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Sight Restoration

Dr. John Papale says most patients who undergo cataract-removal surgery see a more than 95% restoration of vision.

Dr. John Papale says most patients who undergo cataract-removal surgery see a more than 95% restoration of vision.

As the population ages, eye problems will become an increasingly large healthcare issue for society. Fortunately, modern science and new surgical techniques are bringing improved vision — and better quality of life — to those suffering from a number of common ailments.

Several months ago during a routine eye exam, Louise Pugliano was told that she had cataracts in both eyes. The 84-year-old doesn’t drive at night and had no symptoms, but had worn glasses or contact lenses for more than 20 years, and agreed to have cataract-removal surgery.

The first procedure took place Jan. 8, and the second was done Jan. 23, and they were not only painless, but the Springfield woman was thrilled to find she no longer needs prescription eyewear.

“I’m so glad I did this; I had a great experience and wonderful results: I don’t need glasses anymore and can read the small print in the newspaper,” Pugliano said, adding that she had complete faith in her surgeon, Dr. John Papale of Papale Eye Center in Springfield.

Her diagnosed condition, treatment, and response to it are all typical of what’s happening within the broad realm of eye care today — as the population ages, more people are being diagnosed with problems, but modern science has created solutions, many of which are truly life-altering.

Papale told BusinessWest that cataract removal is the most commonly performed surgery in the U.S., and more than 3 million people have the procedure done every year. The 20-minute outpatient operation corrects vision and eliminates troublesome symptoms that affect many seniors, such as seeing halos or being bothered by the glare of oncoming headlights when driving at night.

“Most people have more than a 95% restoration of vision, assuming there are no other problems such as glaucoma and macular degeneration,” Papale said, as he spoke about conditions that affect aging eyes.

Indeed, they are common. The Mayo Clinic reports that about half of all 65-year-old Americans have some degree of cataract formation, and more than 30 million Americans are expected to develop them by 2020. In addition, more than 6.5 million Americans age 65 and older have a severe visual impairment, and rates of severe vision loss are expected to double by 2030.

Dr. Camille Guzek-Latka, an optometrist at Chicopee Eyecare, P.C., says many people use over-the-counter glasses to avoid getting an eye exam. “But the exam is important; we not only evaluate the need for glasses, we look for evidence of eye disease because, as people age, their risk of developing a problem increases.”

Annual eye exams are critical for people over the age of 60 because eye disease can cause irreversible blindness and there may be no symptoms until it reaches an advanced stage.

Dr. Andrew Jusko says an eye exam is needed to detect glaucoma, as there are no symptoms in the early or middle stages.

Dr. Andrew Jusko says an eye exam is needed to detect glaucoma, as there are no symptoms in the early or middle stages.

Although some people don’t have vision coverage on their insurance plan, Eye Care America has provided free exams to almost 2 million eligible seniors (visit www.aao.org), and health-insurance plans cover the cost if a minor medical problem is uncovered, which usually happens as people get older.

“It’s important to protect against damaging eye diseases; people are living longer today and want to maintain full visual functionality through the end of their lives,” said surgeon Dr. Andrew Jusko of Eyesight and Surgery Associates in Springfield and East Longmeadow.

Papale agrees. “The eye is our most important sense: 25% of all input to the brain comes from the eye and nerve endings,” he noted.

For this issue and its focus on the business of aging, BusinessWest examines problems that affect aging eyes and what can be done to prevent and correct them.

Cause, Effect, and Treatment

The lens of the eye consists of a flexible jelly that begins to stiffen as people enter their 30s and 40s. The condition is called presbyopia, and most people need reading glasses to compensate for the fact that their eyes can no longer shift focus easily.

“Many people in their 40s and 50s get by with over-the-counter reading glasses, but by the time they reach their 50s or 60s they usually don’t work well,” Jusko said, adding that early stages of other diseases such as diabetes or hypertension can be seen in the eyes during an exam.

Cataracts cause the lens to change from crystal clear to cloudy, and typically develop as people age. They don’t harm the eye but do affect vision, and surgery to correct the problem involves replacing the aging lens with an artificial one.

In the past, eye drops were always needed for a few weeks following the procedure, but Guzek-Latka said a newer approach is often used today called ‘dropless cataract surgery,’ which occurs when the surgeon injects a combination of antibiotics and steroids into the eye at the time of the procedure to reduce the need for drops after it.

“The surgery is safe and wonderful; it can restore sight, reduce the risk of falling, and people are thrilled with the results,” she noted, adding that, although cataracts are related to aging, prolonged use of steroids for conditions such as asthma can cause them to develop earlier.

Cataracts are a change that occurs as the eye ages, but glaucoma is an age-related disease that causes blindness as the peripheral or side vision is lost.

“It’s called the silent thief of sight because the vision loss occurs slowly and painlessly,” Guzek-Latka said, adding that the condition is linked to a buildup of pressure inside the eye, but it can take many years for the vision loss to occur.

The disease can start in the 40s, but risk increases with age. “People cannot tell if the pressure inside their eye is normal, so they can be going blind and not know it,” Papale told BusinessWest, noting that, since glaucoma frequently only affects one eye, the other eye compensates for it so the person doesn’t realize what is happening.

As a result, it’s critical to catch the disease before irreversible damage is done. “An eye exam will show whether the pressure is normal and if the optic nerves appear abnormal,” Jusko said.

Some forms of glaucoma can be cured, and treatment ranges from surgical procedures to prescription eye drops that control pressure inside the eye.

Jusko often uses eye stents during surgery, which are small devices implanted in the drainage area of the eye to help reduce the need for future medication.

“The average age for glaucoma is the 70s, which is about the same age that people need cataract surgery,” he said, noting that stents can also be used during that procedure.

Age-related macular degeneration, or AMD, is one of the most serious eye diseases and the leading cause of blindness in seniors. “The macula is the part of the retina that gives you the sharp vision you need to read, drive, and recognize faces,” Papale said.

More than 2 million Americans are afflicted with some form of the disease, and that number is expected to more than double to 5.4 million by 2050 due to the aging population.

“It’s the leading cause of irreversible vision loss in people age 50 and older, and treatment for it is limited,” Guzek-Latka said.

“There are usually no symptoms in the early stages, but the disease can be seen when the pupil is dilated during an eye exam,” she continued, adding that, as the disease progresses, it causes distortion in the central vision. “People can still see things on the side, but they can’t read, and faces often appear as dark gray areas. Most people think blindness means total blackness, but it’s very rare not to be able to see any light.”

The cause of AMD is unknown, but it’s important for people to be aware of risk factors. Smoking doubles the risk of macular degeneration, it tends to run in families, women are more likely to develop it than men, and it is more common among Caucasians than African-Americans, Hispanics, and other races.

“People might be able to reduce their risk of macular degeneration or slow the progression by making healthy choices such as regular exercise, maintaining normal blood pressure, quitting smoking, and eating a healthy diet rich in green, leafy vegetables and fish,” Guzek-Latka said.

The disease is divided into two categories — wet macular degeneration and dry macular degeneration. Although there are no symptoms associated with early dry macular degeneration, the vision becomes distorted over time, and once function is lost, it cannot be restored.

However, further damage may be prevented with special vitamins formulated for the eye. “But we don’t recommend taking them unless the person has been diagnosed with macular degeneration,” Jusko said, noting that studies show no definitive or preventive benefits for people without the disease.

Wet macular degeneration is caused by the growth of abnormal blood vessels under the macula that are fragile and prone to bleeding.

“The bleeding is not visible because the macula is in the back of the eye,” Papale said, adding that the dry form of the disease can progress to the wet type.

Treatment includes injections of medicine that block the growth of abnormal blood vessels and can lead to some improvement.

“It won’t cure the disease, but it’s definitely an advance; 10 years ago, there was less hope for people with wet macular degeneration then there is today,” Guzek-Latka said.

She added that FDA approval was granted for an implantable device in 2010 that is used at the end stages of the disease. It’s the size of a pea and magnifies images onto the retina.

“But it’s only used as a last resort. It will not restore vision, but might allow someone to identify faces, even if they are not clear,” she said.

Diabetes is another disease that affects the eyes. According to the National Eye Institute, 40% of Americans over age 40 have some degree of diabetic retinopathy, and one of every 12 people with diabetes in this age group has advanced, vision-threatening retinopathy.

