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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

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

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

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.

Health Care Sections

A Holistic View of Healthcare

Dr. Scott Wolf takes the reins at Mercy Medical Center and the Sisters of Providence Health System at an exciting time in the system’s history, but also a challenging era in healthcare overall — one in which its leaders must emphasize cost efficiency, yet focus on the patient experience and outcomes more than ever before. The key, he said, is to maintain a holistic, ‘360-degree view’ of a rapidly changing industry.

Dr. Scott Wolf

Dr. Scott Wolf says a background in direct patient care gives a physician leader an important perspective that helps him or her impact the operational aspects of care.

Dr. Scott Wolf says he brings to his job what he refers to as a “360-degree view” of healthcare.

That’s a phrase Wolf, the recently named president of Mercy Medical Center and the Sisters of Providence Health System (SPHS), would use early and often as he talked about his background, which blends direct care to patients — he’s a board-certified internist — as well as time spent working on population-health initiatives, the insurance side of the equation, and several roles within the broad realm of hospital administration.

Which means, he noted, that he can see matters from several different perspectives, including those who provide the care, as well as those who pay for it.

“I think every physician should spend a week in a managed-care office, just to understand what goes on beyond their practice,” he said of his time spent with Aetna as senior medical director of Northeast Patient Management. “It really gives the perspective from the payer.”

That was just one of several efforts he made to not only break down his diverse background in healthcare, but also explain its inherent value.

Here’s another one.

“When you think of how healthcare is transforming, with the growing focus on the patient experience, on outcomes, and as we emerge from a pay-per-service, business-focused approach to healthcare, and we evolve into this population-health era, these are the conditions where a physician-leader can excel,” he said, while explaining why more people with direct patient-care experience are now in senior management positions in healthcare. “Having a background in direct patient care really affords a physician leader the opportunity to have that perspective and be able to impact the operational aspects of care.”

Indeed, that full-circle view he described is enormously helpful, he told BusinessWest, because these are extremely challenging times for all those involved in the delivery of healthcare — a time of immense competition, a broad host of financial challenges, and an intense focus on the patient experience.

“All of my experiences have helped me develop a very 360-degree view of healthcare,” he explained, “and the challenge we face on a daily basis of providing the highest-quality care in a very cost-effective manner, while all the while providing an extraordinary patient experience.”

Wolf has the additional challenge of leading a hospital, and a health system, guided by a mission to deliver care to those who most need it, regardless of the circumstances when it comes to profit and losses.

But that mission is what makes SPHS, part of the larger Trinity Health system, unique and such a pivotal force in the Western Mass. region, he said, adding that working in such an environment is quite satisfying.

“That’s what makes the job so rewarding,” he explained. “Everyone in this organization feels a responsibility to carry on the legacy of the Sisters of Providence. They live out our values — caring for the poor and the most needed — and that’s what really grounds us.”

For this issue, BusinessWest talked at length with Wolf, who succeeded Dan Moen in his twin roles in January, about his new role at Mercy and SPHS, the challenging environment the system faces, and how that 360-degree view should help him as he steers the ship through some fairly treacherous waters.

The Big Picture

Traveling back in time to his days in medical school, Wolf recalled a period when was “teetering” as he pondered which specific path to take with regard to a career in healthcare.

“I was already accepted into a fellowship in pulmonary critical care,” he explained. “But I was developing an affinity for primary care, as opposed to subspecialty medicine, and as I thought about my future, I didn’t want to be restricted to one discipline; I really felt that my passion was in helping and addressing the needs of the whole person.”

Such a philosophy is likely a refection of his background — he’s an osteopathic physician, Wolf noted, adding that, while he’s had several employers during his career and a wide array of titles on his business cards, this desire to tend to the whole person has been what amounts to a constant throughout.

Chronicling those career stops, Wolf started with his stint at Hartford Hospital, where he was chief medical resident, as director of Clinical Operations in Ambulatory Medicine. In that role, for which he wore a number of hats, his accomplishments include development of a strategic plan resulting in the implementation of a primary-care model of healthcare delivery, with outcomes demonstrating improved patient care, increased practice efficiency, and improved patient satisfaction.

And it was during this time that Wolf, and the industry in general, began what has been a gradual shift toward population health, or “pop health,” as he called it. He became involved with research involving populations with asthma and diabetes, and the in the course of doing so was introduced to individuals working for Pfizer Health Solutions Inc., a subsidiary of the pharmaceutical giant, and this eventually led to his first serious career shift.

Indeed, after earning a public health degree in population health, Pfizer presented him with an opportunity to take on a leadership role in the design and implementation of disease-management programs.

“I made a bold move to leave clinical medicine and my comfort zone of dealing with patients and jumped into corporate America,” he explained, adding that his four years at Pfizer provided learning experiences on a number of levels — not to mention travel around the world — through his work as medical director of state initiatives, such as the “Florida: A Healthy State” program, which, over its first four years, improved the health of more than 190,000 Medicaid beneficiaries based on behavioral, clinical, and utilization metrics, while generating savings and investment of $139 million.

By 2004, Wolf was ready to significantly reduce his frequent-flyer miles and make another bold move, this one to yet another branch of healthcare, if you will — the insurance industry.

That aforementioned role as regional medical director with Hartford-based Aetna involved mostly a focus on healthcare-utilization services across the Northeast.

As noted earlier, he experiences in this realm were eye-opening.

“It was an incredibly enlightening experience,” he told BusinessWest. “It gave me insight into the business side of healthcare, from understanding utilization to understanding the many challenges payers face in helping to provide appropriate levels of care but do so in a cost-effective environment.

“When you’re sitting on that [managed care] side, you’re exposed to an incredible amount of waste that is delivered in our system,” Wolf went on. “There’s an extraordinary amount of duplication and superfluous tests that are done.”

Wolf said he considered such insight into that side of the business to be a prerequisite of sorts for effective service in the higher ranks of hospital management, so, three years after arriving at Aetna, he decided to go back to the realm where he was most comfortable and most satisfied.

It took just one visit in early 2010, by his recollection, for him to determine that Mercy Medical Center was where he wanted to continue his career in healthcare in the role of chief medical officer.

“From the minute I walked in the door and experienced my first day visiting with key members of leadership at the time, I knew right away that this was the place for me,” he explained. “The commitment to the mission was palpable. The commitment to each other, and just the reverence that was expressed in the hallways among colleagues and patients, was such that I knew that this was the place I wanted to be.”

Healthy Perspective

As he talked about the changes that have come to the healthcare field in recent years, and especially what would have to be described as an even sharper focus on the patient experience, Wolf summoned a name Millennials would probably have to Google to fully appreciate.

“I go back to the days of Marcus Welby,” he said, referring to the television doctor of the ’70s, “when the patient did whatever they were told, how they were told, and they were never in a position to question. What the doctor said was doctrine.”

Those days are long gone, he told BusinessWest, adding that patients are much better-informed than they were years ago, they’re emboldened to ask questions and challenge what they’re told, and their demands and expectations are much greater because of something else they didn’t have in abundance four decades ago: choice.

Scott Wolf says he welcomes the challenge of leading a hospital and health system guided by a mission to deliver care to those who most need it, regardless of the financial equation.

Scott Wolf says he welcomes the challenge of leading a hospital and health system guided by a mission to deliver care to those who most need it, regardless of the financial equation.

“In this new age of consumerism, the patient is becoming much more cognizant and aware and educated about the care and services they are receiving,” he went on. “And they have much more choice about where they seek care and services. Information is now all over the Internet in a very transparent way, so that patients have the ability to shop, if you will. It’s not that we’ve never paid attention to the patient experience before, it’s just now elevated to the point where the expectations of the patients are much greater.”

This new age of consumerism is just one of many elements in that broad, three-legged challenge he described earlier — providing the highest-quality care in a cost-effective manner, while providing the highest levels of patient satisfaction.

And it’s another example of why that full-circle view of healthcare is so valuable today, he said. “With the focus on the patient experience, it’s hard to be able to understand what that experience is like unless you’ve been in a position to deliver that experience.”

But the patient experience is just part of the equation. That experience must be delivered effectively and in a cost-efficient manner, he noted, adding that the constant and ever-growing challenge is to meet what he called the “triple aim.”

“We’re constantly driven to reduce operational expenses,” he went on. “But at the same time, we’re also challenged to hopefully realize operational revenues so we can reinvest in resources; you need to have a stream so you can reinvest in technology, human resources, capital requirements to maintain facilities, and more. It’s a challenge to keep your costs at a minimum, deliver care as efficiently as possible, and be able to generate a margin so you can keep reinvesting.”

In this environment, hospitals and healthcare systems must be responsive and, in a word, somewhat nimble, he said, adding quickly that they must also have the necessary resources to do all of the above.

Being part of Trinity Health gives the SPHS and Mercy the needed size and flexibility to function efficiently and compete in this changing healthcare landscape, he said, adding that the system has undertaken a number of strategic initiatives in recent months to better position it for growth.

These include everything from an affiliation (now being finalized) with Smilow Cancer Hospital at Yale-New Haven Hospital to the acquisitions of Hampden County Physician Associates and RiverBend Medical Group, the latter of which he described as a “true game changer.”

“This is huge in terms of our strategy to pursue our strategy of true population health,” he explained. “The fact that we’ll be on one common electronic medical record will allow for the seamless transfer of information, and we will be able to assure a seamless transition of care from the inpatient arena to a primary-care provider in our community.

“And this truly allows us an enormous foundation of primary care,” he went on. “And primary is really the core of population health.”

Coming Full Circle

Looking ahead, Wolf said the challenges confronting Mercy, SPHS, and all healthcare providers are only going to grow in severity as the population ages, technology improves, and patients become increasingly demanding.

To succeed, providers must be flexible and able to adapt to changes quickly and effectively, he said, adding that the system is now better-positioned to carry out that multi-faceted assignment.

He said his job description comes down simply to giving all those within the system the means and the tools to carry out their mission. And, as he said many times, having a 360-degree view of healthcare certainly helps with that broad task.

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

Health Care Sections

Taking Matters to Heart

By Kathleen Mitchell

Dr. Yufeng Zhang

Dr. Yufeng Zhang says it’s critical to see a doctor right away after unusual symptoms.

The statistics are chilling: Not only is cardiovascular disease the number-one killer of women in this country, every 80 seconds a woman dies from the disease or from a stroke.

Roughly 40 million women across the nation are affected, and although 90% have more than one of the major risk factors — which include high blood pressure, elevated serum cholesterol, smoking, obesity, diabetes, physical inactivity, and family history — up to 80% of heart disease is preventable.

Much has been done in recent years to raise awareness, including the American Heart Association’s Go Red for Women initiative, but Dr. Yufeng Zhang says that, although about 50% of Caucasian women know the risks for heart disease, only one-third of Hispanic and African-American women are armed with such knowledge. In addition, the incidence of diabetes is higher in Hispanic females, which raises their risk for cardiovascular disease or an event.

“Women have fewer heart attacks than men, but their mortality rate is higher,” said Zhang, a cardiologist from Pioneer Valley Cardiology in Springfield.

She added that age also increases risk, because younger women get some protection from estrogen, which declines after menopause.

But that doesn’t mean they’re immune. “We see 30-year-olds in our office with heart disease,” she said.

Most studies on cardiovascular disease have been conducted on men, and the symptoms that occur when a woman is having a heart attack can be very different from what men experience.

For example, sudden exhaustion with no known cause and shortness of breath are signs that a woman should go to the hospital. So is acute indigestion and sweating or shortness of breath with no other cause.

“If you have chest pain with acute stomach discomfort, it’s important to seek immediate medical care,” said family nurse practitioner Kristin O’Connor of Western Mass Physician Associates in Holyoke. “Women’s symptoms are often more vague than the ones men experience.”

Other, more-well-known indicators include chest pain that doesn’t disappear after 15 minutes, arm numbness or tingling, and jaw and back pain. But women often ignore what they are feeling and hope their discomfort will go away.

“So many women come here a few days after damage to their heart has been done, so don’t wait to go the hospital: be vigilant about unusual symptoms,” Zhang said, explaining that she recently saw an older woman whose only complaint was exhaustion when she was having a heart attack.

Stress is also a risk factor and can change the body’s hormone levels. “The heart can temporarily give up if a person is under a lot of stress,” she added.

Preventive measures are important, and O’Connor says women should do all they can to mitigate them.

“Although you can’t modify your family history, you can change excessive alcohol intake, your diet, your weight, and your stress level,” she said, adding it’s also important to know one’s family history. “You can also stop smoking and increase your activity if you lead a sedentary lifestyle.”

Kristin O’Connor

Kristin O’Connor says a woman can be thin, but still have clogged arteries.

Other risks include co-morbid conditions such as kidney disease, hypertension, and metabolic syndrome, which is a cluster of conditions that raise the chances of having heart disease. Many of the factors don’t have symptoms until damage has been done, but, according to the National Institute for Health, if women have three or more of the following criteria, they are at risk for the syndrome:

• A waist measurement of 35 inches or more or abdominal obesity. Excess fat in the stomach area puts women at greater risk for heart disease than excess fat in other parts of the body, such as the hips;

• A high triglyceride level or taking medicine to treat it;

• A low level of HDL or ‘good’ cholesterol, or taking medication to increase it, which also helps remove cholesterol from the arteries;

• High blood pressure or taking medicine to treat it. If pressure rises and stays high over time, it can damage the heart and lead to plaque buildup; and

• High fasting blood sugar, which may be an early sign of diabetes, or taking medicine to treat it.

“But metabolic syndrome is not a disease, so lifestyle modifications can change it,” O’Connor said.

She added that women need to engage in 30 minutes of exercise three to five times a week and increase the amount as their stamina and endurance build.

“You don’t need to run; you can walk, but you do need to increase your activity above and beyond what you do in a normal day,” she told BusinessWest.

For example, although some might assume that a woman who works as a waitress and is on her feet all day is getting her fair share of exercise, O’Connor says it’s not enough because the body adjusts to whatever a person does on a daily basis.

Knowledge Is Key

Managing heart disease is important, and women need to keep track of their cholesterol levels. HDL should be high, and LDL should be low, but even if those numbers fall within a normal range, a high triglyceride level puts women at risk for a cardiac event.

Triglycerides— fats from the food we eat that are carried in the bloodstream — are especially significant in women. In fact, an increase of only 88 points raises the risk that a woman will develop heart disease by 37%, while it increases the risk for men by only 14%. In the past, their importance was overshadowed by a focus on cholesterol, but research has shown that triglyceride levels over 150 mg/dL can increase the risk of heart disease, especially if HDL or ‘good’ cholesterol is less than 40 mg/dL.

Cardiovascular disease includes coronary artery disease, which occurs when there is a blockage in a heart vessel caused by high cholesterol, which allows plaque to build up.

But drugs called statins, which reduce cholesterol and stabilize plaque, can make a difference. Stents can be put into vessels that are blocked to enlarge them, but Zhang warns that people can develop new blockages if they don’t alter their diets and lifestyles.

Guidelines say a woman’s body-mass index (BMI) should not be more than 25, but Zhang said that number may be too high for some groups, such as Asian women.

O’Connor concurs, and says looking fit or being thin does not necessarily equate to heart health.

“It’s not just about the numbers on the scale; a woman may have a normal BMI or weigh 100 pounds, but still smoke like a chimney or drink too much,” she said, noting that it’s important for women to get screening tests during annual visits with their physicians. She added that some women are “skinny fat” — their bodies are thin, but they have clogged arteries from plaque that cannot be seen.

Indeed, what women choose to eat does make a decided difference. Zhang noted that, although many women with heart disease tell her they don’t eat much fat or red meat, new studies show carbohydrates and sugars are the biggest dietary culprit and can significantly increase the risk of dying from cardiovascular disease.

The Journal of the American Medical Association reports that, if 17% to 21% of the calories a person consumes each day come from sugar that does not occur naturally in foods such as fruit or milk, the risk of dying from coronary vascular disease rises by 38%.

“Sugar causes inflammation in cells, weight gain, and is linked to an increase in LDL or bad cholesterol, as well as triglycerides,” O’Connor said.

The World Health Organization advises limiting sugar intake to five teaspoons a day, but since the average adult in the U.S. consumes about 22 teaspoons a day, which is hidden in processed foods and beverages, it’s not an easy change to make.

“But sugar increases blood pressure, weight, and cholesterol, which all raise the risk of heart disease,” warned registered dietician and nutritionist Nancy Dell of Nancy Dell & Associates Nutrition Counseling, adding that it also causes aging and wrinkling of the skin.

Although it’s difficult to give up sugar cold turkey, Dell said it can be done by gradually retraining the taste buds. For example, she told a woman who loves cola to begin adding a small amount of lemon-flavored seltzer to each glass, then slowly increase the amount of seltzer in the beverage over time.

However, consuming too much dietary fat is still problematic, and it’s found in products women tend to enjoy, such as cheese, cream cheese, and coffee creamers, although black coffee and tea can reduce the risk of heart disease.

Trans fats are the worst offender, and a Harvard study found that women in the U.S. with the highest levels of trans fats in their blood had three times the risk of coronary heart disease as those with the lowest levels. And although the U.S. Food and Drug Administration has mandated that companies stop using trans fats in food products, the agency is allowing it to be phased out over time.  As a result, Dell said it still appears in many products, so it’s important to read labels.

“You are what you eat, and if you eat foods that are unhealthy, you will become unhealthy,” she said. “The food you consume becomes part of your body.”

