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Collaboration In Health/Wellness

Collaborators in DASHH include Revitalize CDC, Baystate Health, Health New England, the BeHealthy Partnership, Holyoke Medical Center, the Public Health Institute of Western Massachusetts, the Pioneer Valley Asthma Coalition, and the Green & Healthy Homes Initiative.

This Coalition Keeps People Healthy in Ways Its Partners Couldn’t Achieve Alone

If there’s anyone who understands the impact of asthma in Greater Springfield, it’s Sarita Hudson.

Specifically, as director of programs and development for the Public Health Institute of Western Massachusetts and manager of the Pioneer Valley Asthma Coalition, she understands the connections between one’s physical environment and health — and the factors that have consistently placed Springfield high on lists of riskiest places to live with asthma. But even the Asthma Coalition has its limits.

“We had been doing asthma interventions, working with community health workers, working with clients, doing education, helping them identify triggers,” she said. “But it’s not enough if we can’t actually fix anything in the home.”

Meanwhile, as vice president of Public Health for Baystate Health, Frank Robinson understands the many ways the system’s community health programs and providers promote preventive health and wellness.

“We had been doing asthma interventions, working with community health workers, working with clients, doing education, helping them identify triggers. But it’s not enough if we can’t actually fix anything in the home.”

Still, “Baystate would never be going out and creating healthy homes by doing environmental changes and mitigations,” he explained. “That is not the work of the healthcare system. To be aligned with someone who does that work and gets the health implications and health impacts is perfect, though — it makes a perfect marriage.”

That organization would be Revitalize Community Development Corp. (CDC), which does have a long history of making critical repairs, modifications, and rehabilitation on the homes of low-income families with children, military veterans, the elderly, and people with disabilities.

When these three organizations started talking — about asthma and other issues — they were intrigued by what they might accomplish by working together, said Revitalize CDC President and CEO Colleen Loveless.

“We’d been doing some of this work — mold remediation, pest control — but hadn’t formalized the process in collaboration with insurance companies and the healthcare system,” she told BusinessWest.

Now, thanks to a collaboration called Doorway to an Accessible, Safe and Healthy Home (DASHH), these three organizations are not only identifying families in need of intervention for environmental health issues, and not just educating them on lifestyle changes, but actually making the necessary physical changes to their homes.

“We started talking, and we applied for a technical-assistance grant from the Green & Healthy Homes Initiative in Baltimore. They’ve been doing this work for decades,” Loveless explained. “We were one of five sites awarded that technical-assistance grant.”

Baystate followed with a capacity-building grant, other state grants followed, and DASHH was in business. Since its beginning in 2015, the program has served 130 households with asthma remediation and education, as well as 101 households for age-in-place modifications. Last year, it launched a COVID-19 response project (more on that later), impacting more than 1,550 households and approximately 6,881 individuals.

“It’s a business model that shows that, by intervening and creating healthy homes through environmental remediation, removing asthma triggers, and improving the physical environment, we could reduce asthma incidence in high-risk populations,” Robinson said.

Families referred by Baystate for environmental interventions receive three to five visits to conduct testing, at the start and end of the process, and provide education on how to keep the home clean and safe. If needed, Revitalize CDC brings in services ranging from air-duct cleaning to mold remediation; from pest control to floor covering and replacement, and also provides air purifiers, HEPA vacuums, and cleaning supplies.

By partnering with health-centric organizations, Colleen Loveless (center) and Revitalize CDC was able to infuse its home-rehab efforts with a focus on wellness.

By partnering with health-centric organizations, Colleen Loveless (center) and Revitalize CDC were able to infuse home-rehab efforts with a focus on wellness.

“The goal is to keep people from having to access primary care or the emergency room, and not miss school or work,” Loveless said. “Asthma has such a ripple effect.”

 

Better Together

The initial goal of DASHH was to help older people by improving their housing conditions related to asthma and falls, most notably by providing home assessments and home repairs to help them stay healthy and age in place. Breaking down this enterprise that has earned the title of Healthcare Hero for 2021 in the Collaboration category, the individual honorees are:

• Revitalize CDC; which performs assessments and interventions for adults and children with asthma and COPD and makes safety modifications and aging-in-place improvements so seniors may safely remain in their home;

• The Public Health Institute of Western Massachusetts, which provides support on asthma issues; measurement evaluation; support and coordination for referrals, education, and outreach; coordination and support for asthma home-visiting services; and technical assistance and support, as well as providing materials and services in Spanish;

• Baystate Health and the BeHealthy Partnership (a MassHealth accountable-care partnership plan option made up of the Baystate Health Care Alliance and Health New England), which provide referrals to DASHH through five health centers: Baystate General Pediatrics at High Street, Brightwood Health Center, Caring Health Center, High Street Health Center Adult Medicine, and Mason Square Neighborhood Health Center; and

• The Green & Healthy Homes Initiative, a national network that provides technical assistance on planning, database services, and access to best-practice strategies. The organization worked with the other partners on feasibility studies to come up with ways to fund interventions in the home and determine how those efforts might impact healthcare costs and decrease healthcare utilizations regionally.