That’s a condition that results when small blood vessels in the retina leak blood or other fluids that cause progressive damage to the retina, which is the light-sensitive lining at the back of the eye.

“Once someone is diagnosed with diabetes, they need yearly eye exams to detect it,” Jusko said.

Treatment ranges from the use of lasers to injections and surgical procedures, and primary-care physicians usually work closely with the person to ensure their blood-sugar levels and blood pressure are under control.

Hope for the Future

Dry eye is another condition that can affect people of any age, but is more prevalent in elders and post-menopausal women. It results from inadequate tear production and causes burning, stinging, itching, or the feeling that sand is in the eyes.

It can be alleviated with over-the-counter lubricating drops, fish-oil supplements, and vitamin C. But dry eye that is moderate or severe can cause damage, so people whose symptoms aren’t helped with over-the-counter remedies should see their eye doctor.

There is no doubt that eyesight is affected as people age, but there are things everyone can do to help to prevent disease. Eyes need good blood circulation and oxygen intake, and since both are stimulated by regular exercise, it ranks high on the list.

People should also do their best to maintain normal blood pressure and cholesterol levels, and wear sunglasses that block ultraviolet light.

But getting an annual eye exam is the most important measure anyone can take to preserve vision.

“Eyesight is our most important sense,” said Guzek-Latka. “We rely on it for so many things, and having good vision is a driving factor in people’s well-being as they age.”

Community Spotlight Features

Community Spotlight


Mike Sullivan

With many key projects completed last year, Mike Sullivan says, the town is now assessing its next moves.

Town Administrator Mike Sullivan said 2016 is shaping up to be a transitional year for South Hadley, but not necessarily a quiet one.

“A lot of projects finished last year,” he said, listing completion of a new library, high school, elementary school, and two new parks among them. “Things are steady. Now we’re assessing where we’re at and where we need to go.”

Several avenues have already been pointed out for the Hampshire County town of 17,000, guided by an expansive, town-wide renewal plan with a focus on creating healthy environments, giving the overall commercial landscape a boost, and collaborating whenever possible with neighboring communities.

The latter has been a necessity for South Hadley since its incorporation in 1775, largely due to geography. It’s in a unique spot; bordered by Hadley, Amherst, Granby, and Chicopee, and separated from Holyoke and Easthampton by the Connecticut River, South Hadley is insulated by a series of canals, rivers, and reservoirs, and isn’t fed by any interstate highways. It’s long depended on cooperation with its neighbors, particularly Holyoke, but with the town on solid footing with some new, positive developments on the horizon, Sullivan said South Hadley is positioned to offer its neighbors plenty in return.

South Hadley formed an official redevelopment authority last year, which is now working out a plan for revitalization that will begin in the area of South Hadley Center — commonly known as ‘the Falls,’ a former mill village with historic industrial roots — and branching out across town from there.

“It’s been a detailed and aggressive endeavor,” he said, noting that the plan will be presented to town meeting this year and, if approved, must then also be accepted by the state in order to access grant funding and other opportunities.

“Like most mill villages, we’re looking to regenerate the community and adapt it to be a cool place. The attempt is not to gentrify the mill village by any means — the attempt is to make it more habitable, safer, and particularly more pedestrian-friendly.”

As arguably South Hadley’s largest presence, Mount Holyoke College — and the college-owned Village Commons and Orchards Golf Club — is an active presence in the town’s revitalization efforts. Kevin McCaffrey, director of Government and Community Relations in the office of the president at the school, said Mount Holyoke has ramped up its community-support efforts of late, ranging from collaborations with the town’s schools to planning assistance for a new network of recreational trails that extends the walkable-town concept across the community.

“Mount Holyoke has very close ties to South Hadley in terms of economic development and revitalization, and we work every day to strengthen our relationship to the community,” he said, noting that, most recently, the college contributed $300,000 toward the Bachelor Brook Stony Brook Conservation Area and constructed a new boathouse with a community-rowing component, among other projects.

“Mount Holyoke is closely involved with South Hadley in planning efforts around issues such as development of new bike- and hiking-trail opportunities to enhance the quality of life for residents and our students alike,” added McCaffrey. “Our local connections, already strong, have strengthened further under President Lynn Pasquerella, who is very committed to community outreach, and should continue to grow under acting President-elect Sonya Stephens.”

Jeffrey Labrecque, chief operating officer of the Village Commons, has a similarly positive view of South Hadley’s overall business picture and how it’s positioned for the coming years. Today, the town has an opportunity to tackle some key issues surrounding growth in the business sector, he said, including increasing the commercial tax base in hopes of reducing the residential tax burden.

“I see business in South Hadley as being very steady, with a sudden increased interest in commercial and retail opportunities and with restaurant growth exceeding expectations,” he said, noting that conditions at the Village Commons reflect this stability; the mixed-use complex with a focus on retail, restaurants, office, and residential space is currently at 98% occupancy.

“On the office side, interest has calmed down, but business is stable. South Hadley’s ‘big little village’ continues to thrive and brings in business from all over the Valley,” he went on. “Most importantly, we are here to stay, we are invested, and we voluntarily support the community, its events, and its goals on a variety of levels.”

The Commons is eyeing possible expansion opportunities of its own, perhaps in the areas of additional leasable space or parking. Any move on the part of the Commons or South Hadley at large, said Labrecque, should be made to ensure a strong position in the local market, and always with an eye toward what’s happening in adjacent towns.

“There is a lot of growing competition in neighboring communities, and the future may very well lead to shared departments and services with neighboring towns,” he said. “We would be remiss in our position to sit back and watch; we need to always be looking for new ways to improve growth.”

Making Paper Tigers

In that regard, Sullivan said South Hadley has recorded a few wins lately. One of the most heralded developments in the Falls recently was the arrival of Mohawk Paper, the largest family-owned producer of envelopes in the country. Mohawk’s plant moved into a group of buildings formerly known as the U.S. Gaylord properties last year, and makes more than a million envelopes a day.

“It was quite a coup,” said Sullivan. “They were looking at plants not only in this region — in Chicopee, Westfield, Holyoke — but also locations in other states, including New Hampshire and Connecticut. We see having them choose South Hadley as a big success.”

What’s more, the properties still have more than 200,000 additional square feet of space available that the town is now actively looking to fill. Labrecque said Mohawk’s arrival was exactly the kind of boon South Hadley was hoping for, and added that he sees several other hot spots for development, including the now-vacant Newton Shopping Plaza.

The Village Commons

The Village Commons, a mixed-use complex of retail, eateries, offices, and apartments, is 98% occupied.

“We’re seeing some great growth on the commercial-industrial side, and I remain hopeful that will support additional commercial interest,” he said. “While there are many areas of concern, I hope that much of the focus goes to Bridge and Main streets and the corner of Newton and Lyman streets. Route 33 from Newton Street to Chicopee also has prime areas of opportunity.”

Labrecque noted that growth in the commercial sector is the ultimate goal, but he does see development in the housing market as one of the town’s most immediate opportunities.

“I foresee huge opportunities, especially in the area of rental housing,” he said. “For some 26 years, the Village Commons has maintained a residential waiting list that at times could exceed 30 anxious prospective tenants. Whether you add housing on Main Street or College Street, there will continue to be a need.”

Sullivan agreed that South Hadley’s residential base is solid, and improvements to its infrastructure are very much on the town’s to-do list, in order to continue to attract residents, visitors, and businesses alike.

“We need to improve the housing stock,” he said. “We’re hoping this spurs investment in other properties from people around them who haven’t invested in years but might start feeling a new level of confidence. We’ve been very aggressive enforcing codes and health and safety regulations, particularly among absentee landlords.”

Age-old Practices

Two separate condominium projects are now underway in town — six units in the former public library through a $1.8 million investment, and plans for a second condo development near the new library building have just been approved, raising that investment in housing to nearly $3 million.

It’s a move that goes back to the overall redevelopment plan for the town — “those are the kinds of gateways you want to make really inviting to have people see the value of the community right away,” noted Sullivan — but development in the housing sector is also one aspect of a larger effort to continue to cultivate South Hadley’s strong niche in the business of aging.

“South Hadley is not an aging community so much as it is a community that is investing in aging,” he said. “Whether the community recognized it or just through happenstance, they have positioned the town very well to be ready for that industry.”

