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Healthcare Heroes

This Administrator Provided a Steady Hand in Rough Seas

Helen Gobeil

Helen Gobeil

Helen Gobeil had recently relocated to Western Mass. from the other side of the state, and was looking for work.

She remembers seeing the small, as in small — maybe two lines — ad in the paper for an administrative assistant at Visiting Angels in West Springfield, a home-care provider, and becoming intrigued enough to apply — and prevail in that search.

She would eventually grow into the position and became adept at handling the many responsibilities within the job description, said her boss, Michele Anstett, president and CEO of the company, adding quickly that this was a good thing because all those talents would be needed when COVID-19 arrived in Western Mass.

Indeed, every aspect of this job, from recruiting caregivers to consulting with new clients; from matching caregivers with these clients to scheduling regular care and coordinating care in emergency situations, would become more difficult. Much more difficult.

And there would be new responsibilities added to that already-long list, including the daunting task of providing PPE for those caregivers and providing a compassionate ear to family members coping with something they would struggle to get both hands around.

Anstett summed up Gobeil’s work during this ultra-challenging time by describing her as a “hidden hero of COVID-19.”

By that, she meant she worked mostly, but not exclusively, behind the scenes and not on the front lines. But her contributions to what is an ongoing fight to carry on business in the middle of a pandemic, while keeping both employees and clients as safe as possible, are worthy of that adjective ‘heroic.’

“Not only has she handled this crisis with extraordinary competence and resilience,” Anstett wrote in her nomination, “she has remained a positive force in the lives of clients, their families, and caregivers.

“Not only has she handled this crisis with extraordinary competence and resilience, she has remained a positive force in the lives of clients, their families, and caregivers.”

“COVID-19 has not only presented physical challenges, but also mental ones, including severe anxiety and depression and exacerbating loneliness, isolation, and sleep problems, particularly in the senior population,” she went on. “To this end, Helen has not only served to protect the health of seniors across Western Massachusetts, but she has also given peace of mind to the families, seniors, and caregivers.”

To put these phrases ‘positive force’ and ‘peace of mind’ in their proper perspective, we turn back the clock to last March 23, when Gov. Charlie Baker imposed his lockdown. At Visiting Angels, staff members packed up and prepared to work remotely for what would be three months. But as they did that, Gobeil, in particular, had to develop detailed plans for providing care in the middle of a pandemic, at a time when people, and especially seniors, were wary about letting people into their homes.

For many, though, home care is an essential need, so they had to let people in. But before anyone went in, Gobeil and Anstett would conduct a risk assessment for both clients and caregivers within a given match.

“We would go down the list, and give each client a number — ‘1’ being the least at risk, and ‘3’ the highest,” Anstett noted, adding that there are more than 60 clients on average at any given time. “We would talk about each caregiver and each client and discuss how to keep them safe; if there was a facility that had COVID, we wouldn’t go into that facility.

“Helen stayed on top of all this,” she went on. “She would talk to every single caregiver and find out where they were going, where they had been, whether they had another job … and she would just cut it right down, every day.”

Helen Gobeil with Michele Anstett, president and CEO of Visiting Angels West Springfield.

Helen Gobeil with Michele Anstett, president and CEO of Visiting Angels West Springfield.

Meanwhile, there would be new protocols concerning cleaning within those homes and other steps to control the spread of the virus.

“These were things we did all the time,” Gobeil explained. “Caregivers just had to be extra, extra cautious about what they did.”

And she had to be extra cautious and extra diligent about who else was going into these homes. With that, she relayed a story that brings this element of her assignment into perspective.

“The daughter of one of our clients showed up from Florida — and that was an event,” she recalled. “She didn’t tell anyone she was coming, and went into the home to a bedbound client with our caregivers in the house. She didn’t quarantine — she went from the plane to this home.

“This was a 24/7 case, and we pulled out of that house immediately,” Gobeil went on. “I said, ‘it’s her or us; until she’s gone, we’re out!’ She went to a hotel that night and left the next morning. Another daughter went in and cleaned top to bottom.”

