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Health Care

A Widening Problem

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

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

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

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

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

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

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

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

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

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

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

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

Wrong Direction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Plenty of Options

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

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

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

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

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

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

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

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

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

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

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

Reaping the Rewards

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Health Care

The Eyes Have It

Dr. Camille Guzek-Latka

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I Can’t See Clearly Now

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Early Detection Is Key

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

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

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Health Care

In the Club

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

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

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

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

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

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

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

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

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

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

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

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

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

How It Works

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

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

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

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

Some Tips to Ease
a Child’s Dental Visit

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

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

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

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

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

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

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

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

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

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

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

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

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

Something to Chew On

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Health Care

Recovery Mission

Michael, a three-time resident of Goodwin House

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Strong Dose of Reality

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

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

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

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

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

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

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

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

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

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

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

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

At Home with the Concept

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Positive Steps

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

He admits to being somewhat nervous, but not scared.

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

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

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

Health Care

Deep Dive

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Long Time Coming

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

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

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

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

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

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

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

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

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

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

Margie Pierce

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

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

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

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

Beyond Depression

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

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

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

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

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

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

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

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

And maybe a normal life.

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

Joseph Bednar can be reached at [email protected]

Health Care

In Search of Empathy

Catherine Williamson

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

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

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

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

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

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

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

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

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

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

At a Loss

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

Attendees of the recent Springfield Dementia Friendly Coalition

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

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

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

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

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

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

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

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

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

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

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

Law and Order

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

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

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

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

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

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

Among its mandates, the bill:

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

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

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

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

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

Small Steps, Big Impact

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

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

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

Joseph Bednar can be reached at [email protected]

Health Care

‘We Are a Different Place’

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

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

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

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

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

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

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

George Gorton, left, and Lee Kirk

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

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

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

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

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

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

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

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

First Steps

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Joint Efforts

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best Foot Forward

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Health Care

A Different Kind of Health Crisis

Dr. Gaurav Chawla

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Kate Hildreth-Fortin

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

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

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

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

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

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

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

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

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

A Failure of the System

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Questions and Answers

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

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

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

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

Jenni Pothier

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

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

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

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

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

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

Which is why overreaction is possible and should be avoided.

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

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

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

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

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

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

Bottom Line

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

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

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

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

Health Care Sections

Mindful Connections

Allison Baker (right, with Cheryl Moran)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Active Lives

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Good Nights

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

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

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

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

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

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Health Care Sections

Out of the Darkness

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What’s in the Bill?

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

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

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

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

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

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

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

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

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

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

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

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

One Step at a Time

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

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

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]