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‘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

Progress Report

Questions answered by Dr. Holly Mason

Dr. Holly Mason

Dr. Holly Mason

Q: My mother has been after me to go for a mammogram. When should screenings start if one is to detect breast cancer early?

A: There is no simple answer to that question. The benefits of screening are greatest for those women who are most likely to develop breast cancer and for whom early treatment is more effective in treating the disease.

There is a lack of consensus among the leading healthcare organizations as to when to begin screening for the average risk patient. What is recommended today is that women have an honest discussion with their physician about when their screening should begin. Your physician will make a recommendation for you based on your risk factors, including any family or personal history.

After talking with your doctor about screening, you can make an appointment by filling out a form at baystatehealth.org/getscreened or calling (413) 794-2222.

Q: What is the difference between conventional mammography and the newer 3D mammography now being offered?

A: While 2D mammograms take images only from the front and side, 3D mammograms, which we offer, take multiple images or ‘slices’ of the breast from many different angles to create a three-dimensional picture of the breast. The ‘slices’ can reduce images with overlapping breast tissue and give doctors a clearer image of the breast tissue.

Using 3D mammography can make it easier for doctors to catch breast cancer early and reduce the chances of false positive results. However, not all insurance plans cover 3D mammography.

Q. My mother told me she had a breast MRI. What are the advantages of breast MRI as opposed to mammography?

A: First and foremost, a breast MRI is used to supplement, but never to replace a mammogram for screening of the breast. Breast MRI (magnetic resonance imaging) is another way to look at breast tissue. It requires a dose of a dye called gadolinium. A screening MRI may be indicated, in addition to mammography, if you are at increased risk for breast cancer.

At Baystate Health, we follow the American Cancer Society’s (ACS) recommendations for screening MRI for breast cancer, which include a known gene mutation placing you at greater risk to breast cancer, such as the BRCA mutation, previous history of chest radiation, such as for Hodgkin’s lymphoma, or a family history of breast cancer that places you at a greater than 20-25% lifetime risk for breast cancer. You can learn more at the ACS website www.cancer.org.

Q: How great a risk do women face if they have a family history of breast cancer?

A: It depends on how many family members had breast cancer, their age at diagnosis, and the degree of relation to the women who had cancer. There are many other cancers which may be related to breast cancer within a family, such as gastric cancer, pancreatic cancer, colon cancer and prostate cancer, to name a few. A careful family cancer history is important to determine if there might be a genetic component to your risk of developing breast cancer.

At Baystate, we offer our Family Cancer Risk Program for patients who may be candidates for genetic testing due to a family history of breast and other types of cancer. For more information on this program, call (413) 794-8890.

Q: What choices does a woman with a BRCA gene mutation have?

A: There are two main approaches: heightened surveillance or risk-reducing mastectomy, but this is a personal decision. Women who are planning to start a family or have additional children have the option for increased screening by alternating an MRI and mammography every six months to check for cancer. I do not know how old you are or if you have the BRCA gene, but for younger women still in their 20s, the recommendation is for a baseline annual MRI starting at age 25 and beginning mammography at age 30. This option must also include a clinical breast exam twice a year in combination with monthly breast self-exams.

Q: What are the signs and symptoms of breast cancer?

A: Symptoms which indicate a need for evaluation by a doctor include: A new lump in the breast or underarm, irritation or dimpling of breast skin, redness or flat skin in the nipple area of the breast, pulling in of the nipple, nipple discharge other than breast milk that is spontaneous (not occurring with self-examination), including blood, and any change in the size or the shape of your breast or pain in any area of your breast.

Given the fact that screening mammography often detects a cancer when it is very small, most women do not have any symptoms at the time of their cancer diagnosis.

Q: Can you tell me about any new treatment options for women?

A: Breast cancer treatment has changed quite dramatically since 1990 because of early detection, as well as better treatment and a better understanding of the nature and behavior of breast cancer. Most importantly, treatment should be tailored on an individual basis depending on the tumor and the patient in collaboration with the breast cancer team.

In terms of surgery, mastectomy was once the norm. We are now able to preserve the breast and perform a lumpectomy in most patients who prefer this choice. In women who have a cancer that is too large to allow for a lumpectomy with a reasonably satisfactory cosmetic result, medical therapy with chemotherapy or anti-hormone therapy can be given before surgery to shrink the tumor.

In the late 1990s, a procedure called the sentinel node biopsy was developed, where dyes can be injected into the breast to determine which lymph nodes are the first that the breast drains into. If cancer is going to spread outside the breast, it will go to these lymph nodes first. If the sentinel node(s) is negative for cancer, then there has not been any spread to any of the lymph nodes. By limiting the number of lymph nodes that are removed, the risk of swelling of the arm, referred to as lymphedema, can be minimized.

In women over the age of 70 who have a slow growing type of cancer, a lumpectomy may be able to be performed without post-lumpectomy radiation, as long as the patient is willing to take anti-hormone therapy. In addition, some patients may not need to have any lymph nodes removed. These decisions, however, need to occur in discussion with your surgeon, medical oncologist, and radiation oncologist to ensure that the risk of recurrence is low enough to avoid these treatments.

Medical therapy has also improved with the development of different anti-hormone medications to treat breast cancer, as well as different chemotherapy regimens which are better tolerated and more effective. One of the biggest developments is the use of molecular, or gene profiling, of the tumor, which can help in the decision of whether or not chemotherapy will give a benefit above what benefit is seen with anti-hormone therapy, which can then be weighed against the risks of chemotherapy.

Dr. Holly Mason is section chief for Breast Surgery at Baystate Medical Center.

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]

Health Care Sections

Problematic Projections

opioiddpartEven with media and government now intently aware of the opioid crisis, a recent report still projects that 500,000 people may die from these drugs over the next decade. But the groundwork is being laid, through multi-pronged strategies, to stem the tide of overdoses and deaths. It’s a tall order, those in healthcare say, but they’re hopeful.

The projections are, well, to use a term from this realm in healthcare, quite sobering.

Indeed, a report issued by STAT, a national publication focused on healthcare, medicine, and scientific discovery, noted that a team of experts forecasts that the opioid crisis in this country will get worse before it gets better, and that 500,000 people could die from opioids over the next decade.

Dr. Peter Friedmann

Dr. Peter Friedmann says the culture around opioid use and abuse must change if real progress is to be achieved.

And, unfortunately, that’s not the worst-case scenario.

Those same experts project that the toll could spike to 650,000 over the next decade if potent synthetic opioids like fentanyl and carfentanil continue to spread rapidly and the waits for treatment continue to stretch weeks in hard-hit states.

Most of the forecasts produced by STAT predict the annual death toll will increase by at least 35% between 2015 and 2027. Under the gravest scenarios, it could triple — to more than 93,000 deaths per year.

The report’s alarming projections prompted BusinessWest to reach out to some of those in this region working to stem this tide for input about what will ultimately drive the numbers over the next decade, and what path this crisis will take — toward improvement, or, as those experts quoted in the STAT report suggest, toward even more grave statistics.

There was general agreement that, while there have been some forms of progress with regard to this crisis — in arenas ranging from awareness to treatment — far more profound change will have to come to keep those dire projections from becoming reality. And this change must come in many forms, they said — from reducing the stigma attached to this disease and the proven methods of treating it to curbing the number of opioids prescribed; from allocating far more resources to the fight to compelling more individuals and constituencies to take ownership of the problem.

“The real issue, from my perspective, is that the culture around this disease has been very slow to change,” said Dr. Peter Friedmann, chief research officer and endowed chair for clinical research at Baystate Health, an addiction researcher funded by the National Institute on Drug Abuse, and an addiction-medicine clinician. “There are a lot of people who still view this as a disease that you’re going to cure — you can put someone in the detox for a week or a few weeks, and then you put them in an outpatient program with no medication or anything, and they’ll come, and they’ll be cured.”

Realization that medication-free treatment, or ‘drug-free’ treatment, is not going to stem the tide of overdoses and is, in fact, harming individuals by reducing their tolerance to the drug and leaving them more susceptible to overdose is only one of the factors that go into this needed culture change, said Friedmann, adding that, overall, there is preoccupation (among legislators and others) with creating more ‘beds’ and detoxification, when the focus should be on proven forms of treatment.

Dr. Robert Roose

Dr. Robert Roose says individual states and regions have opportunities to fare better than the projections nationally for opioid deaths.

These include methadone, buprenorphine, and naltrexone, he said, adding that there is also a real stigma about these treatments, which ultimately limits access to them.

But amid all the dire projections, there is some room for optimism, said Dr. Robert Roose, vice president of Behavioral Health for Mercy Medical Center and its affiliates. He noted that the STAT report and others like it are national in scope, and that individual states and regions have opportunities to create their own, more impressive patterns for opioid-related deaths.

And he believes that both Massachusetts and Hampden County could be ahead of the curve in some areas, including opioid prescriptions. He cited statistics showing improvement in total Schedule II prescriptions and individuals receiving prescriptions, both statewide and in Hampden County, thanks in large part to the Massachusetts Prescription Awareness Tool (MassPAT).

decreased-number-of-schedule-ii-opioid-prescriptions

“The hope that I have is that, with some of the strategies that have been implemented in Massachusetts and other states, while we have certainly been hard-hit, we are laying some groundwork to stem the tide and reduce the rate of increase in overdoses in the short term, and in the long term, reduce the rate of overdose deaths,” he said.

Katherine Cook, vice president of Adult Mental Health and Substance Abuse at the Center for Human Development (CHD), agreed, but added that, to achieve progress and a better-case scenario moving forward, cultural changes must take place on many levels, starting with prescription practices and the basic approach to treating illnesses.

“We’re a culture where, for the common cold, for which there is no cure, you can walk into in any drugstore, and there are aisles of remedies,” she said. “That’s how we’re taught to care for ourselves, with a medication.”

There are many components to this opioid fight, said those we spoke with, but overall, the goals are to keep more people from becoming addicted, to treat them properly when they do become addicted, and to provide them with all the tools and resources needed to remain sober.

And these are all very tall orders.

Overall, the experts we spoke with said this country knows what works when it comes to this crisis — everything from stemming the flow of super-deadly synthetic opioids to getting more people access to medications that can reduce cravings — it just needs to do much more of it.

Dose of Reality

As he talked about the opioid crisis and the many projections about what could and probably will be in the decade to come, Friedmann drew many striking comparisons to another crisis that unfolded nearly 40 years ago.

This was the HIV/AIDS epidemic, he told BusinessWest, adding that, during that crisis, as with this one, people were dying, there was a strong stigma attached to the disease (and a reluctance to call it a disease), fear, no shortage of projections about how many people would die in the years to come, and a general reluctance on the part of many parties to take responsibility for what was going on.

“There was a lot of unwillingness on the part of many doctors to deal with those patients,” he said of the HIV/AIDS crisis. “And the notion that it was a disease really only took hold when they identified the retrovirus.”

There is no retrovirus with the opioid crisis, he went on, adding that the stigma attached to this problem persists, and it is only one of the many hurdles to turning the proverbial corner with this epidemic.

Katherine Cook

Katherine Cook says one of the keys to achieving progress with the opioid crisis is removing stigmas and the ‘us and them’ philosophy.

But it is a huge hurdle, said Cook.

“We have come a long way, but there’s still judgment and a devaluing of people, and that’s not just in the U.S.,” she noted. “With substance use, it becomes a moral judgment that people impose on others; we need to show that this isn’t an ‘us and them’ situation — we’re all human.”

Like all those we spoke with, Cook said there are a number of factors that will ultimately determine just which trajectory the graphs charting opioid-related deaths will take in the years to come. These include prevention and treatment efforts, obviously, but also issues such as access to healthcare, employment opportunities, and safe, affordable housing.

“It’s not just mental health and substance abuse,” she told BusinessWest. “It’s all of the social indicators of health, and if we don’t look at that, we’re not going to be able to make a difference.

“And it’s not just treatment beds,” she went on, adding, again that more of those certainly are needed. “It’s also recovery homes, what we used to call ‘halfway houses,’ or ‘three-quarter-way houses’ — ongoing support, and the ability for the community to care compassionately about individuals who are struggling with addiction and making sure those resources are there so people can be successful after treatment or recovery. The ability to maintain recovery will ultimately determine if we see a change and maybe the best-case scenario.”

Rose Evans, vice president of Operations in the Substance Use Division for Springfield-based Behavioral Health Network (BHN), agreed. She arrived at the agency only a few months ago after spending the previous four years working for the Patrick and Baker administrations to address individual and family homelessness.

Rose Evans

Rose Evans says one key to addressing the opioid crisis is removing the silos around programs involved with prevention, treatment, and recovery.

In that role, she saw some of the enormous toll taken by opioid addiction and the many elements to the state’s opioid crisis.

She said BHN has developed a broad portfolio of substance-use programs over the years, including everything from prevention initiatives in area schools to acute treatment services to outpatient recovery programs. In recent years, it has worked diligently to remove silos and integrate such services. And in many ways, she noted, this is what must happen across the broad spectrum of opioid-use prevention and treatment.

“We’ve been mindful of the impacts that substance use and abuse can have on people and not treating it separately from significant mental-health issues,” she explained. “We’re looking at the social determinants in one’s life and treating it in a comprehensive, multi-disciplinary way.

“What we saw in my previous employment was the intersection of opioid use and homelessness,” she went on. “We understand that there’s a relationship and a correlation between one’s use of substances and the impact it can have on employment, education, housing, family life, relationships, and much more.”

Prescription for Progress

Overall, Roose believes the rate of increase in overdose deaths has at least begun to slow in Massachusetts, a dose of positive news he points to as evidence that individual states and regions can defy the most dire projections. And such deaths, while not the only statistic to chart when it comes to this crisis, is easily the most poignant.

“There’s no question that this is about saving people’s lives,” he explained. “And if we can reduce early death related to this disease, we should be doing everything we can to achieve that.”

Friedmann agreed, but noted that opioid-related deaths are, in every respect, like the tip of an iceberg. They are what can be seen, and they are the focus of the front-page newspaper headlines, but there is so much more lying beneath the surface.

Indeed, there are other important elements and forms of data that must be considered when it comes to the broad efforts to stem the powerful opioid tide, he said, and these include the number of people who struggle with opioid-use disorder or addiction and who don’t have access to treatment, as well as the outcomes from treatment.

The healthcare community currently lacks sufficient data in such areas, Friedmann said, adding that better numbers could help in the formation of specific strategies for dealing with the crisis moving forward.

One statistic that he can track is the number of beds, which has increased significantly over the past several years, both statewide and in this region. And the beds have come in several varieties, he noted, including those related to inpatient psychiatric care, detox care, and in-patient stabilization and longer-term transitional support.

“That is definitely providing more access to people who did not have access before,” he said of the increase in beds. “It doesn’t mean that we’ve caught up to the demand by any means, or that there aren’t other areas of the system that need to be increased, but there has definitely been a significant investment on the part of the state to provide more access to care.”

But access is still an issue — waiting lists prevail in this state, and they are considerably longer in harder-hit states such as West Virginia and New Hampshire — as is the matter of providing the right kind of care.

Friedmann said he is currently writing a paper on the broad subject of ‘beds’ in relation to the opioid crisis. The thesis, he told BusinessWest, is that the detoxification system for opioids should be re-engineered, as he put it, with creation of a “system of induction centers,” rather than a system of detoxification centers.

We need to remove from our bodies what we can by way of detox. But then, to send someone back out into the same pasture to eat the same grass is not going to do that individual any good. We need to be able to look at the person holistically to see what they need, and if medication-assisted treatment is what’s going to help them develop the skills to manage in the world and in the environment where they’ve been using, then that’s going to be a lifeline for them.”

“What we should be doing is getting people to get on medication and stay on medication,” he explained, adding, again, that detoxification generally leaves individuals more susceptible to overdose if they relapse, and a huge percentage of such patients eventually do.

Cook agreed. “We need to remove from our bodies what we can by way of detox,” she said. “But then, to send someone back out into the same pasture to eat the same grass is not going to do that individual any good. We need to be able to look at the person holistically to see what they need, and if medication-assisted treatment is what’s going to help them develop the skills to manage in the world and in the environment where they’ve been using, then that’s going to be a lifeline for them.

There are, of course, many other ingredients in a broad formula for progress and creating greener pastures, if you will, said those we spoke with.

They include prevention, safe prescribing, more effective recognition of individuals’ opioid problems, taking immediate steps to curb the availability of fentanyl and carfentanil, and also the development of a qualified workforce to care for those with opioid issues.

The sheer number of hurdles and the complexity of each one combine to create an enormous challenge and, indirectly, those dire predictions moving forward.

“There are so many moving parts when it comes to this disease, and that’s what I find so fascinating about it,” said Friedmann. “And we have to address all of them simultaneously.”

Moving the Needle

Summing up matters succinctly and poignantly, Cook said that, to stem the tide of opioid use and abuse, “we have to keep working hard every day.”

And keep working on a number of fronts all at once, she went on, speaking for all those we interviewed, because there are many layers to this crisis. Only by slicing through all those layers, experts say, can this region and the nation keep the worst-case scenarios from becoming reality.

Friedmann might have said it best when he told BusinessWest, “this is a crisis people talk about, and increasingly we’re seeing some action, but it can’t really come fast enough.”

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

Health Care Sections

A Home for the Dying Finds Life

Ruth Willemain

Ruth Willemain says her decade-long mission to open Harmony House has been a “journey,” during which she’s learned many lessons and met countless wonderful people.

Almost since the day she retired from teaching, Ruth Willemain has been providing hospice care as a volunteer.

And almost from the day she started that second career, she began thinking about ways to provide more and better care to those who don’t have what would be considered a traditional support system as they contend with daunting end-of-life issues and emotions.

It was a poignant, heartfelt plea from one of those who came into her care that, in many respects, turned thought into truly inspirational action.

“This woman said, ‘Ruth, would you please come to my funeral — I don’t want to be alone in the church,’” Willemain recalled, adding that as she pledged to honor that request she understood even more fully that much more was needed for such people than her presence at that service.

So began a decade-long adventure, if you will, that has tested her in more ways than she could have imagined, but also left her fulfilled in ways that few could likely understand.

“It’s been a journey,” said Willemain, using that word for the first of many times. “It’s been 10 long years — I’ve learned many lessons along the way and met many wonderful people.”

This journey is the story of Harmony House, and while getting to here — meaning the grand opening of this unique home — is a great accomplishment in itself, this is really just the first chapter.

Indeed, the small, nondescript, three-bedroom ranch home on Pendleton Avenue in Chicopee is intended to be only a temporary home for Harmony House, with a much larger, six-bedroom dwelling a few miles away eyed as a better, more permanent solution. Meanwhile, opening the home is only the first of many tests; there will be a constant need for volunteers, meals, supplies, and, of course, funding.

But more on all that later.

That ranch house is almost indistinguishable from the dozens of others like it on this quiet street off Memorial Drive — until one ventures inside.

Even then, aside from scattered medical equipment, it looks like a typical home — which is exactly the point. In fact, when this writer referred to it as a ‘facility,’ Willemain recoiled and delivered a rather direct lesson in healthcare terminology — at least her take on it.

“This isn’t a facility — it’s a home,” she said, meaning a home for people who don’t have a home or don’t have anyone who can care for them in their home.

To be more specific, this is what’s known as a ‘social-model hospice home,’ the first in Massachusetts and probably the first in New England. As that name implies, sort of, this is a home essentially operated and funded by the community and staffed entirely by volunteers.

When I walked into that home, I felt like love was in the air — it was something I had never experienced before. Everything told me, ‘this is what you’re supposed to do.’”

Willemain first experienced such a home when she traveled to Cleveland, Ohio years ago for her sister’s birthday, and was asked to pay a visit to an individual in hospice care.

“When I walked into that home, I felt like love was in the air — it was something I had never experienced before,” she explained, adding that it became her mission in life to bring that same feeling to Western Mass.

“Everything told me, ‘this is what you’re supposed to do,’” she said.

As she talked with BusinessWest a few weeks back, Willemain was excitedly looking forward to June 20. This was the day the ceremonial ribbon was to be cut at Harmony House. The mayor had pledged to be there, and so had many area news outlets. There would be a few speeches, and many opportunities to thank what grew into an army of contributors and volunteers that made it all possible. It was to be an important day, to be sure.

But not as important, she noted, as June 26, when the first resident — a woman who had long been on dialysis and decided to end those life-prolonging treatments — would arrive on Pendleton Avenue.

“This is why we’re here — this is what we worked for more than a decade to create,” she noted. “It’s a dream come true.”

For this issue, BusinessWest visited Harmony House and its creator to find out how it came to be, and how there are many chapters still to be written in this remarkable story.

A Dying Wish

As she posed for a few pictures for BusinessWest, Willemain, ever the marketer and fund-raiser as well as the visionary and care provider, quickly added a layer to her outfit — a Harmony House T-shirt, complete with the nonprofit’s very carefully chosen logo.

This would be the trillium flower, and the explanation behind its choice as a symbol for this endeavor goes a long way toward shedding needed light on the home’s mission and how it will go about carrying it out.

Indeed, the three purple petals on the trillium flower represent the three areas of support provided by Harmony House — physical, emotional, and spiritual. And the three sepals represent the three groups of people who will supply that support — hospice teams, support staff, and volunteers.

But to fully explain Harmony House and all that went into its creation, one needs to go well beyond the logo.

For that, we need to turn the clock back to 1999, when Willemain was wrapping up a 45-year career in teaching — one that included stops in New York, Connecticut, and Michigan — at Tatham Elementary School in West Springfield.

“I knew that after teaching I wanted to do something to serve others,” she told BusinessWest, adding that ‘something’ became hospice care, a unique form of healthcare devoted to those who are terminally ill. “I did the training, became a hospice volunteer, and have never been without a patient since.”

As noted earlier, Willemain provided such care for years before embarking on her mission to meet what she saw as an emerging need within this region: to serve those who are — in most ways or all ways — alone as they confront the end of their life.

And there are more individuals in this category than most would think, she said, adding that she knows this from her 16 years of experience as a hospice volunteer.

“Many of the people I cared for didn’t have company,” she noted. “They would say, ‘Ruth, if you didn’t come visit me, I wouldn’t have any company at all.’”

She said this was the case both for people in their homes — if their spouse or other caregiver wasn’t able to care for them — and those in nursing homes.

“For those placed in nursing homes, they were always in a room with a roommate,” she went on. “And there were many times when the roommate would say, ‘no one ever comes to visit me … would you visit me as well?’”

Over the years, Willemain would spend five, six, and sometimes seven days a week visiting those who didn’t have anyone else to visit them. It was immensely rewarding work — “most were just so happy that you found some time to give them some joy” — but also somewhat frustrating.

And such experiences, and especially that woman’s plea to attend her funeral, led Willemain to begin creating that vision for a home that such people could come to.

“This is what broke my heart — I left the nursing home with tears rolling down my cheeks,” she said of that dying woman’s request. “I said, ‘God, we’ve got to do something.’”

As she began her mission to create a home for those in need of such services, Willemain recalls that there were many doubters, those who thought her vision was laudable but the goal was out of reach.

nondescript house on Pendleton Avenue in Chicopee

This nondescript house on Pendleton Avenue in Chicopee is not a ‘facility,’ Ruth Willemain insisted, but a home — and all that term implies.

She listened, but preferred to focus on those who said this would no doubt be challenging, but certainly doable. And they were right.

She started raising money through sales of candy bars and other means, and along the way gathered both supporters and momentum for the social-model hospice home, a concept that certainly needed to be explained because of its uniqueness, even if it isn’t exactly a new concept.

Indeed, as Dr. Karen Wyatt, author of What Really Matters: 7 Lessons for Living from the Stories of the Dying, explains in a recent blog post advocating for this model, it can trace its roots to the AIDS epidemic of the ’80s.

“The first social hospices were created to house AIDS patients as they were nearing end of life and in desperate need of terminal care,” she wrote. “Many of these were literally private residences with multiple bedrooms where a number of patients could be cared for and comforted through the dying process.”

Upon reviewing the current landscape and future issues surrounding end-of-life care, Wyatt noted that the social-model hospice homes may offer solutions to many of the problems she believes lie ahead. They include:

• A shortage of family caregivers: Wyatt noted a study referenced by the AARP Public Policy Institute predicting there will be a severe shortage of family caregivers as the Baby Boom generation ages and faces end of life. While there are currently seven potential caregivers for every patient, the study noted, this ratio is expected to drop to 3 to 1 by 2050.

• A shortage of paid caregivers: Wyatt cited a study published in Health Affairs indicating that at least 2.5 million more long-term-care workers will be needed to look after older Americans by 2030. Social-model hospice homes, she noted, are offering certified training with continuing-education credit for professional caregivers for the terminally ill. These programs will increase the number of workers available to meet the long-term needs of society.

• Need for family respite: Wyatt noted that the Institute of Medicine’s 2014 report “Dying in America” points to a current need for respite and support for family caregivers to help avoid burnout and resulting emergency hospitalizations.

• Cultural barriers to hospice care: Wyatt referenced comments from Dr. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, who stated in a published interview that cultural barriers to hospice care needed to be addressed in the future. These barriers include a lack of cultural diversity in hospice staffs, mistrust of the healthcare system, and worry about insurance coverage and cost of care. The social-model hospice home has the potential to overcome some of these barriers by utilizing volunteers and caregivers from the patient’s own cultural group and neighborhood by functioning largely outside the healthcare system.

• A reduction in Medicare payments for hospice and home care: That Institute of Medicine report mentioned above also indicates that hospice payments from Medicare will be reduced by 11.8% over the next decade, which will likely create financial stress for smaller hospices and lead to decreased access to care.

At Home with the Idea

While Wyatt uses the future tense as she makes her case for the social-model hospice home, Willemain notes that some of these issues are already manifesting themselves.

And in that respect, Harmony House is somewhat ahead of its time, she noted, adding that the home itself, and the model of care to be delivered, have both been designed to maintain a peaceful atmosphere of respect and compassion that honor the dignity of each resident.