After its initial success with Baystate, Revitalize CDC expanded its service area in 2019 to begin collaborating with Holyoke Medical Center and its team of community health workers and navigators. To boost such efforts, the city of Holyoke recently awarded Revitalize CDC’s Healthy Homes Program $100,000 from American Rescue Plan Act funds.

DASHH serves low-income families in Hampden County, which ranks last among the Commonwealth’s 14 counties for health outcomes and health factors for racial/ethnic groups. Springfield had been the asthma capital of the U.S., according to the Asthma and Allergy Foundation, until 2019, and now ranks 12th — still not the most desirable ranking, but an improvement, to be sure.

“You talk to the families, and you see that this is the kind of impact that changes their health,” Hudson said of DASHH’s efforts. “It means they can breathe easier and get the supplies they need.”

For instance, in some cases, “the ventilation ducts have never been cleaned, and every time the heat comes on, they have an asthma attack. Now they’re clean, and it doesn’t happen,” she went on. “Some of these are small, simple repairs.”

This issue has been important to Hudson for a long time, through the Pioneer Valley Asthma Coalition, which was formed 15 years ago to address childhood asthma by improving medical and self-management of the condition, as well as by reducing environmental triggers.

The coalition focuses on outdoor air pollution and indoor air quality and has successfully advocated for new policies, including statewide regulations to prohibit tobacco sales to those under 21; green cleaning policies and procedures adopted by Holyoke Public Schools; an ordinance against burning construction and demolition debris; and asthma protocols and an idle-free vehicle policy adopted by Springfield Public Schools, among many other successes.

It’s work — not just the physical interventions, but education of homeowners, landlords, and primary-care physicians — that should be happening on a wider scale, Hudson said, not just in homes, but in schools and other older buildings where people gather.

“We really see a lot of our housing stock as old, with deferred maintenance, including so much of our rental housing. That’s why we are pleased to see more funding around whole-house renovations.”

 

Quick Pivot

Last year, the DASHH coalition began supporting patients at risk of contracting COVID-19 by providing them with essential supplies and access to nutritious food at home. It made contactless deliveries that also included COVID-prevention supplies, including disinfectants, microfiber cleaning cloths, cleaning gloves, dish detergent, food-storage containers, hand soap, disinfectant wipes, paper towels, and food from local pantries.

“These are people who were quarantining, and we were providing them with cleaning supplies, hand sanitizer, and facemasks — and we found many were food-insecure, so they were provided food from local food pantries,” Loveless said. “The whole DASHH program just expanded from asthma to COVID, and we’re still seeing it now.”

Meanwhile, she’s excited about seeing the coalition continue its broader work — and those regional asthma statistics improve further.

“It’s been a really, really great partnership. It’s a win-win situation — the healthcare system saves money, we’re serving more low-income families in need, and patients are healthier. So it’s really a win-win-win.”

Robinson agrees. “I think the role of Revitalize and other housing providers that understand these issues have made a difference — and make healthcare providers’ jobs much easier,” he said. “They have been instrumental partners in creating safe and healthy houses for older adults as well as creating healthy homes for folks with respiratory diseases, asthma in particular.”

The work is both deeply collaborative and, dare we say, heroic.

“I’m so appreciative,” Loveless said. “Together, we’re able to serve more people in need.”

 

Joseph Bednar can be reached at [email protected]

Healthcare Heroes

She’s One of Many Improving Quality of Life for People with Dementia

Carol Constant

As director of Community Engagement at the Loomis Communities, Carol Constant has developed a number of ways residents of the three sites — Loomis Village in South Hadley, Loomis Lakeside at Reed’s Landing in Springfield, and Applewood at Amherst — can be, well, engaged with the world outside their walls.

“It’s not a silo — we’re out supporting the community, and the community is invited to be a part of what we do,” she said, citing examples like supporting awareness walks, food drives, and other events relevant to area seniors.

But it was a resident of Loomis Village, named Rachel Tierney, who got her thinking about the concept of engagement in a new, broader way.

“She had been a long-time caregiver for her husband, and she’s a retired psychiatric nurse,” Constant said. “She had heard about the dementia-friendly movement, and when she saw my title, she approached me and said, ‘hey, do you want to think about this?’”

