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Business of Aging

Changing the Landscape

By George O’Brien

Erasmo Ruiz says he has found a profession that offers stability, flexibility, and a wide range of options.

Erasmo Ruiz says he has found a profession that offers stability, flexibility, and a wide range of options.

To say that Erasmo Ruiz took a circuitous route to the nurse-pinning ceremony at Springfield Technical Community College late last month would be an understatement. A huge understatement.

Now 34, the father of two teenagers — and the first one in his family to attend college — studied engineering at UMass. But things “didn’t go as expected,” he told BusinessWest, noting that he was into partying and girls far more than he was into his studies and eventually had to drop out.

From there, he went into the Navy, specializing in electronics. But he didn’t finish his enlistment because his father got into trouble with the law and was incarcerated; Ruiz needed to get home and help support his family.

He would join the workforce, trying his hand at everything from manufacturing to time as a clerk in the Post Office. Then, by chance, he got a job as a medical assistant working with a group of neurosurgeons at Baystate Medical Center.

“It just made sense at the time to take things to the next level,” he said of his decision to pursue a nursing degree. “With the guidance of nurses and other medical professionals, I chose this career.”

A circuitous route to be sure, but Ruiz found himself at that pinning ceremony, persevering through a two-course of study that challenged him on many levels. And many men are doing the same thing.

Well, let’s say many more men, and even a phrase like that needs to be put into perspective.

Yes, there are more men getting into nursing these days, at least compared to 40 or even 20 years ago, but the numbers still don’t approach that of women, said Karen Aiken, a Nursing professor at Holyoke Community College for the past 17 years, eight as chairman of the department.

“The labor bureau will tell you, and make it sound really great, that since 1970, the number has tripled,” she said of men in the profession. “But the numbers are so small, that doesn’t mean much; overall, I think the percentage [of all nurses who are male) has risen from 2.9% to just over 9%, so those are still small numbers.”

We’ll get into the numbers and the reasons they’re higher than they were, but not as high they as perhaps they should be, later. First, let’s look at some of the men who are getting into nursing.

Most are not taking what would be called the traditional route, right out of high school, but then again, many women don’t take that path either.

Andy Bean, 38, who graduated from Westfield State University this spring, worked in sales for a trucking company, sitting in front of a computer all day ordering parts for clients. He was laid off once when the economy took a turn for the worse and decided that he wasn’t going to let that happen to him again.

So he segued into healthcare and eventually a nursing program. Actually, several of them. He’s been working toward a degree in healthcare for seven years, by his estimate, and he’s looking to make a home in the emergency room at Baystate Noble Hospital in Westfield, where he’s already spent considerable time as a technician and student nurse.

Andy Bean, seen here in the ER at Baystate Noble Hospital in Westfield

Andy Bean, seen here in the ER at Baystate Noble Hospital in Westfield, likes the fast pace of that setting and wants to start his career in nursing there.

Meanwhile, Nick Labelle, another member of STCC’s class of 2018, now 36, worked in everything from food preparation to sheet-metal fabrication to real estate before getting a job as a counselor in a substance-abuse clinic. It was that last stop that convinced him that he liked helping people and working in a healthcare setting.

But some have taken more of a direct route. People like Brendan McKee from North Attleboro, another recent graduate of WSU. He said that, unfortunately, he spent a lot of time in hospitals in his youth visiting sick family members, and quickly realized he wanted to be part of that environment. Nursing, he said, was his first choice.

Overall, there are many reasons why nursing has become the first choice, or the second, or the fifth, for men, said Lisa Fugiel, director of the Nursing program at STCC, listing everything from solid pay to the availability of jobs as Baby Boomers retire, to the flexibility within the profession and the wide variety of options available to those who choose it.

But for many, it comes down to those same ingredients that bring women into nursing, she said — compassion, caring, and a desire to help others.