This is the essence of hospice care, she went on, adding that this is in many ways an acquired skill, one that involves thoroughly understanding the individual and what they want and need as they confront the end of their life.

“We just want to do whatever they would like us to do for them,” she explained. “For some, it’s simply holding their hand; for others, it’s playing a game with them. It all depends on the individual and what stage they’re at in their lives.”

This is what Willemain wanted to bring to Harmony House, and after years of moving the process forward, she was close to realizing the dream in a large home on View Street in Chicopee. But several legal issues arose concerning that property, which was in foreclosure, she noted, adding that a local family donated the vacant house on Pendleton Avenue to enable Harmony House to open its doors.

That home needed a large amount of work to meet its new purpose, and it received help from a large group of individuals and businesses that handled everything from new wiring to landscaping to the building of a wheelchair ramp.

As Harmony House opens its doors, it is providing what amounts to a home and a surrogate family in the form of trained staff and volunteers who will provide care around the clock.

The home is intended for individuals diagnosed with a terminal illness who have a maximum of three months to live and are under the care of a hospice services provider, which will administer those services at Harmony House instead of a nursing home or other facility.

Care will be delivered by licensed nursing caregivers, food-service personnel, and administrative assistants, but the hallmark of the home will be that around-the-clock volunteer  service.

Each volunteer will work one eight-hour shift a month, meaning there will be a need for more than 90 such individuals, said Willemain, adding that assembling this team of volunteers has been just one of many challenges facing organizers, and the work continues.

It takes many forms, everything from the training of volunteers to recruiting of individuals, families, and restaurateurs to cook meals, to raising the estimated $4,000 a month it will take to pay for a host of expenses, including insurance, utilities, snow plowing, and much more.

To meet these needs, administrators are turning to the community and inviting people to support the home in any way they can. A full wish list of needed items — everything from personal-care items to a small TV for one of the bedrooms — is on the home’s website, for example.

In addition, a meal-a-month program has been launched. It invites churches, families, restaurants, and individuals to follow the lead of Jack Ng, owner of Gnow’s Place in Chicopee, and commit to providing a meal for four to six people each month.

Willemain said the response from the community has been overwhelming, but the need for help will be constant, and will, therefore, pose a stern challenge.

But the need for the Harmony House is real, she said, and she believes the community can and will support the home and its mission.

Final Thoughts

As she talked about Harmony House, the care to be provided there, and her own lengthy career as a hospice volunteer, Willemain said she was probably due for a refresher course in this blend of science, art, and especially compassion.

“So much has changed over the years, including HIPAA and everything else,” she said, adding that she made a point of making sure her training was up to date and up to speed.

What else would one expect from someone who first made hospice care a second career, then made it a passion, and then created and fulfilled a vision to take such care to a new, cutting-edge level?

A level, specifically, where individuals won’t be alone in the church after they die, or — more importantly — during those last few months before they die.

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

Health Care Sections

Some Straight Answers

By Kathleen Mellen

Dr. Linda Rigali shows off a model of traditional braces

Dr. Linda Rigali shows off a model of traditional braces, which have been replaced for many patients by newer, more cutting-edge models.

Dental care has come a long way in the past few decades, with high-tech equipment, less noticeable materials, and less intrusive procedures the order of the day. For proof, look no further than how the art and science of braces have evolved. In short, area dentists say, there’s never been a better time to straighten those teeth.

As long as there have been mouths to feed, there have been crooked teeth. And since ancient times, it seems, we’ve been trying to fix them.

As early as 400-300 BC, the Greek physician Hippocrates was looking for ways to align teeth, and there’s archeological evidence that ancient people sometimes wrapped metal bands around their teeth, presumably in an effort to straighten them. Apparently, even Cleopatra wore braces.

While no one knows for sure how effective those early efforts were, experts say the ancients were on the right track, applying sustained pressure to teeth in an effort to move them into a more favorable position.

It’s essentially the same thing we do today, albeit with much more elegant systems (and presumably less pain), through the practice of orthodontics, a dental specialty that deals with the diagnosis, prevention, and correction of teeth that are not properly aligned.

Modern-day orthodontics was born when, in 1728, French dentist Pierre Fauchard first used a device called a Bandeau, a horseshoe-shaped piece of iron that helped expand the palatal arch. By the mid-19th century, orthodontia was recognized as a science, and by 1901, orthodontists had their own scientific organization, the American Society of Orthodontics, which evolved in the 1930s to the American Assoc. of Orthodontists.

Early training was minimal. The first school of orthodontics, which opened in 1899, offered a three- to six-week course for dentists. Today, the training is extensive, and generally includes four years of undergraduate study, four years of graduate study at a dental school, and two years of post-graduate study in orthodontics.


You literally had to tie the teeth into the wires, and there was a lot more force involved. Today’s braces are tiny, and are bonded onto the teeth, rather than tied around them.”

Just as education has changed over the past century, so, too have materials and techniques, improving outcomes, as well as the patient experience — and much of that has occurred in just a generation or two.

Not Your Grandmother’s Braces

As braces gained popularity during the 20th century, dentists wrapped bands around each tooth and connected them by a wire, inserted into brackets, or braces, that were cemented to the teeth. Gold and silver were popular materials, although each had its drawbacks: gold was expensive and soft, requiring more frequent adjustments; silver was less expensive, but also less malleable.

Dr. Linda Rigali

Dr. Linda Rigali says braces can treat issues like overbites, underbites, crowding, excess spacing, and asymmetries.

Those materials were largely replaced by stainless steel in the early 1960s, but, even then, braces were bulky and uncomfortable, said Dr. Linda Rigali of Rigali & Walder Orthodontics in Northampton.

“You literally had to tie the teeth into the wires, and there was a lot more force involved,” Rigali said. “Today’s braces are tiny, and are bonded onto the teeth, rather than tied around them.”

Materials have improved further since Rigali opened her practice 31 years ago. “We use nickel-titanium, which holds its shape and gets more active with body temperature,” she said. “They very slowly express the forces over a period of time. It’s just as effective as the old ones, but definitely a lot more gentle,” and not as painful as some adults might remember from their own childhoods.

That might help account for the fact that more than 4 million people in the U.S. are undergoing orthodontic treatment, according to the American Assoc. of Orthodontists (AAO).

A century ago, most patients made their first trip to an orthodontist in their 20s, but today, the AAO recommends children see an orthodontist at about 7 years old, when the permanent teeth are emerging, to evaluate whether they will need braces and, in some cases, to do interceptive treatments that can change problematic growth patterns. Indications for treatment with braces are predominantly functional, Rigali says, and can include overbites, underbites, crowding, excess spacing and asymmetries.

Once a need for braces is established, a treatment plan will be devised. A first visit will include a thorough examination, close-up photographs, and X-rays, which have also changed for the better, Rigali says, since she joined the profession.

“Thirty-one years ago, we were hand-dipping X-rays in a dark room,” she said. “Now that’s all digital — we get it all on the computer.”

Among the more dramatic recent advances is the use of nearly invisible Invisalign braces, which are taking off in the industry; about 35% of Rigali’s patients now use the clear, flexible, lightweight plastic aligners that combine advanced 3-D computer-graphics technology with the 100-year-old science of orthodontics.


We do a three-dimensional scan, get a virtual model on the computer, then I can move the teeth, on the computer, through all the stages. Once I have the staging the way I want it, the company produces a series of clear plastic aligners. They’ve got a couple hundred bioengineers working on the process. This has changed things a lot.”

While the theory is much the same as traditional braces — that slow, steady pressure will move teeth — the material and the treatment plan are revolutionary, Rigali said.

“We do a three-dimensional scan, get a virtual model on the computer, then I can move the teeth, on the computer, through all the stages,” she told BusinessWest. “Once I have the staging the way I want it, the company produces a series of clear plastic aligners.” Each set is worn for two weeks, and then is switched out for the next, she added. “They’ve got a couple hundred bioengineers working on the process. This has changed things a lot.”

For example, the use of 3-D scanning technology has nearly eliminated the need for dental impressions, which require pressing a tray of gooey material into the top and bottom teeth.

“It’s the hottest thing now,” said Dr. Janice Yanni, owner of Yanni Family Orthodontics (YFO), who utilizes the ITero Element Scanner in each of her offices, in Longmeadow, West Springfield, and Tolland, Conn. “Our practice is going impressionless — so no more gagging on those impressions.”

Dr. Janice Yanni says she takes advantage of modern technology to make visits fun for patients.

Dr. Janice Yanni says she takes advantage of modern technology to make visits fun for patients.

The advent of the Invisalign braces in 1997 might well have contributed to the 40% rise in the number of adults who sought orthodontic treatment between 1996 and 2015, as reported in the Wall Street Journal. About 20% of Rigali and Yanni’s patients are adults, and many request Invisalign braces, which are used by about 30% of Yanni’s patients in total.

Form Follows Function

As the practice of orthodontics has changed, so, too, have orthodontists’ offices, says Craig Sweitzer, the owner of Craig Sweitzer & Co. General Contractors, who has built some 200 dental offices over his 34-year career.

“When we began, there was different equipment, different decorations — it was a whole different feel,” he said. “The equipment drives the design, and the stress nowadays is to keep things clean, uncluttered, and to hide the equipment. It’s become more friendly-looking.”

In Yanni’s Longmeadow office, for example, there are no visible hoses, lines, cables, or orthodontic tools, even in the treatment room, where, as is typical in orthodontists’ offices, multiple bays are set up in a single, large room for fittings and adjustments. Extra-bright ceiling lights have eliminated the need for the bulky workstation lamps that used to loom overhead, so patients can chat with family members or watch a movie on one of the large, flat-screen TVs mounted on the wall. (“The hot movie right now is Beauty and the Beast,” Yanni said.)

Sweitzer says he and his sons Michael and Brian, who have joined their father’s company, work closely with the doctors on office design.

“It’s nice to control the project, get a relationship with the doctor, from square one,” said Michael Sweitzer, who designed and built Yanni’s Longmeadow office. “It’s really cool, drawing it, then seeing it come to life.”

The company does collaborate with architects, as is required by law. “In Massachusetts, you have to have a registered architect to pull a building permit for a commercial project, anything over 35,000 cubic feet,” Craig Sweitzer said.

Having Fun

There’s more to keep up with these days than advances in the science and technology of orthodontics, and practices like Yanni’s and Rigali’s take advantage of interactive and social media to help make the experience a pleasant one for their tech-savvy young customers.

At Yanni’s Longmeadow office, for example, patients can use one of four iPods set up at a station in the waiting room, designed by Michael Sweitzer with input from an IT specialist.

In addition, YFO sponsors a number of online contests, including #YFOPromPosals, in which patients submit photos of themselves asking someone to the prom to the practice’s Instagram and Facebook pages. They earn points for likes and shares, and the winner receives up to $250 to cover the cost of hair, flowers, and transportation for the prom. (Incidentally, YFO can be found on Snapchat as well.)

Rigali & Walder also holds virtual contests, such as Where in the World is Rigali and Walder Orthodontics? and Hero Dad, which are designed to keep young patients entertained and engaged.

“You’ve got to make it fun,” Yanni said.

Much of today’s research in orthodontia focuses on the biology of tooth movement, and looking for ways to speed up the process. “Everybody wants it done faster,” Rigali said.

One new device, AcceleDent, appears to move things along. Used with traditional or Invisalign braces, the vibrating mouthpiece is worn for 20 minutes a day to stimulate bones, which leads to faster bone remodeling.

“There are studies that show it is speeding tooth movement up to 30% to 50%,” Rigali said. “Studies are still coming out, but we’ve seen some really great results with this.”

Another promising technique, Propel Orthodontics, uses micro-osteoperforations to accelerate tooth movement and bone regrowth.

“We make little perforations right through the gum tissue into the bone. That sets up a wound response that gets the bone metabolism to go faster,” Rigali told BusinessWest. “This has some very legitimate studies; it is based on really good, sound research.”

In spite of advancements that promise to hasten the process, Yanni cautions her patients that there are no quick fixes. She tells them to plan to commit to a two- or three-year period, and once those teeth are straight, a retainer will still be required to keep them from moving back.

“There is no instant gratification in the world of orthodontics,” she said. “You’re either in it, or you’re not.”

Health Care Sections

Nothing to Fear

Dr. Sue Keller (far right) with some of her staff at Strong & Healthy Smiles

Dr. Sue Keller (far right) with some of her staff at Strong & Healthy Smiles: from left, dental assistant Chettele Houle, dental hygienist Michelle Engstrom, and office administrator Cassie Roule.

Dr. Sue Keller jokes that she’s been interested in dentistry since she was 6, when she wasn’t able to eat cookies with loose teeth, so she figured out how to wiggle them and get them out as soon as possible.

But she does have other fond childhood memories of dentistry, like getting a cavity filled around age 9 and the floaty feeling from the nitrous oxide the dentist used. Or her blue-collar father working two jobs to make sure she and her brother could get braces to fix their crooked teeth and regain their confidence to smile. Both memories influenced the kind of practice she would one day run as Strong & Healthy Smiles in Florence.

“I hear about people having a bad experience at the dentist, but that doesn’t have to be the case. I had good experiences, and they can have good experiences, too.”

There’s a joy in taking someone who hasn’t been to the dentist in five or 10 years and helping them get back on track and healthy again, so they keep coming back for maintenance.”

During her residency at Hartford Hospital, Keller considered an orthodontic practice, but decided — after training in settings from preventive care to trauma situations, working on accident victims — to practice more generally.

In 1995, she opened her practice in Greenfield, moving to a larger space in Florence in 2007, and has brought with her some of the concepts forged during her formative years, from conscious-sedation dentistry to an innovative program to help people pay for care — in other words, ways to make visiting the dentist a positive experience, not a negative one.

“There’s a joy in taking someone who hasn’t been to the dentist in five or 10 years and helping them get back on track and healthy again,” she told BusinessWest, “so they keep coming back for maintenance.”

Root Causes

While dentists obviously know how to clean teeth, fill cavities, and install implants, Keller said she sees her role as helping people minimize those aspects of care by taking care of their oral health at home.

“We have a strong preventive-care program,” she told BusinessWest, adding that people often stay away from the dentist out of fear, which only compounds as their teeth deteriorate over the years. If she can get them in good shape and convince them to continue good habits at home, the fear goes away as the visits get easier and easier.

Dr. Sue Keller

Dr. Sue Keller says she wants to get to the bottom of why patients get cavities, not just treat them when they emerge.

To that end, she explained, “we test saliva six different ways and go through a very detailed evaluation of your habits at home, your diet, what you’re drinking, what teeth-cleaning products you’re using — and most of the time, we’re able to find out the likely reasons you’re getting cavities.”

Patients might receive special toothpastes, rinses, other tools, but more important, they get dietary and lifestyle advice to help them care for their teeth and prevent new cavities, she explained. “A good diet and good habits at home really keep people in good stead.”

Many dental habits ingrained in Americans for decades should be reconsidered, she went on. Take the common advice to brush twice a day, a message that emerged in advertisments from toothpaste makers in the 1950s. Since then, most people assume that means brushing upon waking up and going to bed, when the most critical times to brush are immediately after eating.

“Every time you eat, it puts carbohydrates in your mouth, which produce acids,” she explained, before relating a slightly gross metaphor she uses with kids. “I ask them if they wash their hands after they go to the bathroom to get the germs off. Well, when they eat, I say, they poop and pee in their mouth. That usually gets their attention.”

Rather than the wake-up and bedtime brushing regimen, Keller emphasizes brushing after every meal or snack. That’s usually no problem at breakfast and dinner, but people generally don’t feel like bringing a toothbrush to work, so she recommends after-lunch habits like Xylitol rinses and gums, or simply rinsing out the mouth with water. For people loath to floss, she recommends tools like GumChucks that make it easy to reach back into the mouth.

“Whatever someone’s problem is, I have a tool for them to try, as long as they’re willing to put in the effort,” she said. “I want to set you up for success. Maybe you can’t brush after every meal, every day, but if you can embrace the concept of cleaning your mouth after meals, and do it over the course of a lifetime, you’ll need very little dental care.”

When I meet someone with significant dental problems and can help them get their smile back, when they thought it was hopeless and nothing could be done, that makes me happy. We can always do something for someone. Sometimes we have to replace teeth, but usually we can just maintain their health.”

For people who do need more attention, Keller is one of the few offices in the region offering nitrous oxide gas and sedation pills and non-surgical treatment of gum disease with lasers.

“When I meet someone with significant dental problems and can help them get their smile back, when they thought it was hopeless and nothing could be done, that makes me happy,” she said. “We can always do something for someone. Sometimes we have to replace teeth, but usually we can just maintain their health.”

Keep Smiling

Of course, it’s not just fear that keeps people away from the dentist; cost is a factor as well. It’s a particular problem for those without dental insurance through their employers, who decide they don’t want to pay out of pocket for cleanings and other basic procedures, which can lead to long-term issues.

That’s where Keller’s Smile Shares program comes in. Inspired by the region’s farm-share programs where people pay farmers up front and reap a harvest all year, Smile Share members pre-pay a discounted rate at the start of the year for their preventive care and then can access other discounted services throughout the year as well.

“Normal, regular care is affordable and protects you from more expensive, emergency care down the line,” she told BusinessWest. And that’s the key — getting people who have avoided the dentist back to good health, and keeping them there.

“That’s really fun for me, to take someone with brown teeth and turn them into white teeth,” she said. “Then, it’s great when they come in for a regular maintenance visit, and they look great and don’t need much cleaning at all. That’s my ultimate success, when they keep up the good work on their own. There’s great satisfaction in keeping them motivated and on track.”

And smiling, of course.

Joseph Bednar can be reached at [email protected]

Health Care Sections

Holistic Approach

Dr. Lydia Lormand

Dr. Lydia Lormand says an annual gynecological exam plays an important role in a woman’s healthcare regimen.

Women’s health is almost as broad a category as healthcare itself, and the practitioners at Women’s Health Associates in Westfield understand this. Although they focus on obstetrics and gynecology, their holistic approach to patients considers their entire wellness profile, and helps them take steps to stay healthy in all facets of life.

By Kathleen Mitchell

Every day, Dr. Robert Wool spends time educating patients on disease prevention and how to stay healthy.

Although the founder of Women’s Health Associates in Westfield and his fellow practitioners focus on obstetrics and gynecology, their approach is holistic, and they teach patients what they need to know or do to avoid problems in the future.

“Women’s health doesn’t just mean a gynecological exam,” said Dr. Lydia Lormand. “It covers a wide range of topics that include birth control, hormones, post-menopausal management, and taking care of yourself.”

She noted that Pap smears are not needed annually, but yearly exams are important because they can uncover abnormalities such as cervical polyps or masses a woman may have that aren’t symptomatic.

Wool agreed, and said the practice takes a proactive stance toward health.

“Education can prevent so many things, including pregnancy,” he told BusinessWest, noting there have never been more options for contraception, yet 50% of pregnancies in the U.S. aren’t planned. Meanwhile, the incidence of conditions such as osteoporosis can be reduced by diet, exercise, and proper care.

“More than a third of women who break a hip after age 75 aren’t alive a year later,” he continued, adding that older women cherish their independence, which they often lose after a hip fracture.

Women’s Health Associates was founded in 1988, and today its practitioners include Wool, Lormand, Dr. Jacqueline Kates, and three nurse midwives. They have served generations of women in the same families, and the relationships they have forged are invaluable not only in terms of establishing a comfort level, but because knowledge about their psychosocial support systems can be critical.

Wool recently had four generations of women from one family in his office, and with the exception of the new baby girl he had delivered, they were all his patients.

Dr. Robert Wool

Dr. Robert Wool has seen generations of women from the same family and delivered thousands of babies since Women’s Health Associates opened in 1988.

“Knowing the type of support a woman has during pregnancy is important, especially when a teen is pregnant,” Wool said, noting that, if he knows the parents of a pregnant teen are not inclined to help, he can access services from local agencies to ensure the woman is able to comply with her doctor’s advice.

Indeed, trust is a critical component of the practice’s success, and patients talk to the providers about problems such as urinary incontinence or painful sex that they don’t discuss with friends, family members, or other doctors because the topics can be embarrassing.

“The information allows us to find solutions to make their lives better,” Wool said.

Lormand noted that a woman in her 20s recently told her she was in a relationship but wasn’t having sex because she didn’t have a strong sex drive. But she soon confessed that the real reason was because it was painful, which resulted in a resolution of the problem.

“We are still a mom-and-pop shop,” Wool said, adding that this small size allows them to get to know patients on a personal level.

For this issue, BusinessWest examines the history of Women’s Health Associates, what makes the practice unique, and how its scope has changed over the last three decades.

Continuity of Care

Wool was hired by Noble Hospital in 1988 as a salaried employee to staff its newly created practice, Women’s Health Associates, that the facility decided to establish within the confines of the hospital.

“There was only one obstetrical/gynecological practice in Westfield, and it had closed a year before I was hired. One physician had retired, a second left to do a fellowship, and the remaining two moved,” he said, adding that he was given two exam rooms, a nurse, and a secretary.

About two years later, Dr. James Wang was hired to help Wool, and within a few years they purchased the practice and moved to their current location in the Pioneer Valley Professional Center at 65 Springfield St. in Westfield.

The change in location proved beneficial as it put them closer to the hospitals where they were delivering babies: Baystate Medical Center in Springfield, Providence Hospital in Holyoke, then Mercy Medical Center after Providence closed its obstetrics department in 1994.

Today, all of their patients in labor are delivered at Baystate, and they work in conjunction with the hospital’s faculty and resident obstetrics/gynecological practices.

Midwives were added to the staff at Women’s Healthcare Associates after Wool began collaborating in 1992 with Holyoke Midwives, and they taught him techniques that proved helpful to his patients.

“Birthing is a pretty natural process, and in the majority of cases no interventions are needed,” he said, noting that the midwives showed him that if a doctor is patient and allows nature to take its course, most babies can be delivered naturally without having to resort to a cesarean section.

But even though labor and delivery haven’t changed much, the way medicine is delivered has undergone dramatic shifts in the past three decades, and Wool says what sets Women’s Health Associates apart from similar obstetrical/gynecological groups is its size.

For example, during the final weeks of a woman’s pregnancy, she sees all three doctors, so when labor begins, they are familiar with her health and ability to cope with stress.

Lormand noted that, at 1:30 a.m. the night before she spoke with BusinessWest, she received a call that a patient was in labor, and for her and other doctors, knowing a patient’s anxiety level as well as any underlying problems is far more helpful than reading a chart or being told about them.

In contrast, a woman who is a patient in a large medical practice might have her baby delivered by a physician she hasn’t met, then see a different doctor the following day in the hospital because having a large number of doctors on staff means they only have to work assigned hours.

Physicians in large practices also tend to move frequently, which can affect what a patient is willing to talk about. This is important because honesty is critical to providing care, and Wool says it is a cornerstone of the practice, but has to be reciprocal.

“If you tell a woman a procedure won’t hurt and it does, she will never tell you anything personal again,” he said, noting that they prepare patients when they know something will be uncomfortable.

Knowledge and education are critical because many people believe things that aren’t true. For example, Wool received a flood of calls from patients in 2001 after the Women’s Health Initiative published a study that said hormone-replacement therapy was dangerous.

He told the BusinessWest that the study was flawed, and the results were eventually debunked, but the initial findings made national news and did irreparable damage.

Wool said the average age of menopause is 51 ½, and hormone therapy offers invaluable benefits because life expectancy has increased by several decades over the past two or three centuries.

“Some women have menopausal symptoms in their 60s and 70s, and women who are not on hormones develop osteoporosis at a much faster rate,” he said, noting that some researchers believe hormone-replacement therapy improves cardiac health.

Indeed, a study on monkeys whose ovaries had been removed and were fed a high-fat, high-sugar diet all developed heart disease, while monkeys in another group who ate the same diet and also had their ovaries removed, but received estrogen, never had a problem. But Wool noted the therapy needs to begin right after menopause rather than a few years later, and unfortunately, many women shy away from it due to misinformation.

Still, any treatment depends on a number of factors and needs to be discussed with a woman’s healthcare provider. But because osteoporosis is so common after menopause, Women’s Health Associates has developed a strong program to prevent it that includes the ability to do bone-density testing in its offices.

Satisfying Outcomes

The practitioners at Women’s Health Associates have always taken a proactive stance when it comes to educating patients. But they also do routine obstetrical and gynecological care, treat minor and acute problems, diagnose cancer, and work closely with specialists at Baystate Medical Center.

“It’s a real privilege to be able to treat patients over their lifetime,” Wool said, adding that he has delivered thousands of babies and enjoys seeing generations of women from the same families.

Although he and his peers perform different types of surgery and perform many tasks each day at work, he says there is no greater joy in life than delivering a baby and laying it on a mother’s chest.

It’s part of the life cycle and a very important time in a woman’s life, but only one facet of the continuum of care that Women’s Health Associates has provided and will continue to offer patients for generations to come.

Health Care Sections

After the Diagnosis

Jo-Anne Gaughan-Cabral

Jo-Anne Gaughan-Cabral says a cancer diagnosis affects not only the patient, but his or her family and caregivers, and West Central’s cancer-informed program addresses the needs of all these parties.

As a provider of psychotherapy services for patients of all types, the therapists at West Central Family and Counseling observed a striking trend, said Jo-Anne Gaughan-Cabral.

“We noticed, from referrals coming into the clinic, that a growing number of people had been treated in the past, or were currently being treated, for various cancer diagnoses,” said Gaughan-Cabral, clinic supervisor and clinical lead of what is being called the facility’s Cancer Informed Therapy Program. “Although we were already treating the mental-health needs of these people, we decided to develop a more specialized cancer-focused therapy, and we set out to train a group of people to work with patients with cancer.”

West Central Family and Counseling’s (WCFC) new mental-health treatment program is targeted specifically for not just cancer patients, but their families, caregivers, and loved ones.

