate clinical trials.

“That groundwork was set over several years, and it led to the formal dialogue that created the actual affiliation,” she explained, adding that all this what not what she would call a natural process, but rather a “natural evolution” of a relationship or collaboration.

“It was like … ‘OK, we like you, and you like us, this is working — let’s do it,” she told BusinessWest. “‘And let’s broaden it and deepen it, and make it more specific, and define it — and agree to agree and create a relationship.”

And this process of evolution has continued, meaning it certainly didn’t end when the cancer center opened its doors in the fall of 2015, she said.

As an example, she cited a growing platform of videoconferences staged at the center and involving colleagues at Mass General.  There are now three of them; one is a weekly breast cancer conference, another is focused on multiple myloma and takes place roughly every other month with the goal of eventually becoming monthly, and the third is a broader tumor conference staged monthly.

These conferences provide unique opportunities for both the oncologists based at Cooley Dickinson and their patients, Rockwell explained.

“It’s an informal way of getting a second opinion with more complicated cases, she said, adding that this is just one of many ways of bringing everything that Mass General offers to patients in this region, and just one example of ongoing evolution.

Radiation therapists treat a patient in the Mass General Cancer Center at Cooley Dockinson Hospital.

Radiation therapists treat a patient in the Mass General Cancer Center at Cooley Dockinson Hospital.

As for the center itself, Rockwell said its creation, specific design elements, and roster of services was, in itself, an exercise in collaboration.

“We met regularly — every month as the go-live time got closer — and discussed things as a group,” she explained. “That means everything from operations — where should the exam rooms go? And the infusion suite? Where is the waiting room? What is the flow process, from a patient coming in the door to the exam room to the infusion suite? Needless to say, that was an extraordinary amount of collaboration, and our colleagues were an intimate part of those decisions.

“And what’s interesting is that, while they were an intimate part of those decisions, they want us as a community hospital to have our own voice and have our own autonomy,” she went on. “And this is a big part of why I think this works — knowing that we have them in our back pocket if we want advice or counseling on a certain issue.”

Beyond access to the resources at Mass General, convenience is at the heart of the center’s creation and design, said Rockwell, adding that cancer care is now centralized at the facility.

“They have their labs done in one place, see their oncologist at that same place, and also have their scans done and their chemotherapy at the same place,” she explained, adding that radiation is one flight below the cancer center, and a new, multi-disciplinary breast clinic now in the planning stages will just one hallway away.

And this brings her back again to that broad mission of alleviating stress — for patients, obviously, but also for physicians as well, because of the ‘one roof’ nature of this facility and the manner in which it improves communication between members of a patients’ team.

“All the doctors are talking to each other in real time,” she explained. “That alleviates a lot of stress on the physicians, because having each other right there cuts back on phone calls and not being able to reach people; we get to sit down and have the conversations, and come to an agreement on the patient’s plan as a team.”

Coming Together

As she talked about life before the center was created and contrasted it with operations now, Rockwell said that before, things were ‘separate’ — a word she eventually preferred over ‘fragmented,’ although she used them both —and now they are integrated.

And the change is significant for all parties involved — specialists delivering care, their patients, and the patients’ families — because integrated translates directly into “more patient centered,” she explained, which is the quality that those who orchestrated this collaboration and the cancer center itself had in mind when they did so.

“Because we’re all under one roof, the plan for the patient’s care is driven by the patient, the diagnosis, and the team taking care of them.”

This is what she meant by the center being a gift that keeps on giving — a development will continue, just as the center and the collaboration behind it continue to evolve.

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