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Youth in Crisis

Let’s face it — the past year of COVID-19 has probably been tough on you, in any number of ways that weigh on your peace of mind. But what about your kids? How are they doing? And … do you even know? That might seem like a flip or aggressive question, but a group of local teenagers who have been talking to public-health leaders about the issue say their parents aren’t fully hearing them when it comes to the impact of the pandemic. And that impact, in many cases, has been worrisome.

 

Alane Burgess began by stating the obvious.

“It’s not normal for kids to be home all the time.”

As clinic director of the BestLife Emotional Health & Wellness Center, a program of MHA Inc., Burgess is one of many healthcare professionals keenly invested in how the COVID-19 pandemic has impacted young people. And the picture is worrisome.

“They like to be out. They like to socialize. Most kids like to be with friends,” she said. “COVID forced isolation on a lot of people; they haven’t been able to go to school, to socialize, to be involved with activities they once loved, like sports. Community spaces haven’t been open.”

It’s not surprising, she added, that this isolation has contributed to an uptick in anxiety, depression, frustration, and a tendency to act out in negative ways.

Indeed, according to the Centers for Disease Control and Prevention, between April and October 2020, hospital emergency departments saw a rise in the share of total visits from childen for mental-health needs. Nationwide numbers on suicide deaths in 2020 are still unclear, but anecdotal evidence suggests an uptick.

“Kids are excited to go back and see their friends and have some sense of structure, to be in society again. But there are definitely a lot of adjustments to be made.”

But here’s the less obvious reality, Burgess noted: while the pandemic may be (and that’s may be) on its last legs and schools and other gathering places are slowly opening back up, that doesn’t mean the stresses of the past year will just fade away.

“Kids are excited to go back and see their friends and have some sense of structure, to be in society again,” she told BusinessWest. “But there are definitely a lot of adjustments to be made.”

When COVID struck, she noted, the shifts were quick and unplanned — kids were suddenly learning at home, and many of their parents were suddenly working there. It has been a challenging time, particularly for working parents with young children who need help with school.

But transitioning back to whatever will pass for the new normal poses its own challenges, she said. “It was originally going to be two weeks, and weeks turned into months, and months became a year. Now, they’re going back out into a world that’s changed; it’s not going to be the same — there will be masks and social distancing and limitations on clubs and activities.”

Tamera Crenshaw says barriers to accessing mental healthcare are myriad.

Tamera Crenshaw says barriers to accessing mental healthcare are myriad.

Socially, certain young people — those with a more introverted personality — found they thrived in the remote setting, and are anxious about returning to campus, Burgess added. Others found the home setting to be an escape from bullying, and are palpably fearful about going back.

Meanwhile, some students, depending on how rigorous their remote-learning experience was, might find themselves overwhelmed or feeling academically behind as teachers play catch-up. Many students report coasting to passing grades, even very good grades, while feeling they haven’t been learning much.

And the economic struggles affecting many families who lost income or jobs — a definite stressor on kids — certainly aren’t over.

Tamera Crenshaw, a clinical psychologist and founder of Tools for Success Counseling in Longmeadow, said she’s especially passionate about mental health in minority populations, a demographic disproportionately affected by mental-health issues — because, again, those issues tend to be exacerbated by factors like economic stress, which have also landed hard on those populations during COVID-19.

Even remote learning has been a greater problem for communities of color because of issues of technological access and family strife over financial matters, she added. “Home isn’t necessarily the most conducive learning environment — and COVID just exacerbated it.”

An uptick in suicidal ideation is especially concerning, Crenshaw said. “Someone can have a baseline of thought, but when kids are actually expressing a plan or intent, it’s scary. And we’re definitely seeing an increase.”

Some of the factors are typical stressors on teens in any given year, but despondency has certainly been driven by greater economic instability, which can raise tension and anxiety in the home, as well as two competing factors: a longing to end a year of isolation and get back to school, and health fears about the safety of doing so, especially for kids who know someone who has died of COVID.

“These kids have not been forgotten, but even with a vaccine, they’re going to be vaccinated last,” she noted. “I can’t imagine there’s not a fear of going back into the school environment when they haven’t been vaccinated.”

The issues are deep and complex, and solutions aren’t easy. But, like most others in the mental-health field, Crenshaw says the first step to helping young people take charge of mental-health issues is clear and simple.

“You’ve got to name it.”

 

Start the Conversation

That means breaking through societal stigma surrounding these struggles.

“My mission is to destigmatize mental health,” Crenshaw said, noting that several factors contribute to that stigma and the resulting reluctance to seek help. “I want to help debunk that stigma.”

Beyond attitudes toward mental health, another barrier is financial — the challenge of accessing insurance that will pay for treatment, or, for those who don’t have it, navigating out-of-pocket costs while already struggling economically, she added.

“It was originally going to be two weeks, and weeks turned into months, and months became a year. Now, they’re going back out into a world that’s changed; it’s not going to be the same — there will be masks and social distancing and limitations on clubs and activities.”

A third factor is religious belief, specifically a belief by some churchgoers that mental-health professionals are at odds with faith, or that faith makes such help unnecessary. “We’re trying to educate churches and knock down that barrier,” she said. “I’m a woman of faith myself.”

Another factor is the simple fact of how few therapists of color are working today. Crenshaw’s team is largely women of color, but her practice is an exception — which is unfortunate because she knows people of color will often have an easier time trusting someone right off the bat when they can relate to them or see themselves in them.

This last factor might be a long-term struggle to overcome, she added, noting that she teaches classes in her field at Westfield State University, and none of the 17 students currently in one of her classes is a woman of color.

In fact, the mental-health and social-work fields in general are in need of more talent, said Jessica Collins, executive director of the Public Health Institute of Western Massachusetts (PHIWM). She agreed about the access issue as well, noting that mental health should be a basic support, not something available only for people who can pay for it — especially when families who can’t pay are often in greater need of those supports.

Recognizing the importance of these issues among young people, before the pandemic even began, the Public Health Institute facilitated the formation of a youth mental-health coalition in Springfield — one that brings to the table direct service providers like BHN and Gándara, Springfield Public Schools, local therapists, and, critically, a group of 11 teenagers who meet regularly.

The question at the center of the initiative is simple, Collins said. “How do we best support kids? It might sound basic, but it’s fairly new; there has not been an emphasis on the mental health of kids except in extreme cases, where the kids have to go into inpatient care.”

One takeaway so far is that teens don’t feel fully heard by the distracted adults in their lives.

“What we’re hearing, loud and clear, from our young people is, when they talk to adults, adults are not skilled at supporting them,” Collins said. “Adults are stressed, adults are stretched, and that just adds to this epidemic of young people feeling hopeless and alone and unsupported.”

That’s why the Public Health Institute is talking about what kind of training adults — those who work in preschool and school programs, but also parents — might need to learn how to better listen to young people and work through and respond to what they’re hearing.

Jessica Collins

Jessica Collins says parents sometimes get so stressed, they don’t realize how stressed their kids are, too.

“These big direct-service providers are really competitive, so to get them in a room to talk about how can we work together to better support families, instead of just competing for them, that’s fairly new,” Collins said, adding that Daniel Warwick, Springfield’s superintendent of Schools, has also been on board with efforts like this for a long time.

For example, when he saw a 2017 report by PHIWM about the hopelessness felt by local teens who don’t identify as heterosexual, “he was so upset about that, a few years ago, he mandated some training for all Springfield public-school adults to better support kids who are LGBTQ+.”

 

Take It Seriously

That’s a good example of listening to young people and then taking them seriously — which is one way to normalize mental-health needs, Collins said. “If you can’t talk about it, you can’t figure out for yourself what you need.”

And one thing young people need right now is reconnection. While many kids are tired of the technology-only avenues for connecting with friends, Crenshaw said, Zoom calls, text chats, and the like have been an overall positive in staying in touch. But she also encourages kids and families to take opportunities to see friends and loved ones in person, in a safe manner, when possible.

“You can go to the park; you can go outside with a soccer ball, wear your mask, and connect. Some families have said, ‘we can’t do this alone,’ and became part of each other’s bubble, taking turns doing homeschooling. We encourage these ways of connecting with each other.”

And don’t give up on trying to talk to your kids, Burgess said, even when they don’t feel like talking back.

“The most important thing any parent can do during these times is open a dialogue with their children and allow kids to have open communication,” she said. “What are they thinking? What are they feeling? Then we can guide them and help them through their own resiliency and make adjustments.”

Families can help combat their kids’ isolation, she said, by planning quality family time, even if it’s just having dinner together, around the table, every night, or scheduling a family game night every week. Those moments, she noted, can naturally help kids let their guards down.