“The goal of the program is to provide patients and their families cancer-informed therapy. We can accomplish this in the clinic and as a home-based support when it seems needed,” said Gaughan-Cabral. “Clients and family members who are affected by a cancer diagnosis will benefit from this program.”

The effort represents a response of sorts to a 2006 Institute of Medicine report recommending that every cancer patient receive a cancer-survivorship care plan.

“We’re the psychotherapy component for people dealing with depression, anxiety, body-image issues, and needing cognitive behavioral therapy from managing the side effects of chemotherapy, such as nausea,” Gaughan-Cabral said. “We’ve been able to coordinate with other programs like Survivorship Journeys and therapy groups, as well as mentors, people who’ve already had the diagnosis and can walk other people through it. We’re basically trying to treat all the needs of the patient — and their family — as they deal with the negative feelings associated with grief and loss, change in roles, and other issues.”

In the midst of treatment, they’re not feeling well, and they may not feel like talking to someone, but once they’re on the other side, they realize life has changed so much, so we try to pick up with them on whatever they need.”

 

Those issues certainly affect a patient’s loved ones, as all parties struggle with unfamiliar roles, she added, whether that’s parents caring for sick children or grown children managing a cancer journey for their elderly parents. In any case, a cancer diagnosis can be a challenging experience for all, and many clients have reported feelings of anxiety and depression along with grief, stress, episodes of confusion, and acute or reoccurring trauma, she explained.

The team of cancer-focused therapists at WCFC, who undergo a six-month training to be part of the program, work to help patients process the emotional issues that surface during this time, and, if necessary, provide consultation to those providing their medical treatment at local cancer-treatment centers.

Gaughan-Cabral added that, while patients currently undergoing treatment for cancer will be well-represented in the program, most of the participants will likely be survivors who are past their initial treatment. “In the midst of treatment, they’re not feeling well, and they may not feel like talking to someone, but once they’re on the other side, they realize life has changed so much, so we try to pick up with them on whatever they need.”

Those needs are myriad, she said. “How do I go back to work? How do I resume an intimate relationship with my spouse? How do I get back to an active life? Having faced this life-or-death situation, you’re changed by that, and you need new strategies to deal with your world.”

Common Concerns

According to the American Psychiatric Assoc. (APA), general emotional distress, poor coping strategies, and psychiatric disorders such as anxiety and depression are common in cancer patients — perhaps 25% to 30% of them. Depression can not only negatively impact cancer patients’ quality of life, but can reduce their chances of survival, just as it can in heart-disease patients, Dr. David Spiegel, associate chair of Psychiatry at Stanford University and a psycho-oncologist, told Psychiatric News, an APA publication.

Yet, effective treatment of depression may increase the chances of survival. A study conducted by Spiegel and his colleagues in 2010 found that a decrease in depression symptoms was associated with longer survival in metastatic breast-cancer patients. Research during the past decade has also shown that various psychotherapies developed for cancer patients can improve patients’ quality of life, the APA reported.

The fact that more people are surviving cancer diagnoses makes WCFC’s cancer program even more relevant, said Gaughan-Cabral, who noted that referrals come in from hospitals, community-based programs, and simple word of mouth.

To better communicate how the program can help a wide range of cancer patients, survivors, and caregivers, West Central recently hosted an open house for cancer-treatment professionals interested in learning more about the new program, with the hope they would be willing to refer their patients.

“We wanted people who treat cancer — social workers, oncology units, therapists — to see our clinic and come meet with our staff, and make a personal connection,” said Joshua Frank, WCFC’s recruitment and marketing manager.

In addition to the therapeutic services offered on site, outreach and home-based support appointments are available when needed, Gaughan-Cabral said. “For those not able to get to the clinic for the support they need — for example, if they can’t drive — we go out to be with them. That’s one of our strong suits.”

Beyond its new cancer-focused program, West Central provides psychotherapy services to children, adolescents, adults, and elders with a wide range of behavioral-health issues, and also collaborates with schools and community centers to provide additional services, Frank said. But the Cancer Informed Therapy Program is meeting a specific need that isn’t being addressed on a larger scale, Gaughan-Cabral added.

“Feedback so far has been very positive,” she told BusinessWest, adding that the center plans to hire and train more people in this discipline once referrals necessitate a waiting list. “We’ve been so supported by people in the community, and that makes us feel positive about what we’re doing. It’s something that’s really necessary.”

Joseph Bednar can be reached at [email protected]

Health Care Sections

Home Is Where the Asthma Is

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Sarita Hudson

Sarita Hudson says treating asthma patients is a frustrating exercise if they’re just returning to homes filled with environmental triggers.

nyone who has experienced an asthma attack, the chest-tightening, often panicky feeling of not getting enough air into the lungs, knows it’s not a matter to take lightly. Yet, it remains one of the most common medical conditions in Massachusetts, affecting some 10% of Massachusetts residents, according to the state Department of Public Health.

In Springfield, it’s even worse, with rates approaching 18%, making it one of the most asthma-aggravating cities in the U.S.

“Nearly one in five kids in Springfield has asthma, and the rate for adults is almost the same,” said Sarita Hudson, director of Programs and Development for Partners for a Healthier Community (PHC). “And we have health inequities when it comes to asthma — Latinos and the black community are more heavily impacted by asthma and more likely to end up in the hospital and the emergency room.”

This is more than an individual health issue, she noted. When kids miss school days because of asthma, their absenteeism can lead to poor academic performance. When parents have to stay home with them, they miss work, with all the financial implications that entails. Multiplied over hundreds of homes, that’s a region-wide economic and quality-of-life impact.

The region’s air quality is a factor, but so are its aging homes, Hudson noted.

“Springfield has old housing stock — more than 86% of the homes were built before 1978, and 40% were built before 1940,” she said, adding that elements of these homes, ranging from mold and moisture to rodents and poor ventilation, can trigger or exacerbate asthma attacks.

For the past decade-plus, the Pioneer Valley Asthma Coalition, a program of PHC, has worked with families to educate them about asthma triggers in the home, and has gone into schools to push environmental changes, like greener cleaning supplies.

“This is a nationally proven best practice,” she said. “The CDC recommends education around these problems with the goal of reducing ER and hospital visits. The problem is, for some of those kids, you can make behavioral changes — take care to keep pets out of the bedroom, wash bed covers — but there’s still a hole in the roof causing mold, or a pest problem. Or there are ventilation issues; they’re not getting good air supply. It’s a structural problem. So you can educate them, treat them, help them, but they’re going back to an unhealthy home.”

That’s about to change for hundreds of Springfield-area residents who will soon take part in a program, first modeled in Baltimore by the Green & Healthy Homes Initiative, that pays for home improvements specifically related to asthma control — mold and moisture remediation, pest control, ventilation and air quality, removal of carpeting that harbors dust and other allergens — with the goal of keeping asthma sufferers out of the hospital.

“The Pioneer Valley Asthma Coalition has looked at ways people are impacted by asthma, looked at ways we can reduce hospitalization and healthcare, reduce impacts on families, and keep people healthy,” Hudson said. “We’ve done work around outdoor and indoor air quality and worked with the school district here. Now we want to work on the homes.”

Risk and Reward

The intriguing aspect of the project, known as Pay for Success, is how it’s funded. Calling the model a “social-impact bond,” Hudson said private investors will pay the up-front costs to perform interventions for 600 families — 200 families a year over three years. Revitalize CDC and the Springfield Office of Housing are among the partners which will oversee the home improvements.

“If we show impact — if we do what we say we’re going to do, which is reduce healthcare utilization and healthcare costs and keep people healthier — the investors are paid back by the healthcare system: Health New England, the state Medicaid office, Mass Health,” she explained, noting that financing details are still being worked out. If it works, it’s a way for investors with a bent toward social good to earn a return — Hudson said between 3% and 7% is the goal — on their investment in a total stranger’s home and health.

It’s an innovative example of the intersection between clinical care and community-based care, said Frank Robinson, vice president of Community Relations and Public Health for Baystate Health, one of the program partners. “On the community side, we want to work outside the four walls of the hospital, to do what is necessary to make sure the patient doesn’t come back in. So how do we change our policies to support this prevention work?”

Frank Robinson

Frank Robinson calls Pay for Success an innovative example of the intersection between clinical and community-based care.

Jackie Spain, medical director for Medicaid at Health New England, another project partner, said Pay for Success deals with key housing issues that aren’t usually addressed in the healthcare arena. “The nice thing about this initiative is it finds a way to address those issues up front. It’s hard to get payers, like Health New England and others, interested in paying for housing renovations up front, for a lot of reasons; the savings are likely longer-term, and people change health insurance frequently.”

The downside, she said, is that it’s still unclear how to determine how much someone’s healthcare costs have decreased due directly to the housing improvements. Also, in a world where provider contracts often include shared savings, all providers expect a piece of that savings — so who determines what piece is carved out for the social investor, and when will they be paid?

Those details are still being worked out, Robinson said, but an external evaluation program will address those issues by comparing the families that receive interventions with those that don’t, so the partners will be better able to document where the intervention made a difference.

Spain did note that asthma is an ideal condition around which to launch a program like this because the cost savings can be recorded in the short term, as a patient might go to the emergency room at any time. With something like diabetes — which may result in blindness, amputations, or renal failure — the most significant costs won’t appear for years, maybe decades.

Just Breathe

Pay for Success is certainly not an end-all to the problem of asthma. The American Academy of Pediatrics recommends a number of interventions families can implement with little cost to reduce the risk and severity of asthma, from banning smoking in the home to reducing exposure to dust mites.

For the latter, allergy-proof encasings are available to cover pillows and mattresses, and all bedding should be washed in hot water every week or two. Stuffed toys should be removed from the bedroom, which should be vacuumed and dusted regularly. Dehumidifiers and HEPA filters help as well, although these are a bit more expensive, and pets can easily be barred from the bedroom, which, through all these suggestions, can be turned into a safety zone against asthma triggers.

But other interventions, from extermination services for persistent pest problems to mold remediation; from carpet removal to fixing leaky roofs and plumbing, can be out of reach of low-income families, and that’s where the Pay for Success program promises to make a difference. Once the financial details are finalized and investors lined up, the partners plan to contact the first cohort of beneficiaries. Additional project funding will be provided by the White House’s Social Innovation Fund, with technical assistance from the Green & Healthy Homes Initiative.

“We know the number of people who need help, we have a model deemed to be feasible now, and we’re at the point of starting,” Hudson said. “We’re excited about this partnership; we’ve been working on it more than a year.”

Robinson agreed. “We’re hoping this is a way of getting ahead of the curve and improving how we deliver care,” he told BusinessWest, adding that he hopes to see strong evidence that will make such interventional programs routine, not just a one-off. “It’s an exception to how healthcare currently conducts itself, with some of the risk contracting, but it’s a different way of looking at social determinants and not just medical procedures.”

And if more Springfield-area families find some relief from their asthma, plenty of regional healthcare stakeholders will be breathing a bit easier. u

Joseph Bednar can be reached at

[email protected]

Health Care Sections

Skeletal System

Dr. Steven Wenner, who specializes in hand surgery, and nurse practitioner Jessica Drenga

Dr. Steven Wenner, who specializes in hand surgery, and nurse practitioner Jessica Drenga show off a model of the bones beneath the skin.

Rehabilitation is a very broad term in the medical community, encompassing a range of services — ambulatory, cardiac, developmental, the list goes on — with one basic aim: to help patients achieve, or rediscover, the quality of life they desire. This story and the ones that follow demonstrate how area facilities are doing just that.

Thirty years ago, Dr. Joseph Sklar and Dr. Sumner Karas were among a group of physicians who gave birth to a medical practice that was ahead of its time: a place where every orthopedic surgeon had a subspecialty and only saw patients whose problems related to their area of expertise.

New England Orthopedic Surgeons (NEOS) was opened in 1987 by seven doctors and three physician assistants who made the decision to merge Mulberry Orthopedics and Chestnut Orthopedics, which were both in Springfield. The roster of physicians included Sklar and Karas, who met doing their residencies and fellowships at Mass General Hospital, liked the model they saw there that focused on subspecialties, and presented the idea to their partners, which became a central focus as they orchestrated the merger.

Over the past three decades, the practice has been highly successful. It has grown to 18 physicians and 22 physician assistants who see 700 patients a day in their Springfield office and two physical-therapy locations.

“We were a little ahead of the game, but thought this was the best way to deliver optimal patient care,” Sklar told BusinessWest, explaining that the idea stemmed from the belief that, if a doctor focused all of his or her energy on a subspecialty and did the same surgery frequently, their skill would improve, which would result in improved patient care and outcomes.

“We also believed if each doctor specialized in one area, the likelihood would increase that they would be able to recognize unusual problems and know the best way to treat them,” he added.

At the time, no studies had been done to substantiate these beliefs, but over the past several decades, a wide range of benefits from treatment by subspecialists have been documented; they range from accurate diagnoses to a low incidence of post-operative complications.

Today, NEOS is the largest surgical orthopedic practice in the Pioneer Valley. Patients range in age from infants to people in their 90s, although children who need reconstructive surgery for conditions such as congenital hip or spinal disorders or a club foot are usually treated at Shriners Hospitals for Children in Springfield.

Dr. Sumner Karas, Dr. John Corsetti, and Dr. Joseph Sklar

Dr. Sumner Karas, Dr. John Corsetti, and Dr. Joseph Sklar say New England Orthopedeic Surgeons has grown to be the largest subspecialty practice of its kind in Western Mass.

But NEOS does provide care for many young people with traumatic injuries that include broken bones, dislocated shoulders, meniscus tears, or other sports-related problems.

Dr. John Corsetti, who specializes in sports medicine, arthroscopy, and shoulder and knee surgery, joined NEOS in 1995. He was impressed by the practice and said the number of surgeries its physicians perform today is significantly higher than orthopedic groups in Boston.

“Orthopedic surgeons in private practice usually do about 300 to 400 surgeries a year, but our doctors can do as many as 1,300 every year,” he said, noting that many of their patients are referred by other doctors for diagnosis refinement and confirmation.

The practice continues to grow, and on June 5 a new location was opened on Benton Drive in East Longmeadow with the goal of making care more convenient for patients who live in that area or in Connecticut. To that end, the NEOS physical-therapy office in the Sixteen Acres area of Springfield also moved to East Longmeadow.

Two new jobs for physician assistants were created, and an aggressive growth plan is in place for the future, but in the meantime, changes have been put into place that have reduced the time it takes to get an appointment.

In the past the wait was often several months, but NEOS has established a waiting list, and as soon as an appointment is cancelled, a receptionist picks up the phone and begins calling people until someone is found to fill the slot. It has led to 80 additional appointments each week, due in part to a ripple effect: when a cancellation slot is filled, the appointment time the person originally scheduled opens up.

In addition, X-rays no longer need to be taken in advance of an appointment. They can be done while the patient is in the office, which makes it easier for people to get the care and treatment they need in an expedited manner.

For this issue and its focus on rehabilitation and sports medicine, BusinessWest examines the growth of NEOS, the types of problems its doctors treat, and its plans for the future.

Storied History

Karas and Sklar moved to Springfield from the Boston area after completing orthopedic fellowships, which requires an extra year of training in a specialized area after a surgeon fulfills his or her residency requirements.

Sklar joined Mulberry Orthopedics, while Karas joined the Chestnut practice, and although they knew each other, they never dreamed they would play a major role in developing the largest orthopedic practice in Western Mass.

Sklar told BusinessWest he had enjoyed working with children at Boston Children’s Hospital, and one of the things that attracted him to Mulberry Orthopedics was the fact that its doctors provided staffing for Shriners.

It turned out that surgeons from both Mulberry and Chestnut covered for each other on weekends there, and the relationship between Sklar and Karas deepened through their shared work ethics and similar beliefs.

When the decision to merge and form NEOS was made, the two practices had nine doctors between them, but one retired and another moved, leaving seven doctors when the group opened their doors at 300 Carew St. in Springfield.

But forming the new partnership was a complex endeavor. In addition to requiring complete trust and a willingness to send each other patients, there were also financial implications. Since the surgeons agreed to see only patients whose problems fell into their areas of specialized expertise, they had to find a way to share incomes, because limiting their work meant some were no longer doing routine procedures that accounted for a significant percentage of their earnings.

But NEOS quickly became known, and as referrals from other orthopedic surgeons with challenging cases as well as the general public mushroomed, it added a physical-therapy area to its medical office.

“It allowed us to work closely with the therapists, which was particularly important for post-operative patient care,” Karas said, adding that it also enhanced their goal of providing the highest quality of care possible.

Fifteen years ago, NEOS moved to a much larger location at 300 Birnie Ave. in Springfield, and today, it is the only subspecialized comprehensive orthopedic surgical practice in Western Mass. Its physicians are all board-certified and focus on sports medicine, knee and hip replacements, hand and wrist care, foot and ankle surgeries, total joint care, trauma and fracture care, spine care, and orthotic services.

Each surgeon has completed a fellowship in at least one of these areas, but the physician assistants and nurse practitioners are generalists.

“This is important because sometimes it is not clear what the problem is; the neck can cause shoulder pain, while a problem with the spine can result in pain in the hip or knee,” Sklar explained, adding that PAs often determine which doctor the patient should see.

Surgery accounts for only half of the services provided at NEOS because medications, different types of injections, and physical therapy are often the best way to treat muscular-skeletal problems. For example, frozen shoulders can be helped with injections, people with arthritis in their knees or shoulders can experience relief with the help of medication and physical therapy, tendinitis in the hands can improve with splints, and ankle pain can be relieved with a splint or brace, which patients often get before they leave the practice, thanks to the wide array of durable medical equipment that NEOS stocks in its office.

A large number of the surgeries undertaken by NEOS physicians are performed at Baystate Orthopedic Surgery Center, and the results are reviewed by Baystate Medical Center.

“We also keep up with technology,” Karas said, adding that NEOS adopted an electronic medical-records system, has digital X-ray machines, and does casting on site.

Patients also benefit from communication that takes place between the surgeons, especially when a case involves complex injuries. “We come up with a plan and help each other with surgery, which gives everyone a great deal of comfort,” Corsetti said.

Sklar says being able to focus on one aspect of orthopedic medicine gave him the time and experience to create tools and implants that would make a difference in knee surgery, which, coupled with sports medicine, has been his primary focus.

He designed and co-designed two fixation devices that anchor grafts to reconstruct torn ACL ligaments into the bones inside the knee, has developed tools to make arthroscopic surgery more successful, secured a grant from the National Institutes of Health to study the effect of a patient’s outlook on their recovery from ACL surgery, and is an advocate of preventive measures that athletes or anyone engaging in exercise can take to avoid injury.

Changing Landscape

Corsetti said NEOS treats every type of orthopedic problem, and has a large population of patients with degenerative disorders. It continues to specialize and keep current in its respective fields, but thanks to minimally invasive surgical procedures, the length of a hospital stay after surgery has been greatly reduced.

“People used to be in the hospital for five to seven days after a total knee replacement, but now are in for two or three days. In the past, a shoulder surgery could involve a five- to seven-day stay, but today people sometimes return home right after it,” Corsetti told BusinessWest, noting that 60% of the patients they operate on go home the same day and often return to work several days later.

It’s all part of staying ahead of the curve in an ever-changing field, which NEOS has done since its early beginnings when Sklar, Karas, and their partners imagined a new way of delivering orthopedic care in Western Mass. — and made it a reality.

Health Care Sections

Small Steps Toward Wellness

Jill LeGates

Jill LeGates says Weldon’s outpatient services have become both more personalized and more regionalized as the healthcare industry continues to change.

Almost 600,000 Americans died of cancer last year. But almost 15 million were living with — and often well beyond — a cancer diagnosis, a figure expected to rise to 19 million by 2024, as cancer treatments continue to improve and Americans live longer than ever.

That trend poses opportunities in the world of outpatient rehab — opportunities Weldon Rehabilitation Hospital in Springfield has embraced.

“We went through a cancer rehab certification program to offer additional services to cancer patients. It’s a large area of growth,” said Jill LeGates, director of Rehabilitation Services at the facility. “More patients are surviving cancer treatments, but now they have fatigue, pain, dysfunction. We can help return them to the activities of daily living, so that’s been a huge focus for us.”

Specifically, Weldon is certified by the STAR Program (Survivorship Training and Rehabilitation) program, a nationally recognized certification that focuses on improving the lives of cancer survivors who experience side effects caused by treatment.

A team of therapists, physicians, and nurses has undergone training to provide patients with individualized cancer rehabilitation treatment to improve the symptoms that affect their daily functioning and quality of life. It’s similar to rehabilitation that people undergo after a serious illness or injury, but tailored to the unique issues they face as a cancer survivor.

“Our rehabilitation professionals can help you with a wide variety of treatment-related conditions and the symptoms they cause, targeting not just pain and fatigue, but balance and gait problems, memory and concentration issues, swallowing and speech problems, and lymphedema.

“You might expect your oncologist to say to you, ‘I did my job; you’re wonderful. This is your new normal,” LeGates said. “But some patients are saying, ‘I still have this pain.’ So, is there a way we can manage their pain and fatigue, increase their endurance, get them back to working, back to caring for their children, back to living? Rehab can be a huge part of that.”

It’s just one example, actually, of how Weldon — founded in 1974 and part of the Sisters of Providence Health System (SPHS), which includes Mercy Medical Center — continues to change with the times to meet rehabilitation needs.

The most obvious change is the new location of its outpatient services, a block away from the main Weldon facility, in the medical office building the health system opened in 2015 on the corner of Carew and Chestnut streets.

“When we were at the old building, we had multiple outpatient services in different places, scattered throughout the building,” LeGates said. “Here, all the outpatient services are together in one suite — physical therapy, occupational therapy, speech therapy, and some specialized programs.”

Those programs include occupational, physical, and speech therapy; hand therapy for a variety of conditions; specialized programs for lymphedema, swallowing disorders, vestibular therapy, and voice disorders; a wheelchair clinic; a driver-advisement program to help people determine whether it’s safe for them to drive; a broad pediatric program; and the STAR program for cancer patients.

“As a mission-driven hospital organization, our focus is on patient-centered care,” LeGates said. “We strive to provide patients with the individualized care and treatment plans they require. If someone needs more specialized care, we have therapists with those specialties to consult and help patients increase their function.”

Meeting Needs

Patients arrive in Weldon’s outpatient programs in a number of ways, but post-hospital care remains a key focus, especially at a time when the accountable-care model in healthcare is putting a premium on discharging patients sooner than before and emphasizing preventive and rehabilitative care outside the hospital setting.

“They’re coming out of the hospital faster, and health systems are looking at cost containment,” LeGates said. “So the environment where patients receive therapy services is a huge component — how is that patient functioning, and what are their needs?”

While many patients are referred from hospitals, others may be referred directly from physician practices. “They go to the doctor, who identifies an illness, something that requires the services of a therapist. We also see patients that have an injury on the job, and they may need therapy services in order to return to work.”

The pediatric wing of Weldon Rehabilitation Hospital

The pediatric wing of Weldon Rehabilitation Hospital features therapeutic and sensory tools that are both effective and fun.

Since SPHS absorbed the former Hampden County Physician Associates practices and is affiliated with Riverbend Medical Group’s network, these referrals are an especially critical pipeline. “As a huge health system, we want to maintain the integrity of where our patients receive services,” she noted. “Keeping all those services within the health system has been a huge opportunity.”

In short, she went on, “we always knew if we were in strong alignment with referral resources, we would see growth. And we do have a very positive referral base, and we are continuing to grow. Our physical-therapy services are extremely busy, and we’ve added additional therapists to absorb that growth, which is great.”

The growing need for services is also being driven by an aging population, as the Baby Boomers surge into their senior years but are often living with a host of conditions that require therapy. But at the other side of the age spectrum, Weldon has broadened its pediatric services, working with children dealing with autism, sensory-processing disorders, Down syndrome, developmental delays, handwriting difficulty, speech apraxia, language delays and speech issues such as stuttering, neuromuscular disorders, ADHD, and a host of other conditions.

Weldon’s pediatric therapists evaluate each child’s needs and develop an individualized treatment plan that may include one-on-one occupational therapy, speech therapy, and physical therapy, all provided in a colorful, child-centered environment, LeGates said.

“We may work in collaboration with schools or with home services — there’s a lot of collaborating with the pediatric world,” she added. “We’re treating the whole person and all the child’s needs, whether educational, medical, or social. We also have a well-established animal-assisted therapy program with the Zoo at Forest Park; animals seem to bring out a lot in people. That’s a huge piece of what we do as well.”

Regional Focus

Since SPHS became part of a much larger, regional health system, Trinity Health New England, Weldon has begun to assess the regional big picture for rehab services, and perhaps find ways to collaborate on population-health initiatives with facilities like Mount Sinai Rehabilitation Hospital in Hartford and St. Mary’s Hospital in Waterbury, which boasts several outpatient rehab centers.

“How can we expand to grow and regionalize some of this?” LeGates said. “As we look to the future, as we move from fee for service into all kinds of payment changes, we may be able to collaborate on this from a regional perspective.”

Despite that big-picture outlook, however, rehabilitation remains, at its core, a one-on-one connection between therapist and patient.

“It’s a wonderful profession,” she told BusinessWest. “You’re helping people and truly seeing people gain back their independence, gain back function, and return to the activities they had stopped doing.”

In the end, success stories are based on more than hard work in the gym; they rest on strong relationships — which don’t necessarily end when the care does.

“We’ve had patients come back and show us how they’re doing, tell us how they went back to school or went back to work,” LeGates said. “It’s a rewarding career, and the people who work here are a people-driven team.”

Joseph Bednar can be reached at [email protected]

Health Care Sections

Safety Net

Larry Borysyk takes Lucille Chartier’s blood pressure

Larry Borysyk takes Lucille Chartier’s blood pressure as she exercises in Holyoke Hospital’s cardiac rehabilitation gym.

 

Lucille Chartier had no idea she had heart problems until a day last October when she got out of the shower, began sweating, and felt like she was going to pass out.

