Identifying maternal mental disorders 3 Doors opening for eldercare 8 PERIODICAL RATE PUBLICATION
APRIL 2021 VOLUME 37, NUMBER 6
Health care climate alliances concentrate on state-level change in California, Washington By RENEE STOVSKY
“Climate change is no longer a distant threat,” says Rachelle Reyes Wenger, system vice president, public policy and advocacy engagement for CommonSpirit Health.
De-identified medical records data is big asset for health systems Big data analytics may unlock new approaches to treatments By LISA EISENHAUER
Had there been a global analysis and mapping network for health data similar to the networks for weather data that can forecast and track major threats such as hurricanes, Dr. Amy Compton-Phillips believes the warning signs about COVID-19 would have been on radar Compton-Phillips screens much earlier. “I think the fact that we didn’t predict
In this map of the sites of hospitals affiliated with the 14 Truveta partners, circle sizes correspond to the number of staffed beds at each facility. The map does not include clinics, nursing homes, doctors’ offices and other outpatient facilities.
Continued on 4
Crew from Dell Children’s braves storm to reach fragile newborn By LISA EISENHAUER Firefighters battle an August wildfire during a scorching California heatwave.
“We already are experiencing extreme weather events, disastrous wildfires and elevated levels of greenhouse gas emissions and pollution.” Wenger adds that communities of color and those most vulnerable to air pollution are disproportionately impacted by the climate crisis, but no one will escape its effects. “The nexus between climate and health is very real and very personal for Wenger all,” she says. As part of its commitment to advance social and environmental justice, Dignity Health joined with three other large health systems in 2018 to form the California Health Care Climate Alliance. (Dignity Health merged with Catholic Health Initiatives in 2019 to form CommonSpirit.) “Caring for the Earth is not only a moral Continued on 6
Born 16 weeks early, Zaylynn Arias is surrounded by tubes and medical equipment at a hospital in Marble Falls, Texas. The hospital was not staffed or equipped for high-risk newborns like Zaylynn. To oversee her care, a team from Dell Children’s Medical Center in Austin drove about 50 miles through a winter storm.
Zaylynn Arias came into the world with the odds stacked against her. She arrived after just 23 weeks of gestation, 16 weeks shy of her due date and weighing only 22 ounces. The hospital where she was born two hours after her mother checked in was equipped and staffed for only Level 1 maternity care, appropriate for a normal delivery. As Zaylynn was being born on Feb. 17 in Marble Falls, Texas, the city and much of the state were in the grips of a rare, crippling winter blast that brought dangerous road conditions along with freezing temperatures. The weather caused widespread power and water outages. On top of that, like much of the nation, Texas was grappling with a pandemic that had stretched many hospitals’ resources and staff to the brink for almost a year. “She was really born within the context of as many challenges as you can possibly have,” says Dr. John Loyd, division neonatologist chief at Dell Children’s Medical Center in Austin, Texas. The hospital is part of Ascension. Loyd led a three-person clinical team who made a 50-mile trip on ice-glazed, snow-slick highways through the winter storm to Baylor Scott & White Medical Center – Marble Falls. There, they took Continued on 2
As end of eviction moratorium looms, advocates fear housing crisis will spike
John Moore/Getty Images
By LISA EISENHAUER
A Maricopa County, Arizona, constable escorts a family out of their apartment after serving an eviction order for nonpayment of rent on Sept. 30 in Phoenix. With millions of Americans still unemployed due to the pandemic, the expiration of the federal moratorium on evictions looms large for renters and landlords alike.