“You want to have that quality time, that open communication to talk and listen to your kids and ask, ‘how are you feeling? What’s going on? What can I do to help make things easier?’ Sometimes, as a parent, we’re not able to say ‘yes’ to everything, but we can look for compromises and help kids make some of the decisions.”

The problem in identifying signs of distress, Crenshaw said, is that teenagers, even on their best days, often prefer to be isolated, or present a sullen demeanor. So how can parents separate normal teen ‘attitude’ from real warning signs?

“Are they communicating as much with you, or are they isolating in their rooms moreso than normal? Are they eating normally?” she asked. “Even prior to COVID, parents would say, ‘I didn’t know there was a problem — I thought that’s how kids are.’”

It doesn’t hurt for parents to simply ask their kids, directly, how they’re feeling, what’s working or not working in their lives, how school is going, and if they’re feeling more anxiety than usual. “If a teen is isolated in their room, that could be typical teen behavior, but maybe not.”

Physical signs may be visible, too, Crenshaw said, noting that cutting — what’s referred to in her field as ‘self-injurious behavior’ — and eating disorders are more common than some parents think.

But more often, the signs are subtler. “It’s just really knowing their disposition and what they’re involved in.”

Burgess said it’s important for parents not to go it alone if their gut tells them something is truly wrong.

“If you notice your kid struggling with severe signs of depression — really isolating, really struggling — definitely seek professional help. If your kid is talking about suicide or even just having a hard time getting back into interacting or adjusting, seeking professional help is always key.”

In the end, coming out on the other side mentally healthy — and that goes for parents and children alike — will take patience and resilience, Burgess added.

“There’s no guidebook for this. There’s no ‘COVID for Dummies’ book. We’re all doing the best we can to adapt. We’re all just going through an unprecedented time.”

 

Joseph Bednar can be reached at [email protected]

Cover Story

Lessons Learned from COVID

It’s been said time and again that, for businesses large and small, the pandemic provided a number of learning opportunities. Companies learned new ways to do things — mostly out of necessity — while also learning that the ‘old’ way may not be the best way. Meanwhile, the pandemic provided opportunities that didn’t exist before — especially when it comes to hiring — and accelerated the pace of needed change. All that means the landscape has been altered for the long term.

Drew DiGiorgio, president and CEO of Wellfleet

Drew DiGiorgio, president and CEO of Wellfleet, in the company’s mostly unoccupied space in Tower Square.

They’re called ‘insurance bibles.’

That’s the name those at HUB Insurance have attached to the large binders — some of them containing 700 pages or more, in the case of large commercial accounts — that tell clients everything, as in everything, about what’s in their policy, what’s covered, what isn’t, and on and on.

As he held one up, Timm Marini, president of HUB International New England LLC, noted that, prior to the COVID-19 pandemic, bibles only came in the printed variety. Now, if a client wants one — and some of them don’t — a digital file is sent, in part because a client can’t pick one up, and HUB can’t drop one off.

And, by and large, things will stay this way, said Marini, noting that COVID has shown those at the company that they don’t need to kill trees and use up expensive toner to provide a client with their insurance bible.

“Now, you can do it all electronically,” he explained. “And you probably could before COVID, but COVID made us do it more.”

This is just one of the many things companies large and small have learned during the pandemic, lessons that will carry over to the time when COVID is referred to in the past tense. Others involve everything from not having to scan documents for tax preparers to not necessarily limiting a candidate search to those living in the 413, to not having people travel to a conference on the other side of the state if they can instead take it in via Zoom.

“It’s a mix, but many certainly want to come back. They’re lonely … they actually want to work in more of a community setting.”

In a word, the pandemic has shown area businesses and nonprofits that they have more options than maybe they thought they had, when it comes to how and where people work and just how things are done.

For this issue and its focus on the modern office, we talked with a number of business owners and managers about what’s been learned over the past 12 months or so and how COVID has actually made companies more efficient and enabled them to reduce costs in some areas. The observations were telling.

“The audit side of our practice generally required teams of people here to go visit on site at other locations,” said Sarah Rose Stack, Marketing & Recruitment manager at the Holyoke-based CPA firm Meyers Brothers Kalicka. “Because of COVID, we learned we could do these remotely, which is something we’ve never done; this was a first-time experience not just for us, but for people in our industry. We’ve learned that it’s fine, it is efficient, and with some businesses, we’ll keep doing it this way moving forward.”

Timm Marini holds up an ‘insurance bible’

Timm Marini holds up an ‘insurance bible’ — the printed variety. Those at HUB have had to send digital documents during the pandemic, and that trend will continue into the future.

For Springfield-based Wellfleet, now with offices in Tower Square, the pandemic has provided ample evidence that employees in many positions can work effectively and remotely, and this enables the company to expand its horizons when it comes to hiring.

“You can expand your pool when it comes to workforce; we can hire someone not from the Springfield area and have them be successful with the tools that we’ve developed,” said Drew DiGiorgio, the company’s CEO, adding that the company has already hired some people from other parts of the country. Meanwhile, it is working on plans to have other employees work a hybrid schedule, with some days in the office and others remotely.

Chuck Leach, president and CEO of Lee Bank, said that, prior to COVID, HR Director Susie Brown and IT Director Drew Weibel were already hard on work on plans to position the bank to be more flexible with its workforce in terms of where and how it worked. The pandemic served to accelerate that process.

“Even though we’re Lee Bank, a lot of our employees come in from other markets,” he noted, adding that these lengthy commutes prompted talk and then creation of plans for remote work and hybrid schedules. “We were already thinking about it, and COVID forced us to be more deliberate in our approach and our policies and procedures.”

But even with these options in place and far more flexibility with work schedules than ever before, the bank is tilting strongly toward having people work on site — with some exceptions — and it’s also seeing most of its employees want to come back, which is another thing companies are learning as they work their way through COVID.

“It’s a mix, but many certainly want to come back,” Weibel said. “They’re lonely … they actually want to work in more of a community setting. They want to come back, but some find it easier to work at home until the school situation is worked out and their children are back in the classroom.”

Stack agreed. “When the shutdown first happened, everyone was excited to work from home, so a lot of people exercised that option, and some people have found they’re more efficient from home, cutting out that commute,” she said. “But while some still work from home, the majority of people, like 97% of the people at MBK, choose to come into the office every day because they don’t want to work from home.”

Work in Progress

DiGiorgio said it’s somewhat frustrating to walk around his company’s offices in Tower Square.

More than 200 employees moved into the well-appointed space covering three full floors in the late summer of 2019, only to see pretty much everyone pack up and go home to work in mid-March.

“We love it — we wish we could be in it more,” he said with a laugh. “It’s great space — open-floor design, all the things you probably don’t want with COVID. It will be great to get back to it.”

Indeed, that’s a lot of fairly expensive (for this market) downtown Springfield real estate that is not being used. But DiGiorgio doesn’t dwell on matters that are out of his control.

Instead, he’s more focused on what the future will look like — and applying all the lessons learned during the pandemic.

As for that real estate … he said this is a growing company that took three floors with the intention of perhaps soon absorbing a fourth. Need for that additional space is less likely now, he acknowledged, but the company will still need the space it’s now leasing because he fully expects most of his employees to be back in that space.

But not all will have to come back, he went on, and some, as he noted, will never have to sit at a desk there.

“We have, over the past year, hired people in Florida, Tennessee, Atlanta, Minneapolis, Upstate New York … we have a pretty remote workforce,” he said, adding that some of these hires took place before COVID because the tools were in place, but the pandemic has highlighted how effective people can be working remotely, and thus, as he said, broadened and deepened the talent pool.

“We have a billing person who’s in Tennessee. I feel more comfortable now that she can hire people in Tennessee or wherever she needs to; they may not need to be in Springfield, which is what our initial thought was. COVID has opened up our thinking to where we hire people.”

Marini agreed. “We have employees in Wisconsin who work for New England,” he explained. “We have people who decided to move to Florida and still work for New England. We had a little of that before COVID, but what we realized was that, with our ability to get our automation up and running, our digital offerings, that really expanded our talent pool; there have been some relocations during COVID and some new hires during COVID that are not Western Mass.-based. And we have some people in Western Mass. who work for some of our Eastern Mass. locations and even one in New York.”

COVID has reinforced this premise, as it has many others, while accelerating some trends and pretty much forcing companies to do some things they never considered before.

Like those virtual audits at Meyers Brothers Kalicka.

Stack said the firm’s teams have undertaken a number of them, while, in other cases, it has adopted a hybrid approach for some audits, going to the client site for some of the work while handing the rest remotely. Thanks in large part to COVID, there are now several options for handling such work, she said, adding that other lessons have been learned and other new ways of doing things revealed.