“I knew something was really wrong,” said the 68-year-old Chicopee woman, who was diagnosed with a heart attack after an ambulance took her to the hospital.

While there, she was told about a cardiac-rehabilitation program in a gym, but wasn’t given much information, and since she had never exercised on machines, she was hesitant to sign up.

Several months later, she spoke to Larry Borysyk at Holyoke Medical Center (HMC), and after he explained its program in detail and why it was important, Chartier decided to give it a try.

That was two months ago, and today she would advise anyone who has had a cardiac event to take part in cardiac rehabilitation. She enjoys walking on the treadmill as well as the camaraderie between staff and participants, and says it has helped her gain strength and confidence.

Borysyk, cardiac rehabilitation counselor at HMC, said Chartier’s initial reaction was not unusual.

“Cardiac rehabilitation is life-saving, but it can be a scary adjustment for people who have never exercised in a gym, so we try to reduce their mental and physical stress,” he told BusinessWest, adding that individuals need to slowly acclimate to the equipment. Meanwhile, people who exercised on a regular basis before a cardiac event need to relearn what they can do, and how long and hard they can safely push themselves.

Exercise can be problematic because people can become hyper-vigilant after a heart attack and think any symptom is a precursor to another event. But cardiac rehabilitation can help them learn what is normal.

“Each participant is assessed by a nurse while they are exercising to make sure they stay within their limits,” said Kelley Weider, department director of Cardiac and Pulmonary Rehabilitation for Berkshire Medical Center, adding that patients are connected to wireless telemetry monitors, and if they experience symptoms during exercise they are worried about, they are immediately evaluated.

Holyoke, Baystate, and Berkshire medical centers all have cardiac-rehab programs, and participants exercise in their gyms two or three times a week for 10 to 12 weeks under close supervision. Their blood pressure, heart rate, and heart rhythm are measured during activity, and routines are tailored to meet individual needs and fitness levels.

Participants must have a doctor’s referral, and although the majority have had a heart attack or stent placement, others have had bypass surgery, a heart-valve replacement, congestive heart failure, a heart replacement, or angina.

Kelly Weider says studies show regular exercise can help decrease the risk of a second cardiac event.

Kelly Weider says studies show regular exercise can help decrease the risk of a second cardiac event.

In addition to monitoring that takes place during each session, participants receive education on topics that include diet, stress reduction, smoking cessation, and other factors that affect heart health, and slowly build strength, get used to exercising, and understand it needs to become part of their lifestyle.

People also learn the importance of genetics and how that factor and their lifestyle have affected their health. “Heart disease does not happen overnight,” Borysyk said.

For this issue, BusinessWest examines the importance of cardiac rehabilitation, how treatment has changed, and how it helps people understand what they do can safely — and when symptoms should not be ignored.

Changes in Care

Borysyk has worked in cardiac rehab since the early ’70s, and has seen changes due to technology and medical advances that allow heart disease to be detected and treated earlier than in the past, which results in better outcomes.

“Coronary-care units were set up in the ’60s, but before that, nurses did everything for patients after a heart attack, including feeding them. They worried about compromising their damaged hearts, and as a result, people ended up as cardiac cripples,” he said, noting that, in the late ’70s and early ’80s, people were kept in the hospital for two weeks after a heart attack, but today they are released after two or three days.

Cardiac procedures and surgeries are not done at Holyoke Medical Center, and in many instances patients who go to their emergency room are transported by ambulance to Baystate Medical Center.

Heidi Szalai, manager of Baystate Medical Center’s cardiac-rehab program, which is the largest in the area, told BusinessWest that, although rehab doesn’t usually start in the hospital, staff members get patients up and moving.

“We want to make sure they’re walking and that it is safe for them to go home,” she said, adding that healing speeds up when they leave the hospital and they are told about programs available to them when they are discharged.

However, cardiac rehab doesn’t begin for a week or two after a person leaves a medical center, especially if they have had surgery, because the heart needs time to recover.

The programs start with individual assessments to determine the best plan of action. In addition to an exercise routine that is created for each participant, they are taught about risk factors that include high cholesterol, smoking, diabetes, stress, nutrition, and lack of exercise.

“They are usually on new medications, and we need to make sure they understand them,” Szalai said, explaining that some prescription drugs may slow their heart rates, and their doctors receive periodic reports about their blood pressure and how the heart responds during exercise, which helps them determine how well a medication is working and if adjustments need to be made.

Heidi Szalai

Heidi Szalai said cardiac rehab helps patients know how they should feel when they exercise and when to seek medical help.

Lifestyle changes are also discussed. “Some people have always eaten well and are doing everything they should, but need to learn to control stress and cope with it so it doesn’t affect their heart,” she continued, adding that patients have a clinician trained in mindfulness-based stress management. “We tell people that exercise is a dose of medication and has positive affects on risk factors; it helps lower blood pressure, blood sugar, cholesterol, and improves their overall sense of well-being.”

The goal is to get people exercising five days a week, which can make a profound difference because studies show finishing a cardiac-rehab program can lower the likelihood of another event.

Insurance typically covers the cost of the programs, but some people have high co-pays and cannot afford to attend all of the sessions.

When that occurs, staff in cardiac programs do their best in a limited number of sessions. Berkshire Medical Center has a program that pays half of co-pays of $15 or more for qualified individuals, and although it can help, it may not be enough.

“We’ve seen people with co-pays that are $80 a session, so even if they receive financial help, attending 36 sessions may be cost-prohibitive,” Weider said, adding that, in some instances, they have modified the program into six sessions, which is less than ideal, but helps to give a patient security and knowledge about what they can do safely.

“During the intake process, we get a sense of what they’ve done in the past as well as their level of conditioning,” she noted. “About 90% of people haven’t been exercising on a regular basis, but some were running five miles a day.”

Exercise machines are integral to the program and include different types of stationary bicycles, a treadmill, and resistance bands, which are used for strength training.

The final phase of the program is maintenance, and although people can join gyms or exercise on their own, if they still want to be monitored, most hospitals have ongoing exercise programs that cost $40 to $45 per month and are overseen by cardiac rehabilitation staff members who are available to take their blood pressure or put them on a cardiac monitor if they feel it is needed.

Some people like the idea of having that safety net ,and Weider said Berkshire Medical Center’s maintenance program has about 320 participants who want the peace of mind that comes from knowing that, if any concerning symptoms arise, they can be assessed.

“We’ve sent some people to the emergency room, but many times they simply need to be checked out and reassured that they are OK,” she said, noting that a nurse is always available.

Future Outcome

Borysyk says people with cardiac conditions who don’t exercise are at greater risk of not being able to do the things they want as they get older, especially if their diet is poor and they smoke. And although some people avoid cardiac rehab because they want to bury the memory of the event, learning what they can do safely is an excellent way to help ensure their heart health in the future.

“Many studies show that exercise is the biggest modifiable factor to decrease the risk of another heart event,” Weider said, citing one study showing that participants in a cardiac rehab program reduced their risk of another event by 25%.

In addition, it helps participants understand how they should feel when they exercise, what the red flags are, and when they need to call their doctor or go to the emergency room.

“It helps them return to what is important to them in life and gets them into a routine of exercising 150 minutes a week that they can continue when they finish the program,” Szalai said.

It’s definitely an investment of time and money, but one that yields positive results and can lead to a healthier and happier lifestyle.

Health Care Sections

Continuum of Care

Beth VettoriAs the Baby Boom generation continues to hurtle into their retirement years, about 15% of all Americans today are over age 65, a percentage expected to soar to almost 22% by 2040. That demographic tide presents both challenges and opportunities for senior-living facilities, which more than ever are emphasizing a continuum of care and a resident-centric experience.

Beth Vettori has sat with plenty of families stressed out from balancing their own lives with caring for an aging parent, yet reluctant to make the transition into a senior-living community.

“It’s hard for them. Usually, the sons and daughters are in their 40s, 50s, 60s, and most are still working, and it’s hard for them to play an active role in dividing those caretaking tasks,” said Vettori, executive director of Rockridge Retirement Community in Northampton.

But, while many seniors resist giving up a home they may have lived in for decades, she said, the move often goes more smoothly than expected.

“It can be hard for people to let go of where they were living — the memories, the history attached to their previous physical environment,” she told BusinessWest. “But more times than not, we hear, ‘I should have done this years ago.’”

Kelly Sostre, executive director of Keystone Commons in Ludlow, tells a similar story. “I think, sometimes, their families see the quality of life they have here, the friends they’ve made, and they feel guilty for waiting so long.”

One of the reasons families are feeling better about making the transition has been an emphasis, in the modern senior-living complex, on a continuum of care, which gives assurance that the resident won’t have to find a new community if their physical needs change.

Kelly Sostre (center, with Bryan McKeever and Grace Barone

Kelly Sostre (center, with Bryan McKeever and Grace Barone) says the average age of a Keystone Commons resident is older than it used to be, with more health issues to boot.

 

Keystone and Rockridge, for example, both offer independent living, assisted living, and memory-care neighborhoods, all on one campus.

“People are coming here more frail and needing more services. Five years ago, our average age was in the mid-80s; now it’s the low 90s. We’re even moving people in at 100,” Sostre said. “When we opened, the majority our independent-living folks were driving and attending social functions in the community. That’s tapered down.”

The key, then, is to offer a menu of social, culinary, and assistive options that ease the transition into this next phase of life. “We understand home is where they want to be, and if we can provide something here that’s homelike, that’s what we want to do.”


SEE: List of Senior Living Options in Western Mass.


Bryan McKeever, vice president of Roche Associates, Keystone’s marketing firm, stressed that the goal is to provide supportive services that help people maintain as much quality of life and independence as possible, while receiving help with medication management and other daily activities when needed.

Linda Manor Assisted Living in Northampton, true to its name, doesn’t offer an independent-living option, but its neighbor, Linda Manor Extended Care Facility, is a skilled-nursing residence for when the time comes. “A lot of people who come to assisted living are drawn by the fact we’re on the same campus as our nursing home,” said Emily Uguccione, executive director. “As your needs change, you can age in place; the nursing home on campus really helps with that, or if you have an acute healthcare issue or have rehabilitation needs.”

Changing Needs

Linda Manor does, however, offer a memory-care neighborhood in its assisted-living complex, a draw for families who look to assisted living because they recognize the early symptoms of dementia. But the reason for making the jump can be as basic as a need for connection.

“A lot of people come to assisted living needing some socialization, and loneliness is a huge, huge factor,” Uguccione said. “It affects the psychosocial well-being of people across America.”

Emily Uguccione

Emily Uguccione

In assisted living, they know they’ll get their medication on time and as prescribed, and they have transportation to doctor’s appointments, errands, and social trips.”

 

In addition, she said, many candidates for assisted living find they need help with activities of daily living and medication management — often, up to 10 medications a day or more.

“In assisted living, they know they’ll get their medication on time and as prescribed, and they have transportation to doctor’s appointments, errands, and social trips,” she told BusinessWest. “And it’s not just a taxi. Our driver is a wonderful gentleman who provides support and socialization to people as he takes them to the doctor. When someone comes to assisted living, we want to give them support, but also fill in that loneliness gap.”

It’s also about safety, Vettori said. “If a loved one has some sort of deficit that puts them in a category of risk — mild dementia, cognitive decline, physical ambulation, those kind of disabilities — that’s where family members or residents look to us.

“Many times,” she went on, “people have been living independently, maybe have been in their home 30, 40, even 50 years, but now it’s getting harder to get around, especially in Western Mass., outside the large cities, where public transportation isn’t easy to access. So there’s a greater chance of isolation and a greater reliance on family.”

Those who make a complex like Rockridge their next home certainly aren’t required to socialize or engage with people, she added. “But if you take a few steps down the corridor, you’re right there with people who want to be part of your new family. That’s another great piece of living in a community setting. You have people who, for the most part, want to be there, and you can engage when you want, participate in whatever you want, and build friendships — not just with the people who live there, but also the staff.”

Sostre agreed. “They love the idea they can go to a spacious, home-like apartment they’ve decorated with their own things, yet they can be out and about at social activities and pick what they want to do every day. They have those options, and still have the comfort of their own environment, too.”

Activity planners at Keystone aren’t so much dictating a program, McKeever said, as getting to know the residents individually — what their hobbies and interests are — and developing offerings around those interests, while resident committees provide further input on the way activities are structured.

“It may well change month to month. Six months ago, I couldn’t get a card club going,” Sostre said. Since then, a beginners bridge group started up, and that activity has become hugely popular.

As the over-65 population swells, Vettori said, senior-living affordability will become an even more critical issue.

“This is going to be huge as the next group of Baby Boomers start to come online — the discrepancy between low income and high to moderate income. There’s a huge segment of the population falling through the cracks; they make too much to qualify for MassHealth or Medicaid, and don’t have enough to pay privately for a traditional independent- or assisted-living neighborhood.”

That situation inspired the development of Violette’s Crossing at Rockridge, which includes 25 independent rental apartments for people of moderate income, offering an a la carte menu of services.

“We set the income levels so that we could truly help this margin of folks that need a place to live and don’t qualify necessarily for an independent- or assisted-living community or some of the lower-income housing options,” Vettori said. “We’re one of the first across the country to pilot and put together a program like this where we’re not reliant on government funding.”

Focus on Memory

With one-third of Americans above age 85 expected to develop some form of dementia, it’s no surprise that all three facilities BusinessWest visited offer a dedicated memory-care unit.

Uguccione said Linda Manor’s memory-support and specialized life-enrichment program is driven by the habilitation model, which focuses on where their successes are and where their strengths lie, not necessarily on how to compensate for their weaknesses.

“We also do a lot with the environmental factors. The furniture is chosen really carefully, and the staff wears certain colors in the building to promote calm and serenity.”

Vettori said complexes are starting to employ wearable GPS trackers — like pendants and watches — with memory-care residents, allowing them to move more freely in the community. “People want to participate without constraints.”

That dovetails with an overall goal of giving residents more choice, she noted, which is something families increasingly demand.

“Communities like ours are constantly exploring how we can expand our menu of offerings and provide services people are looking for. They can choose to use them or not, but we never take away their independence. We really tailor the individual programming to be resident-centric.”

Sometimes, she added, residents never really accept a senior-living facility as their new home, but simply the place they live now. “Of course, we make them as comfortable as we can, knowing their heart is still at their previous home. It’s not often, but it does happen.”

Uguccione said the idea is to lessen the burdens of daily living so residents can, well, enjoy life. “People do much better when they don’t have to worry about all these other things; they can just enjoy being with each other, making new friends, and they have more time now to take up tai chi or go out to lunch, and don’t have to worry about taking three buses to get to a doctor’s appointment.”

Grace Barone, director of Community Relations at Keystone, said it’s a lifestyle, full of hobbies and interests and friends, that brings purpose back into residents’ days and gives them reason to get up in the morning, in contrast to the loneliness they might have felt in their previous home.

It also lends quality to their visits from loved ones, she added, recalling one resident’s daughter who was pleasantly surprised to see her mother painting, something she used to love but hadn’t done in 15 years.

“They’re not worried about filling the pillbox or whether there’s food in the fridge,” Barone said. “They can just come in and spend time talking and visiting, or share a meal while mom tells them about some fabulous activity she’s done.”

In other words, it feels a lot like home.

Joseph Bednar can be reached at [email protected]

Health Care Sections

Functional Assets

Cheryl Moriarty and Jack Jury

Cheryl Moriarty and Jack Jury say Weldon Rehabilitation Center not only provides physical, occupational, and speech therapy, but educates seniors about health conditions such as diabetes and vascular disease to prevent return visits.

Only a few generations ago, many people who had strokes did not survive, while seniors who had respiratory problems, broke a hip, had an amputation, or suffered from other serious health conditions never regained their strength or functionality.

But, thanks to medical advances, people are not only living longer, many can return home or to an assisted-living facility if they receive rehabilitation therapy after being released from an acute-care hospital.

“It’s extremely rewarding to see someone with a functional problem tell us, ‘I never thought I could do that again,’” said John Hunt, chief executive officer of HealthSouth Rehabilitation Hospital of Western Massachusetts in Ludlow, noting that the majority of its patients are 65 or older. “We’re not making people perfect, but we are increasing their function and helping them compensate for their new disability.”

That’s especially important because today’s seniors are more active than people in previous generations, want to remain independent, and have the ability to continue activities they enjoy.

In addition, hospital stays are often limited to days instead of weeks, and although this helps prevent elders from getting weak from lying in bed for long periods of time, many have more than one health condition and need care immediately after they are released.

“Most people are eager to get home as soon as possible after a hospital stay,” said Heidi Hevey, regional director of admissions and marketing
for Wingate Healthcare, which has 24 facilities in three states. “But going directly home might not be the best choice compared to spending some time in a skilled-nursing facility where the person can rebuild their strength and get help with any new limitations. Our job is to give them whatever is medically necessary to get them back to the highest level of functionality they can attain.”

Jack Jury, lead physical therapist at Weldon Rehabilitation Hospital in Springfield, said education is also important so people understand why their hospitalization occurred, how they can prevent a return visit, what they need to know about their health conditions, and the medications prescribed for them.

“We put a big focus on looking at the patient as a whole and do our best to incorporate their wants and needs,” he said. “But we also make sure the person understands everything about their health. As people live longer, the need for comprehensive education has increased.”

The length of time a patient spends in a rehabilitation facility depends on their health; ability to engage in physical, occupational, and speech therapy; how quickly they progress; and other factors. But insurance typically covers the cost of therapy needed for recovery, which can take place in stages that may begin at an acute inpatient rehabilitation hospital, progress to therapy in a sub-acute setting, and be followed with outpatient or home care.

For this issue, BusinessWest looks at the types of services seniors receive today, the conditions that cause them to need help, and how rehabilitation extends the quality of their life with as few limitations as possible.

Treatment Variables

Rehabilitation can take place in a variety of settings, and physicians make referrals based on individual needs, although ultimately the decision where someone receives therapy is made by the patient or their family.

John Hunt

John Hunt says the need for acute rehabilitation care has increased because people are living longer, and HealthSouth treats many seniors with complex medical and functional needs.

Rehab hospitals offer the highest level of care, but individuals must meet specific qualifications to be accepted as a patient. They include a referral by a physician; a need for 24-hour rehabilitation that can’t be provided in a less-intensive setting such as a nursing home or assisted-living facility; the need for two or more types of therapy, including physical, occupational, or speech/language; and the ability to participate in a minimum of three hours of therapy a day, five days a week.

A physician is present in these hospitals 24 hours a day, and the typical stay is about two weeks. Patients often need more therapy, but at that point they can be transferred to a sub-acute care center or receive outpatient therapy or home care.

Stroke accounts for the majority of admissions at local rehabilitation hospitals, and these patients often need assistance regaining mobility, cognition, speech, and swallowing.

“Recovery is unpredictable and variable and can occur over the course of a year or two,” Jury noted, adding that most of that therapy is delivered in outpatient care settings.

Weldon was recently awarded accreditation by CARF International for its inpatient rehabilitation program for adults, stroke specialty program, and program for children and adolescents. The certification is good for three years, and it is the eighth consecutive time the hospital has received the accreditation.

Meanwhile, HealthSouth has received disease-specific care certification from the Joint Commission for strokes, brain injuries, and pulmonary rehabilitation, in addition to the standard Joint Commission accreditation.

In 2013, its aging facilities were replaced with a $23 million hospital, and every room is private and spacious, which allows patients to have some therapy there if they need or want that option.

Thirty years ago, Hunt said, people were kept in the hospital for weeks after a stroke, but today they are discharged and moved to a rehabilitation facility after a few days, and the goal is to get them moving and back to normal as quickly as possible.

“We start discharge planning as soon as the person comes here, and we let them know the estimated length of their stay,” he noted, adding that 80% of patients at HealthSouth are able to return home, although they may need additional therapy.

For example, an 85-year-old who has had a stroke may have lost the use of his or her right arm. “We help the person gain strength, improve their function, and learn to use the arm in a different way than before the stroke occurred,” Hunt explained. “No two patients are the same, so we don’t have a cookie-cutter approach to treatment.”

In addition to stroke, rehab hospitals see people with brain or spinal-cord injuries, disorders such as Parkinson’s disease and multiple sclerosis, amputations, respiratory conditions, diabetes, infections, and a multitude of other health problems.

Hunt told BusinessWest that many people don’t know that seniors who are living a marginal existence due to functional deficits may be eligible for admission to a rehab hospital, which can improve the quality of their life as well as help their caregivers.

However, discharge planning to ensure that every patient gets the help or care they need is critical. “But it can be challenging,” said Cheryl Moriarty, lead occupational therapist at Weldon Rehabilitation Hospital.

She cited a few examples that make care planning complex: the patient’s spouse may have been caring for them at home but can no longer do so because of new medical complications; patients may need assistance that is difficult for family members to coordinate; and assistance from resources in the community may also need to be arranged.

In addition, family members must receive education about their loved one before a discharge, which includes changes that may be needed at home, such as adding a ramp or moving a bedroom from a second floor to a first floor.

Jury said Weldon sees many patients who have had amputations due to uncontrolled diabetes or vascular disease. They haven’t healed enough to be fitted for a prosthesis and need to learn how to care for their extremity, use a wheelchair or walker, shower, get in and of bed, use the bathroom, and be able to accomplish other tasks of daily living.

The loss of a limb can be difficult emotionally, so Weldon schedules peer visits with amputees for people who have had similar amputations and are about the same age and gender as the patient.

Tamilyn Levin, chief operating office for Wingate Healthcare, says its admission criteria is different than a rehabilitation hospital, and the patient’s length of stay depends on what they need and how quickly they progress.

She told BusinessWest that every Wingate has a gym and team of therapists and nurses. Patients at their facilities can also receive assistance with tasks of daily living, such as getting dressed, if and when it is needed.

Every patient is seen by a physician during their stay, and every Wingate has a trainer whose job is to keep pace with changes in healthcare and make sure employees are kept informed about best practices.

Hevey noted that the East Longmeadow and South Hadley facilities have pavilion suites for patients who need short-term rehabilitation.

“Most of the rooms are private, and there is a separate entrance for this section of each building,” she said, noting that stays are typically two weeks or less and patients receive one to four hours of therapy a day, depending on their needs and how much they can tolerate.

“We treat a wide range of conditions that range from wound care to infections to respiratory problems, and also see patients who are weak and deconditioned from the flu or chemotherapy,” she continued. “Our goal is to get them back to their prior level of functioning.”

Changing Environment

There are 76.4 million Baby Boomers alive today, and many have more than one health condition. “This is the beginning of the senior explosion, and we haven’t hit the peak yet,” Moriarty said.

Changes in healthcare are occurring rapidly, but local rehab facilities are keeping pace with the industry and will continue to do so as the demand for their services continues to grow.

“An individual program has to be created for each person that follows best practices, and because things are constantly in flux, our program has to be very dynamic, so we have an integrated approach from the time a patient is admitted,” Jury said.

Such policies and procedures are helping to make many seniors functional and independent, which represents a vast improvement over generations past.

Health Care Sections

Meeting an Emergency Need

An architect’s rendering of Holyoke Medical Center’s new Emergency Department, set to open in May or June.

An architect’s rendering of Holyoke Medical Center’s new Emergency Department, set to open in May or June.

The numbers alone speak to Holyoke Medical Center’s need for a new Emergency Department, with the current ER designed for 25,000 visits per year but actually logging almost 43,000. But HMC’s new facility, set to open this spring, will do much more than better handle the traffic; it will also call on cutting-edge ideas in design and workflow — not to mention an innovative, dedicated behavioral-health area — to reflect a truly 21st-century vision of emergency care.

Running an emergency room is more than a numbers game for hospitals, involving a complex weave of triage and treatment to ensure that patients’ needs are met efficiently and effectively.

But the numbers at Holyoke Medical Center … well, they were simply unsustainable.

“The existing ER is designed to see about 25,000 patients per year,” said Carl Cameron, the hospital’s chief operating officer. “We saw almost 43,000 last year in that small area located in the back of the hospital, which is difficult to find.”

When Spiros Hatiras came on board as president and CEO of Holyoke Medical Center (HMC) in 2013, one of the first concerns brought to him by the board of directors was the existing Emergency Department, which desperately needed an overhaul and more space. They talked about expanding the existing ER, but the finances suggested building a new one would make more sense — not to mention that a construction project in a working ER would disrupt patients.

“We started the dialogue about what we are going to do with the ED in October of 2014,” Hatiras said. “We talked about the concept of expanding in place, but the exercise proved to be futile because we’d lose a lot of space with the construction. So we changed course and said, ‘maybe we need a completely new building.’”

The end result of those discussions will be unveiled this spring: A new Emergency Department that will expand the current space from 8,500 square feet to approximately 20,750 square feet. A second floor above the new ER will house a medical office building of 18,000 square feet.


List of Acute Care Hospitals in the region


The expansion will increase the ER’s treatment beds from 26 to 40, 12 of those designated as behavioral-health beds, part of a new Crisis Center for Psychiatric Services, segregated from the main ED to give those patients more privacy. The ED will also include two multi-patient trauma rooms, advanced life-saving equipment, six fast-track spaces, and a patient-navigation service as well. “It’s a large increase from where we’re currently at,” Cameron said.

Carl Cameron

Carl Cameron says capacity alone — the current ER is designed to see 25,000 patients annually, and saw almost 43,000 last year — is reason enough to build a new one.

The exterior space will be bigger as well, with room for four ambulances instead of the current two.

Meanwhile, the second floor will be the home of a comprehensive weight and health-management program, including services for bariatric surgery, general surgery, diabetes counseling, behavioral and nutritional education, as well as a patient fitness center.

“It’s a state-of-the-art space up there, with plenty of room,” Cameron said. “One of the rooms is a large auditorium where we can have sessions with bariatric patients.”

The weight-management program, launched last March, has “grown beyond anyone’s imagination,” Hatiras added, noting that it recently saw its 500th new patient. “It’s been amazing, and it continues to grow. This is the result of planning ahead, knowing we’re going to need more space for that program, and potentially more providers.”

