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Business of Aging

Wave Dynamics

Since they started entering the world just after World War II, the Baby Boomers have influenced society in general, and the business community in particular, in all kinds of ways. The same is true when it comes to the healthcare sector, especially as the oldest members of this huge and proud generation turn 75. The impact of such a large and aging group can be seen in everything from hearing practices to the many facets of the long-term care system. And in some ways, COVID has provided a preview of what it is to come.

 

As she talked about the massive Baby Boom generation, how its oldest members turn 75 this year, and about how almost all the Boomers could now be classified as senior citizens, Dr. Maura Brennan summoned a phase she attributed to her mother, but which she uses often as well: “No one gets out of life alive.”

She used those words to convey the thought that, while this Baby Boom generation may in many ways be healthier than those that preceded it — fewer smokers and more exercisers, for example — and it has enjoyed access to better healthcare and innumerable advances in treatment, from artificial joints to improved cancer care, its members will eventually see their health decline, and they will need increasing amounts of care. And many already do.

“I don’t believe this generation, which I am part of, will readily tolerate limited access to the best care.”

While Brennan — a 70-year-old geriatrician and palliative-care physician — says people being able to live longer is in itself a success story, it has also become a challenge, for today, and especially tomorrow.

Which brings us back to those oldest Boomers, those born just after World War II, who turn 75 this year. That’s the age when, statistically, people begin to see their needs for healthcare increase, said Brennan, adding that, as one might logically assume, when a large number of people hit that threshold all at once, the system will be taxed — in all kinds of ways.

“As one might imagine, it’s going to impact virtually every sector and specialty, with the possible exceptions of OB and pediatrics,” she explained. “We’re going to see increasing numbers of older people; not all those folks are going to be frail and complicated, but there will be an increasing number of people with multiple medical problems.

Dr. Maura Brennan

Dr. Maura Brennan says the healthcare system is struggling to meet demand for direct-care workers, and the situation might get worse.

“The numbers and the complexity will rise,” she went on. “And it will impact every area of healthcare, with probably the biggest impact being in home care and nursing-home care because, personally, I don’t believe this generation, which I am part of, will readily tolerate limited access to the best care that’s going to allow them to stay in their homes and communities as long as possible.”

Mary Flahive-Dickson, chief operating officer at East Longmeadow-based Golden Years Home Care, agreed. She said the milestone age being reached by the oldest of Baby Boomers provides an opportunity to look hard at what’s in store for the healthcare system and ask the question: is it fully prepared for the challenges to come? And, if not, what needs to be done so it might be better prepared?

In many ways, Flahive-Dickson said, the COVID-19 pandemic has actually provided a preview of sorts for what’s coming as this large generation ages, with regard to everything from telehealth to the way the overall healthcare system was tested by sheer volume of cases and even vaccination efforts, to the manner in which the need for home-care services is growing.

During the pandemic, this need was fueled by growing fears of nursing homes and other senior-living facilities. Many of those fears still persist, but for Baby Boomers, by and large, the greater issue is simply wanting to remain independent — and in the home — as long as possible.

Eric Aasheim, a certified senior advisor and owner of Oasis Senior Living of Western Massachusetts, agreed. Aasheim, who assists seniors and family members through the complex process of transitioning from home to senior-living communities across this region, said the entire long-term-care sector will be tested by the aging of this generation.

“What I see, and what I worry about, is that the long-term-care system — and that includes in-home care, nursing homes, and assisted living — is just not ready for the sheer volume of patients and residents that they’re going to have,” he told BusinessWest. “And even though these individuals living longer and their resources are being depleted, there are so few places that have any kind of programs for low-income seniors. Unless something dramatically changes in terms of the number of assisted-living facilities that can serve low-income residents, there won’t be needed options for seniors.”

Meanwhile, besides sheer size and that sense of independence and not wanting to rely on others, the Baby Boom generation boasts some other characteristics as well, including what could be described as denial when it comes to getting old and admitting some aspects of their health have deteriorated.

“That’s not a disaster or a tsunami. That’s one of the greatest success stories in modern history; people are able to live longer and enjoy their lives better.”