CHA and other housing advocates worry that once a federal eviction moratorium in place for most of the COVID-19 pandemic is lifted, the nation’s housing crisis will hit a new peak. The advocates say that government relief efforts have kept many individuals and families housed during the public health emergency. They are urging various additional remedies, including quick implementation of financial assistance and programs that are part of the American Rescue Plan, the massive relief package signed in mid-March by President Joe Biden. Sr. Mary Haddad, RSM, president and chief executive officer of CHA, says that legislation will provide much-needed assistance to those lacking health care or in need of housing aid. “The American Rescue Plan represents one of the most significant steps in expand-
ing access to health care and combatting child poverty in our nation’s history,” Sr. Mary says. Diane Yentel, president and chief executive of the National Low Income Housing Coalition, told an MSNBC interviewer that the housing assistance in the relief package is a significant starting point. “This is really a historic amount of resources to help provide some housing stability for renters, for homeowners, for some people experiencing homelessness, but much more will be needed to address the underlying shortage of affordable homes that existed before the pandemic and will exist after the pandemic,” Yentel says in the televised interview. The moratorium on ousting tenants who are unable to afford rent originated in the CARES Act relief package signed into law in spring 2020. That 120-day pause ended in July but was renewed later in the summer Continued on 7
2
CATHOLIC HEALTH WORLD April 2021
Fragile preemie From page 1
over direction of Zaylynn’s care, stabilizing the micro-preemie until an air ambulance could be dispatched safely the next afternoon and whisk her away to Dell Children’s. With its Level 4 neonatal intensive care unit, Dell Children’s offers the most advanced care available for premature newborns. As Catholic Health World went to press in mid-March, Zaylynn remained in the NICU in a medically fragile condition. And, while she will be in the NICU until after her due date, even if everything goes well, Loyd says that it is likely that Zaylynn will be able to go home with her mother acting much like a full-term baby. “Our goal is to send her home breathing normally, feeding normally and gaining weight,” Loyd says. “There’s still a lot that we don’t know,” Loyd said in early March. Her lungs are not fully developed. “That means, they are having to do a lot of hard work they were not designed to be doing. That means swelling, scarring, challenges with development. But the chances are that (her mother) Kimberly
Kelly Klaus, left, and, Nicole Padden care for Zaylynn Arias at Baylor Scott & White Medical Center in Marble Falls, Texas.
will take her home doing those things, that she will grow up and go to school, and that she drives Kimberly crazy like my children drive me crazy.”
Ready to roll Loyd says when Zaylynn was born, the staff at Baylor Scott & White Medical Center knew instantly that they needed expert assistance to save the tiny infant. They called hospitals across the state with highlevel NICUs in search of a transport team. Dell Children’s, like the other hospitals, couldn’t safely send an air or ground ambulance into the winter storm. Loyd was alerted to the dire situation as soon as Dell Children’s got the call for aid. “At that point I resolved to try and do what I could,” he says. This was in spite of having spent the night at Cedar Park Regional Medical Center on the outskirts of Austin assisting in the care of a fragile newborn and then putting in a full day at Dell Children’s, where, because of the winter storm, some staffers were on call for as long as 72 hours and sleeping at the hospital. Unlike many surrounding homes and businesses, the hospital never lost power during the storm. It did have brief interruptions in water service. After talking with the care team in Marble Falls and consulting with other medical leaders at Dell Children’s, Loyd packed his four-wheel-drive SUV with IV pumps, fluids, catheters and other supplies and hit the road. NICU transport team nurse Nicole Padden and hospital charge nurse Kelly