With the new ED and medical office building ahead of schedule — the goal of cutting the ribbon in late June may be pushed up to late May — BusinessWest takes a peek into what is now a mesh of steel framing, but promises to become the state-of-the-art emergency area this community hospital has long needed.

Modern Design

Once the decision was made to build a new structure, Hatiras said, discussions began from a blank slate, incorporating current best practices in layout, workflow efficiencies, and design elements.

“Throughout the waiting area, we’re incorporating a lot of natural light and finishes that make it feel more like the lobby of a hotel than a medical space,” he told BusinessWest. “There’s a lot of glass. Most of the treatment rooms are going to have a window where the natural light comes in. And every single one of the treatment rooms is private — no more lying next to somebody else, separated by a curtain.”

Meanwhile, finishes in the behavioral-health area, including materials, colors, and lighting, are meant to promote a decrease in anxiety. “Behavioral-health patients come in to the hospital in an anxious state,” he explained, “and often the environment — the noise, light, colors ­­— amplifies that instead of toning it down.”

Planners convened a behavioral-health peer group, soliciting input from former patients, to improve their understanding of how behavioral health should be delivered, and those discussions influenced some of the design choices.

Speaking of design, there was also an effort to make the new building match architecturally with its surroundings, which include buildings that date back to the 1800s, so the exterior brick and metal façade will blend in with both HMC’s recently renovated front lobby and the older buildings on campus.

“Not only will this be a functional improvement,” Hatiras said, “but when we’re done, this will be the most beautiful campus in the Valley, and I can say that with confidence, because I know what it will look like, and I’ve seen the other ones.”

Of course, all this function and design costs money, which for years has been a stumbling block to progress, he went on. The current project began with a $13 million to $14 million price tag, which increased to $23.8 million when the second floor was added.

However, approximately $5.5 million is being provided through the federal New Markets Tax Credit program. Hatiras credits U.S. Rep. Richard Neal with helping secure those funds, which will reduce the hospital’s debt service on the project, allowing it to keep healthy reserves and invest in additional health programs.

Meanwhile, HMC also scored a Community Hospital Acceleration, Revitalization, and Transformation (CHART) grant, a state program that promotes care coordination, integration, and delivery transformation to enhance community hospitals in Masachusetts. The $3.9 million grant ­— the largest in CHART’s phase 2 round of funding — supports the integration of behavioral-health services in the Emergency Department. Additional financing partners for the project include Valley Health Systems, MassDevelopment, People’s United Bank, JPMorgan Chase, and A.I. Wainwright.

Spiros Hatiras

Spiros Hatiras says talk of expanding in place was quickly scuttled in favor of a plan that would provide more space, easier access, and no disruption of current emergency services.

“Our total cost is $15 million, which is fantastic because an independent community hospital doesn’t have access to capital,” Hatiras said. “So to be able to do this for 60 cents on the dollar with the rest being New Markets Tax Credits and grants is really fantastic.”

A recently launched capital campaign seeks another $3 million to further reduce the hospital’s project costs. More than $1 million has been raised to date, with campaign donations to support some of the new ED’s ancillary needs and additional equipment.

Raising the Bar

One of the late additions to the project, piling on some additional cost, is a second entrance from the main hospital via the second floor, which adds functionality and easier patient access to the new building, Hatiras noted. But the most innovative element in the new ED is the emphasis on behavioral health, which is a growing issue across Massachusetts.

“In our existing ED, we didn’t have enough capacity for private behaviorsal-health areas,” Cameron told BusinessWest. “The new location is going to include six private rooms and another six detox chairs. I can imagine those will be full on a daily basis.”

In addition to the new building and new equipment being purchased, Cameron added, the ER will employ a more efficient workflow system that moves patients more quickly through the triage station and into a treatment room. The nursing station will be centralized and have visibility to all the treatment areas, to better keep track of what’s going on with each patient and, again, promote better flow.

Parking has long been an issue at Holyoke Medical Center — really, at what area hospital is it not an issue? — and the new building took over a small parking lot. But at the same time, the hospital created 100 new spots elsewhere on campus and launched a valet service to get patients in and out quickly without having to look for parking, Cameron said. “All that has definitely improved parking for patients.”

Hatiras said hospital leadership is formulating some long-term solutions to the parking issue, but they’re solutions to a good problem — that is, how to create more access to a hospital that has been growing to meet the needs of its community. This fact, he said, should be considered by neighbors who might be annoyed at some of the parking spillover onto side streets while HMC strategizes to create more space on its campus.

“In the three years since we started the effort to revitalize Holyoke Medical Center, we’ve added more than $20 million in revenue and a couple hundred employees,” he said. “Even the neighborhood property values are affected positively by the new emergency room and a thriving hospital.”

That progress has been reflected in some of the hospital’s recent honors, he added, including a Top Hospital Award from the Leapfrog Group in two of the past three years, which is given to more than 100 institutions nationwide for their commitment to patient safety. Selection is based on many areas of hospital care, including infection rates, maternity care, and the hospital’s ability to prevent medication errors.

“We want to raise this institution to a level the neighborhood and the city can be proud of,” Hatiras said.

That the hospital earned such recognition while operating an ER in half its optimal space is a testament to the hospital’s providers, he noted, and the expansion will provide opportunities to further boost that performance.

Local Impact

Hatiras is proud that most of the construction has been subcontracted to local workers.

“We’ve made a huge effort so that most, if not everything, stays local,” he said. “That’s a big shot in the arm, an economic boost for the area, with that work flowing through here.”

There’s also a sense of pride that the expansion is on schedule and on budget, he added.

“We finished design plans in February 2015, and were bidding out to the general contractor and getting financing before Christmas 2015,” he said. “The whole thing was lightning-fast. Everyone worked really hard on something that can sometimes take a half-decade of planning before it even gets off the ground.”

That wasn’t an option at Holyoke Medical Center, where emergency patients had been feeling the squeeze for much too long.

Joseph Bednar can be reached at [email protected]

Health Care Sections

Healing Touch

Hazel Ferriter

Hazel Ferriter says massages by Saskia Cote at Bottom-Line Bodywork help her to relax before she starts a 12-hour shift.

Twice each week, the assisted dining room at the Life Care Center of Wilbraham is transformed into a quiet, relaxing oasis.

The blinds are drawn, and soothing music plays softly as employees enter the dimly lit room and are treated to a 15-minute massage designed to alleviate stress, treat aches and pains, and allow them to return to work feeling rejuvenated and ready to help the people they care for.

The service is provided by Body-Line Bodywork, LLC in Palmer, which brings massage therapy into the workplace with a focus on nursing homes, assisted-living facilities, hospitals, and doctors’ offices.

“We specialize in short, targeted sessions to reduce tension, relieve stress, and help prevent carpal-tunnel and other repetitive-motion injuries,” said founder and CEO Saskia Cote, explaining that all massages are done on a massage table as opposed to a massage chair, which allows people to lie down and completely relax.

Although Life Care Center Senior Executive Director Dennis Lopata says the free massages are a simple perk, the benefit is appreciated and important to employees whose work duties include lifting people, assisting them with ambulation, and helping with tasks necessary to daily living.

“The job can be really demanding, especially for certified nursing assistants, who use and abuse their bodies to meet everyday challenges,” Lopata told BusinessWest. “The signup sheets fill quickly every week, and employees tell me the service makes them feel like Life Care cares about their personal well-being. It’s a well-regarded service, and we are happy to have Saskia as part of our team.”

Life Care Center is one of a growing number of companies that are incorporating massage therapy into wellness programs. Studies show the alternative health practice is an effective treatment for stress and pain relief, and doctors and healthcare professionals endorse its benefits.

Research has demonstrated that, in addition to decreasing stress, anxiety, and depression, massage therapy relieves muscle tension and pain, improves sleep, helps headaches, lowers blood pressure, prevents repetitive-strain injuries, increases immune function, treats carpal tunnel and tendinitis, and increases focus, energy, and mental clarity.

A recent study by Beth Israel-Deaconess Center for Alternative Medicine Research and Education and the Center for Health Studies in Seattle concluded that therapeutic massage is an effective treatment for chronic low back pain, while other workplace studies show it results in reduced absenteeism and workers’ compensation claims.

Indeed, it has become a benefit that pays for itself. According to the “2015 Report on Corporate Wellness” by IBISWorld, corporate wellness programs that include massage therapy average a $3 to $6 return on every dollar of investment.

Life Care has not been able to quantify benefits in terms of a dollar amount, but Lopata believes workers’ compensation claims and sick days have been reduced as a result of  the massages that several dozen employees take advantage of each week.

 

Dennis Lopata says massage therapy provided by Saskia Cote

Dennis Lopata says massage therapy provided by Saskia Cote of Body-Line Bodyworks has proved to be highly beneficial to employees at Life Care Center of Wilbraham.

Restorative aide Deborah Rivera is a proponent of workplace massage and has donated her time to peers who are having a difficult day and aren’t on the schedule.

“We try to provide every resident with the utmost in care, but sometimes we can’t do everything we would like to. We see some heartbreaking situations,” she said as she spoke about dementia and other age-related illnesses. “But this takes us away from the unit and puts us in a different stage of mind. We are being cared for and attended to, which is very relaxing.”

She added that a single session has alleviated back pain that stemmed from lifting and transferring patients. “When I leave the massage room, I feel rejuvenated and ready to go back on the floor and be a super aide.”

Winsome Roberts is another massage advocate who signs up for massages at Life Care every week. “I used to get a lot of migraine headaches, but they stopped after several months of massage,” said the certified nursing assistant. “Fifteen minutes may not seem like much, but it helps me to be more relaxed and flexible. The job can be physically and mentally demanding, but this makes a real difference and helps me to help residents who need assistance.”

Healing Journey

Cote has been a licensed massage therapist for 25 years, and has taught massage therapy to students in the U.S. as well as seven foreign countries.

She grew up in the Netherlands and began bodywork training at the Upledger Institute Europe in 1990.

She moved to the U.S. following a spiritual retreat to Santa Fe, N.M., where she learned about the New Mexico Academy of Healing Arts and was accepted into the program.

“I fell in love with massage there,” she said, adding that, after graduation, she worked at Ten Thousand Waves Spa in Santa Fe, which has been consistently named one of the top 10 spas in the world.

In 2002, Cote and her husband left New Mexico and moved to Massachusetts because they wanted to live closer to his family in the Boston area. They settled in Palmer, and she began work as an independent massage therapist. She also taught massage therapy at the Muscular Therapy Institute in Watertown, which recently changed its name to the Cortiva Institute. She was promoted to director of the institute’s continuing-education program and continued in that role until three years ago, when she left to teach at the Massage School in Easthampton.

During a time when she was questioning what else she could do with her life, she received a phone call about a counseling program at Elfinstone College in Rockport. She enrolled and graduated in 2008 with a doctorate that proved to be an important adjunct to her career.

“People store emotions and memories of trauma in their bodies, which sometimes come out when they are touched with compassion,” Cote told BusinessWest, recalling people who received massages after 9/11 and began crying on the massage table.

Three and a half years ago, she was hired to replace a massage therapist working for the Life Care Center in Wilbraham, and the joy she found helping people in the workplace led Cote to found Bottom-Line Bodyworks in 2015.

In addition to massage therapy, she is trained in a number of other healing modalities that include craniosacral therapy, myofascial release, lymphatic drainage, Reiki, and Qi Gong. She also offers hot-stone massage and cupping, which is popular with nursing-home employees because it helps with pain and inflammation while providing a sense of well-being.

“People often think of massage as a luxury, but when they have the opportunity to get a massage at work, it becomes part of their self-care,” Cote said, adding that it helps employees in nursing homes alleviate stress and physical discomfort in their knees, backs, and shoulders that results from working on their feet all day or lifting residents.

Cote also enjoys being able to provide local therapists with work, especially since it can be difficult for them to maintain a steady flow of clients. She has two employees and plans to hire a third in the Foxboro area, as a company there has requested her firm’s services.

In December, Wingate at Wilbraham signed a six-month contract with Body-Line Bodywork, and employees began signing up for weekly massages last month.

Administrator Darryl LeCours said the money for the service came from an $11,000 Pay for Performance Award the facility received last year from the state. The award has to be spent on staff, and after taking a poll and holding meetings to see what employees preferred, it became evident that their top choice was massage.

“Things such as gift cards or food for the break room, which were suggested, have a very short-lived impact,” she noted. “Massage is therapeutic and something tangible we can do to help employees have a better week physically and mentally.”

LeCours added that certified nursing assistants and other front-line caregivers are often exhausted at the end of a shift. But she noted that everyone has a smile on their face when they come out of a session.

“We’re trying to bring happiness into the nursing home, and it’s important for our employees to feel good so they can provide compassionate care to our residents,” LeCours said.

Other companies have called upon Body-Line Bodywork to give massages at employee-appreciation days and similar events, and their numbers are growing.

Beneficial Effects

When Cote arrives at a nursing home, the signup list is always full, and on a recent day, employees at Life Care Center kept stopping by for shoulder or back therapy even though they weren’t on the schedule.

Although it’s difficult to quantify the therapeutic benefits of this service, people have reported they are less anxious, sleep better, and have enjoyed better health as a result of massage.

It also provides them with a refuge from stress in a temporary oasis created expressly for that purpose.

“It’s a nice 15 minutes of silence that allows me to put everything in perspective,” said Ann Caseldan, a speech-language pathologist at Life Care who has enjoyed massages for the past two years.

Hazel Ferriter agrees. She usually signs up for a massage before her 12-hour shift at Life Care Center begins. “It loosens up your muscles and has helped me with a migraine and back pain that comes from lifting. Massage makes you feel better,” said the certified nursing assistant.

Indeed, it’s a win-win situation. “People are always happy to see me, which brings me great joy,” Cote said. “When they receive a massage, they learn how to touch the residents in a healing and loving way and may be able to go the extra mile for a patient because they feel nurtured themselves. It’s a ripple effect of compassionate touch; once someone is touched with love and compassion, they are much more likely to be loving and compassionate towards others.”

Which is a priceless benefit, especially in settings where employees care for loved ones who can no longer care for themselves.

Health Care Sections

Life-saving Knowledge

Barbara Pummell says students who take STCC’s EMT Basics course need to be prepared to put in a lot of work outside the classroom.

Barbara Pummell says students who take STCC’s EMT Basics course need to be prepared to put in a lot of work outside the classroom.

If a medical crisis occurs when Joan Osana is nearby, he feels confident that he can take control of the situation until help arrives.

The 25-year-old father of two just completed an Emergency Medical Technician (EMT) Basics course at Springfield Technical Community College, and although it involved a tremendous amount of study, he is happy he signed up for it.

“I gained a lot of knowledge in a short period of time that will help me throughout my entire life. I would advise others to take the course,” Osana said, adding that he hopes to become a firefighter, and gaining the basic certification in EMT is a stepping stone towards that goal.

Holyoke resident Daniel Rivera also takes pride in the knowledge and skills he mastered during the EMT course that ended a few weeks ago. “I want to save lives and assist people in any way that I can so I can make a difference in my community,” said the 30-year-old father.

His ultimate goals are to become a paramedic, which would fulfill a dream, then study fire science and become a firefighter.

Rivera told BusinessWest he worked in the masonry field until he saved up enough money to buy a home and take the course. “It was my goal for many years, but in the past I couldn’t take time off from work for it. Now, I can focus on what I am learning.”

The 170-hour class takes place in four-hour sessions, either three days or three nights a week, and is popular, but very difficult as it covers a great deal of medical information taught in the classroom as well as in hands-on, simulated settings.

In the past, it was a non-credit offering from the Department of Continuing Education’s Workforce Development Program and could not be applied toward a college degree. But that is about to change: STCC recently announced EMT Basics will be offered next fall as a seven-credit course that can be applied toward an associate degree in fire protection and safety technology or another field of study, although students may still choose the non-credit option.

Christopher Scott said STCC made the decision so more students can afford the course, which costs $1,400 without financial aid and will now number among classes that could qualify for a federal loan or Pell grant. The interim dean of the School of Health and Patient Simulation added that STCC also wanted to help its community partners, who have said there is a real need for EMTs in the Pioneer Valley.

The course credits will also be transferable next fall to other degree programs, including Greenfield Community College’s paramedic certificate course or associate degree in fire science technology, or the bachelor’s-degree program in emergency medical service at Springfield College.

Although EMT Basics is an entry-level course, Scott said, it’s a building block; the next level is Advanced EMT, followed by EMT Paramedic, which is a two-year course.

Barbara Pummell of Human Services Training Consultants Inc. in West Springfield has taught the course for 30 years and told HCN that students who complete it become eligible to take a practical written exam and become registered, then can apply to the state for licensure, which allows them to work for a municipal or private ambulance service. Licensure also raises their status under Civil Service and gives job candidates a better chance at being hired if they want to become a firefighter.

Challenging Curriculum

Pummell’s students come from many walks of life and have included a flight nurse for an ambulance service, physical therapists, physician’s assistants, nurses, and people in non-medical occupations. Although the majority live locally, others have come from as far away as Saudi Arabia or the Dominican Republic.

However, some students aren’t fully prepared for the amount of study the course demands due to the amount of material it covers.

Medical problems addressed include allergic reactions, respiratory issues, wound care, fractures, cardiac problems, how to immobilize a patient after a serious motor-vehicle accident, pediatric care, care for the elderly, and care for people with special needs, which can include autism, someone on a ventilator, a paralyzed individual, or a person with a feeding tube or tracheostomy tube.

“Students also learn about the legal aspects of the profession and how their actions affect them as well as the patients they deal with,” Pummell said.

Lessons are taught about how to deal with someone with a communicable disease such as meningitis, the flu, or pneumonia, and what they need to wear as protection — at minimum, gloves and a mask. “Students are taught to ask questions before they touch a patient,” the instructor noted.

However, the first thing they learn is cardiopulmonary resuscitation, or CPR, and each student must pass a practical exam and short written test and become certified by American Heart Assoc. before they can continue their coursework.

The next topic taught deals with the use of oxygen and other delivery devices, as well as how to splint arms and legs.

“As students became proficient in these skills, we advance to overall scenarios,” Pummell explained, adding that they learn to prioritize needs.

For example, if a woman falls down a flight of stairs and is having difficulty breathing, that must be addressed before injuries are taken into consideration.

Participants also learn how to respond to childbirth, which is taught not only in the classroom, but with a childbirth mannequin that can simulate different situations such as a breech birth or when an umbilical cord comes out before the baby, which can be very dangerous.

The course also takes life-threatening situations into account, such as when an ambulance is called to a scene where bullets are flying. Pummell said the ambulance must be parked a short distance away from the high-risk area until police arrive and deem it safe for the EMT team to enter.

“It’s heartrending when you can’t help someone who is ill or injured, but it’s critical to stay away until it’s safe,” she said, adding that she knows an EMT in Springfield who has experienced bullets flying by his head. “EMTs go in as a team of two, and if anything happens to their partner, their focus switches to that person.”

Scene safety also comes into play during a motor-vehicle accident. Firefighters have to be called if someone needs to be extricated from their vehicle, and a police presence is also critical for safety.

Another part of the curriculum deals with hazardous materials; EMTs can’t take care of a person until they are decontaminated, which is usually done by firefighters.

Pediatrics also comprises a large area of study, as caring for an adult or older adolescent is markedly different than helping an infant or toddler.

“Children’s bodies aren’t well-formed until they are 18. Their bones aren’t hard, and their muscles are not fully developed, so they are more susceptible to injury,” Pummell told BusinessWest, noting that small differences can be critical. For example, a child’s tongue takes up more room in their mouth than an adult’s tongue, which means they are more likely to choke if they lose consciousness as it can slide to the back of the throat and block the airway.

The course is rigorous, and students must be prepared to work hard inside and outside of the classroom, as in addition to time spent at STCC they must accumulate 128 hours of online work that includes exercises and quizzes designed to reinforce what they learn in textbooks and during the hands-on portion of the class.

Students also learn what medications they are allowed to administer. “If they are working for an ambulance service, they can assist a patient with an inhaler, use an EpiPen if the person shows signs or symptoms of a life-threatening allergic reaction, or administer Narcan,” Pummell said, explaining that the latter is a nasal spray used when a opiate overdose is known or suspected.

Other procedures are taught in more advanced courses, but the basic class teaches them how to discern whether they need to call a paramedic who can intercept the ambulance or meet them at the scene.

Eye to the Future

Scott said the course is ideal for people interested in the medical field as it gives them real insights into what will be involved.

“EMT Basics provides students with an entry-level opportunity that allows them to explore the healthcare field experience as well as patient care, and gives them the ability to advance either in a degree program or on the career ladder,” he said.

Rivera said the knowledge he gained has tremendous value. “It provides you with a lot of information that sticks with you. I really enjoyed the hands-on learning and feel confident that I can administer CPR and do a patient assessment.”

Which will fulfill his desire — and the wishes of other students seeking careers that will make a difference in their own lives, as well as the lives of others.

Health Care Sections

On the Home Front

Holyoke Soldiers’ Home resident Ted Dickson

Holyoke Soldiers’ Home resident Ted Dickson

Opened in 1952 to provide long-term care to those who served in the war to end all wars, the Soldiers’ Home in Holyoke has continued to be a solid option to those who have served in all the wars since, and in peacetime as well. The 24/7 care is complemented by a unique environment that brings veterans together, recognizes them for their service, and gets them out into the community. Said its new superintendent, “every day is Veterans Day here.”

 

Bennett Walsh was searching for some words he thought he could sum up the purpose, or mission, of the Soldiers’ Home in Holyoke and, more importantly, what it means to the veterans who reside there and their families.

He eventually summoned the phrase ‘safety net,’ and would use it several times in the course of a discussion about this state-funded long-term-care facility’s past, present, and likely future. And in many ways, that works.

“People come here because, for one of a variety of reasons, the family cannot provide the 24/7 care that their loved one needs,” said Walsh, a retired Marine lieutenant colonel who was named superintendent of the facility just before Memorial Day last May. “We’re a facility that can provide that. In many cases, a husband loses his wife, and she was the primary caregiver. Now that she’s gone, there’s no one in the family that can care for him 24/7. Every veteran here has a different story, but it all starts with a need that we can meet.”

But to those who call this facility home, it is much more than a safety net. For some perspective, BusinessWest talked with Ted Dickson, a submariner who served on the USS Snook, a nuclear-powered Skipjack-class vessel, during the Vietnam War. He suffered a brain aneurism two years ago, underwent surgery at Leahy Clinic, recuperated at several hospitals, and then spent some time in a local nursing home.

It was that last stop that he used as a launching point for his comments about the Soldiers’ Home, which he moved to roughly a year ago.

“I didn’t like that experience at all,” he said of his time in the nursing home before quickly changing the subject to his present surroundings. “It’s much different here … you have the freedom to do what you want, and there are so many activities. But you’re also surrounded by other people who served, and it’s great to be around these people.”

Elaborating, he said that, while the more than 250 veterans living at the facility share a number of common threads and can — and do — share many war stories (in this case, in a literal sense), that’s just part of the equation.

Other parts include the atmosphere, the camaraderie, the compassionate staff, the myriad activities the veterans can participate in —Dickson himself partakes in everything from photography to watercolor painting — and the many events, on site and off, that those at the Soldiers’ Home become part of.

Indeed, they don’t celebrate Veterans Day at the facility, said Walsh; instead, they commemorate what has become known as ‘Veterans Month.’

“Actually, every day is Veterans Day here,” said Walsh, adding that this mindset, or operating philosophy, if you will, is one of the reasons why the facility is a popular choice for those who have served, and their families.

“Every day in November, there was something going on — not only here at the home, but also out in the community that our veterans were asked to attend,” he said while trying to explain some of the many elements that set this facility apart. “It was heartwarming to see the amount of outpouring from all the different groups in the community; the message was clearly sent that our veterans are not forgotten.”

But while the Soldiers’ Home, opened in 1952, has a proud history, a mission that clearly resonates, and a seemingly solid future, there are challenges, said Walsh, whose successor left the facility due to what he considered weak support from the state, compared to what it provides to a much larger sister facility in Chelsea.


List of Home Care Options in the Region


Walsh believes the Holyoke facility is adequately funded — “could I use more money? Ask anyone that question, and they would say ‘yes’” — and that the challenge is to make the most of the resources it has and create greater efficiencies, especially since the facility is now nearly 65 years old and certainly showing its age.

“We have to do better and be smarter,” he explained, adding that this mindset has many components, including greater use of clean energy. “We need to ensure that we’re using every dollar properly because, while this facility has great bones and great structure, when it reaches this age, there are challenges.”

For this issue and its focus on healthcare, BusinessWest visited the Soldiers’ Home and talked with its new superintendent to gain some perspective on its unique mission and how it carries out that all-important assignment.

Branch Office

Walsh is in the process of having his office painted, and one of the first steps in that process is to take down much of the collection of plaques, pictures, awards, and other items he’s collected over the years.

Collectively, they tell quite a story, one of a 25-year career in the Marines that saw duty with each of that branch’s fabled divisions and in nearly all of the notable hot spots since the early ’90s.

Indeed, he was an infantry platoon commander in Mogadishu, Somalia and completed three tours of duty in Iraq and one in Afghanistan. He was stationed on Okinawa when a tsunami slammed into Northern Japan in 2011, and was among those troops assigned to aiding in the recovery from that disaster.

“I was stationed there for 30 days and could feel the aftershocks,” he recalled, adding that, when his time with the Marines ended early last year, he was faced with the often-challenging assignment of determining what comes next. As he looked back, he said that administering a long-term-care facility for veterans wasn’t exactly on his immediate radar screen.

Bennett Walsh

Bennett Walsh says the Soldiers’ Home has effectively served as a safety net for veterans for nearly 65 years now.

In fact, one of his first interviews was with MGM concerning a possible security-consulting assignment with the casino due to open in September 2018, and another concerned a similar assignment with United Technologies.

But upon hearing about the opening at the Soldiers Home, and with some prodding from family and friends, he decided to explore that option.