Sullivan listed elder-care businesses including Loomis Communities, Wingate at South Hadley, and Hubert Place, a federally funded supportive housing development for residents 55 and older, as examples.

“There are also early talks happening now regarding the construction of a new senior center for the town,” he went on, “and of becoming a ‘dementia-friendly community,’ a commitment to working with issues around people with changing abilities due to diseases of the brain.”

To that end, April will be Dementia Awareness Month in South Hadley, and the town is now exploring AARP’s Age-friendly Communities program to develop practices for walking, biking, and other outdoor recreation opportunities that are suitable for users of all ages. If approved, South Hadley would be the first community in Western Mass. to hold the title, and Sullivan hopes the focus on creating walkable areas will resonate with residents of all ages.

One project underway is a shift in operations at the town-owned Ledges Golf Club. The course’s general manager will now serve as the town’s recreation director, with the goal of attracting more South Hadley residents to the property for myriad activities year-round, from walking to snowshoeing. Sullivan said he’s also keenly interested in creating a walking path to Holyoke’s train station, less than a mile away from the center of South Hadley.

“People could walk across a bridge and access transportation to New York or Montreal,” he said. “We think that’s one of those cool features that could be an economic catalyst for South Hadley.”

Stakes and Bonds

All of these endeavors demand collaboration within South Hadley and beyond, but Sullivan, McCaffrey, and Labrecque each told BusinessWest that the climate in town is one more accepting than ever of cooperative ideas aimed at cost savings, efficiency, and economic growth.

“We work with the college quite a bit,” Sullivan said, “and we get a lot of cooperation from many surrounding towns, including Granby, Ludlow, Hadley, Chicopee, and particularly Holyoke. Holyoke Mayor Alex Morse understands the connection that exists between the city and South Hadley.”

McCaffrey said Mount Holyoke also sees that link and many others, and is actively creating programming aimed at the revitalization of South Hadley and economic growth region-wide.

“We’re very interested in discussing further opportunities,” he noted. “South Hadley’s economic health and our health as a college are intertwined, and we are always looking for opportunities to strengthen the bonds of South Hadley.”


South Hadley at a glance

Year Incorporated: 1775
Population: 17,514 (2010)
Area: 18.4 square miles
County: Hampshire
Residential and commercial Tax Rate:    $19.85 (Fire District 1); $20.49 (Fire District 2)
Median Household Income: $46,678
median family Income: $58,693
Type of government: Town Administrator,      Town Meeting
Largest employers: Mount Holyoke College, Loomis Communities, Mohawk Paper
* Latest information available

Business of Aging Sections

Emperor of All Maladies Author Says the Pieces Are in Place

Dr. Siddhartha Mukherjee

Dr. Siddhartha Mukherjee says the so-called ‘cancer moonshot’ will provide a road map for advancing the fight against the ‘emperor of all maladies.’

As he delivered his talk, “The Changing Landscape of Cancer,” to a large audience at CityStage earlier this month, Dr. Siddhartha Mukherjee had a PowerPoint presentation running on a large screen behind him.

In a way, it represented a seriously condensed but still highly informative version of his book, The Emperor of All Maladies: A Biography of Cancer, for which he won the 2011 Pulitzer Prize for general nonfiction, and it led with what amounted to a trailer for the Ken Burns-produced PBS film documentary based on the book.

One of the slides, kept on the screen for several minutes, depicted one of the now-famous full-page ads that ran in newspapers across the country in December 1969 with the screaming headline: “Mr. Nixon: You Can Cure Cancer.”

While one might debate whether those spots legally constituted false advertising, Mukherjee implied, they certainly amounted to wishful thinking — very wishful thinking.

Indeed, neither the nation’s president nor anyone else could cure cancer 47 years ago, he explained, because the scientific community simply didn’t know enough about the disease to remotely approach that ambitious goal.

Mukherjee said those ads, inspired by and paid for by Mary Lasker, the noted health activist, philanthropist, and champion of medical research, were a prime catalyst for what he called “the war on cancer 1.0” — a war declared far too early to result in even partial victory, but one that set the stage for later triumphs.

“We had no understanding of the physiology of a cancer cell, let alone what caused it to turn cancerous, and yet a war on cancer was launched without that understanding,” he told his audience, there, as he was, to celebrate the expansion of the Sr. Mary Caritas Cancer Center. “People have often said that this is like saying, ‘we’re going to the moon’ without having seen a jet engine; that’s what the situation was like.”

Nearly a half-century and seven U.S. presidents later (many of whom have declared what amounted to their own versions of a war on cancer), the situation is much different, said Mukherjee, because the world knows exponentially more about the physiology of a cancer cell and why a cell becomes cancerous.

And this new landscape certainly provides more optimism for the latest declared war on this disease — the so-called ‘cancer moonshot’ (a term that only reinforces Mukherjee’s analogy) — that was announced in January.

“We understand cancer at a cellular and molecular level that we didn’t understand before,” Mukherjee told BusinessWest prior to his talk. “We understand what causes cancer, we understand its progression, we understand some, but not all, of its risk factors, and we have not one, not two, but really several dozen important breakthrough therapies for several forms of cancer.

“The question now is how to deliver those therapies carefully, how to deliver them to the right people, how to pay for them, and much more,” he went on. “Meanwhile, there are many cancers that are difficult to cure and difficult to treat, and they will remain frontiers.”

In essence, the cancer moonshot is expected to yield a road map (a term Mukherjee would use early and often) — actually, several of them — for crossing those frontiers and answering all those questions, he went on, adding that this initiative will bring new layers of progress to what he called a “transformative impact” on understanding and treating the many cancers seen over the past half-century.

For this issue and its focus on the business of aging, BusinessWest took the opportunity to talk with one of the world’s leading cancer physicians about the stunning progress achieved to date and how the next chapter in cancer’s biography will unfold.

A Hard Cell

Reducing a few thousand years of conflict between humans and cancer down to a 55-minute presentation wasn’t easy, but Mukherjee, an assistant professor of Medicine at Columbia University and staff physician at Columbia University Medical Center in New York City, managed by focusing on basic science, the milestones in the history of cancer treatment, and the people who made them possible.

Thus, his powerpoint featured slides on everything from surgeon William Halsted’s 19th-century “radical mastectomy” to Mary Lasker’s newspaper ads, and on everyone from Rudolph Virchow, often called the father of modern pathology and noted for his early work on leukemia, to Sidney Farber, considered the father of modern chemotherapy, to Barbara Bradfield, a pioneer (she was patient zero) in the development of Herceptin, a treatment for breast cancer.

His lecture on the history of the disease and mankind’s attempts to cure it focused on several stages he detailed in his 594-page book. They include, more recently, ‘cancer as a disease of cells’ — the period roughly from 1860 to 1960; ‘cancer as a disease of genes’ (1970-1990); ‘cancer as a disease of genomes’ (1990-2010); and the current stage, ‘cancer as a pathway disease.’

He brought his audience from the first identification of cancer some 4,600 years ago by the Egyptian physician Imhotep to current events, including groundbreaking initiatives to rapidly determine the sequencing of genes in tumor cells, leading to new treatment platforms.

Describing what’s been accomplished to date, he used words such as “remarkable” and “unprecedented,” words he says are fitting given the resilience, complexity, and sheer uniqueness of the disease and each case of it.

“Every single cancer, at the genetic level and the genomic level, is its own cancer, and every single patient is its own patient,” he explained. “We knew this 100 years ago, but we really learned this 100 years later.

“There is no disease — and I will argue that there are few problems in human history — where the level of diversity of the problem, the level of complexity of the problem, is equal to the number of people who have the problem,” he went on, urging his audience to consider the magnitude of what he just said. “Cancer is that problem … and that makes it different than any other disease, and that’s what makes it the emperor of all maladies.”

But while his book, and his lecture, amounted to history lessons, Mukherjee said his current focus is obviously on what comes next, and this brings him back to the cancer moonshot.

“This is an incredibly important effort,” he told BusinessWest before his talk. “It clarifies what the goals are, and that is to have a transformative effect on cancer care over the next 100 years.”

When asked what the initiative, officially named Cancer Moonshot 2020, might accomplish by that date, he said simply, “a line in the sand,” before elaborating and returning to that analogy of drawing a road map.