And that’s why, even though she is generally seeing more patients than she was years ago, Dr. Susan Bankoski Chunyk, an audiologist, says she’s seeing a continuation of, and perhaps even an exacerbation of, an annoying trend whereby people will put off seeking help for their hearing years after they acknowledge they have a problem, due to lingering perceptions about hearing aids making people look old and feeble, even though modern technology has changed that landscape.

And that’s just one example of why there are still many question marks about how and to what degree this generation will present challenges and opportunities moving forward.

 

Age-old Challenges

Before getting into any real detail about the Baby Boom generation and its advancing age, Brennan wanted to set the proper tone for the discussion.

Indeed, she told BusinessWest that years, if not decades, of talk about a ‘silver tsunami’ have succeeded in casting discussion about the aging Boomers — and, again, she’s a proud, card-carrying member of that generation — in often-negative tones.

Mary Flahive-Dixon

Mary Flahive-Dixon says most Baby Boomers want to age in place, in their own homes.

“This notion of the silver tsunami makes the aging of the population sound like an impending natural disaster over which we have no control that’s going to sweep everything away,” she said. “It feels to me, and most geriatrics leaders, like we’re framing things wrong; we’re setting this up as ‘us versus them’ — us young healthy, productive people against those old people who are going to overrun the system. These people are … us. They’re our neighbors, our teachers, our relatives.”

That said, a lot of ‘us’ are getting on in years. Indeed, maybe half or more of all Boomers can now get a senior discount at the movies, the golf course, and the pharmacy. And large numbers of them are now over 70, which means many aspects of the healthcare system — from eye care to urology; orthopedics to hearing care — are certainly already seeing an impact, and it will only grow as more Boomers reach 70, 80, 90, and beyond.

Restating the matter (again, she doesn’t want to classify it as a problem), Brennan said the Baby Boom generation is indeed large (it’s estimated that, by 2035, 10% of the population will be 85 or older; it’s closer to 6% now), and its members are living longer than the generations that preceded them, again, because of better health and better healthcare.

“That’s not a disaster or a tsunami,” she said. “That’s one of the greatest success stories in modern history; people are able to live longer and enjoy their lives better.”

That’s true, but so is what her mother said so often: that no one gets out of life alive.

“Some period of decline is going to occur for virtually all of us — unless we die in our sleep from a funny heart rhythm or get hit by a truck crossing Main Street,” she told BusinessWest. “And the causes of death in recent years have shifted; if you look back 50 or 80 years, the causes of death were frequently things like trauma, infection, death in childbirth — things that take you rather quickly when you were reasonably functional prior to that. That is no longer true. And with the successes we’ve had, and with people living longer, they are increasingly likely to die of multiple progressing chronic diseases.”

What does all this mean? Increasingly, Brennan said, people will need more care from more people as they age and approach end of life — a team-based approach, if you will.

“We’re going to have to think about care a different way because it’s not all about the doctors and the nurses,” she explained. “People will need hands-on home care, they’ll need symptom management, they’ll need direct-care workers who are grossly underpaid and overworked, and who churn through the system, with tremendous turnover.

“We’re struggling to meet those needs now, and it’s perceived to be, and is, a major problem,” she went on. “And if we do not alter the way we are paying, recruiting, supporting, and respecting those people, it will be infinitely worse. We’re going to need to restructure things, pay people differently, and offer them different kinds of professional development and career ladders that will make those positions more attractive; otherwise, we have a self-perpetuating situation. It’s the classic axiom — the system produces exactly the kinds of results it was designed to produce. If we don’t change the system, you get what you’ve got.”

Another issue that will have to addressed regards the number of specialists that will be needed to care for this larger generation of older residents, said Brennan, referring to geriatrics doctors, general nurse practitioners, social workers, pharmacists, and more.

Dr. Susan Bankoski Chunyk

Dr. Susan Bankoski Chunyk says people still put off seeking treatment for hearing loss due to outdated perceptions about hearing aids.