“On the tax side of our practice, we used to have clients in the building all day, every day, from February 1 through tax day, and now, maybe three people a day drop off their boxes of papers; the vast majority of people just e-mail us their material,” she explained. “They’re happy with it, it’s efficient, and it saves us a step. Instead of having to take tons and tons of paperwork and scan it into our digital system, it’s already coming to us in that format.

“We used to have to hire a scanner for tax season — a whole person whose job was to take all this paper that people would drop off and scan it,” she went on. “We didn’t have to hire a scanner this season, and that was definitely a positive change.”

Will Dávila, executive director and CEO of the Children’s Study Home in Springfield, said the pandemic has led to positive change in many forms at his agency and most all businesses and nonprofits. He echoed others when he said that COVID has served to heighten the awareness of how technology can be used to improve efficiency and save time, such as when traveling to conferences or meetings in other cities.

Will Dávila, executive director of the Children’s Study Home

Will Dávila, executive director of the Children’s Study Home, says his agency has learned a number of lessons during the pandemic, many of them involving better use of technology.

“We now have more of a comfort level with working remotely and working via Zoom,” he said, adding that this technology existed long before COVID, but few businesses took full advantage of it. “The lesson for us, and I’m not sure we have it completely figured out yet — it will likely take us some time — is that we can do more with technology than we thought we could before. I’ve been in places where we would talk about technology and teleconferencing and telehealth, and people would balk at it. And now, we’ve been forced to take another look, and we’ve embraced it.”

Looking ahead, he said that, while most people look forward to the day when they can gather and attend conferences and meetings in person, they know there are options — there’s that word again — and they won’t be hesitant to take full advantage of them if the circumstances permit.

Caution Signs

As he walked with BusinessWest through HUB’s headquarters facility on Shaker Road in East Longmeadow, Marini pointed to a number of unoccupied workstations, some of them marked off with the yellow ‘caution’ tape usually associated with crime scenes and construction sites. Such tape can be seen throughout the suite of offices, he said, noting that the space — which was occupied by just over 50 employees prior to the pandemic — has hosted around seven a day on average, with a high of 14, by his count.

Sectioning off such areas became part of life during COVID, he noted, adding that there are myriad ways the pandemic changed the landscape for the company. Overall, there’s been a huge shift; a place once teeming with employees and visiting customers now sees very few of either.

And that has brought challenges — and some opportunities, mostly in the form of learning how to do things remotely and without reams of paper. As he talked about these opportunities, Marini gave a nod — sort of, anyway — to an organization his business works closely with, obviously: the Registry of Motor Vehicles.

“Even the Registry of Motor Vehicles here in the Commonwealth of Massachusetts has become more digitized, more automated, and more flexible, and that’s something I never thought I’d see after 33 or 34 years of doing this,” he told BusinessWest, adding that, in some ways, his company has been inspired by the RMV, as it automates and digitizes many processes that once involved paper and in-person sessions.

As for the challenges, they came in waves, Marini explained, from equipping everyone to work at home, which was expensive and difficult logistically, to helping employees cope with everything from feelings of isolation to simply filling their days with work, even though they were home.

CHuck Leach

Chuck Leach

“Even though we’re Lee Bank, a lot of our employees come in from other markets. We were already thinking about it, and COVID forced us to be more deliberate in our approach and our policies and procedures.”

“We were too accessible when we were home, so there were no breaks for our people,” he explained. “We started having big conversations and hiring professionals to come in to coach us to make sure we took breaks and that there was separation between home and work.”

What will things look like several months from now, especially if the pandemic continues to ease? Marini isn’t exactly sure, but he acknowledged that he spends a lot of time thinking about it and working with corporate to prepare for that day.

He does know that more business will be handled virtually in the future, and there will be little, if any, need for those printed insurance bibles.

As for employees, like others we spoke with, he expected that they will come back, because the company wants them back, but also because they want to be back in that office setting.

Such sentiments were echoed by many of those we spoke with. They noted that it seem logical that, after getting a taste of working at home, many employees would prefer that option, but what employers are generally seeing is the opposite reaction.

“People are sick of remote everything,” said Stack, noting that Meyers Brothers Kalicka has a younger team within the audit department that could do its work from home, but instead it has reserved the firm’s huge boardroom for the past six weeks so the members can work together, but safely and well spread out.

“They have music playing on Spotify every time you walk in there,” she said. “They just want to be in the same space — they think they’re more efficient that way, and they can ask questions of each other faster and stay on track better because they’re all together. It’s not something we told them they had to do; they’ve chosen to do it.”

Dávila agreed, although he noted that he has some employees who are quite happy working at home, and are “working on it” when it comes to returning to the office. By that, he meant he’s offering some flexibility on this matter and not rushing anyone back who doesn’t want to rush back.

“I think it’s partly generational — people who have been in the field for 15 or 20 years or more and are used to those in-person interactions, they’re used to having that time by the water cooler when they’re getting a cup of coffee. I consider those valuable interactions that help with morale,” he told BusinessWest. “But we also have younger staff who are very comfortable with technology and embrace the idea of working remotely.”

But, ultimately, they will come back, probably by the end of the calendar year. “I don’t want to say absolutely not,” he said when asked about hybrid arrangements that offer a mix of remote and in-office work. “But my preference is that we get people back to a schedule where they can see each other and interact.”

Lee Bank’s Susie Brown agreed. “When it comes to Lee Bank, I think everyone enjoys being together,” she said. “We don’t have a lot of people who are unwilling to come back; those that are unwilling are those that have other challenges at home with their children.”

Bottom Line

COVID is far from over, and there are certainly more lessons to be learned as companies large and small continue to cope with an unprecedented challenge.

But it’s already evident that this battle has prompted changes that will live on long after the pandemic is in the rear-view mirror. As they were forced to do things differently, companies learned that, in many cases, these different ways are better than the old ways.

Like the insurance bible. Clients, at least some of them, will still need one. But they won’t need to thumb through 700 pages of printed material to find an answer.

COVID has changed all that — and it keeps on changing the landscape.

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

Opinion

Editorial

In some ways, it seems like it just yesterday. In other ways, it seems like years ago.

That’s what the last 12 months of COVID-19 — 12 months unlike anything any of us have experienced before — have been like. They’ve gone by fast, but it’s been a long, as in long, year.

As with the Kennedy assassination (for those of us old enough) and with the morning of 9/11 for those who are younger, everyone remembers where they were and what was happening when the governor put his stay-at-home order in effect. For many, it meant packing up (if they hadn’t already packed up) and leaving the office for what we all thought might be a few weeks, or a few months at most.

We soon learned that those projections were way off base and that we would be living with the pandemic and all the hardships that came with it for a long time.

In the months that followed, we would learn much more, as our roundtable discussion with six area business leaders (see story on page 6) reveals. We learned that we didn’t have to be in the office, necessarily, to get our jobs done. We learned new ways of doing things. We learned to embrace technology — well, because we didn’t have a choice. And we all wondered why we didn’t embrace it earlier.

We learned some other things, as well. We learned that life is hard, and not just during a pandemic. But COVID, by exacerbating things, made it clear that work/life balance isn’t just a buzz phrase; it is a serious, serious challenge and something that employers now understand better than they ever did before.

As our panelists indicated, we all learned to listen a little more than we used to, and we learned how to more empathic to the needs and challenges of employees. Many of us learned how to be better managers because, in short, that’s what had to happen. We learned that making sales quotas, hitting deadlines, and reaching quarterly goals are not the only things that keep people up at night.

We also learned how to pivot — again, because we had to — and look for new ways to carry out our missions, make payroll each week, keep people employed, and keep the doors open.

In short, we’ve learned a lot — about pandemics, business, life, and ourselves. This is not a silver lining to this horrible crisis — there are none of those. It’s simply reality.

What’s also reality is that the hard decisions and the myriad challenges are not over — not by a long shot. Now, we have to determine how we’re going to execute all these things we’ve learned when life and work go back to normal, or something approaching it.

We have to decide how our businesses will function when it’s safe for everyone to come back to the office or the classroom or the restaurant. We’ve learned that people can work from home, but is that the best place to work — for the company and the employee? And there are other questions, including those related to how we can continue to listen, understand, and be empathic when we’re no longer in crisis mode.

These are just some of the things we need to think about as we mark a dubious milestone — a year of coping with a global pandemic.

It’s been a year to learn, reflect, adapt, and change. And we’re far from being done with any of those things.

Opinion

Opinion

Make no mistake about it, when it comes to the tragic COVID-related deaths at the Soldiers’ Home in Holyoke almost a year ago, there are no silver linings. There is nothing that can fill the void left by lost loved ones, and nothing that can relieve the anguish visited upon staff members who had to endure that catastrophic sequence of events that led to the deaths of at least 76 veterans.

But sometimes, such tragedies eventually lead to progress, to improvements, to new and better ways of doing things. And it appears that this may well be the case with the Soldiers’ Home.