“What will happen over the next four years is that we will clarify that road map, which will hopefully stay with us for the next 80 to 100 years to remind us what the big goals are and whether we met the goals or didn’t meet the goals,” he explained. “We may at times go off the road because we don’t understand something, but as long as we have a sense of what that landscape is like, we can stay on track.”

Again, there will likely be several road maps drawn, he went on, adding that there are, indeed, several fronts in any war on cancer.

One is obviously treatment, he said, noting that considerable progress has been made with some cancers, including blood cancers — leukemia and lymphomas — as well as lung cancer, breast cancer, colon cancer, and prostate cancer.

Another front is prevention, which of course plays a huge role in the larger effort to stem the tide of the disease and greatly reduce the numbers of individuals who will die from it. And within the discussion concerning prevention lies the overarching question concerning whether cancer — or specific cancers — can indeed be prevented.

Some carcinogens, such as smoking, have been identified, said Mukherjee, adding that great uncertainty remains about how many more are still to be recognized. And this is a huge issue moving forward.

“That’s an open question on the table and a very important question: are there still out there major preventable chemical carcinogens — have we missed some?” he asked rhetorically.

“And if we haven’t missed some, what do we do about the fact that the rest of it is spontaneous errors, accidents when cells divide?” he went on. “That has many, many, many consequences, and there have been four or five highly controversial papers back to back in major scientific journals, one claiming the former, the second claiming the latter, one saying it has to do with cells making errors when they divide, the other making the claim that the environmental impact has been underappreciated, and there may be some hidden, unknown carcinogenic input.

“We need to sort that answer out,” he continued, “because it’s a fork in the road, whether we move in one direction or the other.”

There will be several similar forks to confront in the years to come, he said, adding that, beyond treatment and prevention, there are other large issues to be addressed, such as handling the cost of this battle, deciding how resources are to be committed, and drafting a plan for making this a truly international moonshot, not a solely American initiative.

Prescription for Progress

Almost immediately after Cancer Moonshot 2020 was announced, skeptics said it is as unlikely to achieve its stated goals as the initiative launched by President Nixon nearly five decades ago.

Mukherjee is far more optimistic. He notes that the pace of progress has greatly accelerated in recent years as more becomes known about the disease, and that enough will soon be known to not only draw a map, but enable society to reach its destination, one where cancer is far less the killer that it is now.

And he should know. After all, he wrote the book on the subject — a biography for which there are many chapters still to write.

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

Business of Aging Sections
Hospice Brings Quality of Life to Dying Patients, Families

Sarah Jackson, left, and Carol Lewis

Sarah Jackson, left, and Carol Lewis say the team aspect of hospice care is one of its most important features.

There’s a big difference, Leslie Hennessey said, between giving up on life and accepting that the end is near.

“Hospice simply gives people more support toward the end of life,” said the volunteer coordinator for Holyoke VNA & Hospice Life Care. “It’s not giving up; it’s changing the way we look at life. Do you want to go to your beach house one last time? Do you want to go see the Red Sox? We’re really focusing on quality of life, not how many days, weeks, or months you have left. The perspective changes; what’s really important to you? Because now is the time to do it.”

In short, families that choose hospice care for their dying loved ones “aren’t throwing their hands in the air. They’re saying, ‘this is what’s really important to us.’ A lot of times, that’s just spending time together as a family, saying the things they need to say.”

Most hospice programs follow the same format, Hennessey told BusinessWest. “The family and the patient generally meet with their physician about the diagnosis they have, and the physician has to certify that they have less than six months to live if the disease follows its normal prognosis. When we get the referral, we can admit them to hospice.”

It’s also a team approach to care. “Every patient gets a hospice nurse. They can also have a social worker if they’d like, a home health aide, or volunteer services if they choose. On top of that, we have other complementary services; we have a therapeutic heart program, a harpist to play at the bedside for the patient, and a pet therapist who visits patients in nursing facilities. I have a couple of volunteers who practice Reiki and energy work; we can offer that to patients as well.”

Carol Lewis, director of hospice at Spectrum Home Health and Hospice Care in Longmeadow, explained that “we’re looking for patients who have a terminal diagnosis that requires symptom management by nurses who have expertise in that area, and are educated in taking care of the holistic needs of that community. That’s the broad picture of what we do.”

She also stressed the team aspect of hospice care. “That’s the unique aspect of it; it’s a team of trained professionals that address these needs, and it’s not only about the patient, but supporting the family as well.”

For this issue’s focus on the business of aging, BusinessWest takes a look at an area of healthcare that has been growing in prominence as America’s 65+ demographic soars to record numbers — and the many ways hospice care is providing, if not hope for recovery, a measure of peace and acceptance for those approaching the very end of life.

Rising Tide

Indeed, 2009 saw 1,341,391 patients access hospice care; last year, that figure had risen to 1,542,737, a 15% increase.

There’s some statistical evidence that palliative, or comfort-only, care brings real benefits to the dying or critically ill. A study several years ago at Massachusetts General Hospital divided a group of stage 4 lung cancer patients into two groups; all of them received traditional chemotherapy through a physician, but half also enjoyed the services of a palliative care team.

The results, published in the New England Journal of Medicine, showed a measurable difference in the amount of anxiety and depression, while patients who had received palliative care from the start averaged a three-month survival advantage.

While some palliative care includes curative treatment, however, hospice is reserved for patients who forgo all but comfort-centered care; in other words, they’re no longer fighting to get better.

Sarah Jackson, executive vice president of Spectrum, explained that patients can receive hospice care in any community setting.

“Wherever you are, you can select a hospice benefit,” added Paula Boss, executive director of Holyoke VNA & Hospice Life Care. “At home, a nursing home, assisted living, a friend’s home — you can receive hospice care.”

At the heart of hospice care, Hennessey said, is a cadre of volunteers who spend time with the patient, particularly when their loved ones aren’t able to do so.

Leslie Hennessey, left, and Paula Boss

Leslie Hennessey, left, and Paula Boss say hospice services are available to patients wherever they live, whether at home or in a community care setting.

“They can’t provide any personal care or give medications, but they can be a presence in the house, sitting vigil with hospice patients. When a hospice patient is considered to be in the last hours of their life, and especially in nursing homes, if the families are far away and traveling to get to the person, our volunteers will sit with them until their loved ones get there. Families don’t want their loved ones to be alone.”

She said Holyoke’s volunteers hail from all walks of life. “A lot of folks have had experience with hospice in the past and loved ones in a hospice program, and they felt like they wanted to give something back; they realized how important it was, that extra support, how much they appreciated it, and they want to do that for another family.”

Hennessey said she conducts trainings twice a year for people who want to help in this manner. “Sometimes they say, ‘I don’t know if I can do this, but I want to try.’ They’re very special people.”

After all, she noted, “if you’re a hospice volunteer, you have to understand that every patient will die. That’s what we tell them on the phone before we even send them the information packet; I need them to know that every person they meet will die, and I ask, ‘how do you feel about that?’ It’s something they really need to consider. They know what they’re getting into when they walk through that door. They’re amazing.”

Lewis said Spectrum’s program also offers the services of a harpist with a degree in thanatology, the study of death, as well as service dogs that provide comfort to patients and their families.

“We also have a chaplain as part of the team,” she said. “When I say holistic care, I mean we meet physical needs, emotional needs, and more. Sometimes the chaplain is looking at some life review with the patient and the meaning of life, providing some comfort, or maybe just some reading at the bedside.”

Whether it’s the nurse, social worker, home health aide, chaplain, or volunteer at the bedside — and families can call for help 24/7 — hospice care is just as much a benefit for the family as it is for the patient, Jackson said. “We can be helpful for families, giving the caregiver a little bit of respite, by sitting vigil with their loved ones, having a volunteer come in for an hour or two so the family can take a break.”

At the same time, Lewis said, hospice staff takes time to educate the family so they can provide more effective care when hospice workers and volunteers aren’t nearby. “That really helps in the grief process, to look back and know you helped provide the comfort.”

Typically, hospice care includes a full year of grief counseling for the family after the patient dies, Boss said. “Often, the grief really hits them after the funeral, and they have continuing needs.”

Setting the Record Straight

Lewis said families often have misconceptions about what it means to elect hospice care. For instance, “a lot of people think they can never go to the hospital. But any time they need a level of care that isn’t offered in hospice, an emergency situation where they might need short-term help, they can go to the hospital.”