“As the number of older folks is increasing, the number of experts is not increasing, not one iota,” she told BusinessWest. “And, in fact, in some fields, such as geriatric medicine, the number of certified geriatricians has actually probably declined somewhat because we’re not replacing people who are retiring with equal numbers of new grads.”

 

The Shape of Things to Come

Flahive-Dickson agreed, noting that among the Boomers now in or approaching retirement are large numbers of healthcare workers. Replacing them and making the kinds of systemic changes Brennan mentioned will be just some of the many challenges facing the healthcare system moving forward.

Several of the others involve the growing trend of people wanting to age in place — and especially in their own home.

And this brings her back to COVID and what has been learned during the pandemic.

“More care was moving toward the home, basically as a result of general anxiety about facility care — about being in hospital, about being in a skilled nursing facility,” she explained. “Because of this crisis, we’ve seen more people want to get their care in the home.”

And this is a trend she expects will continue into the future as more people from this huge generation confront questions about the care they need and how and where they want it provided.

But questions arise from this supposition — many of them, in fact, including whether there will be enough providers to care for all those people who will want to stay in their homes, and also whether the payers are willing and able to adjust to a changing landscape of need and pay for services they currently don’t cover.

Again, Flahive-Dickson said the pandemic has provided an intriguing lens for looking at the problem — and the future as well.

“If COVID has done anything for us, it has previewed what is to come,” she told BusinessWest. “The pandemic has shown us that this surge in home care is a glimpse of the future. And it has provided this glimpse not only to healthcare professionals and the general population, but also to regulatory bodies, such as Medicare and Medicare Advantage.

“They have had to relax a lot of rules,” she went on. “As the Medicare population is continuing to grow, Medicare benefits haven’t caught up to that, and this is a huge problem. There are fewer than a dozen states that even offer non-medical home-care services to be paid for by a plan, and that plan is a singular plan, and that’s Medicare Advantage. In Western Mass., no one has a Medicare Advantage plan that offers the benefits of non-medical support, so it’s either out of pocket, or you have to qualify for one of the few programs that cover this.”

As for home-care workers, she said a number of demographic trends (Boomers generally had smaller families than the generations that preceded them) and other issues point toward individuals needing someone outside the family to care for them — and real challenges when it comes to having a steady supply of workers to provide that care.

That’s another lesson from COVID, she said, referring to the law of supply and demand, which was certainly exacerbated by a pandemic during which many had apprehensions about working in others’ homes.

“Fewer and fewer family members are capable of being a caregiver, either because there are fewer families, period, or … because family members might be on a different coast,” she explained. “Just because you grew up in Springfield doesn’t mean you stay in Springfield.”

Aasheim agreed, noting that these demographic trends are just some of the challenges facing the Baby Boom generation. Another is their own lack of preparedness for what is to come — financially and otherwise.

He said that only one individual in 10 has long-term-care insurance, and this is a matter to be addressed — just not when someone is 75 or even 65; those products have to be bought much sooner. Meanwhile, not enough members of this generation (and it’s not exactly unique in this regard) have their ducks in a row when it comes to needed documents — and needed preparation for poor health that often comes on suddenly and without much warning.

“What I try to focus on with the Boomers are the things they can do now, before that eventuality,” he explained. “This includes having discussions with your family about what your preferences are in terms of long-term care, gathering the documents together, getting power of attorney and a healthcare proxy, all those things. That’s what I hammer away with them — get that stuff done now, while you’re still healthy and you have the energy and the mental capacity to deal with it, so your family doesn’t have to handle it in crisis mode a few years down the line.”

Unfortunately, he said, many don’t heed this advice.

“They all nod when I talk to them in these presentations, but are they going home and getting that stuff together? My thought would be, probably not,” he went on. “Because most of the calls I get are from people who are in crisis mode.”

Bankowski Chunyk is another who wishes that more Boomers would heed some advice. Or at least listen to family members telling them they can’t hear as well as they used to, and should do something about it.

She told BusinessWest that the hearing industry talked a lot about the Baby Boom generation years (make that decades) ago, and how its size and advancing age would comprise a great opportunity for audiologists, one they should be prepared to seize.