Cautious Approach

Zhang said women have more risk factors than men for cardiovascular disease, so they need to make it a point to care for themselves.

Gender differences that men don’t face include radiation for breast cancer and pregnancy-related hypertension and gestational diabetes, which raise the likelihood that a woman could have a heart attack or heart disease; even though two of these conditions occur during pregnancy, the risk factor doesn’t disappear after a woman has given birth.

Ultimately, prevention is key, and O’Connor recommends that women start blood screenings at age 20 to measure inflammatory markers and their cholesterol.

“Even if the results are normal, the screenings should be repeated every two to three years for the rest of their lives,” she said.

All these factors play a role in maintaining a healthy heart.

“Most heart disease is preventable,” Zhang said, “and if it does occur, it is treatable if women take care of themselves, eat a healthy diet, exercise, see their doctors on a regular basis, and take the medications prescribed for them.”

Health Care Sections

See Change

Drs. David Momnie and Camille Guzek-Latka

Drs. David Momnie and Camille Guzek-Latka say scleral lenses are giving hope to a subset of patients who have tried other remedies unsuccessfully.

Since Bradley Sweet was diagnosed with keratotonus, he’s had to choose between poor vision and constant discomfort. Until now.

Keratoconus, also known as ectatic corneal dystrophy, is a progressive, debilitating eye disease in which degenerative thinning results in irregular bulging of the normally spherical cornea, the clear covering in front of the eye. The condition results in grossly distorted vision, causing glare similar to looking through a windshield while driving in a rainstorm without using wipers.

Eyeglasses don’t help with this particular condition, leaving contact lenses as the only non-surgical path to functional vision. Unfortunately, said Dr. David Momnie, Sweet’s eye doctor and owner of Chicopee Eyecare, soft contact lenses have trouble conforming to the irregular cornea, while rigid, gas-permeable lenses that rest on the cornea can cause discomfort to that area.

In Sweet’s case, his corneal lenses fit poorly and ‘rocked’ on the surface, causing moderate pain. “On top of that, there was chafing; he had a scar from it,” said Dr. Camille Guzek-Latka, who has worked with Momnie since 1990.

But the team at Chicopee Eyecare was able to offer something different from most optometrists — scleral lenses, which contact the sclera, or the white part of the eye, and vault the entire cornea. If they fit properly, they offer both improved vision and comfort, Momnie told BusinessWest. For Sweet, they worked — and the rubbing and chafing was a thing of the past.

“No one else around here is fitting these,” Momnie said, adding that he knows of optometrists in Lowell and Boston who fit them.

Another patient came to the practice with similar issues. In 1994, she had undergone radial keratotomy, a procedure that involves making incisions in the cornea, and one that is mostly out of favor in the vision world. In her case, the procedure didn’t heal properly, and she ended up with distorted corneas, which causes blurred vision.

“We tried all kinds of things on her,” said Momnie, including soft lenses, corneal lenses, and hybrid lenses, which are hard in the middle but have a soft edge.

“We never got a good outcome with any of those,” Guzek-Latka said. “She was motivated, too — she would always say, ‘what do you have? What do you have?’”

When he decided to start fitting scleral lenses last year, Momnie called her up. “She’s the first one who came to mind. I said, ‘would you be interested in coming down sometime?’ She said, ‘I’ll be there in 10 minutes.’”

The fact that she finally found relief is immensely gratifying to Momnie and his team. Keratoconus affects somewhere between one in 500 and one in 2,000 people, and for those suffering with it, it can be debilitating.

“They can’t function; a lot of them can’t drive, can’t get licenses, can’t work,” Guzek-Latka said. “I’ve had people crying because they were so happy once they can see. That’s why we do it. To give someone their sight back is the best feeling in the world. People are so appreciative.”

Forward Looking

Chicopee Eyecare has a long history in the region. In 1974, Momnie took the reins of the practice from his father, Dr. Paul Momnie, who opened the office in 1950. After Guzek-Latka came on board in 1990, Dr. Julianne Rapalus, a part-time associate, joined soon after, and the three have been working together to solve vision issues ever since.

Bradley Sweet

Scleral lenses gave Bradley Sweet the ability to see without constant discomfort.

Specialty contact lenses have long been among the practice’s niches, Momnie said. Until about 10 years ago, his team fit infants as young as eight weeks old with special contact lenses after they underwent cataract surgery. Fortunately, today, children born with congenital cataracts are now able to undergo intraocular lens-implantation surgery, eliminating the need for such specialty contacts.

Scleral lenses are a continuation of that mission to provide widely unavailable solutions for specialty eye issues — in this case, keratoconus.

Glasses can’t help because the lenses are too far away from the surface of the cornea to create the smooth, refractive surface necessary to translate the image clearly to the back of the eye and therefore to the brain. And primitive scleral contact lenses were made of low-breathability materials (the same as in Plexiglas, actually), resulting in severe swelling of the cornea.

However, today’s scleral lenses are manufactured with highly oxygen-permeable materials and are a viable treatment for irregular, diseased, or severely dry corneas, Momnie said. “These lenses require an exact alignment as they rest entirely on the damaged cornea. Fortunately, for some people, newer designs and materials have made scleral contact lenses more compatible with the eye and more comfortable to wear.”

Despite these advances, he added, the eye-care community has been slow to embrace these lenses, probably because they require an entirely new fitting philosophy, Momnie noted. “The lenses must be aligned with the exact amount of clearance to achieve adequate comfort and oxygen transmission to the cornea.”

He’s not surprised their use isn’t widespread. “They’re very time-consuming to fit and require a large investment in fitting sets. However, the more we looked into the advances in scleral-lens technology in the last few years, the more we realized this was a service that we needed to offer.”

The only other therapeutic option for improving vision in keratoconus patients is called penetrating keratoplasty, also known as a corneal graft or corneal transplant.

“In some cases, the eyes are too distorted. If it doesn’t work, sometimes the next step is corneal grafts, but these can have inherent problems too,” Guzek-Latka said. Because of the inherent risks and high cost of surgery, this option is typically reserved only for patients who cannot receive treatment from contact lenses.

Also, “while many transplants are successful,” Momnie said, “the eye is permanently weakened, and often a complex contact-lens fitting is still required to restore vision.”

Progressive View

Keratoconus isn’t the only condition that can benefit from scleral lenses. Others include corneal scarring or irregularity due to trauma or prior surgery, as in the case of the patient with a past radial keratotomy; severe ocular surface disease associated with surface defects like erosions and ulcers; and a number of other conditions, including severe dry eye, radiation injury, chemical or thermal injury, or certain congenital disorders.

In the case of keratoconus especially, Momnie said, there are few options beyond scleral lenses.

“Very often, for keratoconus, we are the last stop before the operating table,” he told BusinessWest, noting that some patients’ corneas are too damaged to avoid surgery. “But if we can keep them off the operating table and fit them with one of these, they’re in good shape.”

Only a handful of laboratories in the country manufacture scleral contact lenses, he noted. Often, the fitting requires two or three attempts before a proper fit is achieved. Advanced, computerized instruments like a topographer and an optical coherent tomographer — which maps the corneal irregularity much like a landscape topographic map, but much more precisely — are used to improve the chances of success.

When a patient does find success with scleral lenses and avoids surgery, which is most of the time, it can be life-changing, Guzek-Latka said.

“To be able to get someone to see, these younger guys trying to raise a family … if you can do that for them, that’s the best feeling in the world for me,” she added. “Anybody can give you a pair of glasses, and we love doing that for people. But when you take someone who can’t see, can’t function, and get them back to work and a normal life, when they look at you and say, ‘I can see, I can see,’ that’s what I love.

“We help more than we can’t, and they’re often pretty desperate by the time they see us; they’ve tried everything,” she went on. “So if we get someone like that seeing and doing their thing, that’s priceless. It’s very rewarding.”

Joseph Bednar can be reached at [email protected]

Health Care Sections

On the Front Lines of a Crisis

Dr. Louis Durkin

Dr. Louis Durkin says heroin overdoses represent simply the tip of the iceberg when it comes the nation’s opioid crisis.

The nation’s opioid crisis has permeated every corner of the country and every facet of life, from the home to the workplace to the college campus. It is also much in evidence in hospital emergency rooms — the front lines of this epidemic in many respects — where caregivers confront everything from overdose cases to individuals desperate for prescription painkillers.

Dr. Niels Rathlev says it was maybe a year ago that he started hearing, anecdotally, that the emergency room at Baystate Medical Center was rumored to be a place where a visitor could quite easily get some prescription pain meds — if they were so inclined.

Fast-forward to just a few months ago, when, he noted with noticeable pride in his voice, he heard — this time directly from people who were so inclined — that this was no longer the case.

“We actually overheard a couple of people in a back hallway here talking,” said Rathlev, chair of the Department of Emergency Medicine at Baystate. “They were saying that it’s much more difficult to get opioids from the doctors here.”

This significant change in dialogue about Baystate’s ER — and the reasons behind it — speak volumes about the many ways in which the ongoing opioid crisis is impacting life in area emergency departments, which are, in many ways, the front lines in this battle, and how they are responding to this epidemic.

The most visible, or news-making, aspect of this crisis and the way it’s affecting ERs is the alarmingly high number of heroin-overdose cases reported across the region. Since last fall, BMC is averaging at least one case a day, and often there are several, said Rathlev, adding that, thanks to naloxone, a medication sold under the brand name Narcan, among others, many of those who overdose can be saved. Still, some do not arrive in time to be revived, he went on, as almost weekly reports from area media outlets make clear.

When asked how many have died, he said simply, “I don’t have a number … obviously, too many.”

But heroin overdoses represent just the proverbial tip of the iceberg with the opioid crisis, said Dr. Louis Durkin, an emergency medicine physician at Mercy Medical Center, noting that there are many manifestations of this problem that are far less headline-grabbing, but nonetheless concerning.

This is especially true of addiction to prescription pain medications, which for years has revealed itself in individuals with chronic pain wandering from ER to ER looking for a prescription to Percocet, OxyContin, or myriad other drugs — and, until recently, having generally good luck obtaining one.

It’s certainly not a new problem; Durkin says he’s dealt with it throughout his 20 years as an emergency-room doctor. But it’s one that has grown in scope because of the manner in which those drugs were prescribed — and over-prescribed — for years, leaving people addicted to them and often desperate to get them.

“We see far more people with opioid issues, especially addiction, than we do with opioid overdoses,” he explained. “And we’ve been working very hard over the past five or six years to mitigate that, because this is clearly a high-risk group for overdoses.”

Indeed, hospitals like Baystate and Mercy have responded with comprehensive programs — greatly assisted by the state Prescription Monitoring Program (PMP), established in 2010 — that identify frequent visitors to ERs, and especially those who come in search of painkillers.

“We look at patients who are high-frequency users of ED services, and that is a pretty good screen, at least to begin with, and we track them,” Rathlev explained. “If you see someone who has been here 50 times in a year, that’s a good indicator.”

Dr. Niels Rathlev

Dr. Niels Rathlev says Baystate, and all area hospitals, are working diligently to control the prescribing of addictive painkillers.

Such information is shared among the hospitals, said Durkin, adding that Mercy has a similar registry, if you will. There are now roughly 600 names on it, he went on, noting that care plans are developed for such individuals with the goal of treating their pain and reducing their risk of an opioid overdose.

In many ways, the region’s ERs serve as a microcosm of the opioid crisis — from the way it has permeated every region of the state, urban and rural, to the many ways the epidemic manifests itself; from the frustration that comes from reviving an overdose victim, only to see that individual back in the ER — or the morgue — just days later, to clear uncertainty about whether the crisis has peaked or is still getting progressively worse.

For this issue and its focus on healthcare, BusinessWest spoke with several ER administrators about the many faces of this crisis and how, in many ways, the ER has become ground zero in a war with many fronts.

Doses of Reality

Dr. Rakesh Talati says Greenfield is like many rural communities stung by the opioid epidemic — only there are some unique circumstances that make the situation there even worse.

Indeed, this city of 18,000 people sits right on I-91, the major north-south corridor for heroin trafficking, and is only a few miles from the Vermont border, where the opioid problem is especially acute, and a shortage of supply has prompted many entrepreneurial-minded individuals to energetically attempt to meet demand.

That makes heroin readily accessible and usually quite cheap, said Talati, chair of the Emergency Department at Baystate Franklin Medical Center (BFMC), adding that all this has also made it extremely, and alarmingly, popular.

“Our younger population seems to be using it quite a bit — heroin is the dangerous drug of choice in our area,” he said. “The problem is probably as prevalent here as it is in Springfield or Holyoke, because we’re just another stop off 91.”

Baystate Franklin sees only a fraction of the overdose cases that the Springfield-based hospitals do (maybe one a week) because it serves a wide but sparsely populated area, said Talati, but it handles its share, partly due to the aforementioned accessibility of heroin, but also because this is the only hospital in Franklin County, and those from the area who have overdosed can’t easily drive past it to get treatment somewhere else, which an individual might do if he or she lived in Northampton, Holyoke, or Westfield, also homes to community hospitals.

“When it’s 40 minutes to the next hospital, or to Springfield, people have a tendency to stop here,” he said, adding that this is also why the hospital sees a comparatively large number of stroke and heart-attack patients for its size. “We’re essentially the one shop in town, so we have to be ready for anything.”

This same geographic characteristic certainly limits the options for those seeking prescription painkillers, he went on, adding that BFMC sees every aspect of the opioid problem.

Dr. Rakesh Talati

Dr. Rakesh Talati

And none of the them would qualify as recent phenomena, he stressed repeatedly, adding that heroin overdoses and patients coming to the ER in quest of powerful painkillers are problems addressed by generations of ER doctors.

But the scope of the problem continues to escalate, said Talati and the others we spoke with, noting that, while the huge amount of attention given the problem on the regional, state, and federal levels has certainly raised awareness of the issue, recent numbers would indicate that progress is elusive.

That is especially true when it comes to heroin overdoses, said Rathlev, adding that, while the effectiveness and improved accessibility of naloxone — one can now get it at Baystate’s pharmacy, for example, with only a $4 co-pay — have certainly made a difference when it comes to saving the lives of those who have overdosed, the number of cases continues to escalate, as does the number of deaths.

Quantifying the matter as best he could, Rathlev said Baystate saw roughly 150 overdose cases in the fiscal year that ended last Sept. 30. But in the first two months of the new year, it saw 109, and is on pace to more than double last year’s total and approach one case per day on average, with perhaps 60% of those cases involving men ages 15-30.

“Whether that was a blip, we don’t know,” he said of the start of the new fiscal year, “but we nearly tripled the rate of the year before for that same time period, and that is certainly concerning.”

Durkin agreed, and said there are many reasons for this rise, including those aforementioned efforts by all ERs — and the medical community in general — to curb the availability of prescription opioids.

“People are switching to heroin because it’s cheap and its available,” he noted, adding quickly that, nationally, overdoses of prescription opioids are still nearly three times as common as those involving heroin — roughly 28,000, compared to about 10,000.

Another reason for the rise in heroin overdoses is the potency of the products now being found on the streets. Some shipments, such as the highly publicized batches of ‘Hollywood’-stamped heroin that reached the area late last year, are quite lethal, he said.

But perhaps the biggest problem, he continued, is that users simply don’t know what they’re getting when they make a buy.

“The problem with an illicit drug is there’s no control,” he explained, “so the potency can vary by orders of magnitude — one batch can be 10 to 100 times more potent than another batch.”

Meanwhile, treating heroin overdoses is only part of the story, said Talati, adding that what happens after a patient is revived is becoming a growing source of frustration among ER personnel.

Such individuals require counseling, detox, and medication-assisted therapy, or MAT, meaning methadone or Suboxone, among other treatments for opioid dependency.

Often, they leave the ER and the hospital without any of the above, because they don’t want it or it’s not available.

“The majority of the patients that overdose on heroin that we revive are uninterested in treatment at that time and just want to go home, and they range in vocalness and belligerency concerning that,” he explained. “Addiction is a very difficult disease, and when they’re right in the midst of that addiction, even a near-death experience isn’t enough to shake them at that moment.”

Often, even for those who are shaken, securing proper treatment can be a challenge.

“What we really struggle with in the ER is that we can stabilize the patient, but then, if they want treatment, getting them into a center is not as easy as it should be,” said Talati. “So, oftentimes, we can’t get them the treatment they want.”

Bitter Pills

As Durkin noted, heroin overdoses represent only the tip of the iceberg with this crisis. Equally alarming is that problem of addiction to prescription painkillers, and efforts to use ERs as a dispensary.

Many chronic pain sufferers resort to the ER because, in most cases, there are few, if any, other options, he said, adding that many have essentially fired their primary-care physician — or been fired by that doctor — because they can’t get want they want there.

And what they’re finding, a trend verified by that conversation Rathlev overheard in the hallway, is that it is now increasingly difficult to obtain what they need in the ER, because those facilities are far more careful about how they dispense such medications.

The state PMP, which collects dispensing information on certain controlled substances, puts information in the hands of ER physicians, who then use it in efforts to control prescription drug abuse.

To explain the problem, and how ERs have responded, Rathlev cited a case that is in many ways typical of what ER doctors see on a regular basis.

“This was a young man who complained of back pain, and he had this pain for quite some time,” he told BusinessWest. “As I recall, he had seen an orthopedic surgeon, and surgery was either scheduled or had been postponed, and now he was in a lot of pain.