Beyond delivering some tough love in situations like that, she has also been providing some compassionate outreach to family members of clients, including one who had to cope with the death of a loved one at a time when the grieving process, like everything else, was made different by COVID-19.

“Often, I tried to bring them to a peaceful moment,” she explained. “In this woman’s case, her mother was dying, and she was very anxious about the whole thing. I said to Michele one night, ‘I’m going to see the client, and I’m going to take some time with the daughter,’ and I did. And after her mom passed, she came here, stood in the doorway, said said, ‘please tell me I can come in — I just owe you a big hug.’”

There have been myriad other tasks and challenges as well, including the matter of simply securing needed PPE for her caregivers. It was very difficult to procure items such as masks and gowns in the beginning, and it’s still a challenge, she said, adding that Visiting Angels and other providers have certainly been helped by Gowns 4 Good, the national effort to collect graduation gowns.

“As we started to get them in, the stories that accompanied them … they were incredible,” said Gobeil. “Notes from high-school graduates, class of 2020, including some from West Springfield, who couldn’t have their own ceremonies — they were heartwarming. We were crying.”

“Often, I tried to bring them to a peaceful moment.”

Meanwhile, another stern test, especially after the federal stimulus package was passed, was hiring caregivers. Indeed, many solid candidates for such jobs were in a position where they were making far more in employment than they could as a caregiver — so they stayed unemployed.

“In the beginning, we couldn’t get anyone to answer our ads,” she recalled. “But we made it through that rough patch, and now, a lot of people are eager to get back to work.”

One of her priorities now is to keep both her caregivers and their clients diligent as the pandemic enters its eighth month of impacting virtually all aspects of life as we know it.

Summing up what it was like — and is still like — she said, “it just multiplied the concern and the vigilance, and the stress was unbelievable, every day. And it is still like that. Every day.”

Coping with all this was certainly not in whatever job description was part of that tiny ad she saw more than a dozen years ago now. And it is certainly not what she signed up for.

But as this job changed with COVID, Gobeil rose to the occasion, accepting each new challenge with diligence and ample respect for her ultimate responsibility — the health and well-being of both her caregivers and clients.

Call her a ‘hidden’ hero if you like, but her hard work and dedication are certainly not lost on anyone she has been involved with during this pandemic.

 

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

Business of Aging

Shifting the Balance

Visiting Angels Director Michele Anstett

When Michele Anstett opened a Visiting Angels franchise with her husband in 1999, it was only the ninth branch of a home-care company that now boasts more than 500 locations in the U.S. and overseas. Home care in general had yet to proliferate; maybe a dozen agencies were offering such services in the Pioneer Valley.

The law of supply and demand meant there were more caregivers than jobs, which was great for companies, she noted.

“We had more control, and they were more willing to do what we said. Because there were fewer agencies for these caregivers to go to, they had less choice. They were easier to hire back then — you could find a well-trained one easily because there was a deeper pool, and they were more experienced. The pay was lower — like $7.50 an hour when we started. And more of them were willing to work full-time. They were more likely to take whatever you could give them.”

These days, that balance has shifted, to say the least. Home-care services, both small independents and national chains, now dot the region, and workers are in demand.

“Now, it’s not us with the control,” Anstett said. “They have the control. They can pick where they want to go. They can choose how many hours they want to work. They’re less willing to take whatever you want to give them.”

It helps, she said, that her Visiting Angels franchise, now celebrating its 21st year, is a known name with deep roots in the community.

“You don’t have someone down the hall where you can yell, ‘hey, can you help me?’ This can be a challenge for some nurses, but the nurses we have appreciate meeting with a patient exclusively, being able to develop relationships they often don’t have time for in an acute-care setting.”

“When we first started, there were only a few businesses like this. It was just emerging, and it was something that was really needed,” she told BusinessWest. “Our model was based on what people wanted. We matched the caregiver to the client. We weren’t telling people, ‘we’ll come here at this time.’ We made it all about the client. But we also matched them with a caregiver, and they could meet their caregiver and say, ‘yes, this works,’ or ‘no, this isn’t a good fit.’ There’s a lot of work in matching a personality, skill level, schedule — it’s really challenging.”