Bankowski Chunyk did prepare, but she said the wave hasn’t been nearly as big as all those experts predicted it would be, largely because of … well, human nature, as well as lingering perceptions about hearing aids and what they say about those who wear them.

She said data shows that, between 1989 and 2019, the average age of an individual being fitted for a hearing aid for the first time fell from 66 to 65.

“I’m not sure a lot of progress was made getting people to address their hearing,” she said with some sarcasm in her voice, adding that, while there are certainly more people of that age than there were several years ago, sheer volume is not creating the immense opportunity that was predicted back in the ’80s and ’90s.

Whether it will materialize eventually or not, she doesn’t know — but she does know the Boomers are perhaps more vain when it comes to hearing aids than the generations that preceded them, so her industry has some work to do to change those perceptions.

 

Bottom Line

Perceptions are not the only thing that will have to change if the Baby Boomers, and those in the healthcare system who will care for them, will adequately manage this sizable demographic shift.

Brennan is right when she warns about this challenge becoming an ‘us versus them’ scenario, but she’s also right (and her mother was right) when she said that no gets through life alive.

As this generation ages, it will present enormous challenges to a healthcare sector that in many ways seems unprepared for what’s coming. That’s evidenced by the number of comments that began with the words ‘if things don’t change’ — comments referring to everything from workforce to accommodations for low-income seniors.

Only time will tell if things will, indeed, change. What is known is that the Boomers, as they have at every other phase of their life, will alter the landscape as they reach 75 — and beyond. And in all kinds of ways.

Health Care

Game Plan

By Mark Morris

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

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

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

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

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

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

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

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

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

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

The Big Picture

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

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

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

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

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

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

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

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

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

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

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

Age-old Concerns

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

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

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

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

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

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

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

Business of Aging

One Step at a Time

Scenes like this one — from the 20th Rays of Hope Walk five years ago — are played out each October in Forest Park.

Scenes like this one — from the 20th Rays of Hope Walk five years ago — are played out each October in Forest Park.

Lucy Giuggio Carvalho is a tough person to say no to, as Kathy Tobin found out one afternoon 25 years ago.

“I was a health reporter for WGGB, and I was in the lobby of Baystate Medical Center to do a story,” Tobin told BusinessWest. “And this little petite thing comes walking across the lobby, points at me, and says, ‘I had a dream about you, and you’re going to help me.’ And that’s how I met Lucy.”

Carvalho — then a nurse at Baystate — had been diagnosed with breast cancer some time earlier, and, inspired by an AIDS fund-raising walk she had recently participated in, had a vision to bring something like that to Western Mass. to raise money and awareness around the cause of breast-cancer research and treatment.

A quarter-century later, it’s safe to say that Carvalho’s creation — known as the Rays of Hope Walk & Run Toward the Cure of Breast Cancer — has done just that, and a whole lot more.

As it turned out, Tobin did help her; WGGB became the media sponsor of the first Rays of Hope walk in 1994, and Tobin spearheaded a half-hour documentary special to bring attention to the cause.

“She had this overwhelming desire, not just to do this walk, but to change the way we treat breast cancer,” said Tobin, who has come full circle since then, now serving as director of Annual Giving and Events for Baystate Health, which has long overseen the Rays of Hope organization.

The first Rays of Hope event attracted some 500 walkers and raised $50,000. Today, it has raised more than $14.2 million and attracts about 24,000 walkers and runners each October. This year’s annual fundraiser, slated for Oct. 21, will once again step off from Temple Beth El on Dickinson Street in Springfield and wind through and around Forest Park.

As usual, all money raised remains local, administered by the Baystate Health Foundation to assist patients and their families affected by breast cancer. Funds support research, treatment, breast-health programs, outreach and education, and the purchase of state-of-the art equipment, as well as providing grants to various community programs throughout Western Mass. 

“Sometimes I can’t believe all that’s been accomplished,” Carvalho said. “I never would have believed we could raise the amount of money we raised; $14.2 million over the last 25 years is a lot of money, and we can do a lot of things with it — and we have. I’m really proud of Rays of Hope and all we’ve accomplished.”