Indeed, out of the ashes of the calamity of last spring have emerged plans for a new, eight-story Holyoke Soldiers’ Home that will replace the 70-year-old facility that is, in many ways, inadequate and obsolete. Last week, the Baker-Polito administration filed a $400 million bond bill to move forward with the construction of the new home, the next big step in the process of making a new facility reality.

While the need for a new Soldiers’ Home has long been understood and embraced, there is no doubt that the events of last spring — when the virus overran the facility amid a series of questionable decisions that ultimately led to resignations and, later, indictments for criminal neglect — have helped pave the way for a proper, modern, 235-bed facility that will serve veterans for generations to come.

This project still has a long way to go before it becomes reality. There are stern deadlines to meet and more important votes to take place in the state Legislature. But there certainly appears to be sufficient momentum to see this initiative to the finish line. It has been generated by caring people who want to do right by future generations of veterans — but also, we believe, by a deep desire to “make things right” for the families of those who died last spring and the for the staff members who have long endured inadequate facilities, said the chairman of a coalition of former Soldiers’ Home administrators, families, and veterans advocates who have embraced plans for a new home.

Truthfully, nothing will really make things right. But this is huge step in the right direction.

Business of Aging

Shot in the Arm

As COVID-19 vaccines begin to roll off production lines, many questions remain — about how quickly they’ll reach the general public, about long-term efficacy and safety, about how many Americans will actually want one.

But on one issue, there is no doubt, Dr. Andrew Artenstein said.

“This is a spectacular achievement just to get where we’ve gotten so far, and I think we should appreciate that,” the chief physician executive and chief academic officer at Baystate Health told BusinessWest. “It’s been a whirlwind, and I mean that in a good way.”

Everyone in healthcare understands the upside — the dramatic promise — of a vaccine as the COVID-19 pandemic enters its 10th month.

“A vaccine is a major component of getting on the other side of this,” Artenstein added. “It’s not the only component, but it’s an important and necessary piece of shortening the duration of this pandemic and possibly preventing future waves.”

With Pfizer gaining emergency-use authorization from the U.S. Department of Health and Human Services to begin distributing its vaccine — and Moderna expected to do the same — the Baker-Polito administration announced allocation and distribution plans for the first round of vaccine shipments to Massachusetts, expected to begin around Dec. 15. The state’s first shipment of 59,475 doses of the Pfizer vaccine was ordered from the federal government and will be delivered directly to 21 hospitals across eight counties, as well as to the Department of Public Health immunization lab.

Doses will then be redistributed for access to 74 hospitals across all 14 counties for frontline medical workers. Another 40,000 doses of the Pfizer vaccine will be allocated to the Federal Pharmacy Program to begin vaccinating staff and residents of skilled-nursing facilities and assisted-living residences in Massachusetts.

In all, Massachusetts is expecting 300,000 doses of vaccines from both Pfizer and Moderna to be delivered by the end of December. Both vaccines require two doses administered three to four weeks apart. While all delivery dates and quantities are subject to change due to ongoing federal approval and allocation, state leaders expect to receive and distribute more than 2 million doses to priority population groups by the end of March.

Dr. Andrew Artenstein

Dr. Andrew Artenstein says the public should not let down their guard when it comes to masking and social distancing while they wait for the vaccine.

“It does make perfect sense,” Artenstein said of the prioritization plans, which reflect judgments on the federal level and ensure delivery to groups like healthcare workers, first responders, the elderly, and people with co-morbidities before the rest of the public. In the case of seniors, for example, “it’s not that they’re more likely to get the virus, necessarily, but they’re more likely to die if they get infected. They do worse.”

Meanwhile, he added, healthcare workers have a greater risk of coronavirus exposure than most other people.

“We’ve been inundated — inundated — with calls from other groups that they want the vaccine,” he said, placing heavy emphasis on that word. “But the truth is, it isn’t available for the general population now, and it may be several months before it is.”

Artenstein, an infectious-disease expert who founded and directed the Center for Biodefense and Emerging Pathogens at Brown University for more than a decade before arriving at Baystate, has been one of the public faces locally of the fight against COVID-19, and he was careful to temper optimism about a vaccine with a reality check on the timeline — and what people need to do in the meantime.

“A vaccine may eventually be the answer, but it’s only going to be part of the solution for the next six to 12 months, assuming we continue to get vaccines that are safe and effective. It’s going to take a while — even if all goes well — before we get enough immunity in the population to really put an end to this thing.

“In the meantime,” he went on, “we would benefit greatly by continuing to push the classic ways to interrupt transmission: masks, distancing, avoiding gatherings. All those things will continue to help us because, even after we start vaccinating parts of the population, it will take the better part of the year to roll it out to everyone, and we need to continue to interrupt transmission.”

Jessica Collins, executive director of the Public Health Institute of Western Massachusetts, agreed, even though it can be a challenge getting through to people suffering from ‘pandemic fatigue,’ who feel isolated and weary of all the changes in their lives over the past year.

“I’m sorry people are tired,” she said. “But the basic messaging isn’t hard — wear a mask, wash your hands, and don’t be inside spaces with a mask off with people you don’t know. I do think the holidays have created a tremendous sense of urgency to remind people again, especially with students leaving schools and coming back to their homes.”

Hopefully, health leaders say, vaccines will put a definitive end to the crisis. But that day is still far off, Collins added. “People need to wait it out.”

 

Making a List, Checking It Twice

In announcing the Commonwealth’s vaccine-distribution plans, Gov. Charlie Baker noted that Massachusetts goes further than national recommendations by prioritizing all workers in the healthcare environment, not only providers, but also food-service, maintenance, and other facility workers. Similarly, home health workers, including personal-care attendants, are prioritized on the list, recognizing their important role providing services to vulnerable individuals and the fact that they often reside in communities highly affected by COVID-19.

Jessica Collins

Jessica Collins

“Messaging is critical, and the messengers are critical. Hopefully, we’ll have good results, and more people will be willing to take it.”

Phase one of vaccine distribution — which, as noted, includes healthcare-facility workers; police, fire, and ambulance workers; congregate-care settings, including not only senior-living facilities, but shelters and jails; and home-based healthcare workers — is expected to last into February. Phase two, expected to run from February to April, will prioritize individuals with co-morbidities that put them at higher risk for COVID-19 complications; all adults over age 65; as well as workers in the fields of early education, K-12 education, transit, grocery, utility, food and agriculture, sanitation, public works, and public health.

Phase three, expected to follow in April or May, will see the vaccine more widely available to the general public.

Baker’s announcement noted that vaccines go through extensive testing, more than any pharmaceuticals, including extensive testing in clinical trials. The U.S. Food and Drug Administration, which approves the vaccine, and the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which will make its recommendation for use, must ensure any vaccine is both safe and effective for the public before approval and distribution.

All this is necessary for emergency-use authorization of the Pfizer and Moderna vaccines, Artenstein said, but the testing process is far from over, and long-term effects won’t be known until, well, the long term.

The emergency-use ruling “is not licensure, but allows the immediate use of the vaccine pending more information that leads to licensure down the road — because we’re in a pandemic,” he noted, adding that he’s optimistic about further testing, as trials so far have shown about 95% effectiveness across all age groups, with no serious adverse effects.

“The data I’ve seen is pretty impressive for efficacy and safety of the vaccine. And there were around 40,000 people in the trial, so that’s a good sample,” he said — enough to start delivering some immunity to high-risk populations now.

The question, especially as distribution widens in the spring, is how many Americans will actually take the vaccine. Collins said the Public Health Institute has conducted preliminary outreach and found some skepticism and mistrust of the government when it comes to vaccine advice, especially in communities of color.

“In order to counteract that, we have been trying to find and lift up messengers in the community who are trusted people, whether faith-based leaders or other trusted messengers, to counteract skepticism and fear about getting vaccines, whether the flu vaccine or the COVID-19 vaccine,” Collins told BusinessWest, adding that the institute held a virtual town-hall event two days before Thanksgiving and asked 10 such messengers to share their wisdom on prevention measures.

Artenstein breaks down vaccine attitudes into three distinct groups of people — two of which are those champing at the bit for a vaccine, and a small but robust community of anti-vaxxers who express skepticism at vaccines in general.

“Then there’s a whole middle group who could be convinced to get the vaccine, but they’re concerned about safety and effectiveness,” he explained. “It’s a risk-benefit calculation, and based on what I know about vaccines, the risk seems low, and the risk of COVID seems pretty high, especially right now, with such high rates in the community.

Hampden County, in fact, currently ranks third among Massachusetts counties for transmission rate, with more than 50 positive cases per 100,000 residents.

Typically, around 70% of people in a community — or a nation — need to be exposed, either through natural infection or a vaccine, to reach the desired herd immunity, he added. “In the U.S., that’s a big number. But the risk-benefit calculation is obvious. You’d like, over time, to have enough people willing to get the vaccine to help the general population.”