For this issue and its focus on nursing education, BusinessWest interviewed several men on their way to joining the profession (the licensing exam is their next challenge). Collectively, their stories help explain why the landscape within nursing — gender-wise, anyway — is changing.

Course Change

Bean told BusinessWest that he likes the pace of work in the ER and the fact that he’s always moving in that setting.

“That’s a big change from when I was just sitting in front of that computer all day,” he said. “That’s one of the things I hated the most about my old job. It just didn’t feel like a good fit for me anymore.”

But pace of work — and fit — are just two of many reasons why there are more men hearing their names called at those nurse-pinning ceremonies, said both Aiken and Fugiel as they discussed the changing demographics in their classrooms.

They both spoke of greater acceptance of male nurses in general and among women receiving care, and, on the flip side of the equation, more acceptance of the profession as a career option among men. And both halves of the equation are important.

“Women are more comfortable with women, and in some areas especially,” Fugiel noted. “But overall, there is more acceptance of men now.

“And we’re seeing a steady increase when it comes to men getting into the profession,” she went on, noting that this is reflected in the numbers of men in the STCC program; there were nine in this year’s class of 74, roughly double the total from when she started 15 years ago.

There are many reasons for this, said Fugiel and Aiken, listing solid pay and benefits, stability (an important consideration given anxiety about many professions in an age of ever-advancing technology), a host of opportunities, and a wide array of specific areas to get into, from critical care to medical-surgical nursing to behavioral health.

“All the students talk about how there are so many options in nursing, which is one of the things that’s so enticing about the profession, whether it’s male or female,” said Fugiel. “Just look at all the options in an acute-care setting — pediatrics, maternity, ER, ICU, med-surg, and mental health — but there’s also community nursing, nursing infomatics, and managed care.

“And there’s stability,” she went on. “A lot of our nurses are getting older, and that translates into opportunities and stability.”

While it’s good for men to be getting into the profession, given its many rewards, it is also good for the profession, the healthcare community, and society in general, to have men as nurses, said Aiken.

“As an instructor and as a seasoned nurse, I believe that that the more men we can get into nursing, the better,” she explained. “It makes it a rounded profession, and it makes the care more rounded.”

Elaborating, she said men can and often do bring a different perspective to the work of caring for people in need.

“Nurses that are female think one way, and our society doesn’t give men a lot of credit for compassion and caring,” she told BusinessWest. “When these men come into nursing, they come in for a reason — they have that compassion and want to care for people.

“A large number of men who enter our program have been out in the workforce and are either changing professions or are looking to be caring professionals,” she went on. “And they bring so much with them when they come in.”

Getting into the profession is difficult for many, she said, and perhaps more difficult than for many women because men are still traditionally the breadwinners in many families, and, therefore, it is difficult to quit work completely or go to school part-time to earn a nursing degree.

Lisa Fugiel says society is becoming more accepting of male nurses

Lisa Fugiel says society is becoming more accepting of male nurses, and, likewise, men are becoming more accepting of careers in the nursing field.

“The commitment, the education, is more than a full-time job,” said Aiken, adding that men often enter a program not fully understanding what they’re getting into and how they’re going to manage that commitment given their other responsibilities, and that’s why many struggle to get to the finish line or never get there.

Labor of Love

As for those that do, well, interviews with several men graduating this year provide solid evidence that men are more open to a career in nursing — and for all those reasons listed above, from the stability to the flexibility; from the nature and pace of the work to the ability to work with people.

“A big factor for me was all the options we have — you can do anything with this,” Ruiz said of that diploma he’s earned. “Also, in terms of looking out for my family, that was also part of it. The demand is there; there’s a nursing shortage.”

Stability was also a big consideration for Bean, who, as noted, had been laid off once and was looking for firmer ground career-wise. He was also looking for something more rewarding and with opportunities to do some ladder-climbing.

He had taken a few EMT courses, and, after returning to his job with the trucking company after being laid off, found it lacking in many ways,

“So I quit my job, and with the support of my wife, I went back to school to get my nursing degree,” he explained. “I found that, with nursing, there were so many avenues to go down; if one didn’t fit, you could find another one that did fit.”