White were emotional when they handed Zaylynn over to the care of the transport team on the air ambulance, which included Padden. “The moment of us walking into the unit was a hugging, tear-laden moment of excitement and then that whole scene was repeated when the transport team arrived with the transport isolette and we knew we would be able to move her safely to Dell Children’s,” Loyd says. The story has drawn extensive media coverage, including a segment on Good Morning America. The accolades for his team’s effort feel A transport team moves one-day-old Zaylynn Arias to the air ambulance that will take her to the neonatal intensive care unit especially gratifying at Dell Children’s Medical Center in Austin. Winter weather prevented a NICU transport team from reaching the micro-preemie given how difficult the immediately after her birth. pandemic has made the past year for health care Klaus joined him for the special mission. adding another one for additional moni- workers, Loyd says. “I probably could have had 12 nurses toring and blood sampling. In photos from “The circumstances were challenging hop in the truck and drive out there with those first hours, Zaylynn is so tiny she is but those challenges often bring clarity and me,” he recalls. “There was such a strong almost impossible to spot among the medi- the clarity that it has brought for me is just desire from the nurses to do what they cal equipment surrounding and attached to that this is why I went into health care and I could to help as well.” her. know Kelly and Nicole would say the same Loyd says the trio of clinicians from Dell thing.” All-out effort Children’s and those from Baylor Scott & leisenhauer@chausa.org Because of the hazardous roads, it took the team about 2½ hours to get to Marble Falls, twice as long as it normally would. En route, Loyd reached the chief medical officer at Baylor Scott & White to arrange emergency privileges so he and the nurses could treat the baby. The group got to the hospital about six hours after Zaylynn’s birth. At the time, Loyd put the chances for the baby’s survival at birth under the extreme conditions at about 5%. He attributes the good prognosis he offers now to the quality of the initial care delivered by the staff at Baylor Scott & White and the NICU care from Dell Children’s. Zaylynn’s mother is doing fine. Despite the rarity of micro-preemie births at Baylor Scott & White, staff inserted an IV into one of Zaylynn’s tiny veins and intubated her to begin ventilation, Loyd says. There was great relief though when the crew from Dell Children’s arrived and went to work, making adjustments to the infant’s breathing tube, ventilator settings Dr. John Loyd and nurses Kelly Klaus, center, and Nicole Padden drove from Austin to Marble Falls in Loyd’s and fluid intake, replacing the IV line and SUV to join the team there caring for micro-preemie Zaylynn Arias.
Upcoming Events from The Catholic Health Association
Webinar: Advanced Issues in Sponsorship – Session Two: Prophetic Action and Advocacy
Webinar: Advanced Issues in Sponsorship – Session Four: Recruitment and Selection of Sponsors
Webinar: Advanced Issues in Sponsorship – Session Five: Initial and Ongoing Formation of Sponsors
Webinar: Advanced Issues in Sponsorship – Session Three: Sponsor and Mission Leadership Relationship
2021 Virtual Assembly
Webinar: Advanced Issues in Sponsorship – Session Six: Ministry Identity and Sponsor Assessment
April 14 | 2 - 3:30 p.m. ET
June 9 | 2 - 3:30 p.m. ET June 14 – 15
July 14 | 2 - 3:30 p.m. ET
Aug. 11 | 2 - 3:30 p.m. ET
May 12 | 2 - 3:30 p.m. ET
A Passionate Voice for Compassionate Care®
chausa.org/calendar
April 2021 CATHOLIC HEALTH WORLD
3
Loyola gets grant to improve maternity and perinatal mental health screening, care Program is focused on minority and underserved women at higher risk of poor health outcomes By LISA EISENHAUER
A pilot program underway at Loyola University Medical Center aims to improve the process for identifying mental health needs in expectant and new mothers and to smooth those mothers’ paths to treatment. Seed money for the program came from a $25,000 grant from the American Hospital Association’s Institute for Diversity and Health Equity and Blue Cross Blue Shield of Illinois. The grant was one of 13 the two organizations awarded last year to Illinois hospitals or health care providers with a goal of reducing disparities in health care. Loyola is using the funding to pay for training for staff in the obstetrics and psychiatry departments on how to screen obstetrics patients for mental health issues and how to provide appropriate care. Some of the grant is also going toward the costs of starting a group therapy program for pregnant and postpartum women experiencing depression. The academic medical center, part of Trinity Health, is in the western Chicago suburb of Maywood and cares for an ethnically and racially diverse population. In its service area, 38% of residents are in households with income below 200% of the federal poverty level.