It wouldn’t have happened, she added, without the continuing, loyal support from the community. “We’ve mostly accomplished what we have through individual walkers and local organizations that have supported Rays of Hope from the beginning. Most of the agencies that got involved in the early years are still involved, as well as the walkers; they come back year after year.”

Carvalho said she created Rays of Hope with a very specific vision.

“I wanted to help people that were going through breast-cancer treatment, to help them navigate the healthcare system,” she explained. “I’d found it difficult, and it was my motivation to make it easier for other people, seeing that I had such a hard time. And I wanted the money to stay local, too. That was really important for me.”

Beyond the critical funding, however, she has long recognized the importance of Rays of Hope as a bonding agent for individuals facing one of life’s most daunting challenges, and the people who love them.

Lucy Carvalho (left) and Kathy Tobin at the first Rays of Hope walk in 1994.

Lucy Carvalho (left) and Kathy Tobin at the first Rays of Hope walk in 1994.

“I think the event is very unique in that, when you’re there, it feels like there’s a big hug all around you, and that people really care about you. It’s just uplifting to be involved, and it’s something to look forward to, something that has become a tradition.”

Tobin also compared the event to a massive hug — one with a great deal of feeling behind it. “We have such a support system in place. It’s like a sorority — but I shouldn’t say sorority, because men are diagnosed, too. It’s just a network of people who care.”

Changing Times

Dr. Grace Makari-Judson has witnessed the evolution of Rays of Hope from a clinical standpoint; she was appointed medical director of Baystate’s breast program at the same time Carvalho was organizing her first walk.

“Lucy’s initial mission for Rays of Hope was not only helping breast-cancer research, but trying to provide coordinated care … a holistic approach,” Makari-Judson said — in other words, to make the journey easier for others than it was for her.

“Thinking back, it’s amazing how much we’ve been able to do with addressing those goals,” Makari-Judson went on. “Twenty-five years ago, women were having mammograms in the hospital, sharing the same waiting room with people who needed X-rays or had pneumonia. Biopsies were done in the operating room, and women got unnecessary scars.

“Today,” she went on, “we have a dedicated breast center where women go for mammograms and other breast imaging. We have needle core biopsy, which is done at the breast center and is a less invasive approach, so women go home with a Band-Aid instead of a scar. That’s the minimally invasive approach started in the mid-’90s and has since become the standard of care. It’s the whole philosophy of less is more.”

Other examples are sentinel node biopsy, introduced at Baystate in 1996, and radiactive seed localization, started in 2010. Both are minimally invasive procedures that Baystate pioneered in the region that have since become national standards of care, Makari-Judson said — and both benefited from Rays of Hope funding.

Meanwhile, Carvalho’s vision of more coordinated care has become reality as well, the doctor said.

Dr. Grace Makari-Judson

Dr. Grace Makari-Judson

“Twenty-five years ago, physicians were seeing patients all in a row — the surgeon, then the medical oncologist, then a radiation oncologist,” she explained. “And sometimes that would leave women with conflicting information. In today’s approach, we have something called a multi-disciplinary breast conference, where we get all the experts together to review radiology images and pathologist slides and come to a consensus recommendation. That has had a positive impact on care and really enhances our mission.”

It’s a model, she said, that started to coalesce around the time Rays of Hope was being launched, and it eventually spread to all Baystate hospitals and eventually became the model of care regionally and nationally.

“Everything about cancer has come such a long way,” Tobin agreed. “Women don’t have to wait days for biopsy results; they don’t necessarily have to have drastic surgeries. Everything about treatment has changed.”

“Twenty-five years ago, women were having mammograms in the hospital, sharing the same waiting room with people who needed X-rays or had pneumonia. Biopsies were done in the operating room, and women got unnecessary scars.”

Then there’s the Rays of Hope Center for Breast Cancer Research, launched in 2011 with the help of a $1.5 million Rays of Hope grant. The center brings together a group of scientists with diverse areas of expertise who work toward reducing the impact of breast cancer — for instance, understanding how obesity, diabetes, and environmental exposures interact to alter breast-cancer risk and prognosis.