Also, Boss noted, “some people think they don’t receive any medication anymore, but that’s not the case. Yes, we often discontinue medications that are not needed for comfort or pain. But some cancer patients receive chemotherapy if there’s a comfort purpose and not a treatment purpose. We’re very strong on keeping people comfortable.”

Hennessey told BusinessWest that hospice benefits are typically covered by Medicare and Medicaid, as well as most private payers. “It’s not always something you’re looking for in your benefit package when you sign up, but most insurances have a hospice benefit, and it can be a huge benefit to families.”

The question for those families is when to take that step and admit that quality of life is more important than fighting an uphill battle for recovery. The growing ranks of older Americans have made end-of-life care a hot topic these days, and a tricky one.

That’s because, while doctors can extend life, often by artificial means, to a greater degree than ever, that intervention is often prohibitively expensive, and the quality of that life often dubious. So, increasingly, patients, families, and caregivers face hard questions — not about whether doctors can add weeks, months, or years to the life of a dying patient, but about whether they should.

“Awareness of hospice has increased, but barriers are still there — a lot of cultural barriers,” Boss told BusinessWest. “Some cultures really don’t understand the hospice benefit; they don’t understand all the things we can bring to them. There’s still a long way to go. A large number of patients are eligible to benefit from hospice, but never elect it.”

Hennessey cited a statistic that about 21,000 patients receive hospice care annually in Massachusetts, about 40% of all deaths. “It’s a good number, but it would be great if it was all patients, or close to 80% of patients.”

She also noted that the median length of hospice care is only 23 days, which means patients and families are often opting for it much later than they’re eligible. “We’re working with doctors and facilities to identify folks who could really benefit from these programs,” she said. “The benefit is for a life expectancy of six months, but in 23 days, we’ve just got things arranged, and then, unfortunately, we lose the patient.”

Lewis agreed. “Unfortunately, some families wait until the very end to contact hospice, but we’re able to get involved six months before the end, when there’s time to develop relationships with the team and to provide quality of life while the person is still here.

“It’s a chicken-and-egg situation,” she added. “A lot of times, people call us at the end, so the community sees us coming at the end and think we’re heavily associated with the end of life. But it’s earlier in the process that hospice really has its true benefit.”

So hospice advocates continue to get the word out to doctors and the public.

“It’s not giving up hope, throwing your hands up, saying, ‘I can’t cure this,’” Hennessey said. “I want to put you in the hands of people who can manage your pain symptoms so you can get the best life you can out of your last months.’”

Joseph Bednar can be reached at [email protected]

Business of Aging Sections
Fallon’s Summit ElderCare Sets a New Standard

Pam White and her mother, Helese

Pam White and her mother, Helese, in the library at Summit ElderCare in Springfield.

Pam White is an only child, and is still many years from being in a position to retire.

Which means that she faces some significant challenges in her role as caregiver for her mother, Helese, who has several health issues, but is neither ready nor willing to move into a nursing home.

Pam told BusinessWest that, as she launched a search for a solution to her dilemma, she did so with a specific mindset. She was looking for a facility that was a step above adult day care and two or three steps above a community senior center — a place where medical care was available in the form of an on-site geriatrician, but where there was also a strong social component with a host of activities for a diverse group of seniors.

She has found all this and a lot more at Summit ElderCare, a PACE (Program of All-inclusive Care for the Elderly) facility operated by Fallon Community Health Plan in Springfield’s North Medical District.

The facility, which opened its doors roughly a year ago, now serves 53 individuals with roughly the same needs as Helese. They are called ‘participants,’ rather than ‘clients,’ ‘patients,’ or ‘customers,’ because that term best describes what they are, said Kristine Bostek, vice president and executive director of Summit ElderCare.

Elaborating, she said they are participating in a program, based on a national model of coverage recognized by both Medicare and Medicaid, that provides medical care, geriatric case management, care coordination, adult day health services, full insurance coverage (including Medicare Part D prescription coverage), and in-home support in a personalized setting that features interaction with other seniors and a host of activities.

All of this resonated with Pam White.

“My mother is a very social person, and what appealed to me is that there would be other seniors involved in this program,” said White. “I wanted to engage my mother in a program where they have activities, and where it’s obviously a safe environment.

“It’s like one-stop shopping,” she went on, referring to the range of services offered at the facility. “They have a primary-care physician that specializes in geriatrics, and if my mother needs lab work, that can be done. And if I were trying to do that as caregiver, I’d be running here and running there, and that’s difficult with my work schedule.”

Kristine Bostek

Kristine Bostek says Summit ElderCare calls those it serves ‘participants’ — rather than clients, patients, or customers — because that word best reflects what they are.

The Springfield location is one of five now operated by Summit ElderCare in Central and Western Mass., said Bostek, adding that the company started with a location in Worcester in 1995 and eventually added a second facility in that city before eventually expanding into Charlton and Leominster. Further expansion into the Merrimack Valley is now under consideration.

An assessment of the Western Mass. market several years ago revealed a need for a PACE facility there, said Bostek, noting that, after consideration of several possible landing spots, the company eventually chose a location in Springfield in a new medical building on Wason Avenue built to Fallon’s specifications.

One year after opening that site, the company is on target with regard to growth, said Mary Woodis, RN and site director, adding that this location will likely hit its goal of 250 participants within three years.

For this issue and its focus on the business of aging, BusinessWest takes an in-depth look at Summit ElderCare’s Springfield facility and how it is improving the quality of life for both participants and their caregivers.

Senior Moments

Bostek told BusinessWest that the PACE concept is gaining considerable traction across the country, with more than 100 sites currently operating nationwide.

Fallon is now the fifth-largest PACE provider in the nation, with 900 total participants, and the largest in New England, she said, adding that the company is a firm believer in this model of healthcare because it provides a viable option to more expensive nursing-home care, and will only become more popular as the population ages because of the many benefits it provides for people like Helese — and the peace of mind it offers to those like her daughter Pam.

The concept was described by both Bostek and Woodis as a “community-based alternative to nursing-home care,” and one with two critical elements: a healthcare component and a social component, which are both considered critical in the delivery of complete care to a participant.

Elaborating, Woodis said Summit ElderCare provides geriatric case management, care coordination, and a host of additional services that include:

• On-site medical care;
• 24/7 emergency access to a staff member;
• Physical and occupational therapy;
• Adult day services;
• Medically necessary supplies and equipment;
• In-home assistance;
• Medically necessary transportation;
• Nutritional counseling;
• Caregiver education and support; and
• Full medical and prescription drug coverage.

The model has met with a good deal of success in Central Mass., as evidenced by the steady base of expansion, said Bostek, adding that, by the start of this decade, the company was actively pursuing opportunities to bring the concept to other parts of the state.

“Based on experiences in Central Mass., we felt there was a huge opportunity to take this model into this part of the state,” she said of the Greater Springfield area. “So we embarked upon a plan to expand in Western Mass.”

The 14,500-square-foot Springfield facility is licensed to serve residents of Hampden County and a few communities in Hampshire County, said Woodis, adding that, while many of the current participants are from Springfield, several other communities are represented. To be eligible for the program, individuals must by 55 or older and meet clinical criteria that Bostek summed up with the phrase “nursing-home-eligible.”

Mary Woodis

Mary Woodis says people come to the program for their medical care, but also for the social aspects.

The current mix of participants includes individuals across a broad age spectrum, said Woodis, adding that many are in their 60s, while a few are in their 90s, and there’s one centenarian. Some have cognitive issues, such as dementia or Alzheimer’s, while others do not, and there is a growing number of what would be considered younger seniors with neuromuscular disorders such as MS and ALS.

“A PACE participant, in general, is a frail, older adult,” said Dr. Alison Grover, the on-site gerontologist at the facility. “They probably average in their low 80s with multiple medical problems and usually some difficulty with mobility and self-care.

“It’s not at all unusual to have some level of memory impairment as well,” she went on, “and it’s our mission to keep such individuals in their home as opposed to in a nursing home.”

Summit Eldercare makes this possible by providing that one-stop shopping Pam White described.

Care Package

Elaborating on this concept, those we spoke with all used the phrase ‘integrated model of care’ to describe what’s offered, meaning both medical care and the many social aspects of the PACE program available at the Wason Avenue facility.