Data-identified need Dr. Aparna Sharma is an associate professor at the Loyola University Chicago Stritch School of Medicine. She directs Loyola Medicine’s residency program for psychiatry and behavioral neuSharma rosciences. Sharma says Loyola has been missing an opportunity to provide needed screening for expectant and new mothers and doing them a disservice by not having adequate skill sets to
Catholic Health World (ISSN 87564068) is published semimonthly, except monthly in January, April, July and October and copyrighted © by the Catholic Health Association of the United States. POSTMASTER: Address all subscription orders, inquiries, address changes, etc., to Kim Hewitt, 4455 Woodson Road, St. Louis, MO 631343797; phone: 314-253-3421; email: khewitt@chausa.org. Periodicals postage rate is paid at St. Louis and additional mailing offices. Annual subscription rates: CHA members free, others $29 and foreign $29. Opinions, quotes and views appearing in Catholic Health World do not necessarily reflect those of CHA and do not represent an endorsement by CHA. Acceptance of advertising for publication does not constitute approval or endorse ment by the publication or CHA. All advertising is subject to review before acceptance. Vice President Communications and Marketing Brian P. Reardon
Associate Editor Lisa Eisenhauer leisenhauer@chausa.org 314-253-3437
Editor Judith VandeWater jvandewater@chausa.org 314-253-3410
Advertising ads@chausa.org 314-253-3477
Associate Editor Julie Minda jminda@chausa.org 314-253-3412
Graphic Design Les Stock
care for their mental health needs. specific or specified Sharma’s partner in starting the channel, how to refer perinatal mental health training prothose patients to us,” gram is Dr. Jean Ricci Sharma says. Goodman, a professor at Loyola’s school Proper training of medicine. She is In addition, because division director of few people in the psymaternal/fetal medichiatry department cine, and medical were trained for cardirector of obstetriing for expectant and Goodman cal services and the new mothers, she says medical perinatal center at Loyola the wait for an appointUniversity Medical Center. ment could take months. The doctors point to data on the “These patients, they impact that the mental illness of need to be referred to mothers has on the women and on appropriate or trained their babies. That data was gathered Postpartum depression, depicted in this photo illustration, often goes undiaghealth care professionals by the Illinois Department of Public nosed and untreated. in a timely manner, and Health and the Illinois Perinatal Qualthey need to be engaged ity Collaborative, a network dedicated to mental health screenings. The clinicians in treatment in a timely manner.” improving health outcomes for mothers use the Edinburgh Postnatal Depression Appropriate treatment can include and babies. Scale, a 10-question screening for perinatal medication, counseling and group therapy, The data, published most recently in the patients. Sharma says. Her team is tracking the numIllinois Maternal Morbidity and Mortality The starting goal of Loyola’s program ber of referrals as well as how many patients Report in October 2018, showed an average was to have the two-week postpartum vis- follow through and how many complete of 73 women died in Illinois within one year its with 80% of patients. Goodman says in treatment for up to a year. of pregnancy each year from 2008 to 2016 February her team had the visits with all The group therapy component has been and that non-Hispanic Black women were their patients, in some cases virtually. In the complicated by the COVID-19 pandemic, six times more likely than white women to past, she says, only about 50% of patients but Sharma’s and Goodman’s teams were die of pregnancy-related complications. were showing up for their six-week perina- in the process of getting it set up early this Mental health conditions were identified tal visits. year. They plan to use part of the grant fundas the specific underlying cause in 11% of “We are hoping if we engage the patients ing for iPads so that some mothers can parthose deaths and as a contributing factor at two weeks that they would come for their ticipate in the group sessions virtually. They in 19%. Substance dependency is assessed six-week visit,” Goodman says. also plan to offer aid to cover other patient separately from mental illness in the report. Goodman says for some new mothers, expenses, such as for transportation, and to especially those with complicated pregnan- provide babysitting services, if needed. Screenings and referrals cies, the early weeks after delivery can be While the teams who are taking part are To learn the latest in best practices for especially challenging. “They deliver and in the early stages of gathering research identifying symptoms of psychiatric disor- things go OK, but it’s like post-traumatic data on outcomes, Goodman says she ders during and after pregnancy and how to stress disorder,” Goodman says of the emo- already sees improvements for patients. treat them, Loyola