It’s important work, and not something to be taken for granted, Tobin said, adding that many events like Rays of Hope eventually peter out — Avon’s national fundraiser for breast cancer isn’t continuing this year, for example — and such events require a lot of work and diligence to thrive and grow.

“Sometimes the fundraising becomes secondary,” she added. “After a while, people want to be a part of it, but they don’t remember the fundraising piece, and that’s critical to our survival. We’re trying to drive home the point that, yes, we need your involvement, but we also need your fundraising, because that’s what makes the programs happen.”

And it’s not just Baystate programs that benefit, Tobin added. Other local organizations, like Cancer House of Hope, also rely on support from Rays of Hope.

“We’re always getting new people involved,” Carvalho said. “Unfortunately, it’s often because they have breast cancer or someone close to them has breast cancer — but that passion keeps us going, and keeps us a vibrant organization. I think we’re always going to walk until there’s a cure, and we don’t need to walk anymore.”

Personal Impact

Denise Jordan was first introduced to Rays of Hope by her late friend, Tracy Whitley, and she joined its advisory board in 2008. A decade later, she’s chairing the 25th interation of the event, dedicating her service to Whitley, who succumbed to the disease last year.

Jordan calls herself an ambassador for Rays of Hope, making public and media appearances and encouraging people to take part in the Oct. 21 walk. She hasn’t found it to be a hard sell.

“I think, as long as people are affected by breast cancer, there will always be a willingness to participate in an initiative whose main focus is finding a cure,” she told BusinessWest. “Also, unlike a lot of organizations, when you give money to Rays of Hope, you can actually say, ‘the money I gave went to this person or that person; I know that because all the money stays right here in the region.’”

During her time as chief of staff for the city of Springfield, Jordan helped establish Pink & Denim Days, when city employees took up that dress code in exchange for donations to Rays of Hope. “It was really an easy ask,” she said. “Folks were very enthusiastic.”

Rays of Hope has proven to be a meaningful event for both survivors and supporters, as well as an educational experience for all ages.

Rays of Hope has proven to be a meaningful event for both survivors and supporters, as well as an educational experience for all ages.

So was Jordan, when she was asked to chair the event this year, even though she had some reservations about the time commitment. But when she thought about her Whitley, and the way she not only battled cancer but became a strong advocate for survivors, it wasn’t a hard decision.

“There’s going to be some special things happening that day,” she said of this year’s walk. “I’m pushing to get more people involved. We’ve had participants in the past who have missed a couple walks, but, this being the 25th anniversary, we’re hoping to bring a lot of folks back to the walk.”

Tobin agreed. “We’re adding some exciting elements. We’re going to tell the story of the progress we’ve made and celebrate some joyous stories of beating the disease — and remember those we’ve lost. I think there will be some special moments.”

Having been active in the walk for 25 years, Tobin has lots of stories, but likes to recount one from the event’s first year. Her 4-year-old son attended and took in the speeches, and as he settled into his car seat for the ride home, he said, ‘I’m so glad I’m not a girl.’

“My feminist self practically slammed on the brakes,” she laughed. But when she asked why, “he said, ‘because I can never get breast cancer.’

“The earnestness of this little boy took my breath away,” she continued. “I realized in that moment the impact this walk was having, and could have, if someone that young understood the seriousness of breast cancer.”

The fact that he assumed it was a girl’s disease isn’t odd; many adults think the same thing, and Rays of Hope has created plenty of teaching moments around that misconception as well.

In short, it’s hard to overestimate the impact this 25-year tradition has had on breast-cancer treatment, research, awareness, education — not to mention the giant hug of support that so many women (and men) need.

“Lucy had certainly given us a gift,” Tobin said. “She had done something incredible in that parking lot that day, and $14.2 million later, we’ve seen a lot of profound moments.”

Added Carvalho, “there’s a spirit at Rays of Hope, and I don’t know exactly how it came to be, but it’s real, and it’s powerful, and it’s heartwarming. That’s what I’m proud of — how the community has come together to make a difference.”

Joseph Bednar can be reached at [email protected]

Business of Aging

The Dream and the Journey

Officials take up ceremonial shovels during the groundbreaking for Hillside Residence on May 18.