“People come here for their medical care,” said Bostek, referring to everything from visits with Grover to occupational and physical therapy. “But they’re also here for the social aspects of this program, doing things with other participants.”

It is this “complete package,” as Grover called it, that separates Summit ElderCare from a typical senior center and adult day care facilities, and also enables older adults to stay out of nursing homes.

Woodis said activities run the gamut from arts and crafts to computer classes; from reading in the facility’s small library to healthy-cooking classes. On the day BusinessWest toured the facility, a Mother’s Day tea was in progress. Participants helped create tissue-paper flowers and also baked pies for the attendees.

The key to effectively providing this integrated model of care is teamwork, said Grover, and there are many members on the team, including nurses, physical and occupational therapists, a nutritionist, social workers, a transportation coordinator — who oversee work to get participants to and from appointments — and others.

Each day starts with a team meeting, she went on, one that essentially assesses the immediate needs of the participant population and creates an action plan.

“We talk about our participants — we talk about who may be having problems, who may be in or out of the hospital, who has a caregiver that’s been in the hospital for the past month,” she explained. “We talk about what we can do to help support the family and what the patient needs to be safe at home. We talk about whether we need to go out and see the patient at home that day. And then we go out and do our various jobs.”

This is an effective model, but one that many in this region don’t know about, said Bostek, adding that, to meet established goals for growth, the company must build awareness about the PACE concept. Meanwhile, it must also be diligent and imaginative when it comes to outreach and building relationships with individuals and agencies that might refer potential participants.

Those constituencies include senior centers and ASAPs (aging service access points), agencies that serve the elderly, as well as hospitals, primary-care physicians and specialists, elder-law attorneys, senior housing complexes, food pantries, and others.

“We really work hard to be very visible in locations where there would be a large older adult population, as well as a low-income older adult population,” said Bostek. “We do some marketing, but it’s really a grassroots approach that we take.

“You sit across the kitchen table from a caregiver and/or an older adult to talk about the program,” she went on. “We have that personalized touch, but we need to make sure that we’re out in the community and that we’re building relationships with community partners and resources, because we want to them to readily identify that this program may be a viable option for someone and refer them to us.”

Caregivers are a very important piece of this outreach process, Bostek continued, citing statistics showing that one in three Americans serve as caregiver to a spouse, older relative, or friend, and many, like White, face considerable challenges as they take on that assignment.

Grover agreed, and cited the caregiver of that aforementioned centenarian as a good example.

“That patient has medical problems and mild dementia, and is cared for by her son at home,” she explained. “In order to keep her there, he needs oversight on medical management, assistance in the home with personal care, and help to simply balance his caregiver role with other roles in his life. She needs help with personal care and mobility, and for someone like that, there aren’t many other alternatives.”

Coming of Age

There were not many alternatives for Pam White as she searched for a program that would allow her to keep working and also enable her mother to remain in her home and out of a skilled-nursing facility.

The program offered by Summit ElderCare has proven to be the solution sought by both mother and daughter, and this story is now being repeated on a regular basis at the Wason Avenue site.

These developments clearly show that the company has become a PACE setter, both literally and figuratively.

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

Business of Aging Sections
Glenmeadow Renovates, Responds to Lifestyle Changes

Tim Cotz, president and CEO of Glenmeadow

Tim Cotz, president and CEO of Glenmeadow

A few weeks ago, Tim Cotz, president and CEO for the past 20 years at Glenmeadow, noticed one of his housekeepers wished an elderly resident ‘happy birthday’ on Facebook.

Of course, he’s impressed with an octogenarian who is active on Facebook, but he said he’s even more pleased to see one of his staff reaching out to her, because it’s the personal bonds among the staff and residents that make Glenmeadow — an independent- and assisted-living complex in Longmeadow — feel like home.

In fact, Cotz can be found pouring coffee every weekday morning at 7 a.m., walking around opening shades for more light, and pouring glasses of chardonnay at a late Friday afternoon cocktail hour; his daily, hands-on style is a physical illustration of what he expects of his 110 employees in all their different roles. This philosophy, and an open ear to requests for change, have helped Glenmeadow grow successfully over the past 20 years, weather the Great Recession, and recently complete a $4 million renovation (more on that later).

Cotz describes Glenmeadow as “unique” in the business of senior living because it’s a stand-alone, nonprofit facility, while most of its competition is religious-based, for-profit, owned by private entities, or merged into large conglomerates.

He told BusinessWest that, while he’s always worked to enhance services and meet the expectations of his residents and their families, it’s a much more vocal demographic these days.

“I don’t think we can ever be a place where we say, ‘this is what we do, this is what we offer, that’s what it is,’” said Cotz, who noted that the organization’s original managers, which became a board in 1985, was long run by a group of ladies; in its 130-year history, Cotz is the first male to have the leadership role in Glenmeadow. “We’re ever-evolving.”

As another example, he mentioned a new addition to the staff, whose role is to help residents with their technology needs. Requests for assistance with iPads, iPhones, laptops, and the general need to keep up with social media is as important to residents, he said, as it is to everyone else today.

When Glenmeadow opened its new facility 17 years ago, “we had one person here with their own computer,” Cotz explained. “Now we have wi-fi throughout the building, and a majority of the folks have computers, so we’re looking at how we continue to enhance those services.”

For this issue’s focus on the business of aging, BusinessWest toured Glenmeadow to learn more about an elder residence with a long history in Greater Springfield, and how that nonprofit is catering to a demographic requesting amenities and programs reflecting a younger mindset than ever before.

Welcome Home

Working in long-term care since 1970, Cotz started as an orderly in college, and graduated from Hartwick College with a bachelor’s degree in healthcare before earning his master’s from George Washington University.

From 1982 to 1988, he served as executive director of the Geriatric Authority of Holyoke, then led Berkshire Health Systems in Pittsfield for five years, before transitioning to Glenmeadow, which at the time was located in downtown Springfield.

Doorstop Café

Tim Cotz said the $4 million in recent renovations includes the Doorstop Café, a popular meeting place for residents as well as visiting friends.

Explaining Glenmeadow’s history, Cotz said the nonprofit was founded in 1884 with donations and bequeaths, making it the oldest residential nonprofit for the elderly in Springfield. Originally named the Springfield Home for Aged Women, it was created to provide shelter and care for female seniors.

“Every city at the time had a ‘poor farm,’ and that’s where old people went,” Cotz told BusinessWest.  “But the citizenry of Springfield felt that they deserved a better option.”

The first structure was a home behind the current Red Rose Pizza in Springfield’s South End, which then moved to a mansion on the corner of Chestnut and Carew streets (the building is now used for alcohol and drug rehabilitation services), and by the 1960s the name was changed to Chestnut Knoll.

When the facility needed more space, it purchased a 20-acre plot of land from Daniel O’Connell’s Sons in 1993, just over the Springfield line in Longmeadow, and construction for the current facility was completed in 1997. The richly landscaped campus and buildings now boast 113 independent apartments (14 more were added in 2000 to the original 89 units), boasting full kitchens and baths, plus 34 assisted-living apartments with kitchenettes.

Demand for units has been fairly consistent over the past two decades, Cotz said. The recession impacted the nonprofit a bit in 2008 and 2009, causing the waiting list to shrink, but residents have consistently filled the apartments. After the recession, not only did the waiting list fill up again, the changing style of how seniors want to live created demands of a different sort.

Great Expectations

Specifically, Cotz pointed out two societal shifts that have affected Glenmeadow over the past decade. First is the trend toward ‘aging in place,’ which the facility turned into a revenue generator in 2001 with the introduction of Glenmeadow at Home, a non-medical, private-duty, home-healthcare company for those living there.

“People are living so much longer and living healthier, and typically there are periods where they need some additional support. So now we can hire our own staff, train them, do the background, and supervise them,” he explained. Residents also have the option to hire outside workers for those extra services, if they so choose.

The goal is to provide non-medical services that help elders stay comfortably in their home, which includes companionship, handyman service, transportation, meals, dog walking, and more. By 2003, Glenmeadow at Home expanded to caring for anyone 62 and older in the Greater Springfield community. Calls to clients’ personal physicians for medical attention are part of the services, and that eventually evolved into care management in the home to coordinate all the services that an elder would need as their medical care requirements increase. Today, Glenmeadow at Home employs 80.