That philosophy hasn’t changed over the years, but the challenge has become more intense with increased competition for certified nursing assistants, home health aides, and personal-care assistants.

Also more challenging is the level of care many patients require, in an era when hospital stays are shorter and Americans are living longer than ever before.

“I was a home-care nurse fresh out of nursing school in the early ’90s, and compared to the patients we saw then — even compared to five years ago, really — the patients are much higher acuity, much more complex, and they really need a lot of care coordination and are on so many medications,” said Priscilla Ross, executive director of Cooley Dickinson VNA & Hospice.

“One of the biggest roles of the home-care nurse is reconciling those medications, because medication errors are one of the most common reasons for rehospitalization,” she went on — for example, people often don’t follow instructions, or aren’t aware of certain drug interactions, or are mixing pharmacy prescriptions with mail-order drugs. “Things are so much more complex than years ago, with hospitals focused on shorter stays, and there’s pressure on skilled-nursing and rehab facilities for shorter stays as well, so people are coming home with more needs.”

Michele Anstett (second from left) with some of her team at Visiting Angels, from left, Julie Dewberry, Helen Gobeil, and Natali Pilecki.

For this issue’s focus on the business of aging, BusinessWest spoke with several home-care professionals about what’s appealing about this critical work, what’s challenging, and why those challenges are only increasing as the senior population in the U.S. continues to swell.

Return to Form

The VNA has a sizable clinical staff, as many of its clients have been in and out of hospitals or acute rehab settings. But the focus isn’t on the illness itself, Ross said, but returning people to functional status in the short term. “They want to get back to making dinner, doing the laundry, taking care of grandchildren. With nursing and rehab, that process can happen much more quickly.”

She noted that the national shortage of non-medical home health aides may be more pronounced than the shortage of nurses, but it’s a struggle for organizations to recruit both. For nurses, not only is the pay scale less than in, say, a hospital setting, but some nurses don’t like the autonomy and independence that home care requires; they’d rather work in a team setting. Of course, other nurses desire the opposite, and relish the idea of focusing on one patient instead of several at a time.

“You don’t have someone down the hall where you can yell, ‘hey, can you help me?’ This can be a challenge for some nurses, but the nurses we have appreciate meeting with a patient exclusively, being able to develop relationships they often don’t have time for in an acute-care setting.”

Julie Dewberry, marketing and recruitment specialist for Visiting Angels, agreed. “They like the one on one,” she said. “They don’t have the pressure of one person with five different patients. Some come from nursing homes and say they don’t want to do that.”

Helen Gobeil, staffing supervisor for Visiting Angels, said determining who will be a good care worker is as much art as science.

“It’s a mother’s instinct — you’ve got to feel it,” she said about sitting with prospective staff. “You see they’re caring, they want to work, they really enjoy elders. They don’t call them old people; they respect them. I have to feel it.”

That ‘feel’ can be as simple as whether the interviewee makes eye contact, Anstett said. “What’s their demeanor? Are they a warm and caring person? If they’re warm, caring, and compassionate, that’s the basis, and we can move on to skill.”

That skill can be reflected in many ways — their degree, their experience, perhaps a referral. Sometimes, the agency will bring on someone whose only experience was taking care of their grandmother. “If they have good character, we’ll put them on a companion case, with a mentor, and help them get more education. We didn’t do that before. Now that the pool is lower, we’re trying to find ways to bring in more people.”

One way is to offer more training to staff. In addition, Visiting Angels has done well bringing on nursing students from area colleges, who are able to supplement their income while gaining on-the-job experience. “They’re very good workers,” she said.

The shallower pool of talent is only one growing challenge; a tougher financial climate is another. Wages are higher — Anstett said her goal is to keep what she pays workers above Massachusetts’ minimum wage as it creeps toward $15 over the next few years — as well as higher recruiting costs and expanded paid medical and family leave in the Bay State.