Officials take up ceremonial shovels during the groundbreaking for Hillside Residence on May 18.

During their long and sometimes frustrating quest to secure funding for what would eventually be Hillside Residence, the Sisters of Providence never stopped believing the project’s model — blending healthcare and affordable senior housing — was worth fighting for. Now that the development is under way, they are even firmer in that conviction.

As she talked about the long and persistently frustrating quest to secure funding for the project that would come to be called Hillside Residence, Sister Kathleen Popko summed things up by recalling sentiments she expressed at the time — words that blended diplomacy, poignancy, and even a little sarcasm.

“I would tell people, ‘though our progress is slow … I’m making a lot of friends locally, regionally, and nationally,’” she recalled, with a phrase that hinted broadly at how many doors, in a proverbial sense, were knocked on by the Sisters of Providence, which Popko leads as president, as they sought to take a dream off the drawing board.

And also at how important it was to be making those friends.

Indeed, while making all those introductions, Sr. Popko and the other Sisters of Providence were gaining even more resolve as well. And it stemmed from the firm conviction that their unique model for Hillside Residence — the intersection of healthcare and affordable elder housing, if you will — was worth fighting for.

And fight they did, for the better part of eight years, a struggle that was ultimately successful and celebrated, as much as the project itself was, at an elabotate groundbreaking ceremony on May 18.

Fittingly, Sr. Popko, during her turn at the podium that morning, borrowed from St. Francis of Assisi to convey what it took to make that moment a reality.

“The journey is essential to the dream,” she said, invoking St. Francis’s famous quote. “With hindsight, I can see the truth and wisdom in that statement. Our eight-year journey to this moment expanded and sharpened our vision, tested our determination, enlarged our circle of friends, and committed supporters to this initiative. Let us work now to realize the dream.”

That dream, as noted, is to bring innovative, health-integrated, affordable elder housing to a region, and a city (West Springfield) where there is an acknowledged need for it, said Popko.

Elaborating, she said Hillside Residence, a demonstration project, will create 36 affordable rental units to frail elders, who will receive healthcare services from the Mercy LIFE PACE program (program for all-inclusive care for the elderly). Both programs are situated on the same 27-acre campus that was formerly home to Brightside for Families and Children.

And the expectation is that this $10 million project will demonstrate that this is an effective model for bringing needed services to what has historically been an underserved segment of the population, she told BusinessWest, adding that there have attempts to create affordable senior housing, but not in the same, holistic environment that Hillside Residence will create.

“This is innovative in that it will keep frail elders independent,” she explained. “They’ll live in an independent-living facility, but they’ll be supported in a way, on the same campus, that they can access a tremendous array of services and at the same time go home and live independently.”

For this issue, BusinessWest looks at both the dream and the journey that made Hillside Residence a reality — and why both are worth celebrating.

The Big Picture

When Brightside’s closing was announced in 2009, it left the Sisters of Providence with what amounted to a 27-acre canvas that could be filled in any number of ways, said Sr. Popko.

An architect’s rendering of Hillside Residence.

An architect’s rendering of Hillside Residence.

What made the most sense, she said, was to use the land and existing buildings, part of what’s known collectively as the Hillside at Providence, to help create a broad array of senior-living and senior-care facilities that would complement each other and meet recognized needs within the community.

This was a process that actually started with the conversion of the former Sisters of Providence Mother House into an independent-living and retirement community known as Providence Place in 1999, and it continued with the creation of Mary’s Meadow at Providence, a complex on the Providence Place campus comprised of 10-person houses designed to give elders a place to live in comfort equal to that of a private home. This was the first ‘small-home’ facility, as they have come to be called, in the Bay State.

The process of filling in the canvas at Brightside was accelerated with the creation of Mercy LIFE, a PACE program operated by Mercy Medical Center that provides tightly coordinated care and support designed to help seniors continue to live safely at home and avoid moving into a nursing home, she said.

The 25,000-square-foot facility, located within what was the main administration building for Brightside, includes everything from a medical clinic to a rehab gym to gathering places.