“I was actively interviewing for life after the Marine Corps — the next act, as I like to say — and I was approached about this position, which appealed to me because I would get to work with veterans,” said Walsh, who is now serving on the home front, in every sense of that phrase.

Since arriving, he’s spent the requisite considerable amount of time and energy needed to acquaint himself with everything from the staff of 300 to the veterans themselves (he knows most all of them on a first-name basis), to the facility’s rich history.

Relating some of the latter, he said the facility — a converted mental-health hospital built on a former apple orchard on a hill on Cherry Street with a commanding view of the Paper City — was built with the intention of serving the nation’s many World War I veterans, who, by the early 1950s, were likely in their 60s or 70s.

Over the years, the composition of the group residing in the home has naturally changed, and it continues to do so, said Walsh, noting that, while the bulk of current veterans served in World War II or the Korean War, there are a large number of Vietnam War vets, now in their early 60s at the youngest, as well. And there are many who served in peacetime in various locations around the world.

“Overall, it’s a very intriguing mix of people, and what they all have in common is that they served their country,” said Walsh, adding that the average age of the residents, as it is in most long-term facilities, is just over 80.

Most are from Western Mass., which is the unofficial service area of the Holyoke facility, he went on, adding that this means all four counties. But some are also from the central and eastern parts of the state as well.

The home, which serves more than 2,000 veterans a year through a host of inpatient and outpatient services, including dental and lab work and a pharmacy, is generally fully occupied, and there is a waiting list.

All branches of the service are well-represented, said Walsh, referring to the Army, Navy, Air Force, Marines, Coast Guard, and Merchant Marine. And veterans currently in residence have taken part in a host of landmark battles and campaigns, including Pearl Harbor, the Battle of the Bulge, the Normany invasion, and the Manhattan Project that brought about the atom bomb.

“There is a lot of history represented here,” said Walsh.

Most veterans will spend two to three years at the facility, on average, he said, adding that veterans are charged $30 per day ($900 per month) to stay there, with most of the costs offset by veterans benefits.

Battle Plan

As noted earlier, the care provided at the Soldiers’ Home is 24/7 in nature, which makes the facility similar to a typical long-term-care facility.

But, given the unique nature of the client base, that is where most of the comparisons end, said Walsh.

Indeed, while each of the veterans living there has a story — both in terms of their service to their country and how they arrived in Holyoke — that is in some way different, there are those abundant common denominators, especially a desire to be among fellow service men and women and enjoy a host of programs and activities simply not available at a traditional nursing home.

‘Veterans Month’ is just part of that equation, Walsh said, adding that there are events all year, and a number of special programs (including successful efforts to make the home a voting place last November) designed to make sure that veterans and their service are not forgotten.

That includes those who fought in what some have come to call the ‘forgotten war,’ the one waged in Korea just as the Soldiers’ Home in Holyoke was opening its doors.

“This year they marked the 50th anniversary of the Vietnam War, and there were special pins made up for all our Vietnam veterans,” he explained. “But we made the decision that we didn’t want to forget the Korean War veterans, so we made up special pins for them as well and had a ceremony earlier this month.”

It was this unique environment and focus on veterans that certainly appealed to Dickson, 73, whose story, at least the the chapter relating to the Soldiers’ Home, began a few years ago, when, as he colorfully put it, “my wife thought I was acting a little wacky.”

Her instincts proved correct, because an MRI revealed an aneurism, which led to surgery at the Leahy Clinic that “took a chunk out of my head and pulled out the aneurism.”

As Dickson said, his stay in a traditional nursing home was not enjoyable, and an examination of options revealed that the Soldiers’ Home was one of them, and he took full advantage of that opportunity.

“It’s been a super experience — it’s nice to be in the middle of a group like that,” he said, adding that, while he’s receiving care, he likes to give back — to both those providing the care and the community at large, through everything from his photography to events for veterans in area cities and towns.

The goal moving forward, said Walsh, is to simply write more stories like Dickson’s, an assignment that comes with many challenges.

And that’s why another of Walsh’s first priorities is to create a long-term strategic plan for the facility, one that will ensure that it can live up to its unofficial operating slogan, “providing quality care with honor and dignity.”

“You have to look forward because, if you don’t, you’re not looking ahead,” he explained. “A big part of our five-year strategy is to make better use of our existing resources.”

Soldiering On

On the day he talked with BusinessWest, there was a Santa Claus suit hanging on a rack in the corner of Walsh’s office.

He acknowledged that, in his present role, he wears many different hats — and in this case, a red wool one, as he distributed gifts to veterans and their family members at the annual holiday party.

The Santa suit — not to mention the jacket and tie he wears most days — is quite a departure from the Marine camos he’s been wearing for more than half his life. But he sees it simply as service, or, to be more precise, as a continuation of service, to both the country and others who have answered the call.

Providing that service in the form of a unique environment featuring specialized 24/7 care is what the Soldiers’ Home is all about. And that’s what makes it a safety net, but also much more.

Just ask Ted Dickson — or anyone else who calls this place ‘home.’

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

Health Care Sections

Articulating Progress

A new partnership between Westfield State University and Springfield Technical Community College will allow nursing graduates from STCC to earn a four-year degree from WSU on the Springfield campus. At a time when it’s increasingly important for nurses to have four-year degrees, the goal, as one STCC dean said, is to “remove any barriers to success.”

From left to right, Jessica Tinkham, Marcia Scanlon, and Shelley Holden

From left to right, Jessica Tinkham, Marcia Scanlon, and Shelley Holden show off the new simulation lab in the Science and Innovation Center at Westfield State University that opened this fall.

Emily Swindelles will graduate from Springfield Technical Community College next May with an associate’s degree in Nursing.

The path to matriculation hasn’t been easy for the mother of three children — ages 5, 3, and 2 — who has worked part-time and commuted from her home in Ellington, Conn., but she has had a lot of support from her family and fellow students, who have become like an extended family.

Swindelles’s dream is to work in a hospital maternity ward and eventually become a nurse midwife, so the 30-year-old was happy to hear that officials from STCC and Westfield State University signed an articulation agreement on Oct. 4 that will allow STCC nursing school graduates to earn a four-year degree from Westfield on the Springfield campus.

The new partnership is the first hybrid RN-to-BSN (bachelor of science in nursing) completion program between two public institutions of higher education in Western Mass. ‘Hybrid’ refers to the fact that it includes online classes as well as courses on the STCC campus that will be taught by instructors from Westfield State.

“I was really excited when I heard about the new program. It’s convenient, flexible, and cost-effective,” Swindelles said, adding that she is used to the commute, familiar with STCC, and likes the fact that, although the majority of coursework will be done online, classes on campus will provide students with the support and interaction that she feels enhances learning.

“I would have taken a year off just to make sure that I was financially capable of going back to school, but with the flexibility of this program, I think I’ll be able to manage school, work, and family,” she added.

Jennifer Hoppie is another STCC nursing student who is enthusiastic about the new program. The 39-year-old mother of two children, ages 11 and 9, moved to the U.S. from St. Lucia in 1999, and her goal is to work in the pediatric department of a hospital and earn a bachelor’s degree because it will increase her job options.

Prior to the matriculation agreement, Hoppie planned to work for a year after passing the board exam required to become a registered nurse, then enter a bachelor’s-degree program. But she says if she can continue her education at STCC after she graduates, she will choose that option because it will allow her to stay close to home in case she is needed at her children’s school.

“The price of the new program is also good; there are people like me who can’t afford expensive tuition,” Hoppie said, adding that she took out a loan to earn the degree she will receive in May.

Lisa Fugiel and Christopher Scott

Lisa Fugiel and Christopher Scott say Westfield State University’s hybrid RN-to-BSN completion program will help remove barriers to education faced by many non-traditional students at STCC.

Indeed, the new RN-to-BSN completion program is touted as the most affordable pathway of its kind; Westfield will accept 90 credits from students toward the 120 needed for a four-year degree, and the cost for the additional 30 course credits will be $10,500.

Christopher Scott noted that STCC has collaborations with other schools of nursing that allow graduates to pursue a bachelor’s degree, and it’s important for students to be aware of all of their options.

“Our goal is to remove any barriers to success,” said the interim dean of the School of Health and Patient Simulation, adding that the majority of STCC students are non-traditional, and many face financial or personal challenges that make getting an education difficult.

“We want them to be able to continue their education and flourish after they succeed here,” he told BusinessWest.

Officials from both schools say the new program is also significant because it is in line with state and national goals to increase the number of nurses with bachelor’s degrees in the workforce.

“There’s been a national call to action from the Institute of Medicine to bring our BSN workforce up to 80% by the year 2020,” said Jessica Holden, a nursing instructor at Westfield State and program director of the RN-to-BSN program.

Holden said the goal in Massachusetts is to increase the number of BSN nurses from 55% in 2010 to 66% in 2020, and to reach the national goal of 80% by 2025. The goals were set by the Massachusetts Nursing and Allied Health Workforce Development Plan and implemented by the Massachusetts Action Coalition.


A list of Acute Care Hospitals in Western Mass. HERE


“There is a growing shortage of nurses, and we see our associate degree in nursing as an entryway into a bachelor’s program,” said Lisa Fugiel, director of Nursing for STCC’s School of Health and Patient Simulation. Although graduates can work as an RN after they earn an associate’s degree and pass their boards, she explained, nurses with a BSN are typically given more responsibility and supervisory roles. They also earn higher salaries, and many healthcare institutions are seeking nurses with advanced degrees to meet certain requirements.

Increasing Opportunities

Most colleges limit the number of credits a student can transfer, and the fact that Westfield’s hybrid nursing program will accept 90 is expected to make a real difference to STCC students.

“They might have to take 50 credits at another college to achieve a baccalaureate degree,” Scott noted, explaining that STCC and Westfield State have made the pathway easier by creating a ‘curriculum map’ that outlines prerequisite courses they need to enter the BSN program.

“It allows for seamless education,” said Marcia Scanlon, chair of the Department of Nursing at Westfield State.

Shelley Tinkham agreed, and said it’s important, because if students take the wrong electives, they will have to take additional classes to meet Westfield State’s entrance requirements. “The map was carefully developed as a partnership model,” said WSU’s dean of Graduate and Continuing Education.

Westfield State officials told BusinessWest they began developing their own RN-to-BSN program, which launched this fall, about four years ago. The STCC-Westfield nursing-degree partnership was developed simultaneously, and everyone involved believes it will increase the number of students who pursue a bachelor’s degree.

“Massachusetts issued a call to action to be creative and innovative in creating a seamless pathway so nurses can progress, and the new hybrid program meets that call,” said Holden. “It’s a new model for Westfield State that is very affordable.”

She noted that the push at the state and national levels to increase the number of nurses with bachelor’s degrees was initiated because nursing has become more complex due to the changing face of medicine, which includes advances in technology and a growing number of patients with multiple health issues.

Critical Relationships

Sims Medical Center at STCC is the largest simulation facility of its kind in the Northeast and has received national recognition.

“We recreate the environment of every type of care in a hospital, from the trauma room to acute care, child delivery, and pediatrics,” Scott said. “We have our own operating room and critical-care unit, as well as a home-care environment.”

Students in the college’s 20 healthcare programs work with human patient simulators that breathe, sweat, have pulses, and react to care and procedures that range from arthoscopic surgery to removing a gall bladder.

“Students can take their blood pressure and do every medical technique on them possible,” Scott said, explaining that the goal is to expose students to situations that can occur before they enter the workplace.

And, since nurses don’t work alone, STCC students work alongside their peers, who are studying a multitude of healthcare disciplines, including respiratory therapy, radiology, and surgical technology.

In fact, STCC’s center is so high-tech that the college has worked with hospitals, medical centers, and higher-education institutions to help them build and operate their own simulation centers and avoid perils and pitfalls in the process.

Emily Swindelles

Emily Swindelles says Westfield State University’s hybrid RN-to-BSN completion program will make it easier for her to continue her education.

Westfield State is among them, and Scott said officials sought the school’s help in developing a simulation center for the university’s $48 million Science and Innovation Center that opened this fall.

Westfield officials went to STCC, toured the campus, and met with faculty, administrators, and architects before designing their own space. They say the relationships that were formed played a role in the establishment of the matriculation agreement.

“Creating a transfer program is difficult, and historically, Massachusetts institutions have not done well with it. But the new program shows we can cooperate; it’s an excellent example of what can be accomplished, as it’s designed to be very flexible,” Tinkham said, noting that Westfield needed to pass a policy and ask its governing board to accept 90 transfer credits for the hybrid program because they normally accept only 67 from a community college.

“Dean Scott was very patient with us,” she continued, adding that Westfield State officials recognized that STCC has many non-traditional students and first-generation graduates who need a supportive environment and may not be familiar with WSU.

The nursing programs at STCC and Westfield State are both accredited. The baccalaureate degree in nursing at Westfield State is accredited by the Commission on Collegiate Nursing Education. STCC’s associate in science degree in nursing is accredited by Accrediting Commission for Education in Nursing Inc.

Ongoing Partnership

Westfield State University wants students entering STCC’s associate degree in nursing program to know they can earn a bachelor’s degree on the Springfield campus and plan to make them aware of the curriculum map at the beginning of each new school year.

“They will feel our presence on their campus from day one,” Holden said, adding that Westfield representatives will pass out brochures and be available to nursing students from the time they begin the nursing program at STCC.

She was hired at Westfield State a year ago, Tinkham has worked at the university for two years, and Scanlon has been there for five, but was named department chair a year ago; they all feel partnerships such as the new one with STCC are critical to the future of nursing.

“We’re already looking at other collaborations,” Tinkham said. “This is just the beginning.”

It’s a good beginning, one that not only addresses the workforce-development shortage, but will benefit the community as many STCC students become involved in charitable causes.

“Helping them to continue their education will allow them to give back even more,” Fugiel said, “and we are really excited to be able to offer them an affordable opportunity to do so.”

Health Care Sections

Smart Shopping

Paula Serafino-Cross

Paula Serafino-Cross says canned fruit packed in its own juice or pre-cut fruit are healthy snacks that many children enjoy.

What people eat can have a profound impact on their health, energy level, the way they feel, and their overall well-being.

But it all begins at the grocery store, where a myriad of temptations can lead shoppers to put foods in their cart that have little or no nutritional value.

“We live in a fast-paced society and eat in response to the visual, or what looks good to us. But if you want to be healthy, you have to prioritize, take time to plan meals, stick to a grocery list, avoid shopping when you’re hungry, and cook using a lot of vegetables,” said Paula Serafino-Cross, a clinical dietitian from Baystate Health Food and Nutrition Services. She added that cooking in today’s world does not have to be time-consuming, thanks to precut fruits and vegetables and products like frozen brown rice.

However, she suggests keeping granola bars or fruit in the car that can be eaten quickly to prevent going into a store hungry or stopping for fast food.

“There is a lot of great food in stores. You just have to figure out where it’s located,” she noted.

Susan Mazrolle agrees. “I’ve given tours to groups of medical students who were well-educated but didn’t know much about buying food and cooking it,” said the in-store consultant dietitian for Big Y in the Springfield region.

She noted that many people are frugal at the grocery store but extravagant in other areas that are not important. “It’s better to spend your money on healthy food than at the doctor’s office. There are good and bad choices throughout the store; healthy shopping doesn’t have to cost a lot, but you have to know what to buy.”

Theresa McAndrew, a Unidine dietitian at Holyoke Medical Center, agrees. She has spoken to many people who have told her they don’t know how to shop well. She tells them not only to read labels, but to pay attention to portion size, as it can be deceiving.

Indeed, Americans have super-sized their expectations about what a serving should look like, and the amount most consider to be normal is not accurately reflected on the Nutrition Facts labeling on packaged foods and beverages.

To correct that problem, the Food and Drug Administration has issued new standards that must be implemented by July 2018. The goal is to bring serving sizes closer to what people actually eat, so when they look at calories and nutrients on a label, it is be more in line with what they are accustomed to putting on their plate. A single serving is not a recommended amount of any food product, but only meant to reflect what the average person consumes.

For example, few people limit themselves to a half-cup of ice cream, which is the amount listed on half-gallons today, so when the new law becomes effective, the serving size will go up to two-thirds of a cup.

“People sometimes buy products based on calorie count, but then consume far more than one serving,” McAndrew noted.

Susan Mazrolle

Susan Mazrolle says many people don’t stop to think about how the food they eat can impact their health.

Other factors that can be confusing include sugar content. There is a difference between natural sugars, which are found not only in fruits, but in products such as milk and plain yogurt, and artificial sugars that are often added to products. The new labeling standards will differentiate between the two types of sugar, which is important in terms of health.

People also make choices based on price, which can work well if you know what to buy, but work against you if you don’t. For example, dietitians say Ramen Noodles are a poor choice because the product is filled with salt and saturated fat, while Annie’s Macaroni & Cheese is a better choice as it doesn’t contain artificial colors or flavors, and adding a few vegetables can bump up its nutritional value.

They know it can be difficult to avoid a buy-one, get-two-free sale, which is an excellent choice if the product is frozen vegetables, but a poor one if it’s ice cream.

“Do you really need three half-gallons calling your name?” Serafino-Cross asked, noting that people who have a difficult time with portion control can still enjoy treats in pre-measured sizes, such Diana Banana Babies, which are frozen bananas dipped in chocolate, or individual Hoodsie cups, which are better than a heaping dish of ice cream.

“Moderation is the key. A few individual bags of potato chips a week won’t hurt you, but people get in the habit of eating an entire large bag,” she told BusinessWest, explaining that eating mindfully without doing other things at the same time and savoring the taste of food allows people to be aware of how much they are eating and how it tastes.

She recommends that people who are interested visit thecenterformindfuleating.org,‎ which contains useful information on health conditions and how to address problems such as overeating.

Helpful Initiatives

Big Y kicked off its Living Well Eating Smart program in 2005, which includes a free, 12-page publication that is published every other month. Each edition has a theme and contains easy-to-prepare recipes featuring products that are on sale.

Big Y also hosts cooking demonstrations, grocery-shopping tours, and health-related events in conjunction with its pharmacies on topics such as cancer prevention.

“The premise is to help shoppers cut through confusing information and products and make their health goals more obtainable,” said Carrie Taylor, lead registered dietitian for the program. “What you bring into the house will impact what you serve, and if it is more convenient, you will be more inclined to eat it.”

She added that Big Y wants consumers to know there are healthy foods they can buy that are easy to prepare. They range from sushi to frozen fruit that can be put into smoothies; pre-washed, bagged lettuce and other greens; pre-cut fresh fruit; frozen vegetables in bags; single-cup servings of brown rice; and frozen fish fillets.

Taylor receives up to 50 e-mails each month that contain feedback from customers and questions that range from information about specific food products to how to follow a meal plan after being diagnosed with a disease.

Big Y’s free shopping tours, with themes that range from weight loss to heart health, are popular, and some people attend multiple sessions.

“We can show you ways to eat healthy with foods that are right at your fingertips that you may not have seen before,” Taylor said, adding that people can also learn how to make changes gradually. For example, it’s easy to make a healthy snack by mixing whole-grain cereal with walnuts and raisins, and if children are used to eating sugary cereals, mixing them half-and-half with healthier brands and slowly increasing the amount of the low-sugar cereal can make change easier.

Mazrolle has conducted many tours in Big Y stores, and says people often fail to consider how the food they eat impacts their health.

Tours start in the produce section, where textures, colors, and tastes are abundant. She talks a lot about easy cooking and provides shoppers with simple suggestions, such as sautéing catfish in a pan with olive oil and adding crushed pecans; adding minced and sautéed mushrooms to ground beef in tacos; and putting pre-cut peppers and onions in a pan with chicken or shrimp and adding bottled dressing, herbs, or teriyaki sauce.

Meanwhile, ChooseMyPlate.gov says half of each plateful of food should be filled with fruits and vegetables, and at least half of any grains should be whole; a sweet tooth can be satisfied with a fresh-fruit cocktail or fruit parfait made with yogurt; and a baked apple topped with cinnamon can be a hot, healthy treat.

Learning Curve

McAndrew said people with diabetes should stay away from foods with added sugars because they have no nutritional value and can cause blood sugar to rise.

Also, individuals with heart disease need to watch their intake of saturated fat because it contributes to blockage of the arteries, and should instead choose cuts of meat that are lean.

It can be difficult to alter your shopping habits if you are diagnosed with one of these conditions, but small changes, such as noting the sodium content listed on food labels, can make a big difference over a lifetime.

“Everyone is tempted by different foods, but there are a lot of components to healthy shopping. Most people like textures, flavors, and taste, which is the reason they eat too much of foods like ice cream. But it’s possible to be satiated with less if there is fiber in the food,” McAndrew said, adding that sprinkling nuts on ice cream makes it a lot more filling.

However, reducing sodium intake is one of the most difficult changes to make, so McAndrew suggests doing it gradually. “You’re more apt to be successful if you take small steps, which is especially important if you have been eating a high-fat, high-sodium diet. Salt is a flavor enhancer, so it’s in almost everything, and going without it is one of the hardest things for our taste buds to adapt to,” she explained.

Curbing cravings for foods loaded with sugar can also be difficult, but, again, it’s a matter of making small changes.

Another obstacle to healthy eating is the time it takes to prepare nutritious food. But grocery stores have begun catering to people with busy schedules, and shelves contain pre-cut fruits and vegetables, bagged salad greens which often come with dressing, and pre-roasted chickens that are easy to serve and a much better choice than fried chicken or frozen chicken nuggets.

“I always look for the best alternative when I shop,” McAndrew said. “There is a lot more information out there than there used to be, and it’s worth taking the time to go on a supermarket tour.”

She suggests making a menu at the beginning of each week and sticking to it; the menu doesn’t have to be detailed, but it can help guide decisions during the week, and giving children choices and having them cook alongside you can inspire them to change their eating habits.

McAndrew says parents often bake cookies with their children, but making homemade chicken nuggets or soup, which can be frozen into individual portions, can capture their interest and lead them to make healthy choices.

What children drink is also important: the American Academy of Pediatrics recommends giving them water or milk rather than juice.

“Studies have shown that children who exhibit poor growth are often filling up on juice that takes away their appetite,” Serafino-Cross said. “Parents think they are buying something that is healthy, but juice is not needed in a diet.”

Ongoing Change

Taylor says the best intentions often go awry, but every day is an opportunity for a fresh start.

“Big Y’s philosophy is to help people reach their goals by making one small change at a time. We don’t have diet sheets or tell people, ‘eat this, but don’t eat that,’”she said. “We meet shoppers where they are, and if you are willing to shift the way you spend your money, it can make a real difference in your health.”

With obesity on the rise, it can also make a difference in your waistline, how you feel, and the number of visits you pay to the doctor in the future.

Health Care Sections

Joint Concerns

PotEdible

By all accounts, the medical-marijuana industry in Massachusetts is booming, and now voters must decide whether to take the next step, and legalize the drug for recreational use. While the measure — appearing as a ballot question on Election Day — applies to users age 21 and up, doctors worry that easy access for adults will trickle down to teenagers, while candy-like marijuana ‘edibles’ could find their way into the hands of kids. Meanwhile, they wonder whether the state, already in the grips of an opioid-addiction crisis, is walking into an entirely new set of public-health problems.

Vermont Gov. Peter Shumlin makes no secret of his stance on marijuana. He’s long promoted legalization of the drug for recreational purposes, as Colorado, Washington, Oregon, and Alaska have done and other states, including Massachusetts, are considering, and he’s spoken and written at length about why pot possession shouldn’t be a crime, but an open, regulated activity.

In short, he’s as pro-marijuana as a governor can be.

Yet, he thinks Massachusetts has a terrible ballot question on its hands.

The marijuana-legalization bill up for referendum on Question 4 of Massachusetts’ Election Day ballot, Shumlin argues on his blog, “would allow edibles that have caused huge problems in other states, smoking lounges, home-delivery service, and possession of up to 10 ounces of marijuana. Vermont’s bill allows none of that. If Massachusetts moves forward with their legalization bill while Vermont delays, the entire southern part of our state could end up with all the negatives of a bad pot bill and none of the positives of doing the right thing.”

If a pro-pot governor has such harsh words for the Massachusetts bill, it’s not hard to imagine what medical professionals think.

“We’re concerned for a number of reasons — about recreational marijuana in general and this particular ballot question,” Dr. James Gessner, president of the Mass. Medical Society (MMS), told BusinessWest. He noted that the human brain is still developing throughout one’s 20s, and among the late-developing areas of the brain are those governing judgment issues.

Dr. JameS Gessner

Dr. JameS Gessner

“Marijuana is the single most commonly used drug among adolescents and has significant effects on the developing brain, impairs memory and judgment, and, with early, prolonged use, can have a distinct, negative effect on intellectual development,” he went on. “My concern is really with the unexpected consequences on youth and adolescents. At a time of risk taking in their lives, this drug really blunts judgment.”

If that’s true, then what the Massachusetts bill does, opponents argue, is make it far easier for adults — and children — to get their hands on a harmful substance they might have avoided before simply due to fear of legal consequences. The bill would also lend a veneer of respectability to marijuana, said Dr. Robert Roose, chief medical officer, Addiction Services, for the Sisters of Providence Health System.

“The main concern is providing access to psychoactive substances that have negative consequences for some individuals, and sending a message that marijuana products are safe and beneficial, when there’s really not strong evidence to suggest either of those things may be true,” Roose told BusinessWest.

Some of the state’s top leaders echo this view. In an opinion piece in the Boston Globe earlier this year, Gov. Charlie Baker, Attorney General Maura Healey, and Boston Mayor Martin Walsh argued that marijuana is not safe — citing risks like impaired brain development, disinterest in school, and motor-vehicle accidents — and increasing access to it makes little sense at a time when the state is already grappling with a well-documented opioid-addiction epidemic.

“There are serious and immediate implications for public safety,” they wrote. “In the year after the drug was legalized in Colorado, marijuana-related emergency-room visits increased nearly 30%, as did traffic deaths involving marijuana. Edible marijuana products — often in the form of brownies, candy, or soda — pose a particular threat for children, who may mistake them for regular treats.”