 

Anticipation and Reality

While surveys currently suggest about 60% of Americans are willing to take a COVID-19 vaccine, that number could rise higher if early results from the priority groups demonstrate both effectiveness and safety.

“The U.K. is going first, and then U.S. healthcare workers have to go — which is obviously the right thing to do — then people over 65,” Collins noted. “It’s not like the general public is being made guinea pigs. We will actually be able to see a lot of people getting the vaccine, and the companies will see the reactions.

“So, messaging is critical, and the messengers are critical,” she added. “Hopefully, we’ll have good results, and more people will be willing to take it.”

Artenstein agreed, adding that, for the group of Americans ready to line up right now, the wait may be longer than they realize, but that’s OK.

“We’re a little over our skis on this,” he said. “There’s a lot of excitement and anticipation, but it’s going to come out as more of a slow roll; there’s a manufacturing process, an approval process, and a safety process. There won’t be 300 million doses available tomorrow, and that’s hard for some folks.

“There’s going to be a lot of interest, questions, and anxiety, and rightly so,” he added. “We’re living in a very different time, and people want to move very fast. But we have to make sure we do things in the safest possible way.”

 

Joseph Bednar can be reached at [email protected]

 

Opinion

Opinion

By Stuart Anfang, M.D.

The holidays are supposed to be ‘the most wonderful time of the year,’ as one song notes. But for some, it may be the most difficult time of the year after the loss of a loved one.

The holiday season can be especially difficult for those who are preparing to spend these joyous occasions for the first time without a spouse, child, or other beloved family member or friend by their side. These feelings of grief are only exacerbated this year by COVID-19, which has taken the lives of so many, plus the general stress of dealing with the pandemic.

It’s only natural to experience a range of emotions such as sadness, loneliness, and even helplessness and hopelessness while navigating the hustle and bustle of the holidays. But you don’t have to suffer alone. Recognize that you are not alone, and that mixed or sad feelings during the holidays are not uncommon. Do not suffer in silence, and watch for the tendency to isolate or withdraw from others. Denying or bottling up your feelings — or self-medicating with alcohol or drugs — are worrisome signs.

As you prepare for the holidays, include activities that are important to you and your family. Share the load and accept offers of help. If some activities are too difficult or draining, set limits or decide to drop them. Remember, it’s OK and not a sign of weakness to ask for help.

It is always important to remember that you have options. You can change routines. Modify past traditions or join your family in creating new traditions. If you wish, you can find a way of formally remembering your loved one who is not physically present with you — for example, serving their favorite dessert and reflecting on the joy that it brought to your loved one in the past. It is stressful to experience the holiday without your loved one, but you can find ways to honor and include them.

Together, you can share a holiday that is different, but still meaningful and hopeful. As a family, you can add a memory ritual into your holiday by including a special activity such as looking at old photo albums or making and displaying a special holiday decoration with significant ties to the deceased. Given the current COVID-19 circumstances, make sure to follow public-health recommendations about masking, social distancing, and gathering in limited numbers.

Many people also find solace in generosity, as this is the ‘season of giving.’ Many people also volunteer during the holidays, such as serving meals at a local shelter or distributing toys to needy children.

For some, the holidays may offer a reprieve from sad feelings, and you may find yourself caught up in the moment as you experience the joy of family and friends around you. But if you are noticing more significant symptoms causing impairment at work, school, or home — problems with sleep, low energy, dramatic change in appetite or weight, inability to concentrate, frequent crying, easy irritability, thoughts of hurting yourself, or wanting to die — that may be time to seek some professional evaluation. A good place to start can be your primary-care provider or a trusted clergy.

The bottom line is, help is available. Do not suffer in silence.

 

Dr. Stuart Anfang is vice chair of Psychiatry at Baystate Health.

Healthcare Heroes

While This Shelter’s Protocols Changed, Its Mission Never Did

The metaphor is an easy one to draw.

“If COVID was the invading army, all of us here — every one of us — had to set the wall and hold the wall and make sure folks were going to be safe,” said Keith Rhone, Operations director at Friends of the Homeless in Springfield, a program of Clinical & Support Options (CSO).

The reality, however, was much more complex. In its dorms, its kitchen, and places where clients meet therapists, clinicians, and other staff one on one, FOH was tasked, back in March, with implementing social distancing and a host of other protocols aimed at keeping everyone safe — both those delivering a broad range of services and those receiving them — while never shutting those services down.

That they did so, and how, makes the entire team true Healthcare Heroes.

“People have to gather here, so we’re potentially a hot spot. All the credit goes to the people who kept it from being that.”

“In some ways, we can’t do anything differently,” Clinical Director Christy O’Brien told BusinessWest. “We’re never going to shut down; we’re never not going to be here. Despite the social distancing we had to do, we’re never not going to be close to our people — not necessarily physically, of course, but we still need to know how they’re doing, how we can help, all those things. Where other places were forced to move to telehealth, that’s never going to work for us. The needs are still the needs.”

Those needs encompass not only shelter, but clinical services, such as mental-health and substance-abuse recovery coaching and therapy; housing — FOH has a number of lease-holding tenants; three meals a day; clothing and toiletries as necessary; transportation and delivery services; prescription pickups; case management … as Rhone put it, “the job here is whatever it takes.”

COVID-19 didn’t arrive at an ideal time, said Bill Miller, vice president of Housing and Homeless Services — not that there’s ever a good time for a global pandemic.

“We were coming out of a winter where we served more people and were more full than we had ever been in our history,” he recalled. “So it was a tough winter, and what the pandemic required was a complete shift in our mindset because our inclination and our mission has always been the same: how do we serve as many people as possible? So we wanted to continue to serve in the same way, but we had to adopt a whole new style.”

Among the changes, picnic tables and tents were erected outdoors — spaced apart — to accommodate distanced meal lines. Volunteers, who are instrumental in the service of FOH meals and other activities, were temporarily suspended. In the dormitories, some beds were removed, with overflow space employed in the dining room. Partitions went up, and guests were arranged head to toe when sleeping.

Some of the leadership team at Friends of the Homeless

Some of the leadership team at Friends of the Homeless, who had to quickly figure out new protocols in the spring while continuing to serve clients at the same level as before.

Additional temporary staff were hired to more regularly and thoroughly sanitize spaces, and hand-sanitizer stations were mounted throughout the campus. Dozens of donors and staffers designed and sewed homemade cloth masks so that each shelter guest would have reusable, washable masks.

Meanwhile, from the pandemic’s earliest days, before on-site testing became available, temperature screenings and interviews were conducted to alert the team to early signs, and as the situation progressed, Baystate and Mercy medical centers were quick to work with FOH on testing.

CSO also staffed and managed large tent facilities, which were erected in partnership with the city of Springfield and served as emergency accommodations in the event of positive cases (see the related story of another Healthcare Hero, page xx). When another shelter in the city needed to close due to guests testing positive, the CSO team was able to quarantine those who had been at risk and refer those who ended up testing positive to state-run MEMA isolation sites. FOH further assisted many of those individuals once their isolation periods were completed.

Why was all this critical? Simply put, while COVID-19 has swept through homeless populations in Boston, Worcester, and other cities, homeless individuals in the Greater Springfield region have been largely spared, thanks to the quick — dare we say heroic — work of the team at Friends of the Homeless.

“People have to gather here, so we’re potentially a hot spot. All the credit goes to the people who kept it from being that,” Miller said, adding that “there wasn’t one person who backed out, who wasn’t going to show up for work. We have a dedicated team who have been here for a long time. It was just incredible how everybody showed up.”

“I like the fact that we work in an environment that cares about people.”

It wasn’t lost on Miller that many people working at Friends of the Homeless fall into high-risk categories when it comes to COVID-19. “To have people come into work anyway is just striking.”

“Everyone came in and suited up and did the work,” added Delphine Ray, manager of Case Management Services. “They didn’t hesitate. This is our home away from home, and, by the grace of God, we managed to pull through.”

Dave Ware, men’s shelter manager, said he had many concerns about to manage the social-distancing aspect of the pandemic at FOH. “They really came together to figure out how to manage that in the dorms and kitchen. They came up with a good strategy to handle the social-distancing part.”

It wasn’t always a top-down strategy, Miller added. “There was a fad in business management some years ago — idea-driven organizations. That meant the ideas came from staff at all levels. That’s what we saw here. ‘What if we try this?’ ‘OK, let’s do that.’ Because this was something we’d never seen before, and we didn’t know what to do. And it ended up going well. Everybody was on high alert, and everyone had ideas.”