Constant did. In fact, the idea of dementia-friendly communities — a movement that aims to teach first responders, municipal workers, and business owners how to interact with people with dementia — appealed to her, so she was pleased when her first meeting in South Hadley, in March 2015, drew a wide range of stakeholders: fire and police chiefs, the town administrator, a librarian, the senior-center director, and Chamber of Commerce members, to name a few.

“They’re going to the bank, they’re going to the grocery store, they’re out in the community. So how can we, as a broader community, recognize it and be helpful to them?”

“We sat them down in a room and said, ‘we have this idea about educating and raising awareness about dementia. How have you experienced dementia in your daily lives?’” she recalled. “These are busy people, and we promised to take only an hour of their time, but just going around the room hearing the stories took an hour. Everyone had a story.”

That’s because, of the approximately 5.3 million Americans currently living with Alzheimer’s disease or some form of dementia, 70% are living in the community, rather than assisted living or nursing care — and 30% of that group are living alone. Going by these estimates, approximately 8,460 individuals with dementia in the Pioneer Valley are living in their homes, and 2,538 are living alone.

“They’re going to the bank, they’re going to the grocery store, they’re out in the community,” Constant said. “So how can we, as a broader community, recognize it and be helpful to them?”

More than four years after that first meeting, the loose coalition known as Dementia Friendly Western Massachusetts (DFWM) has drawn the support of dozens of area organizations, sponsored myriad awareness and education events, and, most importantly, made area communities better places to live for people with dementia.

It’s an effort that will only become more important as Baby Boomers continue to march into their senior years, living longer, on average, than previous generations. The number of Americans with Alzheimer’s is projected to rise by 55% by 2030, and by 2050, the Alzheimer’s Assoc. estimates the total number could explode to nearly 14 million.

Proponents of the dementia-friendly movement say greater public awareness and support programs will reduce the stigma of dementia and improve the quality of life for these individuals and their families. In addition, greater public awareness may lead to earlier detection and earlier treatment.

“There’s a huge stigma around dementia,” Constant said. “How can we make people recognize that there’s no shame in it, that nobody who has dementia did something bad? One of the goals is to destigmatize it because people get worried they’re going to embarrass themselves.”

It starts with small steps, she added. “Just check yourself. You may be in a hurry at the store, there’s a long line at the register, and this person is having a hard time counting their money. So slow down and recognize what’s happening and how to be helpful.”

For taking those steps along with a raft of like-minded individuals and organizations, Constant is positively impacting an often-forgotten population, and teaching entire communities that there’s plenty of work left to do.

Knowledge Is Power

The work of Dementia Friendly Western Massachusetts includes several basic activities, including:

• Education and training for those who might encounter an individual with dementia, including fire and EMT first responders, faith communities, and frontline workers in banks, retail stores, and restaurants;

• Development of support groups, memory cafés, and other programs that support individuals and their families; and

• Development of a website and materials that provide a calendar of events and resources available to families the region.

These supports are critical, Constant said, as research shows that supportive care helps people living with dementia and their caregivers experience less physical and emotional stress, better health, fewer hospitalizations, and less time in long-term-care facilities. Additionally, caregivers need support, as caring for someone with dementia puts a strain on their physical and mental health as well as relationships with other family members. Finally, educational programs that build awareness of the challenges faced by these individuals and their families will help assure that, when they are in the community, they are treated with respect and dignity.

To Constant, much of this work comes down to one question. “How can we be supportive of people in the community and destigmatize dementia? When they get embarrassed and shamed, they isolate and become depressed, and that does not help — that further exacerbates the problem for them. This is a movement to raise awareness and destigmatize dementia, in addition to providing education and support for people in the community about dementia.”

Carol Constant says many people with dementia are out in the community, and the community needs to know how to interact with them.

Take memory cafés, for example — places where people with dementia and their loved ones and caregivers can hang out and relax, free from the stress that often accompanies other community outings, because everyone knows everyone else in the room understands their experience.

“So often, we get caught up with caregiving, and we forget to have fun with the person we’re caring for,” she explained. “So it’s an hour, hour and a half where people can meet someone in a similar situation, hang out together, relax, and have fun.”

Memory Cafés have been established at Armbrook Village in Westfield and councils on aging and senior centers in Holyoke, South Hadley, Belchertown, Hampden, Greenfield, and Shelburne Falls. Heritage Hall East in Agawam is in the process of starting one.

Meanwhile, dementia support groups have been established at Armbrook Village, Heritage Hall East, Loomis House, the Holyoke Soldiers Home, and the Belchertown, Holyoke, and South Hadley councils on aging and senior centers.

Constant is gratified to be recognized as a Healthcare Hero, especially considering the category — Collaboration in Health/Wellness. On several occasions during her interview with BusinessWest, she emphasized that she can’t take credit for all this work; it’s about creating partnerships with area agencies that serve older adults. “We got the right people together in the room, and we started programming.”