They cited a report from the Rocky Mountain High Intensity Drug Trafficking Area, which found that marijuana use has decreased among minors nationwide in recent years, but Colorado youths are 20% more likely to have used the drug regularly since it became legal for adults two years ago. “Many believe that, since the drug is legal for adults, it must be safe to use.”

That trickle-down impact on young people is one key driver — though far from the only one — in a growing movement in the medical community to convince voters to defeat the marijuana-legalization measure in November. Time will tell whether those efforts will bear fruit.

Opposition Mounts

Earlier this year, the MMS joined the Campaign for a Safe & Healthy Massachusetts, a coalition of health and community leaders established to oppose the ballot question allowing commercial sale of marijuana for recreational use. Other members include the Mass. Hospital Assoc., the Assoc. for Behavioral Healthcare, the Massachusetts Assoc. of Superintendents, the Massachusetts Chiefs of Police, all Massachusetts district attorneys, and an array of state leaders including Baker, Walsh, and House Speaker Robert DeLeo.

While a vote four years ago to legalize medical marijuana hasn’t been without controversy — doctors still worry about prescribing a product that’s still illegal under federal law — recreational pot presents a completely different set of issues.

“There’s a lot of data about kids that use marijuana heavily and face school failure, failure to graduate, difficulty keeping a job,” Gessner said. “Plus, it’s smoked. We’ve spent 50 years talking about the dangers of smoking. This is simply another form of lung attack.”

Gessner also raises the potency issue, arguing that the active ingredient in marijuana — known as tetrahydrocannabinol, or THC — typically comprised about 5% of marijuana in the 1970s, while the current potency can approach 30%, though it varies from batch to batch. In Colorado, the average THC percentage has been around 17%.

Dr. Robert Roose

Dr. Robert Roose says it makes little sense to legalize marijuana while the state combats an ongoing opioid crisis.

But even recreational-marijuana supporters, like Vermont’s governor, find the bill currently up for referendum in the Bay State to be a deeply flawed one, favoring potential pot producers and sellers but including no provision for education, counseling, or treatment for users. It also allows a wide range of marijuana products — not just the smoked variety, but waxes, resins, and ‘edibles,’ often indistinguishable from common candy. The latter concerns 120 state legislators who recently voiced their opposition to the ballot question.

They note that edibles account for 50% of marijuana sales in Colorado, and the number of children under age 10 who suffered from marijuana exposure has increased by 150% in Colorado since the state legalized commercial marijuana, including edibles.

“This a bill for producers that allows for one of the most dangerous exposures in edibles,” Gessner said. “These are manufactured products branded to look exactly like legitimate food products. If edibles are available, they will wind up in the hands of the least suspecting groups: babies, infants, children. I can see a fourth-grader eating a brownie laced with marijuana, then riding a bicycle, or an eighth-grade girl eating a candy bar, and who knows what happens?”

The Campaign for a Safe & Healthy Massachusetts recently won a victory in the state Supreme Judicial Court, which ordered the ballot question amended to make clear that edibles, not just smoked marijuana, would be legalized.

“We are pleased the SJC has recognized that this ballot question would usher in an entirely new marijuana-edibles market and that voters must be informed of that fact,” coalition spokesman Corey Welford said in a press statement. “Under this proposal, the marijuana industry would be allowed to promote and sell these highly potent products, in the form of gummy bears and other candies, that are a particular risk for accidental use by kids.”

Since becoming the first state to legalize marijuana for adults, the coalition notes, Colorado has also become the number-one state in the nation for teen marijuana use. Use by teens aged 12-17 jumped by more than 12% in the two years since legalization, even as that rate declined nationally. In Washington, the group notes, the number of fatal car crashes involving marijuana doubled in the one year since legalization.

“When we think about addiction — whether to alcohol, cannabis, or opiates like heroin — it’s appropriately described as a chronic disease of the brain,” Roose noted, “and we know very well, with many years of evidence, that the more accessible a substance with a psychoactive component is, the more likely it is to be used.”

Shumlin — again, an enthusiastic supporter of recreational marijuana — laments the fact that the Massachusetts bill will allow edibles that have caused problems in other states, smoking lounges, home delivery service, and possession of up to 10 ounces of pot, while a bill he is promoting in Vermont allows none of that.

“If Massachusetts moves forward with their legalization bill while Vermont delays,” he wrote, “the entire southern part of our state could end up with all the negatives of a bad pot bill and none of the positives of doing the right thing.”

Reversal of Fortune

For doctors like Roose who have been on the front lines of the state’s battle against rampant opioid addiction, opening the doors wide to recreational marijuana would be a blow against the progress being made against drug abuse and its often-tragic effects.

“The earlier you have someone hooked or identified as a user of your product, the greater market share you can expect down the line,” he told BusinessWest. “That’s the converse of what we’re trying to do in public health; we want to delay the start of something that can affect their brain.”

In their opinion piece, Baker, Healey, and Walsh noted that emergency departments and drug-treatment centers are beyond capacity, and first responders are stretched to their limits.

“We should not be expanding access to a drug that will further drain our health and safety resources,” they wrote, arguing that any tax revenues from marijuana sales would be vastly insufficient to cover the added public-health costs legalized pot would bring, and that almost all the financial benefits would go directly to pot producers and their investors.

Roose isn’t as concerned with the financial costs as the human ones, so he comes back repeatedly to the question, what does substance abuse of any kind do to a society in terms of illness and premature death?

“When we look at alcohol, nicotine, all drugs, we should take an approach that effectively mitigates those risks. That’s what treatment providers in the medical community should be looking at,” he said. “The brain can develop into the 30s, and when we delay the onset of someone experimenting with these substances, we’re looking at benefits to society from less recurrence of mental illness, improved educational attainment, and lowered rates of addiction — very approachable goals for the medical community.”

Conversely, he went on, the more accessible a state makes those substances, and the less the risks to young people are recognized, the more problems arise. It’s similar, he said, to the past cultural belief, long disproved, that prescription medications are somehow safer than street drugs, leading to lax oversight and the addiction problems ravaging the Commonwealth today.

Of course, the effects of legalized marijuana won’t be an issue if voters defeat Question 4. A Boston Globe survey in July found 51% of respondents opposed to the measure, 41% in favor, and the remainder unsure.

Gessner worries that a burgeoning market for marijuana in all its forms would find the most purchase in socioeconomically disadvantaged neighborhoods, and wonders why provisions for addiction counseling and treatment weren’t included in the bill’s language, as they were when casino gambling was legalized in Massachusetts. “Those things are completely missing. The bill doesn’t recognize the unintended consequences, especially for youth.”

Roose stressed that he doesn’t support further criminalizing pot possession and creating new punishments for users. “That’s not shown to have a positive outcome. We would rather intervene with education and provide comprehensive treatment for those substance-use disorders.”

That job will certainly become more difficult if marijuana sales are allowed to emerge from the shadows, easily accessible to adults — and, most likely, young people, too.

Joseph Bednar can be reached at [email protected]

Health Care Sections

Overcoming the Phobia

Dr. James Dores

Dr. James Dores says patients need to know their dentist will stop a treatment if they experience any pain.

The smell of freshly baked cookies wafts through the office at Dores Dental in Longmeadow, and a ‘comfort menu’ on the wall of the waiting room offers patients heated spa towels, movies, noise-canceling headphones, hot and cold drinks, and other items designed to help them relax before, during, and after a treatment.

The menu and idea of overcoming the smell associated with a dentist’s office by baking cookies all day are measures that Dr. James Dores and his staff use to help people overcome dental phobia, a severe, debilitating fear of having any type of dental work done.

And indeed, it’s a significant problem: the National Institute for Health reports the majority of people become anxious before getting dental treatment, and 10% to 20% have dental phobia. It tends to affect more women than men and can be detrimental to health as well as appearance.

People with dental phobia have fewer fillings and more decayed and missing teeth than their peers and typically contact a dentist only when they have pain that becomes unbearable, or when a major life event such as a divorce inspires them to do something about the condition of their mouth. However, waiting until that point often results in the need for complicated and traumatic procedures such as a root canal, which can further exacerbate and reinforce fear.

“About 75% of the population has some fear in regard to dental work. But there are definitely different tiers of it,” Dores said, adding that dental phobia can be resolved, but it takes caring and patience as it often stems from a traumatic, painful experience that occurred during childhood.


Health and Dental Plans in the region


Dr. Jane Martone has seen patients whose mouths are in terrible condition because of their fears regarding dentistry. “Some people are so afraid you will hurt them that just walking through the door is a major step,” said the founder of Westfield Dental Associates Inc., who teaches at the Medical College of Georgia School of Dentistry one week each month.

Dr. Vincent Mariano, a board-certified prosthodontist and co-founder of EMA Dental in Northampton and East Longmeadow, has seen patients who need work done on their entire mouth, and may need as many as a dozen crowns.

“If they have neglected their mouth for years, they can have problems with functionality. Some people have worn down their teeth so much that they can’t chew, or they have teeth that are so loose, they’re just moving around in their mouth,” he said.

As a result, people spend hours in his chair, so it is critical for him to develop a relationship with them and make sure they understand exactly what will be done before any work begins.

“I treat patients with very complicated dental needs, so the relationship is of the utmost importance for success,” he said, explaining that, in addition to fearing pain, many people with dental phobia are embarrassed about neglecting their oral health, but once a patient knows he is not judgmental, there is a much greater chance of success of rebuilding their mouth or treating their problem.

Martone concurs, and has talked to people at length on the phone to allay their anxiety before they work up the courage to visit the office. But since most are in pain, the first step is to eliminate it, although it’s equally important to reduce their overall fear, as preventive care can reduce the likelihood of future problems.

Dr. Vincent Mariano

Dr. Vincent Mariano says establishing trust with a patient is key to alleviating fear.

“People have died from infections because they didn’t seek dental treatment at the appropriate time,” Dores said, adding that gum disease starts out as gingivitis (inflammation) which can easily be addressed in the early stages, but if it progresses into periodontal disease, it can destroy structures in the jawbone that support the teeth.

Researchers are also finding links between gum disease and heart disease, stroke, premature births, diabetes, and respiratory disease, and Martone has discovered medical problems during an office visit and referred people to their primary-care doctor to treat high blood pressure or other health issues they were not aware of.

In this issue, BusinessWest looks at what local dentists are doing to help people overcome dental phobia and how advances in technology help to alleviate pain.

Treatment Choices

Dentists take different approaches to treating patients with irrational fears. They all believe it’s critical to establish a solid, trusting relationship, but some prescribe drugs to relax patients before a visit, while others offer sedation during procedures.

Dores calls every new patient the night before their first visit to welcome them to the practice, allay any fears they might have, and answer questions, and since he caters to people with dental phobia, the conversations can be lengthy.

“Some people have told me they are terrified and really appreciate the call because it shows that someone cares,” he said, adding that many prospective patients read online reviews that help boost their confidence in his practice.

When they do arrive, they are greeted warmly, then given a tour of the office, and before a treatment plan is drawn up, Dores talks to them about their previous dental experiences, taking note of things they didn’t like.

Many report an instance when they tried to tell a dentist they were experiencing pain, but were ignored. “I have had people tell me they were in tears and the dentist kept going,” Dores said, adding that, since people like to talk about bad experiences, it’s easy to have negative experiences validated and reinforced by friends, family members, or co-workers.

Certified dental assistant Diane Harvey, who works with Dores, assesses each patient’s body language before and during treatments, and says talking about their family or pets and using humor helps alleviate anxiety.

“It only takes one bad experience for a person to become scarred for life, and I have seen people shaking and crying before the dentist even comes into the room,” she recalled, explaining that she tries not to leave phobic patients alone in the room and reassures them if they tell her the the work will result in pain.

“I tell them that dentistry has come a long way, and in this day and age there should be no discomfort,” she said.

Mariano says patients need to know that if they raise their hand, the dentist will stop working on their mouth, which is critical, as fear of loss of control is almost as great as the fear of pain. To that end, he not only explains procedures in advance, but gives patients all of their treatment options and lets them choose what they want to have done.

“If a patient is going to lose a tooth, treatment could be a removable replacement or extend to a dental implant. But the patient needs to help make the decision,” he said, adding that he tells people not to focus on the procedure, but to think about the outcome, and since he is doing restorative work, that often means a beautiful smile.

Dores and Mariano sometimes prescribe mild sedatives for patients with dental phobia, which can be taken the night before a procedure and an hour before they arrive at the office. It means they need someone to drive them to and from the appointment, but Dores said their visits are always booked early in the morning so they don’t have time to upset themselves.

Martone said she is the only general dentist in the area who is board-certified in implant surgery, and is also trained and certified in intravenous sedation. She told BusinessWest that many patients with dental phobia seek her services because they want to be sedated even for simple treatments, such as filling a cavity.

Surveys show that IV sedation eliminates embarrassment about the condition of teeth, as well as the fears of gagging, injections, not becoming numb when injected with a local anesthetic, pain, and drills.

However, before it can be administered, the person’s medical history is taken to make sure there are no contraindications, and while they are under sedation, their vital signs are tracked, and they are put on a cardiac monitor.

Since they are not under general anesthesia, Martone noted, people are able to talk and follow commands while they are sedated, but feel no pain and have no memory of what took place when the procedure is finished.

She believes IV sedation is safer than oral medications, as the onset is very rapid, and the dose and level of sedation can be tailored to meet individual needs.

“This is a huge advantage compared to oral sedation, where the effects can be very unreliable,” she told HCN.

Technological Advances

State-of-the-art equipment also helps eliminate pain or discomfort that might occur during a diagnosis or treatment.

Martone uses a DEXIS CariVu device that uses near infrared light to detect cavities. “It allows the dentist to see decay without having to take an X-ray,” she said, explaining that some people can’t tolerate having to hold film in their mouth, and the device eliminates that problem.

Martone and Mariano also have CT-scan machines in their office that allow them to take X-rays without having to put anything in the person’s mouth, and Martone adds that small things can make a difference. For example, she uses a numbing topical anesthetic before giving an injection so there is no pain from the needle. And since rapid injections can also be painful, she makes sure she administers local anesthetics slowly.

Dores employs a DentalVibe Oral Injection System to administer local anesthetics. The handheld device was created by a dentist and sends soothing vibrations to the brain that block any sensations of pain.

He also uses laser therapy to fill cavities and says he is the only dentist in the area with the machine to do so. The device he employs never touches the tooth and delivers anesthesia, eliminating the need for numbing injections, along with wavelengths of light that evaporate the tooth enamel. A drill still may be needed for refinements, but Dores said the majority of the work is done with the laser.

Still, dentists agree that one of the most critical factors in treating fearful patients is a good relationship. “Technology helps, but it is secondary to the main component,” Mariano said. “Pain control begins outside of the office.”

Things like sleep matter: if a patient does not get a good night’s sleep before a treatment, it has an enormous affect on their pain threshold.

Mariano recalled a patient he had worked on before without a problem, but during a visit where she had had three sleepless nights in a row, “she was such a wreck I couldn’t do the procedure. Many times the anxiety and pain patients feel in a dentist’s office is not related to the significance of the treatment,” he told BusinessWest. “The patient’s state of mind is of the utmost importance in successful treatment.”

Which means if the person is going through a divorce, has lost their job, or has another major problem in their personal life, the anxiety they feel will be exacerbated, so they need to be comfortable talking to their dentist about anything that is affecting their state of mind.

Slow but Steady Progress

Dentists say they do their best to have their staff go above and beyond and take extra time with people with dental phobia.

“You have to gain their confidence, as somewhere along the way someone has hurt them,” Martone said, recalling a time when a patient traveled from Orange to see her and started crying as soon as she walked into the office. Another came from Sunderland, and although they had a long discussion about her dental fears, she was afraid to even sit in the chair.

“It takes time to get a person to trust you, and sometimes all you can do is treat their emergency. My goal is to win them over, but it’s not always possible,” she continued. “Their fear never really leaves them, but it is reduced each time they come in.”

Still, the goal is to develop a relationship where the patient feels safe and secure.

“The relationship is a life-long investment,” Mariano said. “It’s all about changing the quality of their life.”

Health Care Sections

Bridging the Gap

Cesarina Thompson

Cesarina Thompson says AIC’s new post-professional doctoral program for occupational therapists takes 16 months to complete and is almost entirely online.

Imagine the following scenarios:

• A mother with multiple sclerosis is too weak to hug her children and wants to find other meaningful ways to demonstrate her love.
• A teen who habitually cuts herself needs to develop new coping skills and find a healthier, satisfying way to get sensory feedback.
• An elderly woman who is unsteady on her feet wants to walk down the aisle when her granddaughter gets married.
• A young person who can’t throw a ball overhead due to a disability wants to be able to play basketball.

There is a specialty in healthcare that finds solutions every day to myriad unique challenges like the ones just presented. It’s called occupational therapy, and the need for this type of individual service is growing.

“OTs work in many settings; some look at people’s cognition, others work in behavioral health with people who have learning disabilities or substance-abuse disorders, and still others help clients relearn skills after an accident or injury,” said Allison Sullivan, assistant professor in the Division of Occupational Therapy at American International College in Springfield.

She added that AIC has created a new, post-professional doctoral program for occupational therapists working in the field to meet the future demand for teaching professionals or individuals who possess the qualifications needed to assume high-ranking positions.

And the need is certainly there: the Bureau of Labor Statistics cites occupational therapy as one of the fastest-growing healthcare fields. It projects 29% growth by 2024 and estimates that 30,400 new jobs will be added to the 114,600 that already exist. In addition, jobs such as occupational therapy assistants are expected to rise by 40% during the same time period.

The job pays well: the median salary in 2015 was $80,150 for OTs and $54,520 for OT assistants. “But in order to produce more occupational therapists, we will need more faculty members who can teach the next generation,” said Cesarina Thompson, dean of the School of Health Services at AIC.

“Our new program will do that and will also prepare people to take on leadership roles or engage in research,” she continued, adding that the new program will start during the 2016-17 academic year and can be completed almost entirely online.

Allison Sullivan

Allison Sullivan says occupational therapists who want to become educators must learn to translate their experience into classroom lessons that students find meaningful.

She noted that many college instructors are Baby Boomers who are likely to retire in the next decade, so planning for the future is critical.

“It takes years of experience and study to become a credible faculty member,” she said, explaining that instructors typically have a specialty and draw on their experience in the workplace, and although many local educational institutions, including AIC, Springfield College, and Bay Path University, offer master’s degrees in occupational therapy, it can be difficult to find a doctoral program.

Sullivan said it takes dedication and commitment to become an instructor, especially since the pay may not be much different than what experienced providers working in the field can earn. But it does require additional education.

“Teaching involves far more than just determining what students need to know. You have to figure out the best way to teach the information,” she said, adding that AIC’s doctoral program will provide OTs with the tools they need to teach, which will be equally important for people who assume leadership positions, as they are often required to conduct training in the facilities where they are employed.

Students in the new, 30-credit program will also learn how to conduct research, which can be very involved and is done in the field as well as in academic settings.

The program has been approved by the National Assoc. of Schools and Colleges, and although the majority of learning will be done online, students will be required to participate in an orientation and three residencies on the AIC campus that will include six hours of direct instruction and at least 12 hours of outside work.

Individualized Work

Sullivan said 30% of OTs are employed in schools, 30% work in skilled-nursing facilities, 30% are in rehabilitation facilities, and 10% have jobs in other places.

But need is growing in every area due to a variety of factors. Baby Boomers are aging, and many require help to remain independent; the rise in the number of children diagnosed with autism-spectrum disorder continues to grow; and public awareness campaigns, such as ones directed at helping people identify the symptoms of stroke, are bringing more people to hospitals who need a continuum of care.

Baystate Rehabilitation Services at Baystate Medical Center reports it is seeing an increase in the number of patients who need treatment, ranging from infants in the hospital’s neonatal unit to elderly people who receive treatment in outpatient centers.

“Our volume continues to grow; we’re serving more physicians in the community and seeing more patients throughout all units of the hospital as well as in our outpatient locations,” said Manager Jim Maloney.

Supervisor Erin Jarosz concurred, noting that, as this healthcare discipline gains increasing recognition, the need for qualified practitioners continues to grow.

Amy Lamb added that changes in the Affordable Care Act have also led to an increase in demand for OT specialists. “The changes were designed to enhance the quality of the client experience, improve efficiency, and decrease cost, and AIC is working to prepare occupational therapists to enter different practice arenas that will allow them to do all of those things,” said the president of the American Occupational Therapy Assoc., or AOTA.

Indeed, OTs take a holistic approach to healthcare as they help children and adults address issues that include improving health and wellness, mental health, productive aging, rehabilitation and disability, and the world of work.

“They help older people live independently and manage health conditions on their own, and also work with children and youth on a wide range of issues that include stress management and weight management,” Lamb noted.

However, what really sets the profession apart from other disciplines is the fact that practitioners address the quality of life a person leads, which includes their psychosocial needs as well as their physical health.

“It’s one of the important aspects of their job,” Sullivan noted, explaining that, when people are in an accident or have physical or mental impairments that hinder their ability to interact with others in a meaningful way or take part in activities that are important to them, it is critical to their well-being to address the problem.

Due to the complexity of the situations occupational therapists encounter on a daily basis, most employers require them to have master’s degrees.

The AIC program has the same requirement, although Thompson noted that OTs with a bachelor’s degree can take 12 credits of bridge courses, then start the new doctoral program.

“The field of occupational therapy will celebrate its 100th birthday next year, and our new program is grounded in the centennial vision of the AOTA,” Thompson said, adding that it states that all OTs in the future will need skills that include leadership, the ability to research, knowledge of best practices, and an understanding of legal and ethical issues. Students will be able to use experiences from their own practice as they examine leadership and management theories and concepts and learn how to apply them.

Sullivan told BusinessWest it’s important for future faculty members to teach students not to make assumptions about their clients and instill the belief that they won’t know what is possible until they work with a person to create solutions to challenges they want or need to overcome.

It’s hard to know what these goals are if they aren’t expressed, but an OT’s creativity can change lives in unexpected ways. As one example, Sullivan conducted her doctoral research on attitudes that healthcare providers have toward people with intellectual disabilities, and set up a program that brought consumers from Human Resources Unlimited in Springfield to the AIC gymnasium to play basketball or engage in other physical activities with a class of OT students.

When they arrived, a man in a wheelchair began crying. “He said it had always been his dream to be in a college gym, and he never thought it would happen,” she recalled, adding that the students learned that seemingly small things can make an enormous difference in the quality of people’s lives.

Future Outlook

As the AOTA and the profession head toward that 100th anniversary, Lamb said, OTs will continue to work to make sure that people have access to services that help them accomplish the things they want to do.

“Our profession focuses on what is important to each individual, which is distinctly different than other professions. We know there is a growing demand for what OTs do, but we need to look at new ways of delivering services,” she noted, adding that AIC’s doctoral program will help graduates identify and develop programs in the community to meet the increasing demand.

Thompson said students will undertake group projects involving case studies that will involve critical reflection and will be able to employ what they have learned in their own practice. “It’s important because graduates may need to create new curriculums and figure out the best way to teach things, or find ways to motivate their staff to do a better job,” she told BusinessWest.

Sullivan hopes the program will encourage more OTs to consider teaching.

“As the profession enters its centennial year, I hope more therapists will think about the future of our field. We can’t meet demands if we don’t translate research into teaching and conduct research in clinical settings that validates the benefit and value of what we do,” she said. “We’re the new kid on the block in terms of treatment compared to healthcare professions such as nursing, but we have a unique approach that differs from what is offered by other service providers.”

Health Care Sections

Getting to the Nut of the Problem

Introducing peanut-containing foods during infancy as a peanut-allergy prevention strategy does not compromise the duration of breastfeeding or affect children’s growth and nutritional intakes, new findings show. The work, funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, was published in the June 10 issue of the Journal of Allergy and Clinical Immunology.

These findings are a secondary result from the Learning Early About Peanut Allergy (LEAP) clinical trial, which was conducted by the NIAID-funded Immune Tolerance Network and led by researchers at King’s College London.

Primary results from the LEAP trial, published in 2015, showed that introducing peanut products into the diets of infants deemed at high risk for peanut allergy led to an 81% relative reduction in subsequent development of the allergy compared to avoiding peanuts altogether. The goal of the current analysis was to determine whether eating high doses of peanut products beginning in infancy would have any adverse effects on infant and child growth and nutrition.

“The striking finding that early inclusion of peanut products in the diet reduces later development of allergy already is beginning to transform how clinicians approach peanut-allergy prevention,” said NIAID Director Dr. Anthony Fauci. “The new results provide reassurance that early-life peanut consumption has no negative effect on children’s growth and nutrition.”

At the beginning of the LEAP trial, investigators randomly assigned 640 infants aged 4 to 11 months living in the United Kingdom to regularly consume at least two grams of peanut protein three times per week or to avoid peanut entirely. These regimens were continued until the children were 5 years old. The researchers monitored the children at recurring healthcare visits and asked their parents and caregivers to complete dietary questionnaires and food diaries.

In the current analysis, investigators compared the growth, nutrition, and diets of the LEAP peanut consumers and avoiders. Many of the participants were breastfeeding at the beginning of LEAP.

“An important and reassuring finding was that peanut consumption did not affect the duration of breastfeeding, thus countering concerns that introduction of solid foods before six months of age could reduce breastfeeding duration,” said lead author Mary Feeney, a registered dietitian with King’s College London.

In addition, the researchers did not observe differences in height, weight, or body-mass index — a measure of healthy weight status — between the peanut consumers and avoiders at any point during the study. This was true even when the researchers compared the subgroup of children who consumed the greatest amount of peanut protein with those who avoided peanut entirely.