“Initially, I was prepared to give him opioids because he appeared to be in a lot of pain,” he went on. “As things unfolded, I checked with the PMP, I looked at his medical records, and I then called his primary-care physician, who said, ‘this is actually an issue for this patient, and you should be really careful what you prescribe.’ I think I did give him one dose of morphine, but I didn’t given him anything after that.”

Elaborating, Rathlev said incidents like this one — and the numbers of them are not declining — turn ER doctors into “sleuths” as they treat pain-related cases that come before them.

And, while such work is necessary, it is at times difficult because it collides head-on with any physician’s primary mission — to ease the pain and suffering of their patients.

“Our attitude is to try limit our prescribing as much as possible,” said Baystate Franklin’s Talati. “But we don’t want to swing in a direction so that some patient with true pain doesn’t get treated for that pain, either.

“It’s a very difficult thing to figure out sometimes,” he went on, adding that one compounding factor is the lack of quality dental care in some low-income populations, which often causes chronic pain — a problem prevalent in Franklin County.

Meanwhile, the new protocols can also lead to some stressful moments, said Durkin, adding that, while more patients seemingly understand why the ER doctor says ‘no’ when they ask for a painkiller, that is not the answer they are looking for.

“There are some very, very angry patients,” he explained. “It can be a difficult conversation, but it can be very rewarding, too, when you get someone into a better, safer place. But it’s not easy; it’s a challenge, and it’s going to be a challenge for a long time.”

Prescription for Progress?

When asked if the medical community, and society in general, had turned any kind of corner with regard to the opioid crisis, those we spoke with all expressed a desire to be optimistic, and to a large extent, they are. But they clearly conveyed the message that anything approaching real progress is still far off.

“I think we’ve hit the peak and are probably on our way down from the prescription-opioid problem — I think there’s now enough support for providers to try to limit, control, and decrease the amount of prescriptions we’re giving, which we didn’t have 10 years ago,” said Durkin. “A decade ago, the culture would be that, if a patient complained that you were not giving them pain medication, you’d be fired as a physician. Now, there’s much more support to limit the amount of prescribing.

“The problem, however, is that we have an incredible number of opioid-dependent people out there that we need to get into treatment, or they’ll turn to heroin,” he went on. “That aspect of the problem will continue to grow until we get a real handle on it.”

Talati agreed, and said there are many aspects of this crisis that would lead him to conclude that it has not peaked yet.

“The thing that concerns me is the age of the people we’re seeing who are using heroin and overdosing on it — people in their teens and early 20s,” he explained. “This means that the education for this has to be for preteens, and that’s a real challenge. Meanwhile, there’s a virtually unlimited supply of cheap, high-quality heroin, and until we can do something about that, it’s clear that we’re not going to make much progress.”

What is also clear is that the region’s ERs will continue to constitute the front lines in this fight, and they will continue to respond imaginatively and responsibly to a crisis defined by a host of stern challenges.

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

Health Care Sections

Check Point

 By KATHLEEN MITCHELL

Maura McQueeney

Maura McQueeney says telemonitoring equipment is so compact, a nurse of yesteryear could have fit it in her briefcase.

Every morning at exactly 10 a.m., Barbara Kobak weighs herself, takes her blood pressure, attaches a clip to her finger that measures her oxygen-saturation rate, then answers a series of computerized questions specific to her condition, which are presented out of sequence from one day to the next to ensure she thinks carefully about her response.

Within two minutes, the results are transmitted electronically to a registered nurse at Porchlight Visiting Nurse Assoc./Home Care in Chicopee, who calls the 84-year-old if anything doesn’t fall within the parameters Kobak’s doctor set for her.

The service is called telemonitoring, and Porchlight brought the equipment to Kobak’s home in January after she was released from the hospital. She had been diagnosed with congestive heart failure, and after an initial meeting with a nurse liaison in the hospital, a registered nurse spent several days in her home making sure she understood how to use the technology.

Home visits were spaced farther apart as time went on, which is typical; the goal is to help the person learn to manage their disease by recognizing potentially dangerous symptoms, making changes in their diet, and taking all medications prescribed for them.

“The equipment is really easy to use; I depend on it and don’t know what I would do without it. It’s reassuring to have someone call me if my blood pressure is up,” she noted, adding that there have been days when her pressure has been high in the morning, but when she puts the cuff on later in the day, she is relieved to see it has returned to normal.

The Chicopee octogenarian is one of a growing number of people who are benefiting from telemonitoring services. The equipment is made by a variety of manufacturers, and it allows healthcare providers to keep a close watch on the patient from a remote setting.

“We call new patients every day until they become comfortable with the equipment,” said Sandra Peret, a registered nurse at Porchlight and associate director of intake/community service. “We tell patients to use it at the same time every day, but if they are not feeling well, they can recheck the values.”

Telemonitoring is typically used to treat people with congestive heart failure or chronic obstructive pulmonary disease (COPD), which can make it difficult to breathe, although an additional module can be added if the person is diabetic and doesn’t have another reliable method to measure their blood-sugar levels.

Experts say it is valuable because people who are newly released from the hospital can feel overwhelmed when they get home due to the trauma of their diagnosis, the amount of information presented to them, and the lifestyle changes they must make to keep their condition from exacerbating, which can lead to rehospitalization.

“These conditions require a lot of self-management and usually include dietary changes such as cutting down sodium intake,” said Melissa Pouliot, a registered nurse and Porchlight’s intake/telemonitoring manager, noting that telemonitoring helps the patient see a direct correlation between their behavior and their health. For example, if someone eats Chinese food, their weight is likely to rise the next day due to its high salt content.

When that happens, a registered nurse calls the patient and conducts an assessment by phone to determine if the doctor needs to be notified. In some cases, there is no need for alarm, while in other instances, the person’s physician may be called to see if medication changes are in order.

From left, Melissa Pouliot, Sandra Peret, and Kathleen Stezko

From left, Melissa Pouliot, Sandra Peret, and Kathleen Stezko say patients being telemonitored are given a finger clip that measures oxygen saturation.

However, patients sometimes don’t follow instructions given to them, which can have a direct effect on their vital signs. For example, they might fail to weigh themselves at the same time each day or wear heavy shoes or clothing while they are on the scale.

In any case, the patient is followed closely, and if the weight gain continues, the doctor is contacted. “The ultimate goal is keep the patient from having an acute attack,” said Sue Pickett, director of Mercy Home Care, adding that patients track their symptoms themselves on a calendar even though the results are stored in the computer.

“Telemonitoring is a wellness proactive measure that allows us to catch symptoms early before they exacerbate and become a crisis,” she told BusinessWest. “The reason why these programs are so important is because is because rehospitalization is very common for people with congestive heart failure. We have patients who have been in and out of the hospital every other week.”

Nuts and Bolts

Major advances have been made in telemonitoring equipment in recent years, said those we spoke with.

In the past, people needed a landline to transmit information remotely, but today Bluetooth, cellular, and satellite technology make it possible to provide the service whether or not the person has a phone in their home.

The equipment patients receive from the VNA or home-healthcare service usually includes a blood-pressure cuff, an oxygen sensor that is clipped onto a finger, and a scale, which is plugged into a monitor with a touchscreen that not only transmits the information, but stores it, although there are some variations according to the company producing the equipment.

Pouliot said people tap the screen on the monitor Porchlight uses, and when a voice asks them what they want to do, they hit the corresponding icon. When they are finished with their reporting, which takes less than 10 minutes, a voice on the monitor asks the patient a series of questions which can range from “has the doctor changed your  medications?” to “do you want someone to call you?” as well as reminders to take their medication.

However, these systems are not appropriate for some, including people with dementia or individuals with a disability who don’t have a caregiver.

“The person has to want to do this and be able and willing to use the equipment every morning,” said Sheryle Marceau, manager of clinical practice for Mercy Home Care.

The remote monitoring is combined with education that takes place during visits to the person’s home. Mercy’s patients are given printed materials with valuable information including symptoms that should not be ignored by people with congestive heart failure. They include unexpected or rapid weight gain; weakness or fatigue; dizziness or faintness; swelling of the legs, ankles, feet, or abdomen; more frequent visits to the bathroom at night; chest pain; and other signs.

“Exacerbation can be prevented, but people need to know what they can do every day, which includes reading food labels, taking their medication, and eating foods low in sodium,” Marceau said.

She added that hospital stays are usually short, so the staff doesn’t have time to teach the patient all they need to know. In addition to the goal of keeping them from returning to the hospital, they want patients to be able to maintain their quality of life and stay active in the community.

So, while the technology is important, it’s what people do with the information gleaned from daily readings that makes a difference.

“It helps patients connect the dots,” said Maura McQueeney, president of Baystate VNA and post-acute executive.

For example, if a patient has a big holiday dinner and their blood pressure and weight rise the next day, it will trigger a call from the nurse who will discuss what they have eaten and determine whether the doctor needs to be involved.

Medication is critical, but unless patients understand the importance of each drug prescribed for them and know exactly what it does, they may take it inconsistently or fail to get it refilled, particularly if they are on a fixed income.

“We try to update each patient’s medication list because the physician may make changes during an office visit, and monitoring allows us to see if the new medication is working,” McQueeney told BusinessWest.

Baystate typically uses telemonitoring for patients who have experienced heart failure. They usually keep the equipment 30 to 45 days or until the nurse feels the patient is capable of caring for himself or herself and has learned the association between symptoms that may indicate their disease is getting worse.

Insurance doesn’t pay for telemonitoring, but local visiting-nurse associations find it so valuable, they do not charge patients for the equipment or the service.

“It’s a tool that provides us with consistent information,” McQueeney said, adding that Baystate began tracking the effectiveness of telemonitoring in high-risk patients about 18 months ago and found their rates of rehospitalization are lower than the national average.

“If a patient calls at 8 p.m., we can have them slip on the blood-pressure cuff and the oxygen clip and get on the scale, which gives the nurse valuable information,” she noted.

In many cases, people have more than one chronic condition, which complicates matters, but a registered nurse has the ability to discern whether pain from a surgery or anxiety is likely the cause of shortness of breath, heart palpitations, or other complaints.

It takes a long time for most chronic diseases to become apparent, but there are points at which the disease progresses.

“Without monitoring, it can seem that the disease got worse overnight, but when a patient can chart their vital signs on a daily basis and know they are being watched by a registered nurse, trends can be identified that alert them to changes that require the doctor to become involved,” McQueeney told BusinessWest. “Telemonitoring is a tool that helps keep people out of the hospital. It involves education and a collaboration with the patient, the registered visiting nurse, and their physician.”

As a result, the service can make a critical difference in a person’s life.

The American Health Care Assoc. reports that the majority of people with chronic heart disease or COPD are elderly, and being readmitted to a hospital increases the risk of complications and infections during their stay as well as the likelihood that their functioning will be decreased when they return home. In addition, every hospitalization exacts an emotional toll on the patient and increases the cost of Medicare, since people are living longer and the incidence of chronic diseases has increased dramatically over the last three decades.

Weighing In

Before nurses discharge patients from home-based services, Marceau said, they make sure they have absorbed what they need to know and have a blood-pressure cuff and scale so they can continue to weigh themselves daily. “We have purchased scales for people who are unable to afford them and teach people when to call their doctors,” she noted.

However, Porchlight has found some patients or their families opt to pay for the telemonitoring service even when the person no longer needs it because it gives them peace of mind.

“It’s great for family members who are concerned about a loved one,” Pouliot said, adding that the service costs about $100 per month, and people on fixed incomes can apply for reduced rates.

Kathleen Stezko agrees. “People get nervous and aren’t sure who to call or whether they should call anyone if they don’t feel well. But telemonitoring provides them with reassurance; they know someone is checking on them each day and will get in touch with them and their physician if it is necessary,” said Porchlight’s vice president of clinical services, adding that people using the equipment can call at any time of the day or night if they have concerns.

Indeed, the peace of mind and patient learning that results from telemonitoring is so important that most VNAs and home-care agencies that use it keep adding more equipment, which helps patients and also ultimately reduces the cost of healthcare.

Kobak can attest to the comfort it provides. “When my friends visit and see this,” she said, “they are so impressed.”

Health Care Sections

Waking Up to a Problem

Dr. Wendy Chabot

Dr. Wendy Chabot says lack of sleep can cause behavior problems in children that range from temper tantrums to a lack of impulse control to hyperactivity.

Experts say many children and adolescents don’t get enough sleep.

The reasons vary from family to family, but since parents often work long hours and evening meetings range from Girl Scouts to sporting events, it can be difficult to establish and maintain the same bedtime every night.

But research shows that a lack of sleep or a schedule that is out of sync with the child’s natural biological rhythms can lead to short- and long-term problems that include behavioral difficulties such as acting out in school, as well as academic issues such as poor grades or an inability to remember as much as their well-rested peers.

“Kids are really not getting enough sleep, and this has significant consequences for their mental and physical health. It’s not an optional activity; it’s essential because it is the third leg on the stool to optimal health, which includes exercise and eating a healthy diet, ” said Dr. Wendy Chabot, pediatric coordinator for Sleep Medicine Services of Western Mass. in Amherst and Springfield.

She cited research that shows it only takes a sleep deficit of 30 to 60 minutes each night to affect behavior and result in poor thinking skills and problems with attention, memory, decision making, organization, and creativity.

“When I talk to parents and kids, I tell them sleep is important if they really want to bring their ‘A’ game to life, whether they are learning to walk or play the piano. I can’t think of any aspect of a child’s life that isn’t affected by lack of sleep, and although many people get by on less than they need, if it becomes routine, they do so at their own peril,” Chabot continued, adding that sleep restores the body and the mind.

Rebecca Spencer agrees. “Sleep is important for memory,” said the assistant professor of Psychological and Brain Sciences at UMass Amherst, who conducts studies on sleep and cognition. “Our research shows if you teach preschoolers something in the morning and they take a nap, they remember all of it later on. But if they don’t have a nap, they forget 15% of what they learned. The same argument can be made for adolescents; the more sleep they get, the more they remember what they learned the previous day.”

She added that the law regarding naptimes for preschoolers in Massachusetts was modified recently, and children are now required to have a 45-minute “rest opportunity.”

“There used to be stronger language, and some preschool directors have told me the requirement used to be two hours,” Spencer continued, adding that the Montessori School in Amherst has a “no-nap room” for children who don’t want to sleep, and the Jewish Community Center Preschool in Springfield offers swimming or French lessons for children who don’t nap.

“The preschool curriculum has become very competitive, and there is not enough time for them to do everything they want, so they find ways to get around naptimes,” she told BusinessWest.

But napping — or not, as the case may be — at preschool is just one of many issues involved with the larger issue of children and sleep.

“If a child is sleep-deprived, they tend to have behavior problems; they may have frequent temper tantrums or be non-compliant and have poor impulse control,” said Chabot. “In younger children, the signs and symptoms of a lack of sleep resemble the signs of ADHD, and many children who are diagnosed with it actually have an underlying sleep disorder, which is their main problem.”

Chabot conducts sleep studies on children as young as age 3 when there is reason to believe they may have obstructive sleep apnea. The potentially serious disorder occurs when the person is sleeping and involves 10- to 20-second pauses in breathing that occur frequently throughout the night due to some type of airway blockage or obstruction, such as enlarged tonsils or adenoids.

“Although we used to think it was really rare in children, studies are showing it’s not uncommon in kids age 5 and older,” Chabot told BusinessWest.

She added that children who don’t get enough sleep are more likely to sleepwalk or have night terrors or nightmares, in addition to unwanted behaviors during the day.

The Rest of the Story

Experts say most adolescents are sleep-deprived.

“They live in a state of persistent jetlag,” said Spencer, adding that they need nine to 10 hours of sleep each night, but a 13-year-old’s biological clock isn’t set to allow them to fall asleep before midnight.

So even though they may have a 10 p.m. bedtime, their circadian clock won’t allow them to fall asleep that early, which bumps up against the time they need to start school.

“However, studies show if the school start time is delayed and they get more sleep, their grades improve,” she went on, adding that such data has led some school districts, including Northampton and Amherst, to hold discussions about having a later start time.

Rebecca Spencer

Rebecca Spencer says sleep is important for memory, which affects how well students retain what they learn in school.

But Spencer said many teachers don’t like the idea, and it can be difficult to implement due to sports schedules, although some cities, including Worcester, have made the change.

Williston-Northampton School in Easthampton also switched its start time, and students now begin classes a half-hour later than they did in the past.

“A year after they made the change, they reported more students were eating breakfast and taking medications they need,” Spencer said, explaining that since 50% of students live on campus, they need to get to the nurse’s office before school starts to get any drugs that have been prescribed for them.

Getting more sleep for adolescents is critical because research shows that those who don’t get enough also have less control over their emotions.

“They’re more temperamental, and it’s easier to set them off,” Spencer noted. “Plus, we also know that teens who sleep six hours are more likely to get the flu or colds than those who sleep eight hours, and as we get into cold and flu season, it makes a pretty big difference.”

Chabot concurred, and said sleep is more than a time for the body to heal and fight off infections; studies show young adults don’t respond as well to vaccines when they are sleep-deprived.

“Teens who miss out on one to two hours of sleep a night during the week can’t make up for it on the weekends; they need nine to nine and a quarter hours of sleep, but most get only seven hours, so they would have to sleep almost all weekend to make up the difference,” said Cabot. “There just aren’t enough hours in the day, and if they try to do it, their biological clock will get out of sync.

“When the biological clock keeps getting reset, it’s as if the teens have traveled to California and back,” she went on. “They have ‘social jetlag,’ which makes you irritable and causes headaches and stomachaches. But a lot of teens live like this.”