As noted, he’s been going to school, part-time or full-time, for seven years now. It’s been a struggle at times, but he kept his eyes on the prize awaiting him.

“I was taking classes while working, then quitting and going back to full-time, then working again quite a bit in the emergency room while going to school full-time,” he said. “It’s been a long road, and I’m happy to be done with it.”

Job satisfaction was also a mostly missing ingredient for Labelle, who tried to find it, without much success, in fields ranging from hospitality to selling houses. He found much more of it working in that substance-abuse clinic, but desired an even higher level.

“I wanted a career that would directly impact patient or client care,” he explained. “I did a variety of career assessments, and found that nursing was something that seemed to suit me with regard to compassionate care of client needs, and also something that would be challenging.

“I needed a job that would really challenge me, and I was looking for stability as well,” he went on. “And nursing really fit that criteria. It was a very careful decision.”

As it was for Brendan McKee, who, as noted, didn’t segue into nursing; it was his first choice.

“I did spend a lot of time in hospitals with sick family members,” he recalled. “And I got to see how the nurses worked and took care of my family. It left a really good impression on me.”

He entered Westfield State out of high school, and, like all nursing students, was exposed to a number of different and intriguing paths within the profession. One of them was work in the ICU, and that’s where he is slated to work, at Baystate Medical Center, this fall.

“I like the acuity of it — I enjoy being in that demanding of an environment,” he explained. “I’m the kind of person who runs well when there’s a lot to do and there’s a faster-paced environment.”

A second reason for choosing the ICU, said McKee, is that he eventually wants to work in anesthesia, and the ICU is the “gateway,” as he called it, to that specialty, just as the nursing degree itself is the gateway to a seemingly endless range of career paths within healthcare.

Making a Difference

Ruiz, like all those we spoke with, said he’s taking things one step at a time right now. That means his focus is on passing the licensing exam, which he’ll tackle in the next few months.

After that? He has a comfort level on the “neuro side,” as he called it, but he’s also willing to explore.

“I grew up in Springfield, and I would love to work with the community,” he told BusinessWest, adding that one of his rotations while at STCC was at the High Street Clinic, located in one of the city’s poorer neighborhoods. “I think I could make a difference in a center like that, but I’m not really sure that’s what I want — there are lots of options.”

With that, he summed up why more men are getting into a profession long dominated by women. They want to make a difference, and they’re becoming more accepting of a profession that allows them to do just that.

The numbers of men are not rising quickly or dramatically, but the arrow is definitely pointing up. And as Aiken and others noted, that’s good not just for the men taking this career path, but for those they will serve when they reach their destination.

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

Business of Aging Sections

Sight Restoration

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cause, Effect, and Treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hope for the Future

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

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

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

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

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

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

Business of Aging Sections

Emperor of All Maladies Author Says the Pieces Are in Place

Dr. Siddhartha Mukherjee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Hard Cell

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prescription for Progress

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

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

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

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

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

Sarah Jackson, left, and Carol Lewis

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

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

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

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

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

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

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

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

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

Rising Tide

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

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

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

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

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

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

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

Leslie Hennessey, left, and Paula Boss

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

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

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

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

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

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

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

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

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

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

Setting the Record Straight

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

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

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

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

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

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

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

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

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

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

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

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

Joseph Bednar can be reached at [email protected]

Business of Aging Sections
Glenmeadow Renovates, Responds to Lifestyle Changes

Tim Cotz, president and CEO of Glenmeadow

Tim Cotz, president and CEO of Glenmeadow

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

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

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

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

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

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

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

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

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

Welcome Home

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

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

Doorstop Café

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

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

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

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

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

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

Great Expectations

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

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

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

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

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

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

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

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

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

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

Living Social

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

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

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

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

Elizabeth Taras can be reached at [email protected]