Finally, as noted earlier, workers increasingly eschew full-time work and often make home care one of two jobs, and they increasingly resist set shifts in favor of flexible schedules.

“We are a known name with deep roots, but it is a challenge,” she said. “We do well, though — we’re finding people of quality. Because of our experience, we understand what makes a good caregiver and who wouldn’t make a good caregiver, and how to screen them properly.”

Constant Mission

Roseann Martoccia, executive director of WestMass ElderCare, says her 45-year-old organization’s goal has long been in line with the goals of the home-care industry.

“From the beginning, our mission has been constant: to help people remain at home with the supports they need,” she said, noting that most people, as they age, want to remain in their homes, with some measure of independence.

To help them achieve that goal, WestMass ElderCare offers a broad range of supports, not just home care, aimed at helping seniors live independently. These range from nutrition services — it delivers about 1,400 hot meals daily in seven communities — to adult foster care; from housing support to personal-care management, helping people with chronic conditions or disabilities direct their own care by hiring and supervising personal-care attendants.

In the realm of home care, the goal is similar to other agencies: to help transition people from rehab settings into the home, and to maintain their function there.

“Our goal is to provide compassionate care and guidance so people can live in their homes and communities,” Martoccia said. “When we visit the home, we’re setting up a plan of care. What is your family doing? What do you need help with? What do you want help with? What’s most important?”

“Generally, people have chronic conditions, and their family may be at a distance, or they may not have a lot of family supports,” she continued. “In that case, we might be providing more services to them, helping them with many things they may not be able to accomplish on their own.”

WestMass focuses on the needs of family caregivers as well as patients, she added — people who have to work or raise families, but still want to make sure their parents or grandparents are OK.

“A lot of times, we hear caregiver stories about how what we do helps them and gives them peace of mind,” she said. “They may be checking in daily or weekly, but they know services will be coming.”

Cooley Dickinson VNA & Hospice has a different model than home-care agencies that focus on non-clinical assistance, often over the long term. Instead, it hires nurses and physical, occupational, and speech therapists, among other team members, to help clients transition from an acute or rehab setting to home life over a shorter term. Involving family caregivers in the process is often critical.

“We offer things your average person can’t provide without some training — wound care, IV therapy, or teaching about disease processes and how to manage an illness and manage medications,” Ross explained. “We’re teaching family members how to do wound care, how to provide care at home.”

The other side of the company is hospice care, which can be a longer-term engagement for people who are grappling with terminal illness and the decisions that come with it.

“What matters to you? What are your goals? How do you want your care to play out? It’s really hard to have that conversation, introducing that sense of taking away hope from people,” Ross said.

“But often, when you open those conversations, you’re relieving a burden for the patient and their family, and giving them an opportunity to actually talk about the elephant in the room — and that can lead to earlier access to care,” she went on. “Studies show that the earlier patients get on hospice, the better they do in the course of their terminal illness and the better the family does in the bereavement process.”

Giving Back

There’s a large, framed photograph at Visiting Angels of an aide with Anstett’s mother-in-law, who required home care due to Alzheimer’s disease around the time she and her husband opened the franchise; she passed away a few years ago. It’s a reminder that these services hit close to home for many people, and they’re important.

And not just for the clients, said Natalie Pilecki, the company’s administrative specialist. For workers in this field — at least the good ones — it’s more than a job.

“Spending time with the elderly is always nice,” she told BusinessWest. “The hours are good, the flexibility is always good, and they enjoy socializing with the elderly. Every day is different — it’s different every time you walk into their house.”

A good work experience starts with the employer, though, Anstett said. “I think we all have to value our workforce. We did a survey of our caregivers, about what’s most important to them. They put the highest value on how they’re treated. Pay was second, and benefits third. We listen to our caregivers, and those are the things we work on.”

She noted that one client has been with the company for 13 years, just one of many long-term connections being made.

“You develop a relationship with clients and their families. It’s about giving, and when you give, people respond. The job gives back.”

Joseph Bednar can be reached at [email protected]