However, there are things that parents can do to help children get enough sleep, which is important, because habits formed at a young age often continue into adulthood.

The place to start is with learning how much shuteye your child should get.

Toddlers ages 1 to 3 need between 11 and 13 hours of sleep a night; preschoolers ages 3 to 5 need between nine and 11 hours of sleep; children ages 6 to 12 need between 10 and 11 hours of sleep; and adolescents age 13 to 18 need between nine and 9 ¼ hours of sleep.

Consistency is critical, and once a bedtime has been set, it shouldn’t differ more than an hour each night, whether it’s a weeknight or weekend.

“Many parents let adolescents go to bed super late on weekends and free sleep in the morning,” said Spencer. “But if they sleep from 2 a.m. to 10 a.m., when Monday morning arrives, the shift will be difficult for them, and they will feel jetlagged all day.”

Chabot agreed. “There are two main things that control sleep — one is the biological clock, and the other is called sleep drive, which simply means the longer you are awake, the greater your drive is to sleep,” she explained.

Experts say exercise can help children and adolescents fall asleep more easily, but exercising within a few hours of bedtime can interfere with a person’s ability to fall asleep, which is an unavoidable problem for teens who have sports practices and games in the evening.

Caffeine should be avoided late in the day, and children and adolescents shouldn’t go hungry, although eating a full meal an hour before bedtime is not a good idea either.

Maintaining a good sleep environment is also important. An ideal setting is a comfortable, dark, quiet, cool room. In addition, experts advise parents not to put TVs or computers in their children’s rooms because late-night television viewing, playing computer games, Internet use, and text messaging can result in problems falling and staying asleep.

“It’s important to have a media curfew,” Chabot said, explaining that, when there is a lack of bright light, the body begins to release the hormone melatonin, which helps the body sleep.

In the morning, shades or blinds should be pulled up right away because getting as much access to sunlight as possible stops the body from continuing to release melatonin and allows people to wake up.

As for preschoolers and changes in policies on napping, this is troublesome, said those we spoke with, because it plays into some of the myths surrounding sleep. For example, parents often assume that, if their child isn’t voluntarily taking a nap, they don’t need one.

“But research shows that if preschoolers are encouraged to take a nap, they will, and it’s important because many are not getting enough sleep at night,” Spencer noted.

Many parents also mistakenly think that, if their child takes a nap, they won’t be able to get to sleep at night, but research doesn’t support that belief. Spencer said the key is consistency: it’s only when naps are sporadic that it makes a difference, and if a child takes a nap at the same time every day, they will fall asleep as easily at night as they would without one.

“The extra sleep is so important, and it’s beneficial to memory, although it’s not something many parents are aware of,” she added.

In addition, young children who nap exhibit more control over their emotions than those who stay up all day.

“If they haven’t gotten enough sleep, they can become defiant and switch between being grumpy to aggressive. They can also become hyperactive and giddy due to a lack of sleep,” Spencer said, adding that children differ from adults, who tend to get lethargic when they are tired.

Field of Dreams

Chabot said sleep studies are relatively new in the field of medicine, and it was only after the first EEGs were performed in the ’50s that researchers began to realize that sleep is an active time for the brain.

“It’s taken a long time for knowledge to filter down into medical education and training,” she told BusinessWest, adding that, when she was in medical school at Tufts University between 1980 and 1984, the curriculum did not contain a single lecture about sleep.

But in subsequent years, research has shown there are consequences to not getting enough shuteye, which include increased risk for type II diabetes, obesity, depression, and anxiety.

“It’s important for families to make sleep a priority if they want their children to function at their best,” Chabot said, adding that it can be prudent to have a child cut down on activities if their schedules are really busy.

There’s an easy way to tell if your child is getting enough sleep, she continued.

“They should wake up on their own at the same time every day without an alarm clock, get out of bed right away, and be in a good mood and feel rested,” she said. “If you need to drag your child out of bed, they are not getting enough sleep.”

It’s a simple measure that’s easy to follow for parents who want to increase their child’s chances of excelling in all aspects of their life.

Health Care Sections

Share Scare

Elizabeth Morgan

Elizabeth Morgan says young people interacting online are “experimenting with their public persona.”

Worried parents have all kinds of reasons why their kids shouldn’t participate in social media, Elizabeth Morgan said. But perhaps it might be helpful for them to consider why they want to.

“Researchers have asked teenagers this, and the typical reason is to connect with other people. Their primary motivation is to maintain connections, and establish new connections, with other people,” said the assistant professor of Psychology at Springfield College.

Teens with niche interests or unique challenges also benefit from social media, she said, because they might not find similar support locally.

“A lot of times, they’re using it to get information and learn about some experience they’re going through from people online who may not be in their immediate social network,” Morgan said. “That’s one of the positives. Think about a teenager with a chronic illness in Western Mass., where not many people experience that chronic illness. They can connect with people in Missouri, California, or Florida who are going through the same thing, to get information about what they’re going through.”

Still, whatever the reason, young people are also doing something developmentally important when they interact online — they’re experimenting with their public persona. And that can present social and emotional pitfalls.

“For some teens and tweens, social media is the primary way they interact socially, rather than at the mall or a friend’s house,” said Dr. Gwenn O’Keeffe, co-author of a clinical report issued by the American Academy of Pediatrics (AAP), called “The Impact of Social Media Use on Children, Adolescents, and Families.”

“A large part of this generation’s social and emotional development is occurring while on the Internet and on cellphones,” O’Keeffe added. “Parents need to understand these technologies so they can relate to their children’s online world — and comfortably parent in that world.”

Morgan said the idea of self-presentation in social media, on sites like Facebook, Instagram, and many lesser-known outlets, represent a developmental task. “Teenagers are always testing different identities, different personas face to face, and social media provides a way to do it in a safe place where they can manage their presence.”

But how safe is it, really?

“There are all kinds of risks, in the different choices kids make, in how they’re going to be seen and categorized by their peers,” said Dr. Barry Sarvet, chair of Psychiatry at Baystate Medical Center. “Kids have to deal with that anyway, but the online factor makes it quantitatively different; their choices potentially have bigger, broader consequences because of how viral things can get online. Misunderstandings happen more easily online; things are misconstrued.”

The preteen and teen years come with an array of hazards that aren’t exclusive to the Internet age, he went on, from character disparagement and low self-esteem to being stalked or threatened by truly dangerous people.

“Parents need to be aware of and help kids understand the dangers, but they’re not brand-new dangers; there have always been risks of kids being exploited, stressed, and depressed because they’re being stigmatized and misunderstood. And there have always been social networks, circles of friends, cliques. Social media is just another expression of that — but it’s got higher stakes in some ways, because of the permanence and irrevocability of what happens online.”

The solution, Sarvet says, isn’t necessarily to block teenagers’ access to the online world, but to become partners with them and help them manage it. Because social media, while a potentially valuable tool, poses some complex issues at a particularly vulnerable age.

Pursuit of Happiness

Morgan cited a study indicating that some people who use Facebook are happier than those who don’t — or, perhaps, happy people are more willing to share their lives on social networks — but, interestingly, excessive Facebook use may be linked with depression.

“Facebook can be a great experience that leads to connection, but it can also lead to depression, partly because of social comparison to other people who are presenting their best side,” she said, adding that those effects are not pronounced when people compare themselves to immediate friends and family, but spike when making comparisons to casual acquaintances, perhaps because that ‘best side’ seems more like reality.

When teens make the same comparisons to their peers, it’s even worse, she said, because social comparison is already a big issue in adolescence, so it makes them feel worse about themselves. “They might say, ‘look, he has 200 likes; I only have 100,’ or ‘she has 600 friends; I only have 550.’”

That said, it’s difficult to define exactly when young people should enter the social-media world because there’s such a broad range of personal development.

Dr. Barry Sarvet

Dr. Barry Sarvet says the choices young people have when it comes to social media come with “bigger, broader consequences” than ever before.

“Some are late bloomers, some early bloomers,” Sarvet told BusinessWest. “Kids will say, ‘all my friends are on it, so I should be allowed.’ But parents have to consider how mature their child is and how vulnerable they might be and their level of judgment. One 13-year-old can have really good judgment and be very safe and be able to follow guidelines and understand why they’re important, and another 13-year-old may be completely unready to have that freedom and power.”

It’s natural, he went on, for kids to desire more freedom than they’re ready to have. “Parents have to constantly make those difficult decisions, how much freedom to give them. A lot of times, kids have to earn the trust. Parents may say to their kids, ‘I want to trust you, but you haven’t earned it because you haven’t been responsible or careful about things, so I don’t feel you’re ready right now.’

“We live in a world where a lot of personal sharing is going on, and kids don’t always understand the impact of what they put online or even just messaging with each other, not realizing things can be forwarded; even those Snapchat images can be captured and saved,” Sarvet added. “The complexity of people’s privacy, understanding the importance of privacy, is something that takes a lot of judgment, which kids don’t always have.”

Lapses in judgment can wreak havoc on young lives, O’Keeffe said, adding that young people can harm their reputations and safety by posting personal and inappropriate information. Meanwhile, information about sites they visit may be captured and used to target them with advertising.

“Cyberbullying happens as well. That’s the dark side of the situation,” Morgan told BusinessWest. “Really, it’s on the parents to try to help manage their children’s experience and be aware of what’s going on, so if there do happen to be instances of cyberbullying, the parents can help the child deal with it.”

Straight Talk

The AAP has issued a series of guidelines pediatricians can use to help families navigate the social-media landscape, including:

• Advise parents to talk to children and adolescents about their online use and the specific issues that today’s online kids face, such as cyberbullying, sexting, and difficulty managing their time;

• Advise parents to work on their own ‘participation gap’ in their homes by becoming better-educated about the many technologies their children are using;

• Discuss with families the need for a family online-use plan, with an emphasis on citizenship and healthy behavior; and

• Discuss with parents the importance of supervising online activities via active participation and communication, not just via monitoring software.

Some house rules can be as simple as using the Internet only in a common room of the house, or not logging on past a certain hour at night, as not to disrupt sleep, Morgan added. “There are so many ways to manage these experiences beyond saying, ‘no social media at all.’”

She added, however, that it’s just as important for parents to develop trust and strong communication with their children, so they feel comfortable approaching the adults with problems that arise.

“Be sure your child knows what can happen and, if it does, that you’re available to help them deal with it, whether that involves blocking a person from your network or pressing charges, if stalking is going on, or just learning how to respond to, or ignore, negative statements and emotionally cope with them. Parents can be a good resource for all of that.”

Sreedhar Potarazu, an ophthalmologist and CEO of VitalSpring Technologies Inc., recently wrote at CNN.com that young people are growing up to expect immediate response, gratification, and notification, all hallmarks of social media, and their brains no longer have time to evolve; instead, they must adapt to change in an instant.

“The results are distressing. The difficulties of growing up have never been so public,” he wrote. “Social technology provides a platform where things can run wild. Imagine the stress of high school — the competition for popularity, the pressure to fit in, the judgmental nature of social activities — at an accelerated pace.”

He suggests a number of steps parents can take to help their children navigate this world, such as:

• Create more structured forms of social media that prevent children from diving into, say, Snapchat right from the start;

• Provide a way for parents and administrators to get feedback on their kids’ online use without intruding on privacy and alert them to impending dangers;

• Add courses on social technology and responsibility to school curricula, teaching adolescents that what they do online exposes them to the whole world — sometimes forever, and perhaps affecting their job searches and choice of a mate; and

• Ease up on the pressure, and persuade teens that that they don’t have to market themselves constantly, and that social media can be a mechanism for fostering collaborative relationships, rather than competition, aggression, and irresponsible behavior that contributes to anxiety and depression.

A Question of Trust

Sarvet stressed, however, that the online world is not an intrinsically bad place.

“I think there’s still a lot of richness,” he said. “I tend to encourage parents to be open-minded about this stuff because I think a lot of parents are very suspicious and skeptical of it and focus more on the horrible things that can happen, and they’re also very unrealistic about their ability to control it.”

To wit, a recent Pew Research Center study found that 92% of teens go online daily, and 24% say they are online “constantly.” Common Sense Media reports that 90% of teens have used social media, and 75% of them have profiles on social-networking sites. In another study, CNN found that some 13-year-olds check their social-media feeds 100 times a day.

“I think it’s important for parents to recognize that their kids are in school, out in the world, and they should assume — even if they have a rule that their kids are not allowed to be on Facebook — that their kids might be on Facebook,” Sarvet said. “They should accept that they’re not in charge all the time of their kids’ use of social media, and they can’t be. If you accept that, the focus becomes less on having rules and more on helping them understand the complexity of what they’re doing online.”

Barring teens outright from social media, he suggested, only manages to destroy the lines of communication that might come in handy someday, whether dealing with serious issues like cyberbullying and sexting or simply learning more from one’s teens about the online world, which sites are popular, and what kids today are doing there.

“If they have a nice, respectful relationship with their kid, it allows the parent to have a guiding influence and an opportunity to learn what kids are doing and have an open dialogue about it,” Sarvet went on. “When parents are overly nervous and, in response to this nervousness, start making these strict rules, it just invites kids to find ways to get around the rules, and they no longer talk to their parents about it, knowing you’ll be mad at them.”

In short, he told BusinessWest, “control what you can control,” and the rest is building trust.  No one said it would be easy, in a culture where positive connections and lurking dangers are both just a few clicks away.

Joseph Bednar can be reached at [email protected]

Health Care Sections

A Patient-focused Leader

Nancy Shendell-Falik

Nancy Shendell-Falik says her role comes down to helping the care teams within the Baystate system focus “on what matters most to patients.”

Nancy Shendell-Falik was recently promoted to president of Baystate Medical Center and senior vice president for Hospital Operations at Baystate Health. That’s a long title and a lot to fit on a business card. It’s also a big job, one she boiled down to leading efforts to continually improve quality and consistency across the expanding Baystate system and maintaining a laser focus on the patient experience.

Patients and family members walking in the Daly Entrance at Baystate Medical Center are greeted by a large sign that reads: ‘Identify Your Caregivers by the Colors They Wear.”

Those words appear beside a picture of a smiling nurse wearing royal-blue scrubs, the color chosen to designate the men and women in that profession. Meanwhile, those in radiology wear black, orderlies wear dark brown, those in rehab wear light gray, and so on.

This program involving standard attire, now in use across the Baystate Health system — which also includes Baystate Franklin Medical Center, Baystate Mary Lane Hospital, Baystate Noble Hospital, and Baystate Wing Hospital — was essentially the brainchild of Nancy Shendell-Falik, although she quickly added that there was a large team that brought the concept to fruition.

Motivation for the standard colors was simple, said Shendell-Falik, recently named president of Baystate Medical Center and senior vice president for Hospital Operations at Baystate Health, who used a few anecdotes to get her main points across about the system’s desire to improve the overall experience for the patient and his or her family.

“One story that struck me concerned a father in the PICU [Pediatric Intensive Care Unit] who was waiting to speak to the surgeon who operated on the child,” she recalled. “A person in OR blue scrubs came in at 6 or 6:30 in the morning, and the father thought, ‘oh my gosh, I’m going to get my questions answered,’ and the person proceeded to empty the garbage. This individual said how challenging it was to determine who was coming in and going out.”

She remembers that there was some minor resistance to the color-coding plan, mostly from individuals concerned about losing some of their individuality. She also remembers how almost all those with angst quickly came around on the concept.

“Now that they’ve lived it, a few have come back to say, ‘I totally get it,’” she told BusinessWest. “Patients now understand who’s coming out in and out, and this provides a less-stressful environment, and employees understand that is how we support what our patients need.”

In many ways, the standardized-colors initiative and the reasons for it speak to Shendell-Falik’s preoccupation with the patient experience — and also effectively sum up a rather broad job description.

When asked to elaborate on it, she said her role comes down to helping the care teams at the system’s five hospitals and other operating platforms “focus on what matters to patients.”

Elaborating, she said this assignment is both an art and a science, and at its core it involves perhaps the most important — but often forgotten skill — in healthcare: listening.

“Rather than just tell people what to do, we want to partner with patients to help them understand their options and respect their wishes,” said Shendell-Falik, who for the previous two years served in a dual position at Baystate Health as senior vice president/chief operating officer and chief nursing officer. “We’re really working on listening, and have been training people across our system on appreciative inquiry. So we’re focused on asking questions so we understand what’s really important and so we can connect with people on a personal level.

“This is a journey for us,” she went on. “We have a goal to be a ‘top 20% in patient experience’ hospital by 2020, and the way to get there is to focus on that human connection, respect what patients want, and treat them as individuals.”

And by doing so, she intends to build a stronger, more flexible system able to respond quickly and effectively to the many changes coming to this industry.

“We are looking to work as a team that is united and aligned, and making decisions that are really building the strength of Baystate Health,” she explained. “We’re looking at how we can create the most sustainable future for Baystate, and how we should reinvest in our organization.”

For this issue, BusinessWest talked at length with Shendell-Falik about her new roles and, more specifically, about her hard focus on the patient experience and how it manifests itself beyond the colors of the scrubs worn by the system’s employees.

Background: Check

By the time she arrived at Baystate in July 2013, Shendell-Falik already knew a good number of the people she was working beside — because they interviewed her for the job she was seeking.

“I must have interviewed with 50 people,” she said with a voice that resonated with pride and a sense of accomplishment. “Mark Tolosky [then president and CEO of Baystate Health] said I might have hit a new record.”