Meanwhile, the remainder of that 78,000-square-foot administration building has been devoted to reuses ranging from hospice care to a home for elder-focused programs administered by the Center for Human Development.

What emerged as a missing piece in the puzzle — and the next dream for the Sisters of Providence — was an affordable senior-living facility, one where the residents could take full advantage of the many programs and services at Mercy LIFE.

Talks for such a facility — and thus that ‘journey’ Sr. Popko described — began in 2011, she said, adding that it took the better of eight years (and work with four different mayors of West Springfield) to secure everything from the proper zoning to the needed funding.

And the latter part of the equation became more difficult when, in 2012, HUD, the U.S. Department of Housing and Urban Development, ceased funding for so-called ‘Section 202’ projects, those aimed at expanding the supply of affordable housing with supportive services for the elderly.

“So we had to take a step back and try to look for alternative sources of funding,” said Sr. Popko. “That included private sources and looking at federal grants and so forth.

“And they really weren’t forthcoming at the time,” she went on. “We visited many legislators and congressmen, and we brought in experts to come in and talk about some other concepts we were thinking about. We had people come out here, we visited state offices … we talked to so many people.”

State Elder Affairs Secretary Alice Bonner

State Elder Affairs Secretary Alice Bonner addresses those assembled at the May 18 groundbreaking for Hillside Residence.

Like she said, progress was slow, but she and others were making acquaintances.

“Everybody was very encouraging — they kept saying, ‘go ahead, yes, do this,’” she recalled, adding that the words of encouragement were not backed up with checks.

But the sisters pressed on. They succeeded in getting the property rezoned, and eventually started making progress on funding, thanks in part to a timely visit to Mary’s Meadow by state Elder Affairs Secretary Alice Bonner in April 2016.

“I said, ‘I just need minutes of your time,’” Sr. Popko recalled, adding that she used it to give the secretary a brief overview of the Hillside Residence project and hand her a concept paper of the proposal.

Bonner put the paper in her backpack, but eventually took it out, read it, and became sufficiently intrigued to call Sr. Popko and arrange a meeting to discuss the matter.

“We brainstormed about what could happen,” she recalled, “and also about how we could remove the silos between housing and health services and bring the two closer together.”

Eventually, the sisters were able to cobble funds together for a number of state and federal sources, including the Housing Stabilization Fund, the National Housing Trust Fund, the Housing Innovation Fund program, and the Mass. Rental Voucher Program. Also, private funding was provided by the Sisters of Providence and the Harry and Jeanette Weinberg Foundation, and the West Springfield Community Preservation Committee also chipped in toward the price tag, currently pegged at $9.65 million.

The project will focus on serving individuals who are 62 and older, with incomes at 50% of the area median income (AMI) or lower, and whose healthcare needs and housing instability can be optimally addressed by the program, said Sr. Popko, adding that, because the project has secured commitment of state rental subsidies, Hillside Residence participants’ housing costs will be capped at 30% of their income.

And while meeting an immediate need for those twin services — housing and healthcare — the project will be adding to the base of research on the efficiency and effectiveness of the integration of PACE and affordable elder housing.

“This data will assist policy makers, housing developers and managers, and healthcare providers better understand the benefits and operational challenges of an integrated PACE housing model,” said Sr. Popko.

The Next Chapter

As she talked about Hillside Residence, Sr. Popko noted that there is still more of the former Brightside canvas to be filled in.

Indeed, there are several cottages on the property that are roughly 9,000 square feet in size and could be transformed into more housing for the elderly.

“We could have another 50 units on this site, but it will be even more difficult to attain funding for that,” she said, adding that those cottages comprise what would be phase 3 of the work at the Hillside at Providence and the proverbial ‘next dream.’

As for the one currently coming to fruition, she said, again, that St. Francis of Assisi was right.

“Our journey of eight years was probably essential for realizing this dream,” she said in conclusion. “Because we’ve brought together people from the state level, we’ve brought together funders, legislators, and people within the community of West Springfield, to a point where they all want this to happen. That’s what has brought us to this moment.”

That, and a firm determination never to let the dream die.

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