The second trend Cotz has observed is a renewed focus on fitness and lifestyle programming.

“The population we’re serving is clearly looking for more options for wellness, so much so that 83% of the people in this building exercise regularly,” he explained, which has led to an expansion of wellness services on site.

“When we opened 17 years ago, we had a room about this size, and if people brought an exercise bike, we’d store it in there,” Cotz said, pointing around his office, which comfortably holds a desk, a table, and two easy chairs. “Well, now we have three trainers on staff, Nautilus equipment, and numerous exercise classes each day, from stretching to balance to Tai Chi, PiYo [a blend of Pilates and yoga], and aquasize.”

This attention to physical and mental wellness, Cotz told BusinessWest, is due to behavioral differences among three generations: the Silent Generation (born 1925-1944) and the GI Generation (1905-1924), which together which make up a large portion of Glenmeadow’s older residents, and the older edge of the Baby Boom Generation (1945-1964), who are now entering the facility or on the waiting list.

“They are very different populations; the expectations of people we’re serving are changing,” said Cotz. “My parents’ generation, the GI population, were kind of ‘give me a cot and a cup of coffee, and I’m good to go.’ But the people in their early 70s coming in clearly have higher expectations in terms of amenities, programs, and services.”

The standard independent-living facility — with individual living units, one large dining room, and some separate rooms for a lounge, library, puzzles, and crafts — are from a bygone era. Now, the demand for more contemporary open space and more choices for meal times has changed the entire look and feel of Glenmeadow’s first floor.

The complex recently invested $4 million in renovations to tear down interior walls, open up meeting rooms, add more windows for natural light, expand the wellness area, and split the formal dining room to create the casual Doorstop Café, as well as more administrative space for the growing Glenmeadow at Home.

Living Social

Another concern is the alarming trend of cognitive loss, ranging from general senility to vascular-related dementia to Alzheimer’s disease. Both Glenmeadow and Glenmeadow at Home aim to identify the first signs of impairment and the supports necessary to keep people independent for as long as possible.

While Glenmeadow is a private-pay business, the nonprofit accepts donations through requests and estates, and has an investment portfolio of $15 million. Those investments can help those that outlive their resources; Cotz said the facility has never discharged anyone due to inability to pay.

In addition, a few years ago, Glenmeadow began offering the use of its facilities to non-residents for only $25 per month. With little advertising, membership escalated to more than 80 people after renovations were completed last fall. Members take advantage of the pool, use the fitness programs and equipment, and grab soup or coffee at the Doorstop Café, Cotz said. “It allows the public to realize first-hand what could be their next home.”

That’s certainly worth a Facebook ‘like’ or two.

Elizabeth Taras can be reached at [email protected]

This Veteran Goes to the Front Lines — of Home Healthcare

Nicholas Colgin

Nicholas Colgin is still climbing — both literally and figuratively — as a guide for blind individuals on summits, an advocate for unemployed veterans, and now as the owner of his own home-care business.

There have been a number of datelines attached to news stories involving Nicholas Colgin.
Many of them originated in the Tagab Valley in eastern Afghanistan, where, as a combat medic serving in Bravo Company for the Army’s 82nd Airborne Division, he saved the life of a French soldier shot in the head while facing enemy fire himself, an act of bravery that earned him the Bronze Star. It was also while serving in that remote region that others in his squad saved 42 Afghanis from a flooding river, an experience that he believes gave additional validation to his time serving in that conflict.
Later, though, there were stories out of Washington, first when he went to speak before Congress on the difficulties many veterans of Iraq and Afghanistan were experiencing as they sought gainful employment, and later when he was mentioned in speeches given by President Obama that outlined steps to combat the high jobless rates among what are known as the ‘9/11 generation’ of veterans.
Referencing Colgin, who, despite those actions that earned him a medal, couldn’t get a job as an EMT in Wyoming because he lacked the proper certification, the president said, “that isn’t right, and it doesn’t make sense — not for our veterans, not for the strength of our country. If you can save a life in Afghanistan, you can save a life in an ambulance in Wyoming.”
Fast-forward roughly two years from that speech in a former gun factory at the Washington Navy Yard, and the latest dateline for news on Colgin is, improbably, Springfield, Mass. Indeed, he’s not in an ambulance, nor in Wyoming, but instead in one of the many corner offices on the 12th floor of 1350 Main St., also known as One Financial Plaza. There, a map covering more than half of one wall identifies his territory — all of Western Mass. and some of Northern Conn. — as a franchisee for a national chain called Right at Home, which, as the name suggests, is a home-care agency.
There are a number of pushpins now on that map. They identify major healthcare providers in the Greater Springfield area as potential partners of sorts as Colgin looks to obtain market share in what is becoming a crowded playing field for home-care services.
Cultivating such relationships is now a major part of Colgin’s job description, although he noted quickly that there are many pressing issues as his gets this business off the ground, from interviewing candidates for caregiver positions to hiring an operations staff to staging an open house.
“We’ve had more than 300 applications in the past two or three weeks,” he noted, adding that the process of screening these candidates is ongoing. “They go through orientation, and we put a lot of time and investment into training to make sure we’re not sending someone into a person’s home that we wouldn’t let in our own grandmother’s home or parent’s home.”
How and where this entrepreneurial gambit came to be is an intriguing saga, one that says a lot about this determined individual, who overcame a number of injuries himself to put his name — which at one time he had trouble spelling because of a traumatic brain injury, or what those who’ve suffered one call a TBI — and the title ‘owner’ on his current business card.
Summing it all up, he said it has to do with mountains, or, more specifically, with climbing, and the need to keep doing it.
Elaborating, he divided returning veterans (and people in general) into three categories: ‘quitters’ — those who give in to their frustrations and often become substance abusers; ‘campers’ — individuals who come home and “relax for a while” (something he admits he did to some extent); and ‘climbers’ — those who “just keep climbing.”
“I decided I was going to be a climber,” he said, “and do it literally by taking blind people up mountains, and more figuratively by finding the next goal in life.”
Nicholas Colgin earned a Bronze Star for saving a man’s life in Afghanistan, but later was wounded himself, an experience that transformed a helper into someone who needed help.

Nicholas Colgin earned a Bronze Star for saving a man’s life in Afghanistan, but later was wounded himself, an experience that transformed a helper into someone who needed help.

For this issue and its focus on the business of aging, BusinessWest talked at length with Colgin, who has gone from being the face of unemployment among returning veterans to an individual now employing others in a venture with which he feels, well, right at home.