And that intense interviewing process left her not only with a sense of confidence — something that comes when you impress several dozen people enough to win a position that attracted hundreds of well-qualified candidates from across the country, if not around the world — but also a good dose of inspiration.

“I was really inspired by the people I met through that interviewing process,” she explained. “When I came out to Western Mass., I saw how Baystate had been very progressive in building the enterprise from ambulatory sites, physician practices, multiple hospitals, an insurance company [Health New England] … and was really forward-thinking about how we move from a fee-for-service world into an environment that values population health.”

Nancy Shendell-Falik takes leadership roles

Nancy Shendell-Falik takes leadership roles at a hospital that has recently seen significant expansion and a health system that continues to broaden its reach in Western Mass.

In October, Shendell-Falik was promoted to a position — president of Baystate Medical Center — that has traditionally been held by the president of the Baystate system, including the current holder of that title, Dr. Mark Keroack. However, with the recent expansion within the system, the need for this administrative change became apparent, she said.

“As we added two more hospitals, the system is now five hospitals,” she explained. “And with that came the belief that integration across all of the enterprise is really essential, and there needs to be a senior leader focused on that.”

Shendell-Falik brings to the position nearly 35 years of experience in the healthcare sector, both in direct patient care as a nurse and in administration. She has spent much of the past 20 years in leadership roles within the broad and ever-changing realm of patient-care services.

She began her career at Newark Beth Israel Medical Center as a staff nurse in pediatrics. She quickly moved on to roles as head nurse in that department, head nurse of the Young Adult Unit, patient care coordinator of the Young Adult & Independent Care Units, and director of Nursing in the Maternal-Child & Pilot Nursing Unit.

She then went to Robert Wood Johnson University Hospital in New Brunswick, serving over the next seven years in a series of roles, culminating with assistant vice president of Nursing and Patient Services, which she held until 1998, before being recruited back Newark Beth Israel Medical Center.

There, over the next 11 years, she served as vice president of Nursing, then president and senior vice president of Patient Care Services.

She held that same title — as well as chief nursing officer — at Tufts Medical Center in Boston, where she arrived in 2009 in an effort to “expand her horizons,” as she put it, after spending 22 years at Newark.

At Tufts, she led a number of initiatives to improve clinical quality, patient safety, and the patient experience. Among many other accomplishments, she implemented a system of performance scorecards across departments, served as executive sponsor of the Tufts Patient and Family Advisory Council, and sponsored a unique, cutting-edge leadership-education program.

A change at leadership at Tufts in 2012 and that facility’s continued struggles in the ultra-competitive Boston market — “they’re truly the underdog there” — prompted her to seek a change, as well as a specific role.

“Having been a chief nurse for 15 years at that time, I wanted to go to a place that was progressive enough to embrace a chief nursing officer and chief operating officer role,” she told BusinessWest. “That place turned out to be Baystate.

A Healthy Outlook

Actually, Baystate was the first facility to reach out to her — through an executive search firm, said Shendell-Falik, adding that, as a result, this wasn’t a lengthy search for a new opportunity.

That’s because of what holding those two titles together would likely mean in terms of implementing needed change and progress — especially in a welcoming environment like Baystate.


Click HERE to download a PDF chart of hospitals in Western Mass.


“This was the first time Baystate combined the chief nurse and the chief operating officer,” she recalled. “And I think that change resulted from the philosophy that, when you look upon your product as patient care, and excellence in patient care is what you’re striving to achieve, it really helps when everyone is aligned — not only the clinicians, but the support services as well. And that role really helps promote that.”

But to serve in that role, she first had to navigate all those interviews.

If she did, in fact, set a record for most inquisitors, it was because that new position involved so many stakeholders — from dozens of direct reports to the physicians she would be working with day in and day out.

“I was physically back here three times, and two of them were multi-day episodes,” she recalled, adding that there were a number of group interviews.

Over the past two years — during which, as COO and CNO (chief nursing officer), she became the first nurse to sit on the system president’s cabinet —  Shendell-Falik has worked with those who interviewed her to implement a number of changes and new programs, the so-called ‘standard attire’ initiative being the most visible, both literally and figuratively. Those efforts resulted in Baystate Medical Center being named to an elite group of high-performing hospitals by U.S. News and World Report for 2015-16.

Looking ahead, she said the now-larger system — it has added Wing and Noble since she arrived — has to keep a continued focus on patient services and how to improve them, because despite Baystate’s growing presence, patients ultimately have choices about where they go to receive care.

To bring area residents to Baystate’s hospitals, she went, the system has to focus on consistency across the network, quality of care, and that all-important quality — value.

Shendell-Falik said her 35 years of experience on the front lines, in administration, and, specifically, in patient-care services have helped ready her for work leading Baystate Medical Center and the entire system through this period of profound change within the healthcare universe, a time, as she said, marked by movement away from the fee-for-service model that has been in place for so long and toward population health.

She noted that many of those she’s working with, including Keroack, have similar backgrounds with direct patient care followed by years of leading others providing such care.

“It’s an easy conversation to help explain what you need people to do or how you create a vision, because you understand what it takes to care for patients,” she said of her diverse background and that enjoyed by so many others now in healthcare administration. “The years I had as a hands-on provider will always be near and dear to me. And they really created my value system of being a very patient-centered leader.

“I think you also gain credibility when you are able to understand the work of providing direct patient care — and also ask people to be good stewards of the organization,” she went on, “whether that’s ensuring the most effective utilization of our resources or helping people understand that the patient experience is extremely important today, and it’s not something that sits on a back burner.”

Forward Progress

As she talked about her new role — as well as her old one — at Baystate, Shendell-Falik recalled a conversation she had with one of the medical center’s nurses at a donor reception.

“She came up to me and said, ‘I’ve worked at Baystate for more than 40 years; I can now retire because I know there is a nurse at the president’s cabinet table.”

Now, that nurse not only has a seat at the table, but an even more prominent seat as president of the medical center. She intends to use it to create consistency across the system’s many platforms and continue the needed focus on the patient experience.

That includes the colors of the uniforms being worn by the various departments, but that’s only a small part of the story.

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

Health Care Sections

Tough Pill to Swallow

HCNcover1215ART

Causing 1,200 overdose deaths per year, the opioid-abuse problem in Massachusetts has reached crisis levels, to hear some doctors and lawmakers describe it. While the goals of those two groups are similar, their strategies for tackling the epidemic can differ. Take, for example, Gov. Charlie Baker’s recently announced bill, which seeks to sharply limit the length of opioid prescriptions and allow for the involuntary hospitalization of substance abusers deemed to be in immediate danger, to name two controversial provisions. Doctors may quibble over the details, but Baker argues that a tough problem requires equally tough solutions.

Gov. Charlie Baker knew his bill would ruffle a few feathers. That was the point.

He said as much when he reminded lawmakers last month that Massachusetts doctors, in 2014, wrote more than 4.4 million prescriptions for Schedule II and Schedule III drugs — defined as medications with high to moderate potential for dependency and abuse — totaling more than 240 million pills.

“I should remind everybody that we only have six and a half million people in the Commonwealth of Massachusetts,” Baker said. “In the same year, over 1,200 people died of opioid overdoses. Simply put, the status quo is unacceptable, and it needs to be disrupted.”

Baker was testifying before the Joint Committee on Mental Health and Substance Abuse, alongside Boston Mayor Martin Walsh and Christopher Barry-Smith, the state’s first assistant attorney general, in support of “An Act Relative to Substance Use Treatment, Education and Prevention,” a bill the governor filed in mid-October to address an opioid epidemic in Massachusetts that claims the lives of nearly four residents every day, on average.

Dr. Robert Roose, chief medical officer of Addiction Services for the Sisters of Providence Health System, was part of a 16-member working group Baker assembled earlier this year to craft a plan to combat what medical professionals have been calling a statewide crisis, and said the bill’s components — including a 72-hour limit for new opioid prescriptions and involuntary hospitalization of patients who might pose a danger to themselves or others — originated from that group.

“We took our responsibility seriously, to come up with interventions and strategies to address the epidemic in a bold way,” Roose told BusinessWest. “The premise we were operating from was that this epidemic is unlike any we’ve seen before, both in magnitude and breadth of who is impacted, and knowing the strategies we’ve attempted in the past likely would prove insufficient, we wanted to come up with bold, new strategies.

“Governor Baker’s bill does exactly that,” he went on. “These are provocative and bold ideas that have generated some discussion, if not controversy, throughout the medical community and healthcare systems, as well as, perhaps, with patients themselves and treatment advocates.”

Certainly, Dr. Dennis Dimitri is well-versed in the opioid issue, as president of the Mass. Medical Society (MMS), which has come up with its own broad series of strategies to combat the problem. He cited a recent poll by the Harvard School of Public Health showing that nearly four in 10 Massachusetts residents personally know someone who has abused prescription pain medications.

Therefore, he thanked the governor and lawmakers for their multi-pronged approach to addressing the crisis, including significantly increased funding for addiction services, insurance coverage, and enhancements to the state’s Prescription Drug Monitoring Program. “We strongly support these and other measures,” Dimitri said.

Still, not every detail of the bill — the logistics of which still need to be hammered out — will necessarily go down easy with the state’s physician community.

Drawing a Line

Take, for example, a provision in the bill limiting patients to a 72-hour supply the first time they are prescribed an opioid or when they are prescribed an opioid from a new doctor.

“Looking back over the past 20 years,” Roose said, “we have overprescribed for pain and done an insufficient job of educating patients in the community about potential risks of opioids. The medical community has been engaged with this issue increasingly over the past several years, but, clearly, what has been done is not enough.”

Dr. Robert Roose

Dr. Robert Roose says the governor’s working group on opioid abuse recognized that bold strategies were needed to combat a growing crisis.

As a member not only of the governor’s working group but the Mass. Hospital Assoc. (MHA) Substance Use Disorder Prevention and Treatment Task Force, Roose has been heavily involved in discussions of prescription limits. While the limits themselves aren’t controversial, the details are a point of contention. While Baker seeks a four-day limit in his bill, the MHA prefers a five-day limit, while the Mass. Medical Society seeks a seven-day limit, calling four days simply too onerous for many patients.

“A patient with acute pain beyond the proposed initial 72-hour treatment period would have to return to their physician’s office, obtain a paper prescription, bring it to the pharmacy, and wait for it to be filled,” Dimitri said. “An elderly or disabled or poor patient, especially one without a helping caregiver or transportation, could be left to suffer.”

Dimitri understands the rationale behind limits. Citing statistics from the Centers for Disease Control, he noted that more than 80% of people who misuse prescription pain medications are using drugs prescribed to someone else. That’s why the MMS proposed a seven-day limit last spring, which includes a sunset provision to take effect when the crisis abates, allowing prescribers to care for their patients on an individual basis.

Dimitri also encouraged lawmakers to consider allowing ‘partial-fill’ prescriptions, which, he said, would help patients “balance the need to relieve pain with an adequate supply of pain medications by only filling part of their prescription, with the ability to later go back if necessary to fill the rest.”

On the federal level, current Drug Enforcement Administration regulations prohibit partial-fill prescriptions, but the MMS has supported an effort by U.S. Rep Katherine Clark, who represents Massachusetts’ 5th District, to urge the DEA to change the partial-fill rules.

“We continue to support incorporation of clinical judgment,” Dimitri added, “fully understanding the severity of the significant challenges confronting the Commonwealth and our patients.”

Roose admitted many providers are leery about a prescribing limit as short as 72 hours, but also conceded that it might be an effective tool.

“A lot of work has been done by the medical community to recognize the risk of overprescribing or having excessive medications left around, but where do you draw the line?” he said. “On the face of it, physicians don’t want to be regulated; they don’t want to have their behavior dictated into statute. But, at this point, I think we have evidence suggesting that measures need to be taken to protect the community and the public health. We do want to reduce the availability of unused medications in the home.”

Barry-Smith agreed. “We’re confident that the Department of Public Health will work with the medical community to implement and, if necessary, refine that 72-hour limit,” he told the legislative committee, “but, as a general matter, there can be no doubt that additional safeguards on opioid prescribing are necessary.”

Added Walsh, “help means prevention, and I agree with the governor. A common-sense limit on first-time opioid prescriptions would provide an effective checkpoint to limit the flow of addictive narcotics into our homes and our communities.”

Against Their Will

Perhaps more controversially, Baker’s bill would grant medical professionals the authority to involuntarily commit an individual with a substance-abuse disorder for treatment for 72 hours if they pose a danger to themselves or others. Currently, such people can be held for treatment only through a court order — and the court system isn’t always available when a patient needs protection.

“We already have, in Massachusetts, a process of involuntary commitment for individuals in danger of substance abuse,” Roose said, noting that Baker’s proposed statute would streamline the process, recognizing that the critical moments of a substance-abuse episode can happen at any hour of the day, 365 days a year.

“Treatment is often delayed through other, voluntary routes. This could provide an avenue where individuals in immediate danger are transported to a facility, at least for evaluation by a medical professional,” he explained, adding that such a process would in no way replace or minimize the importance of available avenues for individuals and families to seek voluntary treatment.

“But it does take into consideration the fact that addiction is a disease that fundamentally impairs somebody’s control and judgment,” he went on. “While we need to, in my view, move toward decriminalizing substance abuse and offering treatment as opposed to punishment, we also need to provide treatment on demand when people need it, where they need it, and at the right level of care. This could provide another avenue for people in immediate danger to be stabilized and evaluated. That could save countless lives.”

However, Dimitri argued, addiction-medicine specialists have raised concerns that such commitment won’t work without access to more treatment resources and post-hospitalization care.

“There is a paucity of evidence that forcing hospitalization on patients not ready to make a change will be successful, and there is evidence that addicted patients released from hospitalization with no plans to pursue after-care are at higher risk for opioid overdose,” he told lawmakers. “My colleagues in emergency medicine and hospital leadership are concerned that this proposal could create a new standard of care requiring all patients who are suspected of having the potential to overdose to be involuntarily hospitalized. This will result in new demands on hospital medical and psychiatric beds that are already severely strained.”

Roose noted that increasing involuntary hospitalization could be an additional impetus for increasing additional capacity and treatment services in the state — a process that is ongoing, with dozens, if not hundreds, of new inpatient beds soon to be available in Massachusetts, including the four counties of in Western Mass.

Also, “requests for new programs have been released by the Department of Public Health in recent weeks,” he added. “I believe that the Department of Public Health and the administration recognizes capacity is insufficient and are making strides in response to that.”

Dimitri agreed, but said involuntary hospitalization might be putting the cart before the horse. “The Commonwealth has spent a tremendous amount of time and resources in trying to resolve the issue of emergency-department overcrowding, boarding, and diversion. This could further exacerbate that problem without actually benefiting patients.  New funding has become available to expand capacity; let’s see what progress we can make before adding more stress to our system.”

While the concept might be controversial to some, Roose said, the devil is in the details.

“We need to answer questions about the logitistics, our capacity for treatment, how this will end up being implemented, and potential risks to providers who choose to — or choose not to — utilize this statute,” he said. “We know right now we don’t have adequate substance-abuse treatment in this state, but that should not be a reason, in my view, to not be creative in how we treat patients.”

Watchful Eye

Other elements of Baker’s bill aren’t as controversial. For example, practitioners would be required to check the state’s Prescription Monitoring Program (PMP) prior to prescribing an opioid to a patient, and would be required to fulfill five hours of training on pain management and addiction every two years.

“Monitoring is an extremely useful tool for providers,” Roose said, noting that it’s a tool to determine what prescriptions a patient has received and prevent duplicate prescriptions through different doctors at different pharmacies.

Dimitri noted, however, the Legislature’s recent law mandating the use of the PMP the first time an opioid or benzodiazepine is prescribed.  “We believe it would be prudent to keep the existing law in place without modification at this time,” he said. “As improvements are realized with the new PMP, we can better determine optimal use.”

He also suggested enabling the PMP to ‘push’ information to physicians, indicating how their prescribing patterns compare to their peers.  “Programs such as this have successfully reduced opioid prescribing in other states, and we welcome the opportunity to work with you on developing language to allow for these concepts.”

Dimitri also used his testimony to remind the committee that the MMS launched multiple efforts of its own last spring to combat the opioid epidemic. Among them are new prescribing guidelines since adopted by the Massachusetts Board of Registration of Medicine and disseminated to every practicing physician in the Commonwealth; free continuing-medical-education programs on opioids and pain management available to all prescribers in the state; and a collaboration with the commissioner of Public Health and the secretary of  Health and Human Services to bring together the deans of  the state’s medical schools in developing  a first-in-the-nation set of core competencies for medical students in the prevention and management of prescription drug misuse.

Still, Barry-Smith said Baker’s bill is a strong additional step in the right direction.

“The bill is bold, it’s innovative, and, as the governor already stated, it makes crystal clear that the status quo will not suffice,” he argued. “Changes need to occur, and the first of those changes concerns prescribing practices.”

He cited a statistic that the U.S. has less than 5% of the world’s population but consumes 80% of the world’s opiate supply. “To address that problem, this bill puts in place education requirements for prescribers, seeks to increase the use of the Prescription Monitoring Program, and sets a general limit on most opioid prescriptions.”

Boston’s mayor testified that he supports the bill because “I know from personal experience that, to get people the help they need, we have to meet them where they are, whether it’s on the streets, in the hospitals, at home, at work, or at school.”

Walsh added, however, that healthy communities start with education, not just regulation. “This bill provides a tool to help educate parents and children about the dangers of misusing opioids.”

Stay Tuned

Roose also believes fighting the opioid crisis requires a multi-faceted, collaborative effort.