O’Brien also praised clients of Friends of the Homeless for taking the pandemic seriously and getting tested in the early days, before much was known about the virus and they were already preoccupied with some very real concerns, from mental health to lack of housing. “COVID wasn’t a primary concern for a lot of people. But they jumped on it when informed.”

He recalled warm moments, too, among upsetting ones — “incredible moments of humanity, seeing people come together in a time of crisis and fear. It was very genuine.”

That said, the need for the broad array of services provided by Friends of the Homeless to hundreds of people every day remains persistent, as does COVID-19 itself, as the cold weather approaches — not that those needs go away in the warmer months, Miller said.

“There may be peaks and valleys of needs; it’s not predicated only on cold weather. We used to see more of a lull in summer, but not so much anymore. And when times are hard economically…”

He didn’t have to finish that thought to register his point, which is, the tougher a community’s social and economic challenges, the more necessary FOH becomes.

“I like the fact that we work in an environment that cares about people,” Ware added. “When you look nationally and globally, you see so many people suffering, homeless, without food. We’re just a small place that takes care of those needs, but nationwide, so many people are suffering in this way. I’m proud to work in a place that takes care of people who need it. We’re one of the only places around here that does it on the level we do.”

As noted earlier, this is not an organization that can just shut its doors to the ‘invading army’ of COVID-19.

“We’re home for many people,” Miller said.

“And if we don’t do it,” O’Brien added, “who will?”

 

Joseph Bednar can be reached at [email protected]

Coronavirus

Trial by Fire

STCC respiratory-care students

STCC respiratory-care students Stefani Glukhova and Max La work at Baystate Medical Center.

Tallon Tomasi used to punch the same clock everyone else does when starting her shift as an LPN at the Leavitt Family Jewish Home in Longmeadow.

Not anymore. Because she works in a COVID-positive unit at the skilled-nursing facility, she enters by a different way than those in the negative units.

“Now, when we come in, we do this check-in system where we wash our hands, get our temperatures taken, we’re asked about symptoms related to COVID, about recent travels, recent exposure to people who have traveled. Then we get our gear, we wash our hands, and go to work.”

As a nursing student at Holyoke Community College, Tomasi is just beginning her healthcare career, and doing so right on the front lines of a global pandemic the likes of which haven’t been seen in more than a century.

Some aspects of it are tough to bear.

“The thing that’s very hard is not having family members being able to come in and see their loved ones as we are going through this difficult time,” she told BusinessWest. “Some of our patients have dementia, and not being able to see their families, it is challenging.”

“The thing that’s very hard is not having family members being able to come in and see their loved ones as we are going through this difficult time. Some of our patients have dementia, and not being able to see their families, it is challenging.”

That said, “I think our facility has done a good job,” she went on. “We do phone calls with family, and we do FaceTime, so I think that helps a little bit. But not being able to physically touch loved ones is hard for some of the patients and their family members.”

Tomasi paused to consider what else has been challenging about working in healthcare during the time of COVID-19.

“Everyone is so fearful of not knowing what’s going to happen,” she finally said. “That’s a big problem. We are not fully aware of how this thing will go, how to treat it, so the new big problem is fear — fear of the unknown. We don’t know everything about it, there’s anxiety around it, and I sometimes get scared because I know that I have the ability to spread it. But you know what has to be done — you have to help.”

With graduation — such as it is this year — just around the corner, many more nurses and other healthcare professionals are getting ready to transition from college into full-time work, but they’re facing an uncertain job market when so much of the sector’s energy is tied up in simply containing the pandemic.

“I checked in with some of our soon-to-be-graduates, and as far as the job market goes, I would say it’s pretty much up in the air and confusing,” said Kathleen Scoble, dean of the School of Nursing at Elms College.

On one hand, she noted, Hartford Hospital and St. Francis Hospital just down I-91 have responded “pretty expeditiously” to graduating seniors, several of whom landed positions right away. On the other hand, Baystate Medical Center has informed applicants that its new-graduate nursing program, traditionally a very popular landing spot for Elms grads, has been postponed.

Brooke Hallowell

Brooke Hallowell

“We have mechanisms to do more triage and problem solving with patients before they come to a place where they’re exposing themselves to others.”

But the need is great, she added, and Elms President Harry Dumay agreed, adding, “I’m proud of being part of this sector and proud of not only our institution, but all students and graduates on the front lines during these difficult times.”

Even if, as we’ll see, it can be a little challenging getting to those front lines.

Field Work

For Springfield Technical Community College, which boasts the largest health-simulation center in the Northeast, students not having access to campus means not being able to use those tools in their training, President John Cook said.

“That does hinder the potential of our students to finish, graduate, and work in these fields, which, if they weren’t in demand before, are certainly in demand now.”

That’s a major factor in nursing right now, Scoble said.

“If you ask students what our major responsibility is, it’s preparing them for licensure; it’s our primary responsibility as a program, to make sure they meet all their graduation requirements. And that has been a keen challenge the last semester; all of our clinical learning experiences were canceled — understandably.”

Carol Leary, president of Bay Path College, also noted that nursing students have had their clinicals put off — and there’s only so much that can be accomplished online.

“For me, that is a concern because many of them need to sit for their licensing exams before they can begin to work,” she said. “The accrediting bodies are trying to work with all the programs across the country to figure out how students can sit for exams.”

Scoble noted that only one testing site is open in the entire state where nursing students can take their licensing exam, known as the NCLEX, and that site is following CDC requirements for social distancing. “So you can imagine, with thousands of nursing graduates in the state, how long it will take for them to test the class of 2020. But they’re trying to open as many sites as they can.”

In Gov. Charlie Baker’s guidance when shuttering the Massachusetts economy in March, language was included allowing new nurses to practice without a license, if supervised by a professional nurse of equal or higher education.

“It’s really up to the employers how they would receive a new graduate who is not licensed, how they would recruit and receive them,” Scoble said. “We would provide any supporting documentation they would require.

“I checked in with some of our soon-to-be-graduates, and as far as the job market goes, I would say it’s pretty much up in the air and confusing.”

In the past, she explained, a typical student would agree to a position in early spring, then take the exam in June and start work around July.

“All that is unknown right now. Students would say the only thing they can control is finishing the program and preparing for NCLEX. We’re stressing to our soon-to-be-graduates to prepare for the NCLEX — and continue to prepare — until they have the opportunity to sit for the exam.”

In a similar situation, three respiratory-care students from STCC recently began working at Baystate Medical Center after applying for and receiving limited permit licenses, said Esther Perrelli Brookes, director and department chair of the Respiratory Care program. Eight other students have applied for limited permit licenses so they can work in the field.

“Students chose to study respiratory care because they want to help people. They want to make a difference,” Perrelli Brookes said. “I’m extremely proud of my students who are stepping up during this unprecedented health crisis. I’ve had many students reach out to say they want to find out what they can do now. I’ve been helping them get their limited permit licenses.”

“I was one of the first in my class to do it,” student Max La said. “It’s a good learning experience because other respiratory therapists are there and you can learn from them.”

The limited permit license means he can perform certain tasks, but not everything a fully licensed respiratory care therapist would do. “We can’t touch the ventilators,” he said, referring to the devices that some seriously ill COVID-19 patients use in hospitals.

At Baystate, La does not work with COVID-19 patients, but must wear a gown, mask, and other personal protective equipment (PPE), and he said Baystate takes precautions to protect him and others from contracting the coronavirus. “There’s always concern, but Baystate has a good policy. Everyone has masks, and they do temperature checks when everyone is walking in.”

STCC’s respiratory care program trains students skills in treatment, management, diagnosis and care of patients with breathing problems associated with diseases such as COVID-19.

According to the U.S. Bureau of Labor Statistics, respiratory therapists will continue to be in high demand at hospitals and medical facilities, with job growth of 21% projected between 2018 and 2028 — and that was before COVID-19 wrought what is essentially a respiratory crisis around the globe.

Seeds of Change

Demand should remain high in many health fields, said Brooke Hallowell, dean of the School of Health Sciences at Springfield College, though it may be uneven in the short term. Take physical and occupational therapists — in emergency-care settings, they’re playing an important role in patient care. But those who work with post-surgical patients for, say, joint replacement may find work more intermittent as many elective procedures are being postponed.

One area of growth is in the realm of telehealth, she added. “All of our health professionals are going through a rapid transition in terms of telehealth access, and Medicare and insurance companies are adjusting their policies related to telehealth, and reimbursement for telehealth visits is being revamped.”

These efforts are intended to reduce the spread of COVID-19, but the lessons being learned may be long-term, Hallowell noted.

“Instead of waiting in a room full of sick people to be seen at the doctor’s office, we have mechanisms to do more triage and problem solving with patients before they come to a place where they’re exposing themselves to others. I think this is here to stay … how we carry out our practices will be changing in big ways.”