In general, the peanut consumers easily achieved the recommended level of six grams of peanut protein per week, consuming seven and a half grams weekly on average. They made some different food choices than the avoiders, investigators noted. For example, consumers ate fewer chips and savory snacks. Both groups had similar total energy intakes from food and comparable protein intakes, although the peanut consumers had higher fat intakes and avoiders had higher carbohydrate intakes.

“Overall, these findings indicate that early-life introduction of peanut-containing foods as a strategy to prevent the subsequent development of peanut allergy is both feasible and nutritionally safe, even at high levels of peanut consumption,” said Dr. Marshall Plaut, chief of the Food Allergy, Atopic Dermatitis and Allergic Mechanisms Section in NIAID’s Division of Allergy, Immunology and Transplantation, and a co-author of the paper.

This work was supported by NIAID with additional support from Food Allergy Research & Education, the Medical Research Council & Asthma UK Centre, and the UK Department of Health.

This article was prepared by the National Institute of Allergy and Infectious Diseases, which conducts and supports research — at the National Institutes of Health, throughout the U.S., and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing, and treating these illnesses.

Health Care Sections

Out of the Darkness

HCNcoverART0616

For a decision of such finality, the choice to end one’s life has come easier over the past 15 years, according to both national and statewide statistics. The reasons for the increase in suicide rates are myriad — economic stresses, mental illness, social isolation, substance abuse, and too many others to mention — and the outward signs are often unclear. But resources are available across the region to stem the tide, if only at-risk individuals can be identified in time and steered toward the help they need.

It’s alarming enough, Melissa Perry says, that overall suicide rates, both nationally and in Massachusetts, are on the rise. But she is struck by some of the details that comprise the larger trend.

For example, suicides among girls ages 10 to 14 tripled over 15 years, from about 50 in 1999 to 150 in 2014 — a relatively small number compared to the general population, but a distressing statistic nonetheless. Perry, director of Behavioral Health Nursing at Holyoke Medical Center (HMC), suggests one factor behind this increase: the pervasiveness and incessance of bullying in the social-media age.

“When we were young, we were able to get away from the name calling and getting picked on in school, just by going home,” she told BusinessWest. “Social media has kicked it up a notch. Girls are picked on at school and then continue to get picked on every time they’re on social-media sites; it continues and never ends. I really think that plays a huge role in girls struggling. Even switching schools doesn’t solve the problem.”


 Click HERE to view a chart of Behavioral Health Centers in the area


According to a study released earlier this spring by the National Center for Health Statistics, it’s not just teen and tween girls at risk. After a period of consistent decline in suicide rates in the U.S. from 1986 through 1999, rates for the overall population have increased steadily from 1999 through 2014, the last year for which data is available. In fact, 42,773 people died from suicide in 2014, compared with 29,199 in 1999.

“That’s a significant jump,” said Nina Slovik, a social worker and clinic director at the Center for Human Development, before detailing some possible drivers behind the surge. “The economic climate is a very significant factor — job loss and financial insecurity. Social isolation is a factor, which can be seen in the rate of divorce and the increase in the number of people who are not getting married and might not be socially connected. And you certainly cannot discount the enormous increase in drug addiction and substance abuse.”

Nina Slovik

Nina Slovik says suicide triggers range from economic insecurity and social isolation to substance abuse and mental illness.

The bottom line is that suicide is now the 10th-leading cause of death in the U.S., and number two among the 15-24 age group. Slovik noted that African-American men are the only demographic group whose suicide rate is down, and the only age group to decline is men and women over 75.

“The problem is widespread across all the other age ranges,” she said, adding that people who feel disenfranchised, such as LGBT individuals, are at higher risk, while those who have made suicide attempts in the past are much more likely to try again in the future — about 40 times more likely, in fact, than those who have never done so.

“The causes can be complicated,” said John Kovalchik, HMC’s Outpatient Behavioral Health manager. “There’s a family history of violence, sexual molestation and abuse, a history of substance abuse or mental illness, being incarcerated, having access to firearms, things of that nature.”

Access to tools of violence don’t tell the whole story, however. While the share of suicides involving guns has declined since 1999 — from 37% to 31% — suffocation deaths, including strangulation and hanging, are up from less than 20% to about 25%, perhaps reflecting the fact that everyone has access to such means, while gun-ownership rates are down in some states.

The larger question, of course, is what to do about what Slovik characterizes as not just a psychiatric problem, but a full-blown public-health issue. The professionals who spoke with BusinessWest agree that suicide prevention and intervention resources abound in Western Mass., but identifying at-risk individuals and connecting them to help isn’t always easy. But through education and greater public awareness, they say they’re making strides.

No Boundaries

While financial struggles are rampant at a time when Americans hear the recession is over, yet many are still unemployed or underemployed; and while substance abuse is a growing issue in many states, including Massachusetts, the risk factors for suicide extend far beyond those timely factors, ranging from mental illness and a history of abuse to lack of an emotional support system to family disruptions like divorce and lawsuits, according to the Mass. Coalition for Suicide Prevention.

“Suicide doesn’t really have any boundaries; it’s one of those things that can occur in any population,” said Robert Reardon, who chairs the Pioneer Valley Coalition for Suicide Prevention, the statewide organization’s regional chapter. “We want to make sure the message we’re sending out about suicide prevention is as diverse as our communities in the Pioneer Valley.”

Reardon is also director of Outreach and Community Services for Tapestry Health, a regional network of public-health services that, as one part of its mission, links people to suicide-prevention services and offers workshops and educational programming aimed at making people more aware of the outward signs of potential suicide.

Those signs vary widely, but can include feelings of hopelessness; preoccupation with death; withdrawal from family, friends, sports, and social activities; drastic behavioral changes; depression, anxiety, and eating disorders; giving away possessions; taking unnecessary risks; lack of energy; inability to think clearly or make decisions; loss of interest in work or school; changes in appetite, sleeping habits, or personal appearance; and financial worries — just to name a few.

However, the Mass. Coalition notes, individuals also possess ‘protective factors’ — personal, familial, and interpersonal factors that help one cope with life. These range from a sense of humor to good problem-solving skills; from strong faith to good nutrition and regular exercise; from connectedness to family or church to a sense of purpose.

“Nobody is just one thing — a big mass of depression or mental illness or alcoholism,” Slovik said. “Everyone has particular strengths and skills. We have to look at the larger picture.”

Kovalchik said it’s important that people are able to recognize not only the warning signs of a potential suicide, but these resiliency factors, so they can help their loved one focus on them instead of their stressors.

Which means talking and asking questions when warning flags emerge. The coalition emphasizes that talking about suicide will not put the idea into someone’s mind; rather, most people will be relieved that someone has noticed their pain and are willing to help.

After all, the organization notes, people who die by suicide generally do warn others, and may be trying to get attention in order to get help — and they should be taken seriously.

“It never hurts to ask someone questions,” Slovik said. “Whether it’s a family member, friend, co-worker, whomever, if for any reason you think a person is at some risk, you won’t create a suicidal person by asking direct questions; that’s a myth, and it’s not borne out by clinical experience or data.

“Asking people about suicide does not increase the risk,” she went on. “In fact, it may decrease their sense of isolation, the feeling that nobody knows what they’re going through, that nobody has ever felt like they do. There’s a lot of shame and embarrassment associated with feeling suicidal, and if you can overcome that sense of isolation, that’s a good first step that can lead to a larger discussion.”

She doesn’t recommend giving clinical advice to someone who is suicidal, but it’s important to listen closely, express understanding, and suggest resources that might be able to help.

“There are often shame-based associations with being depressed, being anxious, being frightened, being bullied,” she told BusinessWest. “But if you can break down the barrier by getting them to talk about it, that can be very meaningful. Getting in the door is a big deal.”

Medical professionals are increasingly doing their part, Kovalchik said, by screening patients who arrive in emergency rooms for behavioral-health issues, substance abuse, and past trauma, to name a few signs. “It’s important that we don’t separate the body from the mind, as we have historically.”

Melissa Perry

Melissa Perry

The importance of speaking directly to someone suspected to be a suicide risk is often magnified when dealing with a teenager, Perry said, because this group tends to be more impulsive and often responds to a stressor more quickly than someone a bit older.

“If someone might be thinking about suicide, having that conversation — and then supporting them and offering them hope — is a big step,” Reardon said. “Then you can help that person seek help through other resources; there are a lot of mental-health services and organizations in the region that can provide support.”

Healthy Choices

For its part, Tapestry works with recovery learning communities, or RCLs, a program of the state Department of Mental Health to offer information and support to people struggling with mental illness, and that initiative’s Alternatives to Suicide peer-support groups.

“Those have been well-received by folks because they’re run by people who have attempted suicide or had long-standing thoughts of suicide,” Kovalchik said. “But you have to get someone to buy in and seek help. That is the tricky piece, I think.”

Meanwhile, the Mass. Coalition for Suicide Prevention, since its founding 17 years ago, has worked with the state Legislature to get more than $28 million allocated for suicide-prevention services targeting veterans, older adults, college and university students, youth and young adults, mid-life adults, and LGBT youth.

The coalition’s training efforts have reached nearly 31,000 advocates, teachers, clinicians, substance-abuse staff, elder advocates, and youth service organizations, among others, and the organization co-sponsors 14 Massachusetts Suicide Prevention Conferences, attracting hundreds of participants each year.

Efforts like these, and the programs operated by agencies like the Center for Human Development, are making a difference in the lives of those they reach, Slovik said, even though too many are still succumbing to suicide.

“The most significant approach to preventing suicide is getting people to find a place where they can talk about whatever is going on in their lives — that therapeutic relationship with somebody that can help engender a sense of hope,” she said. “Hope is really the most critical factor in preventing suicide. How do you instill hope in people? It’s relationship-based: talk to people, find out what their risk factors are, and focus on their protective factors.

“It’s a complex problem, and there are no guarantees,” she concluded. “We don’t kill anyone, and we don’t save anyone. If we’re lucky, we help people save themselves.”

Joseph Bednar can be reached at [email protected]

Health Care Sections

Thinking Outside the Pillbox

Dr. Christopher Keroack

Dr. Christopher Keroack

Dr. Christopher Keroack, like so many who grew up in the Northeast, recalls a childhood visit to Riverside Park in Agawam, now known as Six Flags New England. Back then, at the center of the grounds was a crowded area known as the International Plaza, connecting the north and south sides of the amusement park.

He was 7 years old on this particular visit, and his mother told him to hold her hand while crossing the plaza, so he did — he thought. “The density of the crowd resembled a New York nightclub, but I struggled through it and emerged holding my mother’s hand — only, when I looked up, I was shocked to find the hand wasn’t hers.”

He describes the feeling — still resonant decades later — of being lost and frightened, and his decision to go to the park’s magic show, a location he and his mother both knew well. He sat down in the front row and cried as the show began, but the plan worked — his mother intuitively found him there a short time later, and all was right with the world again.

Keroack, director of Pioneer Valley Weight and Wellness Center in Springfield, tells this story at the start of his new book, Changing Directions: Navigating the Path to Optimal Health and Balanced Living, and retold it recently while sitting down with BusinessWest. The point is that being lost as a child is an alarming experience, and returning to a place of safety and familiarity is a hallmark of finding one’s way again.

“Part of me believes this is what has happened in the medical field,” he told BusinessWest. “Once compassionate healers, our field has transitioned into protocols, ICD-10 code diagnoses, prior-approval paperwork, and endless uses of drugs.”

As a result, Keroack — and many of his colleagues, he believes — long for a return to the “golden years” of medicine, when one-to-one relationships with patients were richer, and when doctors were committed to healing and compassionate caring, not a sea of protocols and quick-fix prescriptions. “I believe,” he said, “that we can return to those days.”

His book, published earlier this year, is a primer on the philosophy of ‘functional medicine,’ which is, at its core, a blending of the ancient arts of medicine, including Eastern medicine, and the modern approaches of scientific, Western medicine. Having studied both, Keroack has crafted a practice in the Valley that incorporates elements of these two worlds and demonstrates to patients why they should — and do — work in tandem.

“It just fits into everything all physicians originally wanted to believe in,” he said. “We went into medicine for the purpose of helping and healing people.” The book — which he calls “a field guide to navigate the confusion of healthy living” — is an effort to help people understand these concepts and put them into practice.

He likens functional medicine to a tree. The roots of the tree — unseen but taking up as much space underground as the branches do above — are what nourish the tree, not the leaves. The leaves may show the outward signs of disease,  but the deeper problems originate in the roots. “Functional medicine,” he notes, “sees the roots and knows that, by nourishing the roots, the leaves will grow.”

Another metaphor, he said, sees the body’s systems as a flowing stream, one in which pollutants and chemicals from a factory upstream are contaminating the water, creating imbalance and toxicity. The ‘downstream’ approach of Western medicine is to put a water filter on the kitchen faucet — but what about the water in the dishwasher, shower, and washing machine? Ideally, the correct approach would be to remove or divert the pollutants and chemicals at the source. That, in a nutshell, is functional medicine.

At the Core

The core of this philosophy revolves around what Keroack calls the “fab five” — food, movement, stress, sleep, and relationships — and the way they intertwine to impact one’s overall wellness.

“If we ate the correct food, stayed up on hydration, went to bed on time, had our debts paid, had harmony in our marriages, and got out of the chair and moved around, we would be radically healthier. But we don’t do these things, because we rely on pills, potions, and lotions.”

One barrier, he said, is that Western physicians are trained in pharmacology and diagnosis codes, so they get locked into that pathway. “But I get to have real conversations with people about these foundational factors, and then they get better.”

KeroackCoverKeroack is board-certified in internal medicine and bariatric (weight-management) medicine, and originally built his practice around weight loss, moving gradually into a broader wellness focus, where patients lose weight as just one benefit of a total lifestyle shift. But in addition to his formal training, he has certifications from the Institute of Functional Medicine and the Cenegenics Education and Research Foundation for Age Management Medicine.

Beyond the ‘fab five,’ each personalized health and wellness plan takes into account five foundational imbalances: nutrition, metabolism, inflammation, detoxification, and oxidation. Together, he calls them the ‘star of wellness,’ noting that “all five aspects of your health are equally important. A problem in any one leads to imbalance with the others.”

According to the Institute of Functional Medicine, “functional medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both person and practitioner in a therapeutic partnership. … By shifting the traditional disease-centered focus of medical practice to a more person-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms.”

That’s why it’s important to spend time with patients, he explained, understanding their histories and considering the interactions of their genetic, environmental, and lifestyle factors that can influence chronic disease — in a way that goes far beyond mere diagnostic codes.

At the root of functional medicine, the book notes, is the idea that the body, given the right balance of food, movement, stress, sleep, and relationships, will take care of itself.

“It’s not that complicated, but it does require discipline and planning,” he told BusinessWest. “At the same time, you can find the necessary components at the supermarket, in the backyard, and in the bedroom.”

That’s not to say medications and technology don’t play a role in modern healthcare; they certainly do. The key word is balance — and it’s safe to say many doctors lean much further in the opposite direction, putting far less emphasis on elements like food, stress, and positive relationships than they do on a prescription.

“The Western-medicine approach to illness looks at things from the bottom up — once we get sick, we can do something about it,” he went on. “Functional medicine looks at things from the top down — what can we do not only to avoid getting sick, but to optimize your health? I’d like to think most people want that. Rather than just not having diabetes, they want to be in the best health of their lives.”

Keroack claims that most people eating correctly — say, a Mediterranean diet with plenty of fruits and vegetables from all the color groups — are getting the vitamins and minerals they need from their food, but dietary supplements are often helpful. But the average consumer gets overwhelmed going into stores that sell supplements because no one has explained what will work best for them.

“I had an elite hockey player in the other day. He wanted to take some performance-enhancing supplements, but the ones he was using were all turmeric and ginger, which are anti-inflammatories, which are fine afterward, but they don’t enhance performance; he needed carnitine and taurine. Somebody sold him the wrong thing, based on the chemistry of these botanicals. Just like I can’t play hockey at his level, he’s trusting people to give him the right stuff.”

Another patient, diagnosed with yeast overgrowth, was taking a supplement better suited for liver cleansing before Keroack steered her differently.

“She had spent her hard-earned money on something intended for something else,” he said. “If you pick the wrong things, spend your money, and get frustrated, you think, ‘that’s one more provider that has not helped me.’”

Guiding Hand

Keroack, on the other hand, wants to teach patients how to maintain their own health so they’re not as reliant on medications and other trappings of modern medicine.

“In Western medicine, we talk about diet and exercise, but we don’t explain how,” he told BusinessWest. “Studies show they have more impact on diabetes than medicine, but we don’t educate people — really educate them — in diet and exercise at all.”

The bottom line, he went on, is that the simple tenets of functional medicine can seem, frankly, too good to be true to a generation raised on pharmaceutical marketing. “But if you change your food, change your movement patterns, change your stress levels, you’ll get better. And it’s logical and intuitive that you would.”

Keroack’s father was an emergency-room physician decades ago, using much more primitive technology than doctors have available to them today — and he wouldn’t recommend a return to that. But why, he asks, not marry today’s capabilities with the sensibilities of yesteryear, a practice of medicine based on communication, understanding, and the doctor-patient relationship?

“I’m shooting to return to the golden age of medicine, just not using old-school technologies,” he explained. “I understand that technology has changed, but I’d like to see our policies and protocols match the information that’s available. There is legitimacy to the colors in fruits and vegetables, the inflammatory effects of gluten and dairy, the chemical effects of pesticides and herbicides and pollutants. There’s real science behind that. We don’t have to stop at lowering calories and walking 10,000 steps.”

In the end, when he thinks of how Western medicine has evolved, he returns to that story of a 7-year-old at Riverside losing — and then finding — his way.

“We think we’re holding on to a hand we trust, only to go through the journey and find it’s not what it was,” he said. “We’ve been disheartened, disillusioned. Patients are constantly telling me, ‘doctors have no time to spend with me and listen; all they have is pills.’”

Through his practice — and, now, his book — Keroack is doing his part to change that paradigm.

Joseph Bednar can be reached at [email protected]

Health Care Sections

Merciful Mission

Steven Marcus

Steven Marcus says many elders in nursing homes suffer from undiagnosed depression that can lead to death.

Steven Marcus folds his hands and leans forward as he talks about his mission in life.

It is profound, and centered on an issue few would attempt to tackle: finding people in nursing homes in Massachusetts who suffer from depression or mental illness and getting them the help they need.

It’s a subject close to Marcus’ heart, and an area in which he and his wife Renee have been highly successful. More than 15,000 people receive services every month from New England Geriatrics and its parent company, West Central Family Counseling in West Springfield, which they founded 22 years ago to realize his goal.

“We need to put the words ‘geriatric depression’ into people’s vocabulary. It’s not a dirty little secret; it’s a disease that kills,” he told BusinessWest.

Dr. Ricardo Mujica, a geriatric psychiatrist, addiction psychiatrist, and medical director of New England Geriatrics, says 20% of the elderly population have symptoms of mental illness that are not part of normal aging, but often go unaddressed due to medical or emotional biases.

For example, irritability is a sign of depression in elders, but many families wrongly attribute it to the aging process and think “grandpa is just a grumpy old man.” The problem is compounded by the fact that many physicians don’t have specialized training in geriatrics, so they are apt to miss or misdiagnose an elder’s depression or mental illness.

“Part of the definition of growing older is being a survivor,” Mujica said. “But the combination of multiple medical problems, frequent admissions to a hospital, and moves from one place to another can alter moods and coping skills and make it difficult for older people to stave off depression and anxiety. It’s very important to bring support to these people, especially if they are in nursing homes.”

He added that they are difficult places for anyone to adapt to, and this factor, combined with the fact that the person’s health is not optimal and they often need 24/7 care, put them at risk for anxiety and depression.

“But if their mood is stabilized and they begin to feel better, it becomes easier for them to cope with their situations,” Mujica said, noting that medication and psychotherapy can make a real difference, although antidepressants and related medications can affect elders differently than young people.

In addition, many elders have substance-abuse issues caused by loneliness and depression that their families don’t know about or don’t imagine possible. Mujica said women tend to turn to alcohol, while men take prescription drugs.

Jan Mitchell agrees that elders face a unique set of challenges. “As people age, they go through many transitions; their children leave home and move away, they develop medical problems, their friends pass, and their spouses die,” said the director of West Central Family Counseling, adding that any or all of these issues can lead to anxiety and depression. “Our goal is to assist them so what they are facing doesn’t become an all-encompassing issue which they feel they are powerless to change.”

Marcus became aware of the depression that troubles so many elders two decades ago. At the time, he was a seminarian, and although he loved bringing religious services to people in nursing homes, he noticed three things: the majority didn’t want to be there, they were rooming with someone they didn’t want to be with, and they disliked the food they were served.

The same complaints were voiced by prisoners he visited during a clinical rotation connected to earning his master’s degree in social work. The rotation took place at the former York Street Jail in Springfield after he left the seminary and took the advice of mentors Sheriff Michael Ashe and Springfield Technical Community College’s then-President Andrew Scibelli to continue his education in that field of study.

“People in both places were suffering horribly from loneliness and depression,” Marcus said, explaining that depression was not something people talked about at the time.

After he finished his degree program, he decided to turn his passion for helping elders into a business.

He and his wife Renee bought West Central Family Counseling from a psychiatrist and psychologist in Franklin and gave birth to New England Geriatrics, which operates under West Central at the same time.

Expanding Horizons

Marcus says it wasn’t until the Affordable Care Act took effect that Medicare and Medicaid were willing to pay to treat clinical depression at the same rate they did for other diseases.

“We worked tirelessly with young Congressman Patrick Kennedy of Rhode Island, who was the chief sponsor of mental-health parity,” he said, noting that the combination of medication and talk therapy results in a 95% cure rate.

The typical patient that New England Geriatrics treats today is an 85-year-old, white, widowed woman on 12 medications with a high co-morbidity rate.

“They are the sickest and frailest souls in the Commonwealth,” Marcus noted.

Referrals often come from nursing homes and prompt a comprehensive team response; a psychiatrist, psychiatric nurse, and psychiatric social worker are assigned to each patient. The nurse ensures that the patient receives the optimal level of care and there are no adverse drug reactions or interactions with their current medications or anything new prescribed by the psychiatrist, but Marcus says the practice is to “start low and go slow with medications because you have to be very, very careful with this population.”

The social worker works with the patient’s family, which is important since the majority of the company’s clients in 150 nursing homes across the state have dementia. A neuropsychologist also becomes part of the team if the person’s competency or ability to live independently is in question, and that determination is often critically important to families who struggle with the decision of whether a parent or loved one needs to be moved from their home into an assisted-living facility or nursing home.

“It’s not uncommon for a person to have a fall at home, break a hip, and be sent to a nursing home, which will call us,” Marcus said. Another instance is when a senior’s behavior undergoes a sudden, radical change, which can cause them to become violent and be admitted to a hospital.

Marcus told BusinessWest the reason for a pronounced change in behavior can include medical problems, such as a painless urinary tract infection. But many elders suffer from problematic drug interactions, are overmedicated, and need a psychopharmacological review.

“It’s important to figure out what is wrong with the patient,” he said, adding that an in-depth review of medications can result in reducing antipsychotic medications prescribed to curtail troubling behavior.

But this revelation wasn’t arrived at suddenly, and when Marcus realized patients in nursing homes were becoming combative for no apparent reason, he reached out to Dr. Mark Folstein at Tufts Medical Center, who was classified as ‘the father of geriatrics’ after he created the Mini-Mental State Exam, which takes less than 10 minutes to administer and assesses the degree of a person’s dementia.

For the next two years, Marcus sent 40 patients a month with sudden behavioral changes, from all over the state, to Tufts Medical Center, where they were kept for 10 days. Each patient met daily with a psychiatrist, geriatrician, social worker, nurse, and psychologist who came up with a diagnosis and created a simple plan for their release.

“It was literally life-changing for the patients and their families,” Marcus said, adding that, in many instances, changes were made to the medications people were taking.

Since that time, New England Geriatrics has opened four similar programs at Holy Family Hospital at Merrimack Valley in Haverhill, Baystate Wing Hospital in Palmer, Nashoba Valley Medical Center in Ayer, and St. Anne’s Hospital in Stoughton. They provide a total of 68 geriatric psychiatric beds to care for elders who have dementia and a psychiatric illness, such as depression. They are kept for seven to 19 days, and educating families is a vital part of the program, especially since Marcus said many don’t know that Alzheimer’s is a terminal disease.

“Our whole world consists of educating and journeying with our patients and their families,” he said, explaining that they give families information about how the disease progresses and what to expect.

Tireless Efforts

In addition to their business, Marcus and his wife have owned and operated three nursing homes and a hospice program. And although they have gone above and beyond achieving his initial vision, his focus is on the future.

He is concerned about the Baby Boomers who will retire in record numbers over the next decade, and wants to provide clinical services for them as he says depression and dementia go “hand in hand,” and white, widowed men have one of the highest suicide rates in the nation.

To that end, he plans to launch a new outpatient program in West Springfield focused on mental healthcare for elders, and a team of geriatric specialists has been hired to cater to their special needs.

“We want to identify problems before they become catastrophic and help any elder who is depressed, lonely, or withdrawn,” he said.

Mujica told BusinessWest there are three main predictors of healthy aging: being physically active, having a good social network, and having a sense of spirituality, which gives people hope and something to believe in.

But even if all of these factors are in place, aging can be difficult due to ongoing losses that people often need help coping with.

“When the life someone knew begins to slip away, it is our job to help them transition through their loss and develop a life worth living,” Mitchell said.

The new clinical services will make a difference, but it’s not enough for Marcus. He is on the board of directors at Westfield State University and has been instrumental in having courses in geriatrics added to the curriculum in the master of social work degree and new physician’s assistant program, which will start next fall.

“Roughly 10,000 people in this country will retire every day for the next 13 years, and geriatrics will become the next huge business,” he said. “But we need to address their issues early in the game. Families need to have a good, solid education about the problems their loved ones will face so we can stop their loneliness and depression.”

That’s both his passion and his quest: to bring hope, peace, and healing to a population whose suffering is sometimes overlooked — and often forgotten.

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