“The medical community is actively working with the administration and the Department of Public Health, addressing this issue,” he told BusinessWest. “Certainly education is a big piece of this, and this bill, as well as efforts from the Mass. Medical Society and the Mass. Hospital Assoc., will increase provider education on appropriate prescribing, addiction, and how it can be treated.”

Dimitri said the state’s physicians stand ready to aid in the effort, no matter what the outcome of Baker’s bill.

“Addiction is a chronic disease that is difficult to overcome,” he said. “Reversing this epidemic will not be easy, but I am committed, as is the medical society, to do everything necessary to continue our efforts and increase our outreach for the benefit of our patients.”


Joseph Bednar can be reached at [email protected]

Health Care Sections

Steering Committee

Al Parrow

Al Parrow enjoys driving for the Road to Recovery program so much that he bakes cookies for patients and the people who work in the chemotherapy and radiation units.

When Al Parrow retired from his job at ADT Security Systems, he never imagined that, a year later, he would spend his days driving people he didn’t know to and from doctor’s appointments.

But the 70-year-old has become part of a team of dedicated volunteers who make a profound difference in people’s lives through the American Cancer Society’s Road to Recovery program. The initiative provides free transportation to people who have no other way to get to cancer treatments, and volunteers say the gratitude those patients express is more than enough payment for using their own vehicles and gas.

Parrow signed up as a Road to Recovery volunteer four and a half years ago after he began to get bored with retirement, and says he has been behind the wheel constantly ever since.

“I seldom say ‘no’ if they call me; I’ll drive five days a week if someone is without a ride,” he told BusinessWest as he spoke about the intangible rewards of the position. “Everyone is so appreciative, and they always thank you.”

Gary Watson

Gary Watson drives two to three days a week for the Road to Recovery program and has taken people as far as Boston for cancer treatments.

“I drove one man to his daily radiation treatments, and he didn’t speak English, so we couldn’t converse, but each time I picked him up, his wife stood in their front window and bowed to me,” he went on. “On the day of his final treatment, she came running out and gave me a big hug, then they stood together and bowed in the rain while I drove away. It is the highest sign of respect. Little things like this mean so much, and volunteering is uplifting because everyone you meet is so grateful. The rewards are phenomenal, and it’s worth every trip every day.”

Gary Watson could not agree more.

He’s been a Road to Recovery driver for more than six years, and enjoys it so much that, when he was unable to drive after surgery, he worked from home as a program coordinator. But once he regained his strength, he got behind the wheel again, because he finds the personal interaction very satisfying.

“I started doing this because I wanted to do something after I retired that would be rewarding and allow me to meet wonderful people,” said the 73-year-old, explaining that, when he saw an item in the newspaper seeking drivers for the program, he knew it would be a good fit, because he has known many people with cancer and is a good driver.

Although the majority of volunteers take people only to appointments at local hospitals, sometimes a patient needs to go to Boston for a second opinion or specialized treatment or procedure, and Watson is always willing to go the distance.

“I knew there was a need for long-distance drivers, and it was something I was willing to do,” he said.

Several years ago, the Springfield resident was recognized with a Driver of the Year Award, but he told BusinessWest to downplay the honor. “I’m just so glad there is a program that offers a service like this for folks who truly need transportation. They’re very grateful,” he said.

Indeed, that’s exactly how Betty Swanson feels. “I don’t have any family whatsoever, and I wouldn’t be able to get to my treatments without this program,” said the 78-year-old. “I’m a widow, we never had children, and I don’t have any siblings. I do have a car, but haven’t been able to drive since I had surgery last December.”

Parrow has given her many rides, and she enjoys his sense of humor. “He is such a nice man and keeps me in stitches all the way to my appointments. When we arrive, he gets out of the car, opens the door, and comes into the building with me. I tell him he doesn’t have to do it, but he takes my mind off of things,” she said.

Driving Force

Karen Mernoff , Road to Recovery coordinator for Hampden and Franklin counties and the South Shore of Massachusetts, says comments like Swanson’s are typical.

Drivers in this program often ease people’s troubles simply by their willingness to help, she noted.

“We can’t cure people’s cancer, but we can make their life easier during treatment,” said Mernoff. “Most of them don’t have family in the area, and many elderly people have stopped driving.”

It is for these reasons and many others that the Road to Recovery program, which has been operational for many years, is currently in dire need of volunteers who are able and willing to transport people to chemotherapy and radiation treatments or procedures.

“We recently had to turn people away who were desperate for a ride, and some had to miss their cancer treatments as a result,” Mernoff explained.

Michele Dilley urges people who are interested in volunteering to call the American Cancer Society at (800) 227-2345. “I truly believe this is a life-saving program for people who don’t have family nearby,” said the ACS program manager for mission delivery in the Bay State.

Background checks are conducted on all potential drivers. But anyone who is 18 to 85 with a clean driving record, a reliable and insured vehicle, and a desire to help is welcome.

Referrals come from social workers or patients who call the ACS, and Mernoff said she does her best to match drivers with people who live near them to reduce the time they are on the road.

She told BusinessWest about an elderly patient who was taking two buses to get to chemotherapy, and added that it hurts to have to tell people there is no one who can give them a ride. And since many volunteers are seniors and go south during the winter, the need for help increases at this time of year.

Volunteers are free to drive as little or as often as they want, and if someone is having a hectic week, it’s perfectly acceptable to say they aren’t available.

“There are no penalties, and people can take breaks or vacations whenever they want,” said Mernoff. “We are very flexible, and if something comes up and someone can’t drive or has to take time off for a personal matter, it’s fine.”

Joe Audette

Joe Audette says volunteers for the Road to Recovery program perform a valuable service in the community.

In most cases, volunteers take someone to an appointment, bring them home, and are able to return to their own home within an hour.

“Sometimes the person just needs to go for blood work. But if they didn’t have the ride, they couldn’t get it done, which is why our program is so critical,” she continued. “But we don’t expect people to go out in a snowstorm or really bad weather.”

Still, some drivers are so dedicated, they will do their best to get patients the care they need, even in inclement weather.

Joe Audette is one of them. After retiring from a 42-year career with the U.S. Postal Service and thinking about volunteering at a hospital, he discovered the Road to Recovery program.

“I like to drive, like meeting new people, and wanted to give back to the community,” said the 69-year-old.

He has driven patients to and from appointments for the past three years.

“I’ll drive anytime unless the weather is so bad that they cancel everything; some people are in treatment every day or every other day, and the ACS tells you how long the appointment is likely to be,” he went on. “It’s interesting, and you meet some really nice people. I’m not much of a talker, but I try to cheer them up by keeping the conversation light and commenting on the weather or the way people in cars around us are driving. I stay in the office once we arrive because they might get done early or need an extended amount of time. And it feels so good when they thank me.”

The Ride Stuff

Audette has also gone above and beyond for some people. For example, a man he drove was upset because his prescription wasn’t ready at the pharmacy when they arrived after his appointment. So, although Audette knew it wasn’t part of his job, he offered to pick it up later. “I wanted to ease his worries,” he said.

In another instance, a woman accompanied her husband to the treatment, but told Audette there was no need for him to stay while her spouse had a procedure.

“But she changed her mind, and when it was over, she told me she was glad I was there. She would have sat in the waiting room for several hours by herself, and you never know what’s going to happen or what’s going on in someone’s mind,” Audette said. “I’ve had surgeries and always had family members or someone there to pick me up. I knew I wasn’t alone, and don’t want anyone else to feel that way.”

He has been invited into people’s homes, and at least one family has offered him something to eat. But that rarely happens and is not something he’s comfortable with. But he loves the interaction that occurs while he drives.

“One lady was Russian and didn’t speak any English. So we used hand signals to communicate, and when we got to the hospital, we were laughing,” he recalled.

He added that, although some of the people he has transported have their own cars, they can’t drive because of medication they are taking, and often don’t want to take a bus because their immune systems are compromised.

Occasionally volunteers and patients get to know one another well enough that the patient requests that particular driver when they need a ride again. “But it’s not necessary to form relationships with the people you transport, and we don’t expect it to happen,” Mernoff said.

Parrow is extremely outgoing, and has laughed and joked with patients.

“I’m a cribbage fanatic, and since I usually wait for the patients, when I found a lady who also liked the game, we played during her chemotherapy treatments,” he told BusinessWest.

Parrow has also encouraged people to continue with their treatments when they tell him they are discouraged and feel like stopping.

“And because I like to cook, I bake cookies and give them to the patients and people who work in the radiation and oncology units,” he continued. “Not everyone has to do as much as I do, but I lost my mother to cancer more than 30 years ago, and if she was still alive and sick, I hope someone like me who enjoys driving would give her rides.”

Worthy Cause

In addition to losing his mother to cancer, Parrow has also lost a brother, sister-in-law, and niece. He finds the volunteer work meaningful and brings different types of music on CDs to suit the tastes of those he’s driving. “Everyone doesn’t have to do these things,” he said. “But I really enjoy this.”

Audette expressed similar feelings. “I feel good about doing something useful for someone else, and hope I give each person a few minutes of happiness,” he said, explaining that they often laugh together.

But, enjoyment aside, this volunteer work makes a profound difference.

“I can’t tell you enough how important this is,” Swanson said. “I have no other way to get to my appointments and no one else I can count on. This program is a lifesaver, and I appreciate it so much.”

Health Care Sections

The Big Disconnect

The big disconnect

Implementation of electric health records (EHR) has been a process defined by clearly stated goals and — thus far — frustrating results. The objective was and still is to improve communication and share important medical information. In practice, the technology simply hasn’t worked as designed, an opinion summed up in these comments from the head of the American Medical Assoc.: “Physicians are trying to use EHRs to improve patient care, investing a lot of time and money into making them work, but they are being thwarted.”

The goals of electronic health records are easily understood. The path to get there … well, that’s a bit thornier.

“The big push for us is still meaningful use and the sharing of data. That’s what everyone wants … to share information across the continuum,” said Carl Cameron, chief operating officer at Holyoke Medical Center, before offering an example of what an effective EHR system would accomplish.

“If your primary-care doctor sends you a referral to a specialist, they can share information back and forth. If you end up in the emergency room, the doctor can see the information about your last visit or past visits to the primary-care office. Historically, care has been episodic. Basically, if you have a sore throat or something else is wrong with you, you call the doctor’s office, they see you and document it, and nobody else may ever see that note.”

However, when the Centers for Medicare & Medicaid Services (CMS) created mandates in 2009 for hospitals and other providers to move toward EHR use (the term is used interchangeably with EMR, or electronic medical record), they didn’t anticipate the sheer number of different systems that would arise and the confusion they would engender. Today, well over 80% of all physician practices in Massachusetts have established EHRs — for practices with more than 10 doctors, the figure is close to 100% — but not without frustration, cost, and a large dose of uncertainty.

It’s not just a Massachusetts problem. Dr. Steven Stack, president of the American Medical Assoc., recently wrote an article in which he detailed cases like that of a Georgia physician in pulmonary critical care and sleep medicine who was an early adopter of EHR technology in 2006, more than three years before the legislation that mandated it and established the first deadlines.

She said her three-physician practice has spent $84,000 on EHR and related IT costs, yet she doesn’t plan to continue its use, preferring instead to take a financial penalty, because she’s so dissatisfied with the limitations of the system.

Carl Cameron

Carl Cameron says a key goal of electronic health records is sharing patient information across the continuum of providers — no easy feat.

“Physicians are trying to use EHRs to improve patient care, investing a lot of time and money into making them work, but they are being thwarted,” Stack wrote. “The goal of the meaningful-use program was to encourage physician adoption of EHRs. This has been accomplished. Today, more than 80% of physicians have implemented some form of EHR system. But we’re not getting what we expected from this technology.

“As physicians,” he went on, “we had hoped that these tools would help facilitate patient engagement, reduce administrative burdens, and promote the exchange of data. Those three things have definitely not happened. Instead, we’re dealing with systems that won’t talk to one another, cost too much to maintain, and require us to spend an inordinate amount of time entering data instead of helping patients.”

Delcie Bean, CEO of Paragus Strategic IT in Hadley, has heard similar frustrations. His firm got into the EHR consulting business several years ago — a ripe field, since doctors by 2011 and 2012 were hiring EHR vendors at a rapid pace. The pace has slowed down considerably, Bean said, largely because the practices that planned to adopt EHRs have done so, but also because of uncertainty about the technology’s end game.

“There seem to be some practices that, for one of a couple reasons, are hesitant to do it. First and foremost, there continues to be a huge consolidation of private practices by hospitals, and doctors are saying, ‘why spend all that time and money when, in a couple of years, we’ll be acquired by a hospital?’ It’s hard to answer that question,” he said, adding that many doctors don’t feel incentivized to adopt the technology until it becomes marketable or it becomes more clear whether they’ll be acquired or stay private.

“The second thing is, there has been a ton of consolidation at the EMR level, and a lot of providers are waiting to see which EMRs end up being the one their specialty or their region rallies around,” Bean continued, adding that the number of competing EMR systems has begun to shrink, from around 500 at its peak to about 400 today. “With so many players, doctors are waiting to see who’s going to end up on top before they invest. With such a huge investment of time and money, they’re afraid of getting it wrong. I don’t blame them.”

In the Beginning

EMRs represent a new and often-intimidating landscape for doctors. As recently as 2003, fewer than 5% of the Commonwealth’s hospitals, and even fewer practices, used any sort of electronic record system, according to the Mass. Medical Society (MMS).

Lee Martinez

Lee Martinez says hospital IT challenges range from consolidating community-based physicians under EHR systems to teaching patients how to use online data portals.

But in 2009, as part of the American Reinvestment and Recovery Act (ARRA), the federal government included a section called Health Information Technology for Economic and Clinical Health, or HITECH, with the goal of improving patient care through federal investment in IT infrastructure and — crucially — adoption of electronic health records capable of interoperability, privacy, and security.

Included in ARRA — otherwise known as the federal stimulus bill — were provisions for incentives of at least $44,000 per physician for meaningful use of an EHR. Reimbursement would be issued through Medicare and Medicaid after proof of regular EHR use in more than 20 areas, including computerized order entry, e-prescribing, recording demographics, medication lists, allergies, vital signs, smoking status, and several clinical measures.

At the heart of this process is the term ‘meaningful use,’ which is essentially using EHR technology to improve healthcare quality, safety, and efficiency; engage patients and families more directly in their care; improve care coordination between providers; improve population and public health; and maintain privacy and security of patient information.

Stage 1 of meaningful use, the explosion of activity in 2011 and 2012 that Bean referred to, concentrated on data capture and sharing. The goal of stage 2, which CMS expected to be complete by this year, focused on advancing clinical processes, such as more rigorous health-information exchanges, stricter requirements for e-prescribing and lab results, electronic transmission of patient-care data across multiple settings, and more patient-controlled data.

The problem is that many providers need more time to achieve the goals of stage 2 meaningful use, and won’t realistically approach the requirements for stage 3 by the 2017 deadline; these include improving quality, safety, efficiency, and health outcomes; patient access to self-management tools; and documented improvements in population health through EHRs, just to name a few.

“I think it’s a huge challenge, and it’s draining the resources that many providers need to put into this, whether it’s dollars or staff or upgrading applications or hardware — all those things enter into the picture,” MMS President Dr. Dennis Dimitri told BusinessWest. “And even though the EHRs have to be certified to allow physicians to use them and qualify for the incentive payment, it doesn’t mean the EHR allows you to easily do all the tasks of stage 2 and eventually stage 3.

“Anecdotally, I know more than one physician who’s said, ‘it’s too hard to work, too time-consuming, and it’s interfering with my ability to take care of my patients; I’m not going to qualify for stage-2 meaningful use,’” he went on. “And with the potential for financial penalties from CMS, physicians are just putting their hands up and saying, ‘I can’t do it.’”

That’s why medical societies across the country are pushing for changes in the timelines for meaningful use stage 2 and 3, he added. “Physicians bought in; they thought it was the right thing to do. And now they’re finding out these systems are not living up to the promise.”

Theoretically, EHRs should improve practice efficiency. By replacing paper records with electronic data, the thought went, practices could reduce record handling and access data more quickly for clinical, workflow, and billing purposes. EHRs are also intended to improve quality of care, reduce prescribing and treatment errors, and prepare practices for the collaborative world of accountable care.

But, in reality, the MMS reports, doctors are complaining that inputting data electronically actually takes up more time than written records, system outages are persistent, technical support from vendors can be unreliable, and — perhaps most significantly — interoperability and transportability of data from one EHR brand to another is not yet common, and changing brands can be costly, time-consuming, and stressful.

“Electronic medical records have added to the amount of time physicians spend entering data, which increases their workload. Most physicians will tell you their day is longer by using EMRs, not shorter,” Dimitri told HCN. “They also worry that an electronic medical record gets between them and the patient, when the physician is spending a lot of time looking at the medical record, filling in information, checking boxes. There has been some concern that may have a negative impact on the patient-physician relationship.”

Cameron agreed. “Providers have to change the way they interact with patients, and that’s not always easy because now they’re talking with the patient with a laptop between them, looking at the record. Certainly, that’s a challenge.”

Come Together

As for interoperability of EHR systems, the industry is seeing improvement, if only due to consolidation. In fact, according to the MMS, 80% of Massachusetts practices are using one of seven large EHR vendors.

“People wanted to get away from this ad hoc system of 20 EMRs in the community,” said Lee Martinez, chief information officer at Cooley Dickinson Hospital. So CDH, for its part, is moving to Epic, one of those seven vendors, and is slowly bringing its affiliated physician practices on board.