In the Line of Fire
Colgin was in the Peruvian Andes late last month, leading a team of 12 disabled veterans up 18,000-foot Mount Mariposa, when he received word that his franchise had secured the license necessary to operate in Massachusetts.
The juxtaposition of those happenings adds some poignancy to Colgin’s remarks about climbing, and also to the many facets of his life and the ways he measures success.
“I was going to do one last guiding trip before opening the business,” he explained. I submit the application and hop on a plane to Peru. I get one day in, and our application has been approved. It was a tricky place to be in — I’m in Peru, and now my business is open, and I’ve got to get back and hire employees.
“It’s been quite a journey, and this part of it is really just getting started,” he went on, before venturing back to another dateline in his life, the first.
That would be Chesterfield, Va., a small community not far from Richmond, where he spent several generally unhappy and challenging years.
His mother wound up in prison, and his father, with only a sixth-grade education, struggled to earn a living. Colgin said he was essentially raised by his grandmother, and by his senior year in high school, he was in many ways rudderless. It was a friend bent on joining the Army who provided inspiration and a compass point, but Colgin still had no idea what to do with himself — in the military or after his tour of duty was over.
“I signed on as a medic,” he said, following those words with a pause and shrug as if to indicate there was no profound reason for that choice. “I had never done anything in healthcare … when I went to sign up, I didn’t really know much about the military other than what you see in movies. I had just seen Black Hawk Down, and I said to them, ‘I want to be one of those guys.’
“They chuckled at me and said, ‘that’s not really a job,’” he went on. “They said, ‘you’re pretty smart … you can be this, or this, or maybe a medic.’ I said, ‘I’ll be a medic — that sounds like a job people really look up to.’”
He would eventually find out just how off he was in that reasoning — at least when it came to finding a job a few years later.
Fast-forwarding a little, Colgin passed the six-month training course to become a medic; two-thirds of those in his class did not. He worked in several facilities stateside, teaching medical classes, and was set to get out of the military without being deployed, but wound up volunteering for an assignment. “I figured, we’re at war; I might as well do my part,” he said, adding that a deployment he thought would last six months to a year instead stretched to 15 months.
He called it the “quintessential war experience,” one that took place mostly at Firebase Morales-Frazier. The highlight of his tour, if one could call it that, came in 2007 when he went to the aid of a French soldier hit by Taliban fire. The two were pinned down for about three hours, under constant fire, while Colgin administered care credited with saving the man’s life.
Colgin has several scattered memories of that experience, everything from being able to put whatever French he managed to retain from high-school classes to good use, to his own emotions as he offered care and counseling to the wounded soldier.
“You’re in Afghanistan, you’re getting shot at, people are getting blown up … you’re treating these people day in and day out, but you don’t really get scared; you just say, ‘this is just a job, this is what I’m here to do, treat it as a professional situation,’” he recalled. “But then I remember taking care of him. We’re in a small vehicle finally getting out of there, and his legs are on mine. I’m trying to tell him everything’s going to be all right. I was saying it confidently, but my legs just wouldn’t stop shaking, because I didn’t know if he was going to be all right. But I knew if he wasn’t going to be all right, it was not going to be because I slacked on my job and didn’t do all I could.”
Just a few months later, Colgin was driving a Humvee — something medics don’t often do, but he felt compelled to take his turn behind the wheel — when it took a glancing blow from a rocket-propelled grenade, or RPG. He said his head hit something, probably the steering wheel or windshield, breaking his nose and giving him what he called a “concussion of sorts.”
“One side of my body was numb, and I remember thinking that something wasn’t right,” he recalled. “We didn’t really know a lot about traumatic brain injuries at the time. I came home, had a lot of surgeries on my face — they rebuilt my nose — and needed a lot of treatment.
“I had been this helper overseas,” he went on, “and then I came home and needed help for the first time in my life. I’d never been in that situation before and didn’t really know anyone who had been in that situation before.”
And while he would eventually find some assistance, he essentially helped himself to a new career opportunity and that suite on the 12th floor.

Peaking His Interest
While serving in the Tagab Valley, Colgin, like many veterans, filled the idle time by reading whatever he could get his hands on. And increasingly, this meant books and especially magazines — because they weigh less and are thus easier to carry — about the outdoors.
“I was going to be an outdoor guide,” he said of plans he was making for life after military service, adding quickly that most of these were mapped out before he was injured. “I had never seen these huge mountains in person — I’d never really left the East Coast — and was just fascinated by that country.”
Upon returning home and “healing up” in North Carolina, Colgin would settle in Wyoming to pursue that dream, but he failed in his quest to graduate from the National Outdoor Leadership School due to lingering health problems, physical and mental — he would go back four years later and complete the program, though — and eventually shifted his career aspirations to healthcare, only to find more frustration.
“I had provided medical care in extreme situations — I’d saved someone who was shot in the head while I was getting shot at myself, in the middle of Afghanistan with limited resources — so I figured I shouldn’t have any problem doing emergency medicine, such as work as an EMT,” he told BusinessWest. “Unfortunately, I was wrong.
“And this is an issue that many people in the military are facing and that they’ve just started addressing in the past few years,” he went on. “Basically, you’re trained to do a job in the military, and you can do it in the military, but the certifications do not transfer to the civilian sector. I was trained as an EMT basic, sent to Afghanistan. I’m treating people who were shot in the head, I’m giving IVs and administering medications — and you can’t do that stateside.”
Those who drive trucks and service vehicles in the military face similar roadblocks, he said, adding that thousands of individuals have struggled with the task of turning experience with the armed forces into a job back home.
And this was the message Colgin wanted to bring to elected leaders and the civilian population as the dateline for his story shifted to Washington in mid-2011.
As a representative with Iraq and Afghanistan Veterans of America (IAVA), he spoke before Congress on his frustrations with finding employment in what he considered his chosen field, and made it clear that he was not alone in this predicament.
His comments caught the attention of many groups and individuals, including the commander in chief.
“I remember I showed up to work one day — I was interning for the IAVA — and someone said to me, ‘the White House called for you,’” he told BusinessWest. “That’s not something you hear all the time, and I thought they were joking with me, but they were serious.
“I called them back, and they told me the president was considering telling my story in a speech the next day,” he went on. “They weren’t sure he was going to tell it, but I had to get to D.C. I got a haircut, grabbed my suit, and hopped on a train to Washington.”
After the president’s speech, Colgin found himself in demand — with the media, at least. He did appearances on CNN, the Rachael Maddow Show, the CBS Early Show, and others, becoming adept at live interviews. This face time with the public brought him some job offers — “although not as many as you might expect with the president telling your story” — and eventually he took one, working as membership coordinator with the IAVA, and resettled in Manhattan.
That island is worlds away from Chesterfield, Va. in every respect imaginable, and Colgin liked being an advocate for veterans, working with Congress, and getting plenty of coverage in the media. But something was missing from the equation.
Actually, two things.
The first was an entrepreneurial venture that he could call his own, and the second was what he called “a community in the true sense of the word, a place where I could rest my head, then get up and really get involved in making a difference.”
He would eventually find both in Springfield.

Summit Meetings
Recalling the chain of events that led to his grand opening nearly a month ago, Colgin started with his decision to “step back,” as he put it, and take a sabbatical from his job with the IAVA. He took this opportunity to do some of the outdoor work he’d started dreaming about in Afghanistan, and eventually made acquaintances with Eric Weihenmayer, the first blind man to scale Mount Everest.
“He and I became good friends, and I ended up picking up a lot of skills to guide individuals up mountains and in the back country,” he recalled. “It was a great experience … I started guiding blind people up mountains. I came back to New York after my sabbatical and realized I had to make a change in my life.”
Coincidentally, he attended what he called a “business boot camp for veterans” in Boston, an intense, three-week program conducted in conjunction with Harvard that helped him discover latent entrepreneurial instincts and drive.
“I realized that what was inside me was stronger than anything in my way,” he told BusinessWest. “I realized that I could open a business; I left and started looking for investors.”
As that search for financial backing commenced, so, too, did the process of choosing what kind of business to get into, he went on, adding that he soon concluded that he would like to do something healthcare-related, and something that would make a difference in peoples’ lives. Discussions with a consultant specializing in linking individuals with franchise opportunities narrowed the search to a few national chains, and eventually to Right at Home, an Omaha, Neb.-based enterprise launched in 1995 that by that time had facilities in more than 40 states as well as in the United Kingdom, Brazil, China, and Canada.
It was not, however, doing business in Western Mass., and Colgin, with $250,000 from some investors, decided to seize that opportunity.
“It was just me and the dog, and I could go anywhere and do anything,” he said, referring to his English pointer, Dixie, whom he described as his rock. “I wanted to stay on the East Coast, and started looking at places and scheduling visits. I ended up coming to Springfield, and it looked like a place where I could put down roots. I moved around a lot with the military and never really had a family growing up, but when I came here, I got a sense that this was a place where I could grow.”
Colgin acknowledged that there is considerable competition within the growing home-care industry and that he has a lot to learn as he joins that crowded field of players. But he believes he has the basic ingredients to reach his goals, which he admits are still being set.
“The language of healthcare is pretty universal, and caring is pretty universal as well; if you can care for Afghanistan locals in the middle of a war, you can take care of anyone in the world,” he said, adding that Right at Home has a proven model and track record for success that he believes he can build on. “I care about helping people realize their dreams, and I care about doing the right thing, and at the end of the day, that’s what this is all about.
“They’re extremely innovative,” he said of the chain. “They have great brand management and amazing quality.”

On a Grand Scale
Based on all that has happened in his life since those initial, awkward discussions with Army recruiters nearly a decade ago, it would be logical to assume that Springfield probably won’t be the last dateline for news stories about Colgin.
As he said, he’s a climber, and he doesn’t intend to stop doing that.
For now, though, the climb has reached Western Mass. and a critical juncture in his career, and there are immediate goals right ahead of him.
The plan is to keep reaching higher — in every aspect of that phrase — but that’s something Colgin has been doing his entire life.

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