Those partners in Dementia Friendly Western Massachusetts include the Alzheimer’s Assoc.; the communities of South Hadley, Holyoke, and Springfield; the Department of Elder Affairs; Holyoke Medical Center; WestMass ElderCare; Greater Springfield Senior Services; Holyoke Community College; Chapin Center; A Better Life HomeCare; Springfield Partners for Community Action; Grupo de Apoyo de Demencia at Baystate Medical Center; the Public Health Institute; PeoplesBank; O’Connell Care at Home; Massachusetts Councils on Aging; Silverlife Care at Home; River Valley Counseling Center; Safe Harbor Adult Day Services; UMass College of Nursing; Springfield College; and the Holyoke VNA.

The purpose of their collective efforts, simply put, is to build broader community awareness of the issues around dementia, not only through the website and materials promoting support resources and programs, but by encouraging and training organizations, agencies, and towns in the region to become involved in the dementia-friendly movement.

First Response

To date, DFWM organizations have established and led hundreds of educational programs across the region, including educational programs to a wide array of audiences, including first responders, city and town employees, nursing homes, rehabilitation centers, councils on aging, schools and colleges, hospitals, nursing homes, home healthcare agencies, chambers of commerce, businesses, Rotary clubs, faith communities, retirement communities, civic organizations, elder-law programs, and local and national conferences.

Each target audience has different needs and different ways to connect. For example, first responders often feel frustration when encountering people with dementia, because their role is often to stabilize a situation and then move on. When they encounter a situation where it’s obvious that someone in a home is struggling with dementia and may not have the supports they need, they often feel there’s not much they can do, Constant said.

With that in mind, Dementia Friendly Western Massachusetts developed a visual resource, the size of a business card, that’s printed, in both English and Spanish, with the contact information of organizations that can provide dementia-related resources to families. First responders can leave this card with a family when they feel it’s warranted.

“First responders rush in and rush out — assess the situation and get everyone safe. Then they leave,” Constant said. “There’s a sense of frustration when they know the situation is bigger than ‘we got the fire out.’ This is something they can hand to the family member.”

Or, when police arrive at a home, they might encounter someone who’s agitated and on edge, but not dangerous or mentally ill — they simply have dementia and are trying to navigate a stressful situation.

“Maybe we need to slow it down a little bit, make eye contact, get at their level,” she said. “When I talk to first responders, I see and hear that they do this naturally, but a little layer of education around it is also really helpful. And I’ve heard that from police chiefs in all the communities we’ve been working in.”

It’s just one way she and the other coalition members are changing the conversation around dementia — right down to the very words people employ.

“So much of the language we use around dementia is ‘afflicted,’ ‘stricken,’ ‘the tsunami’ — all this negative language,” she noted. “No wonder it’s stigmatized. So, how do we make people feel not ashamed, not embarrassed about it, and not isolated?”

The community education goes beyond words, as well, and gets to the heart of how people with dementia are treated. For instance, people will sometimes stop talking to an individual with dementia altogether — instead always addressing their companion — even though there’s often many years between diagnosis and the time when someone becomes so debilitated they can’t go out anymore.

“The essence of that person is still there,” Constant said, citing a Maya Angelou quote — not first uttered in reference to dementia, but nonetheless applicable: “people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

“They can still experience joy; they can still experience humor,” she went on. “So what are we doing when we say, ‘you are no longer able to cognitively keep up with this fast-paced conversation, so sit in the corner by yourself.’ One of the goals of all this work is to improve quality of life.”

That goes for everyone — individuals with dementia, their care partners, and the community as a whole.

Filling the Room

Constant is grateful the Loomis Communities gives her a “long leash” when it comes to her work with Dementia Friendly Western Massachusetts, but not surprised, as it’s really in Loomis’ best interest.

And she’s also thankful for the individual moments that demonstrate the value of engaging people with dementia fully in society.

“Having someone who’s living with dementia come up and talk to you and start a conversation and share their experience and that of their care partner, it’s wonderful to see,” she said. “If we can do one thing to make the quality of life for someone better, why wouldn’t we?”

When her mother-in-law was diagnosed with dementia 30 years ago, she added, she didn’t have the resources available today; no dementia-friendly initiatives existed back then. But she wishes they had. “I learned all my lessons the hard way. I wish I had known as much about it as I do now.”

Still, there’s a lot to learn, she added, and a lot of passionate people — again, this is certainly a collaborative award — working on improving quality of life, one person and one community at a time.

“It’s been great making these connections, and that’s really powerful,” Constant concluded. “If it was up to just one person to do this, it wouldn’t happen. It’s all about getting all the right people in the room.”

Joseph Bednar can be reached at [email protected]

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