However, Bean said, interoperability remains a big question mark for many practice administrators grappling with EHR adoption. “Doctors know this will help their practice ultimately, but there are so many questions about interoperability, referrals, how patients access their records — a lot of uncertainty and unknowns. And whenever there’s uncertainty, people stay on the fence about it.”

Meanwhile, Holyoke Medical System has about 80 doctors in its health-information exchange, which uses the eClinicalWorks system.

“We’re working very hard to put all these initiatives in place and make sure we provide good-quality patient care,” Cameron said. “We’re in the process now of implementing a product called Qpid, which is essentially like a Google for healthcare. Basically, it sits on top of your medical record and becomes a search engine to help us do surveillance on a behavioral-health patient or cardiac patient, for example; when the patient presents in the emergency room, it will give the clinician a dashboard of past information so they don’t have to search the entire medical record.

“We believe that snapshot provides a higher level of care for the patient,” he went on, “helping clinicians make real-time decisions in the emergency room. Eventually, we’re going to tie that into the health-information exchange … we see this as a very powerful tool.”

The next piece, Cameron said, is applying EHR systems to population health, in terms of managing, say, the region’s diebetic population or COPD population, with the goal of reducing rehospitalization.

“That’s the big focus — keeping them out of the emergency room and, if they do show up, making sure they don’t come back within 30 days, because Medicare and others are starting to penalize hospitals for patients [returning to] the emergency room,” he explained. “We’ll have patient-care navigators with access to patients’ information, so if they have chronic diseases such as diabetes, follow up with them, make sure they’re keeping their appointment to see their specialist, make sure they’re taking their medications. This will help reduce the overall healthcare costs of those patients.”

Another component to population health is teaching patients how to use electronic portals, secure websites where they can access their personal health information.

“We have a patient portal and a physician portal here at Cooley Dickinson,” Martinez said. “I think that’s one big promise for the near term — getting patients more involved in this. In our community, a lot of patients are using the portal to manage their own care. We think that’s extremely important.”

Understanding the broad promise of EHRs but also recognizing the current challenges, both the AMA and the MMS are advocating for a pause in stage 3 mandates until all practices can reach stage 2. For its part, the Centers for Medicare and Medicaid Services (CMS) recently issued some final and proposed regulations for stages 2 and 3 of meaningful use (see story, page 33).

Dimitri recently testified before the state Legislature’s Joint Committee on Health Care Financing in support of a bill that would provide additional time for healthcare providers to comply with the interoperable EHR mandate contained in the 2012 healthcare cost-containment bill, Chapter 224.

“While the medical society continues to study and encourage adoption of interoperable medical records where appropriate,” he told lawmakers, “legislative mandates carrying financial penalties are not the appropriate policy level to promote this practice.”

Brave New World

Speaking with BusinessWest, Dimitri said the state’s physicians are not shrinking away from the future, but rather embracing it.

“I think physicians have been excited about the potential of electronic medical records for some time. A few early adopters have been doing some kind of electronic medical record for well over a decade. A larger number of physicians didn’t have full electronic medical records, but had been electronically prescribing for some period of time — again, going back well over a decade.

“Since then,” he went on, “the speed with which electronic medical records have been adopted in physician practices has picked up so much that in excess of 80% of physician practices now have an electronic medical record. So, from my perspective, physicians have been very interested in this technology and have high hopes about what it can do for them. The bad news is, electronic medical records have not been the panacea that many of us hoped they would, improving the ability to collect and share data and extract information about patients and population health.”

Time will tell whether EHRs flourish and reach their intended goals, but HMC’s Cameron feels the promise is worth the effort.

“There are a lot of challenges right now,” he said, “but I still believe technology should be a part of revolutionizing healthcare.”

Health Care Sections

Critical Juncture

Hector Pope (right) says Attain Therapy’s Bridge program helped him

Hector Pope (right) says Attain Therapy’s Bridge program helped him recover from knee-replacement surgery much faster than expected.

People who have had surgery or injure themselves often don’t know what to do when their physical-therapy sessions end. They want to continue making progress, but are often at a loss regarding how to reach their personal goals, since they don’t want to reinjure themselves and lack knowledge about what exercises they can do safely, given their limitations.

In fact, said Donna Durocher, it’s a common problem. “Insurance companies often limit the number of sessions a person can attend,” explained the senior physical therapist and clinic manager at Attain Therapy + Fitness in East Longmeadow. “We provide patients with as much education as possible before they are discharged and tell them it’s very important to continue to work on their strength and mobility. But when they get home or go to a gym, many are unsure about what they should do or avoid doing.”

Attain has created a unique program to address that gap. It’s called the Bridge, and allows people to continue to improve and get into shape.

“It offers the next level of care after physical therapy to ensure continuation on the road to recovery,” Durocher said. “It’s a good transition to help people move to the fitness level they hope to achieve.”

The program consists of six sessions and costs $150, which begins with a comprehensive screen to determine the person’s fitness level. When that is complete, the trainer works closely with the patient and their physical therapist to tailor a program that meets their needs and ensures they reap optimal benefits and can meet their goals.

Attain co-owner Terry Ditmar says every trainer at Attain has a master’s degree either in strength and conditioning or exercise physiology, and is well-versed in working with the post-rehabilitation population, which sets them apart from many of their peers.

Indeed, Stephanie Davsky says the Bridge program made a significant difference after she had bunion surgery last February. “I was turning 50, and when I finished physical therapy, I was feeling sorry for myself. I wanted to lose weight and get in shape, but didn’t want to go to a gym,” she said, adding that she was leery of reinjuring her foot and had never worked out before.

When her physical therapist suggested she enroll in the Bridge program, she decided to try it, and it proved so beneficial, she has continued to work with a personal trainer in the East Longmeadow facility.

“They take all of your limitations into consideration,” she said. “They made sure I did exercises to strengthen my foot without hurting it, and helped me with a diet. They also make you feel really good about yourself and work with you to accomplish everything you want to do. If I hadn’t gone through the program, I might have tried doing a little exercise at home, but that would have been it.”

For this issue and its focus on fitness and nutrition, BusinessWest takes an in-depth look at the Bridge program and how it certainly lives up to the name it’s been given.

Joint Sessions

Hector Pope has participated in the Bridge program twice, and also continues to work with an Attain personal trainer. He underwent knee-replacement surgery in the summer of 2014 and a second procedure last spring.

His surgeon told him it was important to strengthen the muscles around the knee prior to the first surgery. “So I did a pre-Bridge conditioning program at Attain and met twice a week with a personal trainer,” said the 64-year-old Baystate Medical Center emergency-room doctor, adding that, although he and most other people who have knee replacements typically have very limited motion before surgery, “anything you can do ahead of time makes it easier.

“It’s all about preparation before, therapy afterwards, then continuing to be active; you need to build up your muscles again,” he noted, explaining that he didn’t realize just how important pre-conditioning and post-surgery (Bridge) training were before he had his knees replaced.

The Bridge program made recovery easier and got him in the habit of doing strengthening and flexibility exercises. “I could have gone back to work in nine weeks instead of usual 12. You have a partner helping you, and everyone here puts themselves in the client’s shoes,” he said. “It made all the difference and opened up a whole new world to me, and because I am older and don’t want to reinjure myself, I am going to continue this for the rest of my life.

“Most people need some guidance, and it’s worthwhile to have weekly reinforcements,” he went on. “You need to keep exercising if you want to maintain your range of motion and have a good outcome.”

Although Pope and Davsky have chosen to continue with one-on-one training at Attain, many Bridge graduates leave and resume their normal lifestyle, while others choose group classes in the facility or return to their own gyms after gaining confidence and strength.

The program was conceptualized in 2008 after Attain took over a large space in East Longmeadow that had been used by a national sports-performance franchise. It had AstroTurf fields, a basketball court, and an indoor, 60-meter track, and initially the programs appealed to the athletic population. But the fact that East Longmeadow is not close to a major metropolitan area with a sizeable population of athletes made it difficult to continue to offer performance programs on a large scale, Ditmar said.

“We realized the majority of the general population who really needed guidance had other issues keeping them from their fitness or activity goals, such as back pain, knee problems, or chronic diseases like diabetes,” he told BusinessWest. “So we began providing medically guided programs for patients who had exhausted their insurance or were graduating from physical therapy and wanted to continue their progress and maintain a healthy lifestyle.

Terry Ditmar (left) and Trevor Dorian

Terry Ditmar (left) and Trevor Dorian say exercise physiologists in the Bridge program work closely with physical therapists to come up with a specific exercise plan for each client.

“We learned that people were often overwhelmed when they went to the gym on their own, even if they had some help from trainers,” he went on. “And our blend of physical therapists, strength coaches, and exercise physiologists provided something not found elsewhere.”

He added that, although Attain’s Bridge program is offered at all of its locations, the East Longmeadow facility has the fitness equipment needed to conduct group classes, programs, and personal training.

The program starts with the aforementioned functional-movement screen, which is conducted by a strength coach.

“We look at how well the person can perform basic movements, such as a squat, which is needed in everyday life to sit and stand up,” said Trevor Dorian, head strength and conditioning coach. “If someone can’t do basic movements well, they will compensate on a daily basis, which can lead to imbalances or an acute injury.”

When the assessment is complete, a specific program is developed to target the client’s needs, and he or she attends five 30- to 60-minute sessions, with the length dependent on how much they can tolerate. During each meeting, they do exercises specifically chosen for them, based on recommendations and input from their physical therapist combined with the person’s goals.

“Sharing information about someone’s health condition is important to the success of this program. It’s not always easy to do in this day and age, but because we work with our own physical therapists, for us it’s seamless,” Ditmar said.

He added that Bridge participants range from young people to senior citizens. For example, high-school athletes have become clients after undergoing ligament surgery and completing physical therapy.

“But there’s a big difference between being able to walk and run and going onto an athletic field where you have to function at 100% and may fall, get bumped, or get hit,” Ditmar noted. “The Bridge program allows them to move to the next level.”

Elders also often take advantage of the program. “Someone may have an arthritic knee, and even though their pain is brought under control, they don’t know what exercises they should do. And it can be overwhelming for them to go to a gym,” he told BusinessWest. “But by the end of five sessions, they are confident enough to continue training on their own. It’s especially important for this population because seniors who give up exercising can lose their strength and independence. But this can help prevent that from happening.”

Other Options

Attain also offers small-group classes with six to 10 participants. The personal attention, key to the Bridge program, continues in each class as trainers keep a close eye on each person.

“We correct their form and keep them motivated,” Dorian said. “What makes us different than a regular gym is that everyone is supervised. We don’t have a lot of machinery and are focused on proper biomechanics, so when a coach demonstrates a technique, no one else does the exercise at the same time. We deal with all types of limitations and can regress or make adjustments to someone’s prescription, even if it’s in a group setting. People can also e-mail or call us if they tweak their back or do something bothersome at home. We want to make sure that they are exercising correctly to minimize the risk of injury.”

“Safety is a high priority,” Ditmar agreed. “But our coaches are educated and have a great deal of experience working side by side with physical therapists. They’re members of a team.”

He added many people live with chronic pain that could be alleviated.

“They don’t realize, if they worked with a physical therapist, then transitioned to a strength coach, they might be able to get rid of it,” he explained, noting people can call and make an appointment to get an assessment done, which in some cases has led to physical therapy or one-on-one training.

But no matter how or why they get started, the focus is always on the individual’s lifestyle and situation.

“Our Bridge program is a way to extend the progress you have made and give you confidence to continue exercising independently in a way that keeps you safe,” Ditmar said, “so you can progress to the next level.”

Health Care Sections

Driving Forces

By TODD C. RATNER, Esq.

Todd C. Ratner

Todd C. Ratner

Do you remember the day when you received your driver’s license? Most people experienced a rush of excitement and a sense of freedom that they could clearly recall many years later. Now imagine losing this mobility and freedom . . . or, being the one who has to inform an elderly driver that their driver’s license should be limited or even taken away.

The thought of having this often-awkward and painful conversation tempts loved ones to procrastinate; however, adequately preparing for this conversation with an elderly driver who poses a danger to himself and others, and understanding the resources available to both you and your loved one, can facilitate what otherwise might be a traumatic experience.

First, it is important to recognize that everyone ages differently. As such, age alone should never be the sole factor in determining whether or not an elder has the ability to drive safely. However, there is no denying that a person’s physical and cognitive abilities often deteriorate with age. As we age, there is a greater likelihood of becoming inflicted with chronic diseases such as arthritis, dementia, and hearing impairment. In addition, safety of the elder is a concern, as elderly people are more likely to be injured than younger people in similar automobile accidents.

Because the Commonwealth of Massachusetts has no special licensing requirements for elderly drivers, family members should continually watch for signs of diminished capacity. Specifically, family members should ascertain whether or not the driver gets lost, has an increasing number of accidents, becomes forgetful, or has problems understanding simple instructions. Additionally, both Massachusetts and Connecticut require drivers to inform the Registry of Motor Vehicles and Department of Transportation if they have a medical condition that they believe may affect their ability to operate a motor vehicle.

In the event that you believe an elderly driver should reduce or stop driving, it is important to form a plan prior to commencing a dialogue with this individual. Driving is often the last means of independence, because it provides the elderly with the opportunity to visit friends, go shopping, and manage other tasks of daily life. Elderly drivers may get defensive and angry upon hearing that someone is attempting to take away this freedom. Thus, approaching this subject with realistic expectations is critical.

It is important to introduce this subject at a quiet time when both you and the elderly driver are relaxed, without any other immediate concerns. It is also preferable to include the elderly person in the decision-making process, if possible, instead of dictating a decision to them.

You may wish to discuss this matter together with other family members, doctors, and people that the elderly person respects. You might try having the elder write down both pros and cons, in the hope that they will realize that there are benefits to not driving. The initial conversation does not need to yield permanent decisions. Often it is preferable to put the discussion on temporary hold for a few days, to allow time for reflection on various options.

Caregivers and family members may also get assistance from all available resources to facilitate the determination of whether or not the elder should be driving. One option is offered through Weldon Rehabilitation Services on Carew Street in Springfield. They have developed a program to assess an individual’s ability to drive safely. The Driving Assessment Program will take approximately 90 minutes to complete. It commences with a licensed and registered occupational therapist providing a clinical evaluation. If warranted, an on-road evaluation and on-road training with a licensed driving instructor may also occur.

Upon the completion of the evaluation, the results and appropriate recommendations will be discussed with the driver and their physician. The program evaluates vision and perception, physical status, mobility, upper- and lower-extremity reaction time, traffic sign/situation identification and interpretation, cognition, and adaptive equipment. A family member may accompany the elder to the evaluation. To schedule an evaluation, contact the Driver Advisement Program at Mercy Medical Center’s Weldon Rehabilitation Services (413-748-6880).

Other resources to consider are the Berkshire Medical Center’s Driver Evaluation Program in Pittsfield (413-447-2000); the Fairlawn Rehabilitation Hospital’s Driving Evaluation Program in Worcester (508-791-6351); the AARP’s Driver Safety Course (888-227-7669 or http://www.aarpdriversafety.org); the Association for Driver Rehabilitation Specialists, which offers referrals to professionals trained to help people with disabilities, including those associated with aging (866-672-9466); and the AAA Mature Operator Program (800-622-9211).

If the elderly driver cannot operate a vehicle safely and refuses to stop driving, then further action may be warranted. There are several options available:

• Stage an intervention. This involves family members, health care workers, and anyone respected by the elderly driver, uniting to talk to the elder, firmly but compassionately, in an effort to help the senior accept the issue.
• Contact the local Department of Motor Vehicles and register a complaint. You may wish to do this anonymously.
• If all else fails, you may need to disable the car. This subterfuge should always be a last resort, but sadly, some families do find it necessary. This could include taking away the car keys, disconnecting the battery, or moving the vehicle to a location beyond the elderly person’s control. Duplicity is not a long-term solution, but if there is an immediate need to get the elder off the road, it is sometimes necessary.

Denying an elderly person a driver’s license can be an extremely traumatic event. Restricting or removing an elderly person’s right to drive should be done with careful planning, and by taking advantage of the community resources available.

Todd C. Ratner is a shareholder with Bacon Wilson, and member of the firm’s estate planning, elder, real estate, and business & corporate departments. He handles all aspects of estate planning and probate and real estate, as well as general business matters. He is a member of the National Academy of Elder Law Attorneys and was a recipient of Boston Magazine’s Massachusetts Super Lawyers Rising Stars award from 2007-2012, and Lawyers Weekly Up & Coming Lawyer in 2014; (413) 781-0560; [email protected]

Health Care Sections

Roundtable Refinements

David Cruise

David Cruise says employers consider the partnership a good way to find quality workers, among other benefits.

Anticipating the workforce needs of healthcare providers five, 10, or 20 years down the road doesn’t require a crystal ball. It does require forward thinking, initiative, and effective partnerships between the many players involved with creating a large, effective workforce. And these are the ingredients that go into the Healthcare Workforce Partnership of Western Mass., an arm of the Regional Employment Board of Hampden County.

Dramatic changes are expected to take place in the field of healthcare and the way it is delivered over the next five years. But graduates from local colleges should be well prepared to fill the needs of regional employers, thanks to the Healthcare Workforce Partnership of Western Mass., an arm of the Regional Employment Board of Hampden County, or REB.