Interest in some health programs may shift as well, she added. For example, cardiopulmonary rehabilitation, a specialty within physical therapy, is getting more attention for the vital role it plays in COVID-19 treatment. And Springfield College is probably launching its new undergraduate program in public health this fall at the right time, too.

“We expect that will be a popular major, as people become more aware of what public health and epidemiology are,” Hallowell said. “That’s good timing for us.”

Christina Royal, president of Holyoke Community College, told BusinessWest that a great deal of first responders, nurses, and other healthcare workers have taken classes at community colleges like HCC at some point.

“When I think about our role in ensuring that we have the workforce talent we need in healthcare, which is the primary sector in Western Mass., I think it’s important that we continue to think about the kind of training we’re doing and how to continue to support this community.”

Scoble doesn’t foresee a time when nursing is not an in-demand profession.

“I’m not sure what we’re going to experience over the next few months,” she said. “A lot has to do with how we come back as a country, as a state, and as a community, but I have no doubt that every single one of my graduates will land a position at some point. If this was a normal period of time, a normal spring, many of the graduates would be on the fringe of accepting a position. They would have had interviews and been called back. Right now, a lot of that is at a standstill.”

When they do land jobs, Scoble added, “they’ll have the knowledge and skills and competencies, but lack a great deal of experience. So my number-one concern is, will they enter a work environment where they have the kinds of orientation and support they need? It’s definitely a concern.”

Stefani Glukhova, one of STCC’s respiratory-care students who started working at Baystate in March, may put some of those concerns to bed.

“All the staff here are very kind and generous and are always willing to help you,” she said. “As it gets busier at the hospital with fighting COVID-19, the registered respiratory therapists work around the clock to help fight the virus. My fellow classmates and I do our very best to be available and help out with treatments, floor therapies such as chest physical therapy, and much more.

“This is an amazing learning experience that I would recommend,” she concluded — even if it comes during a pandemic that no one would ever recommend.

Joseph Bednar can be reached at [email protected]

Commercial Real Estate Sections Special Coverage

Hitting ‘Pause’

 

 

Evan Plotkin calls it the “trickle-up effect.”

He was referring specifically to the pressures placed on the owners of multi-family dwellings and apartment complexes — and also to those landlords’ vendors — when, as a result of job losses forced by COVID-19, tenants cannot pay their rent, yet they’re protected from eviction by state and/or federal legislation.

“Multi-family property-management companies and landlords may be impacted disproportionately to the extent that there are forgiveness rules being discussed that would loosen rent-payment obligations and allow residential tenants to defer rent payments,” he said. “Clearly, unless there are provisions for the property owners to be made whole on the deferral or forgiveness of rent, it could create a variety of economic hardships to those property owners.”

But the trickle-up effect applies to virtually all types of commercial real estate and fallout from COVID-19, said Plotkin, president of Springfield-based NAI Plotkin, who tragically lost his mother to the virus earlier this month. He and other property managers who spoke with BusinessWest noted that the pandemic has forced the closure of all kinds of businesses and severely impacted the cash flow of almost all others. And this has obviously made it difficult for some to the pay the rent.

Some tenants have requested deferrals or other forms of help, but others didn’t exactly ask. They essentially just took them.

“I have some tenants, large, strong companies, that have sent letters saying they have stopped all payments to all vendors, landlords, etc. — period, without any time frame,” said Ken Vincunas, president of Development Associates, which has co-developed and now manages a number of office and retail properties in Western Mass. and Connecticut. “There was no explanation, really, just ‘we’re strong and we’ll be back, but … we’re not paying you.’”

Vincunas, who was in the process of writing e-mails to those at the top levels of those companies saying that such tactics were “un-American, like hoarding, and not the right thing to do,” said many other large companies have been far more diplomatic, with actual requests for 50% of rent payments, with offers to pay it back over the next six to 12 months.

Meanwhile, others we spoke with said they are working with tenants while also introducing, or reacquainting, them with the phrase force majeure (more on that later).

Ken Vincunas

Ken Vincunas

“There was no explanation, really, just ‘we’re strong and we’ll be back, but … we’re not paying you.”

But issues with collecting rent comprise just one of the many COVID-19-related challenges now facing commercial real-estate brokers and managers. Others include trying to do business differently, with many people working remotely; a dramatic slowing of activity within the market as companies pause to assess the damage and debate whether to move forward with planned deals; and emerging concerns that, as time goes by and companies see the advantages to having people work at home, companies may adjust their needs for space downward in the years to come, creating more problems for building owners.

“Businesses are getting a test run right now with working from home,” said Plotkin. “And if that works for them, there’s a strong possibility they might want to continue that, which would create havoc in the office-leasing market — and the office-investment market.

“Everything flows from the occupancy of your building,” he went on. “If your building becomes less occupied, it’s worth less, the market value goes down, and it triggers all kinds of things that are not necessarily good for the office-business market; that’s a clear fear that we have.”

Jack Dill, a principal with Springfield-based Colebrook Realty Services, which manages a number of properties across the region, agreed, but offered the hope that these ongoing experiments will lead some to conclude, as he has, that having people working in one place promotes collaboration.

“Work is a social enterprise — it’s about relationships, and it’s about trust,” he told BusinessWest. “It’s about the free flow of information, and that’s a lot harder when people are disbursed.”

Vacancy Signs

As he talked with BusinessWest in mid-April, Vincunas noted that he had recently sent in his application for relief from the SBA-administered Paycheck Protection Program.

The application was made to essentially cover the costs of keeping the staff at Development Associates’ small office in Greenfield — located at the Greenfield Corporate Center, which the company manages — on the payroll.

And that’s just one of a long list of COVID-19-related hardships that the company is coping with. Indeed, Vincunas noted that one staff member, concerned about the health risks associated with coming to work, abruptly retired several weeks back, prompting some shuffling of duties and leaving the company generally short-handed.

“She didn’t want to leave the house,” he noted. “And that really set us back. She retired, and that was that, leaving us to pick up the slack.”

The story is generally the same with other property managers and brokers, who are, like businesses in virtually every other sector, coping with new realities when it comes to where and how work is being conducted.

Evan Plotkin

Evan Plotkin

“Businesses are getting a test run right now with working from home. And if that works for them, there’s a strong possibility they might want to continue that, which would create havoc in the office-leasing market — and the office-investment market.”

As for business itself … on the brokerage side, things have slowed considerably, as might be expected given the vast amounts of disruption, fear, and general uncertainty caused by the pandemic.

But some deals have been completed. Vincunas said he signed on a new tenant at the beginning of the crisis, and some smaller build-out efforts — being undertaken “slowly and carefully to ensure social distancing” — are in progress.

Dill said the ‘deal flow,’ as he called it, is still moving, and his company closed on a few leases early in April. Properties are still being shown, he went on, albeit carefully, and while observing certain protocols, such as frequent use of hand sanitizer and sanitizing frequently touched surfaces.

But, like others we spoke with, he noted that, as the crisis has continued, the pace of business has slowed, and many who were in the exploratory stages of a potential move have backed off, waiting for the skies to clear.

“We’ve had some say, ‘interesting, attractive property, we’re interested, but things are so unsure, let’s let this settle down and we’ll re-engage at the other end of this.’”

Vincunas agreed. “At the beginning of this, I lost three hot deals that were going ahead, and none of them have come through,” he said, noting that one involved a building in Agawam he was going to buy and lease to an interested tenant. That interest is now gone.

“I had two other tenants who were going to lease space in a building we own already, and both of them said, ‘we have to slow down, things are changing … we don’t know,’” he went on. “Everyone has this uncertainty, and they’re thinking, ‘let’s not do anything for a while.’”

As for existing tenants, while some are experiencing something approaching business as usual — Vincunas has a kidney-dialysis venture and an ambulance company in his portfolio of tenants, and they certainly fall into that category — many have been forced to close their doors because they’re not essential, and most others are hurting to some degree.

Therefore, property owners are working with these tenants, offering some deferrals on at least a portion of their rent, Plotkin explained, noting that there is what amounts to a ‘base rent’ amount in each lease, as well as an additional amount to cover operating expenses, including security, cleaning, utilities, and others.

“The base-rent amount can be deferred, not abated, for a period of time,” he explained. “But the amount for operating expenses can’t, because we still have to keep the lights on, and we still have to pay the bills.”

Extraordinary Times

This brings us back to ‘force majeure,’ a common clause in contracts that essentially frees both parties from liability and obligation when an extraordinary event or circumstance — such as a war, riot, hurricane, or flood — prevents one or both parties from fulfilling their obligations under the contract.

A pandemic certainly fits that description because some businesses have been forced to close by state decree, and almost all others have been negatively impacted in some way. It’s the force majeure clause that no doubt prompted those letters that Vincunas described earlier.