“Our partners come together to think through strategies to respond to ever-changing workforce needs,” said David Cruise, the REB’s president and CEO. “Part of the challenge is to be forward-thinking, innovative, and able to anticipate and balance supply versus demand within the healthcare workforce sector.”

The partnership has two divisions: the Western Mass. Nursing Collaborative, composed of employers and nursing school deans, directors, and faculty members; and the Allied Health Committee, which includes employers, educators, training providers, one-stop career centers, and project managers and personnel. They have each collaborated on a number of new programs and initiatives that Cruise believes are making a difference in educating, attracting, and retaining qualified healthcare professionals.

One of the workforce partnership’s current projects is an on-the-job training program that allows new hires to earn while they learn, and provides them with the knowledge or skills needed to succeed in their specific position. It’s funded through a two-year grant, and reimburses employers 50% of the workers’ salaries during a pre-set training period that cannot exceed 20 weeks.

Cruise said the first year was spent developing the program with employers. And although the wage reimbursement offsets the cost of the additional training the program provides, employers say it’s a secondary benefit.

“They believe it’s an efficient way to find good candidates and regard the reimbursement simply as a value added,” Cruise told BusinessWest as he talked about the process of selecting and presenting employers with a pool of qualified job applicants.

They come from a variety of venues, and a significant number are referred by local colleges. Others come from the one-stop career centers (FutureWorks and Career Point) which conduct assessments before choosing candidates, while the remainder apply directly for advertised positions in a traditional manner.

However, a large percentage have some clinical experience, because the grant can only be used to fund training for nurses or people in allied healthcare fields, and each employer has to provide the REB with a monthly progress report on their new hires.

Although the grant limits what professions are eligible for reimbursement, the program was enhanced in late June by a $25,000 grant from Bank of America that does not specify what jobs it can be used for.

“It will offer us greater flexibility and can be cobbled with other grants,” Cruise explained. “The REB is matching the $25,000, and the money will provide reimbursements for 10 new employees in nursing, medical assisting, health information technology, medical billing/coding, and other positions that include pharmacy technicians and community health workers.

“We’re trying to shorten the recruitment period for employers with this program,” he went on. “They have complete authority over the final hires, and this is putting people to work and giving them opportunities.”

Targeting Young People

The Healthcare Workforce Partnership works on many fronts, but has prioritized its goals, said Cruise.

They include creating more workforce diversity in Hampden, Franklin, and Hampshire counties; educating more advanced nurse practitioners and physician assistants; the formation of a Career Pathways Initiative that brings together high schools and community colleges to create industry-specific programs that align education, training, and employment opportunities for today’s youth; support for new graduates as they transition into jobs; and education that promotes team-based healthcare.

Cruise said Chicopee Comprehensive High School and Holyoke Community College are piloting a Pathways to Prosperity Health Sciences program that is similar to a grade-9-to-14 career path model that was launched several years ago at West Springfield High School to fill jobs in the precision manufacturing sector.

The impetus began after Cruise contacted Kenneth Widelo, Comp’s career and technical education director, and explained the grade-9-to-14 model, then met with officials from Holyoke Community College (HCC) and set up a meeting between the two schools.

“It quickly became obvious that a program could be mutually beneficial, and although there wasn’t any funding to create a healthcare model, they felt it was so important that they cobbled resources to make it work,” said Cruise.

Widelo said they had several meetings with representatives from HCC to create an appropriate curriculum before the program was launched. “We had researched healthcare-delivery systems used by other vocational technical schools, but they all put students into one very specific track, such as working as a certified nursing assistant,” he told BusinessWest, adding that their goal was to offer a broader range of options.

The pilot program kicked off two years ago with 10th graders, which allowed the high school to make refinements to the curriculum. It has been highly successful, and allows students to earn 21 credits at HCC before they graduate high school.

“After they matriculate, they can transfer to the community college or attend a four-year college and go into nursing, work to become a doctor, or pursue a degree in healthcare business management,” Widelo said, noting that internships are part of the curriculum.

However, both schools are looking forward to the fall semester, which will mark the first class of incoming freshmen in their newly created Medical Science Academy, which is in line with the grades-9-to-14 career pathway they set out to establish.

Wideo said recruitment efforts for participants involved a variety of measures. Students from the city’s two middle schools completed a career-assessment survey, and two career counselors talked with them, then worked with the middle school guidance departments to identify interested candidates. They were interviewed, and a group of 40 graduating eighth-graders was selected and will begin their course of study this month in HCC’s science laboratory.

“We’re really excited about the program,” said Widelo, adding that students had expressed interest in healthcare careers in the past before the track was created.

Cruise said the students are enthusiastic and understand that the program will help them jumpstart a career.

“The academy has a rigorous academic program that has been aligned with the demands students need to satisfy in order to move seamlessly into an associate-degree program,” he told BusinessWest, noting that the five college courses they take in high school will save each student approximately $3,000 in tuition.

“It’s a model we think could be used by other schools, and once we get the template down, there is no doubt that it could be replicated,” he went on. However, it will require willing partners and involvement by the private sector, which could include summer jobs that bring the students’ academic studies to life.

Filling a Critical Need

The Western Mass. Nursing Collaborative, meanwhile, is also doing its best to guarantee there will be enough well-educated nurses to fill a growing need in Western Mass., which is especially important because registered nurses represent the largest segment of the healthcare workforce.

“They’re working from a set of priorities and updating their strategic plan by setting specific goals,” Cruise noted. “We have more than 40 very active educational institutions and employers who are members, and it’s important to provide a forum for them because the healthcare landscape is changing rapidly. The needs are so dramatic that they have to be innovative and responsive as they make plans to move forward and meet the workforce needs of the future.”

Their priorities include increasing the diversity of the nursing workforce, ensuring that nurses have the competencies and full scope of practice needed to meet the changing health needs of the community; increasing the number of nurses with a bachelor’s degree or higher; increasing the supply and diversity of nursing faculty in area programs and the retention of new nurses in all care settings; and sustaining the partnership.

Patricia Samra, a registered nurse and director of Clinical Workforce Planning and Finance for Baystate Health, said the Western Mass Nursing Collaborative was formed in 2006, thanks to a three-year grant, and was initially called Partners Invested in Nursing. “It focused on workforce initiatives and marked the first time that major healthcare providers and educators in the region convened,” she said, explaining that they included all area schools of nursing along with employers that ranged from hospitals to long-term care providers, who have been working steadily to make sure there is a pipeline of qualified nursing students who are supported after they graduate and get jobs.

The support is imperative, because approximately 30% of nurses leave the profession less than two years after they begin working.

“They burn out due to a lack of confidence,” said Samra, adding that Baystate has created a program to lower that rate.

It brings newly hired nurses together monthly to share emotions as well as clinical challenges, and they are given a case study to analyze, which involves discussing best practices and allows them to reflect on their own experiences.

“They may go into our simulation lab and practice techniques, but the goal is not to gain clinical experience, it’s about critical thinking at the bedside centered around quality care and patient safety,” said Samra, noting that their retention rate has risen significantly since the program began.

Karen Rousseau, director of the Division of Nursing at American International College, says the school works closely with Baystate, and some of its staff members are clinical instructors.

The school also has alliances with other employers, because nursing students have to complete a designated number of clinical hours, which is done in a variety of settings.

“One of the biggest projects our students have been involved with in the past two years is helping patients transition from an acute-care setting to their homes,” said Rousseau, noting that they have shadowed nurses from visiting nurse associations, then worked with the nurses to identify gaps to improve care.

AIC is also a partner in the Health Inter-professional Educators of Pioneer Valley, which seeks to promote communication between students in areas such as ethical dilemmas.

Baystate’s Patricia Samura (left) and AIC’s Karen Rousseau

Baystate’s Patricia Samura (left) and AIC’s Karen Rousseau say the Western Mass. Nursing Collaborative has forged strong bonds between hospitals and nursing schools.

“It grew out of the Cooperating Colleges of Greater Springfield, and encompasses AIC, Western New England University, Elms College, Springfield Technical Community College, HCC, Baypath University, Springfield College, Westfield State University, UMass Amherst, and members from Baystate Medical Center who are interested in supporting interprofessional education and collaboration in health care,” Rousseau said.

Keeping Pace

The programs created by the Healthcare Workforce Partnership of Western Mass under REB’s umbrella ensure that communication takes place between schools, training facilities, and employers. “It’s a challenge to meet the headwinds we are facing, but there is a growing demand for healthcare professionals both at the patient level and away from the bedside,” Cruise noted.

As a result, the collaborations that are formed are taken seriously by members.

“We all believe the partnership is very valuable,” said Samra. “The REB helps get organizations to the table for two to four hours each month, and even though we are all busy, full-time working professionals, it’s worthwhile because it adds value to all of our programs.”

And it also helps ensure a steady flow of workers in the pipeline to meet the growing healthcare needs of this region for years to come.

Health Care Sections

Down to a Science

Dr. Barrie Tan

Dr. Barrie Tan, seen here in the early stages of construction of American River Nutrition’s plant in Hadley, says he’s “all in” when it comes to researching and manufacturing tocotrienol vitamin E.

For some time now, Dr. Barrie Tan says, vitamin E suffered from what might be considered a public relations problem of sorts.

Indeed, the dietary supplement, a noted antioxidant discovered in 1922 and available to the public for decades now, had been drawing mostly unfavorable reviews for its disappointing lack of benefits for cardiovascular health. One large-scale clinical study even concluded that it actually increases the risk of prostate cancer.

But Tan, president of American River Nutrition (ARN), stressed that the bad press essentially concerned what would be considered one form of vitamin E.

As he explained, the supplement is not a single compound — contrary to popular belief up until a few decades ago — but rather a family of at least eight similar, yet structurally different, molecules. And while the once-popular vitamin E alpha-tocopherol has seen its stock fall somewhat in recent years, the lesser-known form of the supplement — tocotrienols, as they’re called — have seen theirs rise amid links (through tests on animals) to everything from improved cardiovascular health to delaying the onset of cataracts; from enhanced bone health to cancer treatment and prevention.

And it is a product known as DeltaGold, with the marketing slogan “Simply Tocotrienol,” that Tan will be manufacturing at a 25,000-square-foot facility now taking shape in Westmass Development’s Hadley University Business Park, in the shadow of the UMass Amherst campus, where he was once a professor of Food Science and Nutrition.

In recent months, the company, the plant, and Tan have been in the news — primarily because the facility will use propane rather then natural gas, simply because there is a moratorium on new natural-gas hookups in that region, a ban that has many concerned about possible long-term effects on economic development and that has also thrust the proposed but highly controversial Kinder-Morgan pipeline even further into the spotlight.

But Tan hopes to change the tenor of the headlines concerning his venture, and, in many ways, he already has.

Indeed, there’s been a steady stream of articles in various health publications regarding tocotrienols, DeltaGold, and Tan. Most of these stories talk about the supplement’s potential and about ongoing studies and trials. However, evidence is mounting that this natural form of vitamin E, derived from annatto (an orange-red condiment and food coloring derived from the seeds of the achiote tree — more on that later), could have a number of significant health benefits.

“We’re engaging a study on cardiovascular benefits, and there are also studies on several forms of cancer,” said Tan, adding that the phrase “Simply Tocotrienol” captures the essence of this development, and its significance, because DeltaGold is considered to be the only natural, annatto-derived tocotrienol that is free of tocopherols.

And that’s important because research has shown that tocopherol interferes with tocotrienol benefits, essentially resulting in that aforementioned bad press, he explained, adding that, in 1996, it was first determined that the cholesterol-modulating properties of tocotrienol were found to be compromised by what Tan called a vitamin E “sibling” — alpha-tocopherol.

“The researchers concluded that effective tocotrienol preparations should contain less than 15% of alpha-tocopherol and more than 60% of desmethyl tocotrienols [gamma- and delta-tocotrienol],” he told BusinessWest, adding that the only natural source of tocotrienols that fits those tight parameters is annatto, derived from trees grown mostly in Central and South America, but also India and Sri Lanka.

annatto

Tocotrienol is extracted from annatto, a substance derived from the seeds of the achiote tree.

Tan has found a way to extract the tocotrienol from annatto through a proprietary distillation process that produces no toxic or harmful byproducts, and he’s ready to take his venture to a much higher level.

For this issue, BusinessWest talked at length with Tan about DeltaGold, American River Nutrition, research on possible pharmaceutical versions of the product, and where he wants to take this company in the years to come.

A Venture Takes Root

Tan has taken a rather circuitous route to his current station as an entrepreneur and researcher at the forefront of developments with vitamin E. In fact, he summed up that path and detailed what’s transpired over the past several years by borrowing from Robert Frost.

“We certainly took the road less-traveled,” he said, referring to what became years of research and development of the far-lesser-known variety of vitamin E, and eventually DeltaGold. It’s a trek that’s taken him from his native Malaysia to Amherst and eventually to South America, where he found not only what he originally set out to find — a plant rich in carotene — but also something more promising, and lucrative, just a few yards away.

Our story begins in late November 1982, when Tan arrived at UMass Amherst. He taught there for more than a decade, first in the Chemistry department and later the Food Science department. It was during that latter assignment when he initiated work with vegetable oil and, through that, the tocotrienol form of vitamin E, which he found in palm oil.

“We didn’t know much more than that this was a different kind of vitamin E,” he explained. “We started doing research and found that it was different in its properties than tocopherol.”

Research in this area eventually led to formation of a business venture called Carotech, which, as the name suggests, was involved in products derived from carotene. It was later sold to a Malaysian concern. At  the time, Tan said, he lacked the skills needed to lead a business, and when the Asian economy tanked in the mid-‘90s, Tan started a lab from which he created American River Nutrition in 1998. He told BusinessWest that he soon put aside work with tocotrienols and went back to researching potential medical uses of carotene.

This work took him to South America in early 2000 to search for a plant said to be a potent source of carotene. He found that plant, a much larger version of the traditional, garden-variety marigold, but 30 feet away, he found something else.

“It’s what the British call the ‘lipstick plant,’” he noted, referring to the achiote, which bears a red fruit, or seeds, which natives of that region used as body paint and, yes, lipstick; other uses include the coloring of cheese, margarine, fabric, and other products.

But Tan made another key discovery.

“The chemist in me hypothesized a theory,” he explained, “which is that there must be something very powerful that protects the carotene color from this annatto, which is not protected otherwise, from degradation. I wondered what it might be.

“This question that I raised eventually helped us in the discovery of this form of vitamin E [natural tocotrienol],” he went on. “We thought that it could be a powerful antioxidant, or anything, really. But shocking to us, and to everyone else, it was the most potent form of vitamin E.”

Seed Money

Fast-forwarding a little, Tan said ARN eventually filed a patent and commenced work on a method for effectively extracting this new form of vitamin E, one free of tocopherol, from the plant’s fruit.
“I decided that this was a gamble worth taking,” he said. “So … to use the simplest term I can think of, I was all in.”

Over the next six years, research continued into the engineering of a process to extract the tocotrienol and take what eventually became known as DeltaGold to the marketplace.

“It was very risky — we weren’t making any sales,” he said. “Those were lean years, but we had a rich patent, and we found places that would process this for us in the United States and were able to get into the business.”

The timing wasn’t ideal — the nation’s economy nosedived in 2008, slowing Tan’s pace of progress with his venture. But a critical mass of sales had been achieved, and solid foundation had been established on which to build.

And he’s doing just that — figuratively and quite literally.

Indeed, with financing from Citizens Bank and the U.S. Small Business Administration, Tan is erecting his facility in Hadley, one in which he expects to grow the workforce from the current nine to 15 or 20.

Meanwhile, he’s working to broaden a customer base that already includes a number of manufacturers of dietary supplements and related products, including Nutricology, Biotics Research Corp., Bronson Laboratories, and many others who use DeltaGold in products bearing their brand names.

Tan’s undertaking is another gamble, but he remains all in, as he said, because the news on tocotrienols, and especially those derived from annatto, is increasingly promising.

One recent study conducted by scientists at the University of Missouri, for example, found that certain doses of tocotrienol, combined with a healthy diet, decreased lipid levels significantly after four weeks. According to another report’s findings, published in Evidence-Based Complementary and Alternative Medicine, tocotrienols from annatto, mainly composed of delta-tocotrienol, stimulated bone formation and cut back bone decay in a post-menopausal osteoporosis rat model.

Another study found that vitamin E tocotrienals from annatto may slow the development and reduce the number and size of breast tumors in rats, and still another concluded that annatto tocotrienol may delay the onset and progression of cataracts when given in a topical formulation.

“There might be 100 researchers at universities and institutions conducting research on tocotrienols, and they seem to say that they are good for chronic conditions,” said Tan, listing as examples type-2 diabetes and certain types of cancer, such as breast cancer, ovarian cancer, and prostate cancer.

Research involving DeltaGold and a number of cancers is ongoing, with involvement from students at the university, he continued, adding that others, as noted, are exploring its potential benefits with cardiovascular health, bone health, cholesterol, and other health issues.

“Over the past five years, we’ve been focusing on investments in clinical studies,” Tan went on. “Everyone wants to know what this will do in human beings. It’s an easy question to ask, but not an easy question to answer.”

Fruits of His Labor

Just how that question is eventually answered will obviously be a huge factor in the future of DeltaGold and ARN, Tan acknowledged.

But in many ways, the gamble he has taken is already paying off.

That chance discovery in South America years ago is bearing fruit in many ways, and this venture has tremendous potential to blossom into a business with national and international reach.

Indeed, by taking that road less traveled, Tan and ARN have embarked on an intriguing and potentially lucrative entrepreneurial path.

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