Dill said Colebrook is working with clients on a case-by-case basis, and is working with tenants experiencing hardships. Like the others we spoke with, he referenced the trickle-up effect, or the ripple effect, that tenants not being able pay some or all of their rent will generate.

“When you go to the next circle out … if landlords have tenants who can’t operate and therefore don’t have the cash flow to pay rent and other changes, that immediately impacts landlords and their ability to meet their obligations, including debt service,” he explained.

While coping with the present, those we spoke with are also looking to the future, and they project that the pandemic will change the landscape in perhaps profound ways.

For starters, Vincunas believes that the current trend toward more purchases being made online, with items — from groceries to books to sporting goods — being delivered to the home will continue, and it will drive need for additional warehouse space.

“So many things are drop-shipped,” he explained. “The warehouse and logistics business is due for a big infusion of activity, just by the nature of a growing reluctance among people to leave the house.”

Conversely, this trend will negatively impact the retail side of the business, a trend that’s already playing out on Main Streets and in malls across the country.

But it’s the office sector that has those looking down the road most concerned. Indeed, those we spoke with said it’s possible, and perhaps likely, that companies will learn from this pandemic that there are advantages to having some people working at home and fewer people at the office. And, eventually, this will lead to downsizing and less overall demand for office space.

“The office market, and retail, are the two sectors of real estate that will be most impacted by this,” said Plotkin. “In the case of office, we were seeing some pretty good momentum right before COVID-19 — Springfield usually lags behind, but nationally, the office segment was doing very well. That has come to a complete standstill.

“And the fear amongst my colleagues is that people are starting to realize that this home-work model works for them, and will this replace the need for office space?” he went on. “It remains to be seen how this is going to play out, but that’s a real fear out there; as leases renew, those tenants might be evaluating whether they need the amount of space they occupied. They may do a home/office model that would reduce the amount of space they need.”

Those we spoke with are certainly hoping that, while businesses get this ‘test run,’ as Plotkin described it, they decide there are advantages to having co-workers in one place.

“That collaborative model is important for innovation,” said Plotkin. “Having people together in close proximity offers the sharing of ideas and collaboration in ways you can’t get with a Zoom meeting.”

Dill agreed. He said companies, and his is one of them, are experimenting with having workers dispersed and working from home, and some of the results are trickling in.

“It’s working pretty well,” he said. “But it’s not the same as having your people together, where they can meet casually, sit down in the same room, and solve a problem.”

Time and Place

Just what will come of the ongoing ‘test run’ of remote working remains to be seen.

What’s clear now, though, is that this pandemic is having a significant impact on the commercial real-estate market locally, and across the country.

The ‘trickle-up’ effect, as well as the trickle-down effect, are real, and as the crisis continues, the toll it is taking on this important sector continues to mount.

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

Coronavirus

Mixed Bag

Matt Sosik helped Char Gentes

Matt Sosik helped Char Gentes secure a PPP loan through bankESB that kept Riverside Industries employees paid for eight weeks

Char Gentes calls the Paycheck Protection Program “a lifeline.” Her nearly 200 employees no doubt agree.

Gentes is the president and CEO of Riverside Industries, a nonprofit that serves people with disabilities, helping them find ways to achieve daily independence, from securing and maintaining jobs to undertaking activities like voting and going to the store.

In mid-March, the organization was shut down by the same mandate that has shuttered the doors on countless businesses and nonprofits across Massachusetts. Four weeks later, Riverside hadn’t laid anyone off — but that situation was unsustainable.

“We had been keeping our employees paid as we were waiting to hear what the state reimbursement was going to be; actually, a lot of nonprofits were doing that,” Gentes told BusinessWest. “The senior management, myself, and the board were all on the same page — we wanted to keep our employees home, we wanted to have their back, and we wanted, as much as possible, to continue to pay them 100% and make sure they had health insurance. These human-service workers are often people who live paycheck to paycheck.”

When bankESB approved a Paycheck Protection Program (PPP) loan to Riverside Industries, Gentes could breathe a little easier, as the loan will allow it to pay its employees for the next eight weeks.

“We’re grateful for those eight weeks, and we certainly hope to be able to open our doors sometime in June,” she said.

While Riverside’s Easthampton facilities are closed, its mission has not stopped, as the organization continues working with clients under a new remote service model. Without the PPP loan, Gentes said that she would be facing some difficult decisions on how to keep her organization operational.

That contrast — between desperation and relief — explains why so many small businesses are frustrated with the PPP, which quickly ran out of money, and also generated plenty of confusion in the banks where business owners applied for loans.

The PPP is a small-business stimulus program included in the federal government’s Coronavirus Aid, Relief, and Economic Security (CARES) Act. The PPP initially provided $349 billion for U.S. Small Business Administration (SBA) lenders like bankESB to fund loans to businesses in order to guarantee eight weeks of payroll and other costs to help businesses remain viable. To qualify, businesses must have 500 or fewer employees and demonstrate that they have been negatively affected by COVID-19.

When the $349 billion ran out in less than two weeks, the shortfall generated an immediate outcry — not only for a second infusion of funding, but because of news that large, national companies were claiming tens of millions in PPP funds while small businesses couldn’t get access.

That second round of funding — $310 billion in total, approved by the U.S. Congress on April 22 — may not last much longer, but banks have likely learned lessons from the first round.

Sense of Urgency

Matt Sosik, president and CEO of bankESB, remembers those first days of the PPP well.

“It was harrowing. They did, in fact, rush it because they felt the urgency … but the program was not ready for prime time,” he recalled. “When it rolled out, a lot of people were frustrated, but — and I’m not trying to sound defensive — I wish people wouldn’t blame local banks. We were in the dark; the customers knew what we knew, and it wasn’t enough. They didn’t provide enough instruction.

“In the end, we made it out on the other side, and we got caught up,” Sosik told BusinessWest in mid-April, noting that the three banks in the Hometown Financial Group family, including bankESB, approved $100 million under the program, and spent the next week getting money into the hands of the people who were approved.

“It was very, very difficult — a massive amount of work by our employees. They kept grinding and got us out on the other side of things,” he said.

U.S. Treasury Secretary Steven Mnuchin reported that, following the PPP launch, the SBA processed more than 14 years’ worth of loans in less than 14 days.

“The PPP enjoyed broad-based participation across the country from lenders of all sizes and a wide array of industries and businesses,” he noted. “From its start on April 3, PPP provided payroll assistance to more than 1.6 million small businesses in all 50 states and territories. Nearly 5,000 lenders participated in this critical program, including significant lending by community banks and credit unions. Nearly 20% of the amount approved was processed by lenders with less than $1 billion in assets, and approximately 60% of the loans were approved by banks with $10 billion of assets or less. No lender accounted for more than 5% of the total dollar amount of the program.”

“It was harrowing. They did, in fact, rush it because they felt the urgency … but the program was not ready for prime time.”

The majority of these loans — 74% — were for under $150,000, he noted, but that didn’t stop a swell of outrage following reports of large companies, from Ruth’s Chris Steak House to Hallidor Energy, claiming eight-figure PPP loans.

Few in Washington balked at the need for additional funding. The second round of $310 billion is part of a larger, $480 billion relief package that also includes money for hospitals and expanded COVID-19 testing. Of the $310 billion, $60 billion will be set aside for smaller lending facilities, including community financial institutions; small, insured depository institutions; and credit unions with assets under $10 billion.

The Next Wave

Bankers hope for a smoother process getting the new funds approved.

“It got off to a rocky start and got a lot of bad press — I Googled and found maybe one story with a remotely positive angle to it,” Sosik said, before coming back to Riverside Industries. “This is a story about the good parts of humanity — the work Riverside does and our ability to play a small role in helping them stay alive. They do such incredible work, such necessary work.

“Riverside is a strong organization financially,” he went on. “It’s just that, when funding isn’t coming in, it doesn’t have a war chest to keep dipping into.”

As for Gentes, she’s hoping the loan helps her not only take care of employees, but prepare them to return when the governor says it’s OK to open the doors and restart person-to-person services.

“When we’re ready, we need our workforce to come back, and we need them to be ready to come back,” she said, adding that the organization’s roughly 150 clients are called once a week, maybe twice, to make sure they’re OK. “We’re in the process of developing remote learning, and assessing what each client has available to them in terms of technology to make this happen.”

Countless other small businesses and nonprofits have equally pressing needs, and could use a lifeline, she told BusinessWest. “Without it, a lot of nonprofits will go under.”

Sosik likes hearing that.

“I have to admit, it’s heartwarming to make a difference,” he said. “And I’ve heard some other good stories. There’s so much uncertainty — ‘I’ve put all my blood, sweat, and tears into my business; is it all over for me?’ To relieve that pressure has been a heartwarming experience for us.”

Joseph Bednar can be reached at [email protected]