is tapping the specialized tional aftermath. “They’ve gone through One big improvement is the access to care training offered by Postpartum Support this terrible stressful situation and then from Sharma’s team. “Patients seem hapInternational its Perinatal Mental all comes out OK, but then they feelWhy that pier, more relaxed, it’s much easier Whatthrough is Postpartum Depression? is itmuch important? Health Certification Program. So far, eight nobody talks to them anymore. They think, for them to engage,” Goodman says. clinicians, including doctors, nurses, thera- ‘Hey, I lost that advocate. I’m all by myself Goodman hopes to find funding and A mood disorder in women after childbirth Without treatment, postpartum depression can pists and social workers, have completed with the new baby and I’m exhausted.’” other support to continue the program What istraining. Postpartum Depression? Why is when itorimportant? Symptoms include feelings of extreme sadness, up to months years the eight-week online Patients who the doctorslast or nurses identhe grant expires after one year. anxiety, and that may make it having or being at There long term consequences mother’s Goodman and herexhaustion team are now screentify as risk forare mental “We’ve been kickingfor around ideas of how A mood disorder in women after childbirth Without treatment, postpartum depression can difficult to complete daily activities and baby’s health ing all their patients for depression and health conditions get referrals to Sharma’s to get community buy-in to support it Symptoms include feelings of extreme sadness, last up to months or years feelings more intense and last longer It may interfere to doesn’t take other The mental healthare conditions at variteam for care. Those referrals took place with goingthe on,”mother’s Goodmanability says. “It anxiety, and exhaustion that may make it There are long term consequences for mother’s ous points their of pregnancies and doing beforetothe new program got started, butanda care lot offor money support it. It’s more about thanindifficult those “baby blues,” a term used connect with her to baby to complete daily activities and baby’s health postpartum visitsworry, with new mothers at two they many were spotty. “OB providers, they knewthe engagement and interest.” with describe sadness, and tiredness It may cause baby to have problems The feelings are more intense and last longer It may interfere with the mother’s ability to weeks women after delivery ratherafter than the waiting of that there was a women’ssleeping, mental health a baby eating, andforbehavior thanexperience those of “baby blues,”birth a term used to connect with and care her baby untilsix weeks. Those visits also include program, but they were not aware of any leisenhauer@chausa.org It does not have a single cause, but results from are effective options, describe worry, sadness, and tiredness many ItThere may cause the baby treatment to have problems withincluding women experience afterand theemotional birth of a baby sleeping, eating, behavior a combination of physical factors counseling andand medication It does not have a single cause, but results from There are effective treatment options, including a combination of physical and emotional factors counseling and medication
Postpartum Depression in Illinois Postpartum Depression in Illinois
Postpartum Depression in Illinois In Illinois, 1 in 5 new moms That’s 30,000 women each year
In Illinois, 1 in 5 new moms experience postpartum depression Whatexperience is Postpartum Depression? postpartum depression
That’s 30,000 women each year
EnoughWhy to fillis it important? to fill postpartum depression can Enough Without treatment, almost 100 almost last up to100 months or years commercial commercial There are long term consequences for mother’s airplanes! and baby’s health
A mood disorder in women after childbirth Symptoms include feelings of extreme sadness, anxiety, and exhaustion that may make it difficult to complete daily activities airplanes! The feelings are more intense and last longer It may interfere with the mother’s ability to than those of “baby blues,” a term used to connect with and care for her baby Women in Illinois are more likely to experience postpartum depression if they: describe worry, sadness, and tiredness many It maypostpartum cause the baby to have problems with Women in Illinois are more likely to experience depression if they: women experience after the birth of a baby sleeping, eating, and behavior It does not have a single cause, but results from There are effective treatment options, including a combination of physical and emotional factors counseling and medication
Live Live in ain a
nothave haveaahigh high DoDo not
Experienced Experienced
Are low Are low
Rural school degree domestic abuse In Rural Illinois, 1 in 5 new moms That’s 30,000 each year AreaArea school degree income domestic abusewomenincome experience postpartum depressionHad a low birth Are less than Smoked before Are less than Had a low birth Smoked before 20 years old weight infant pregnancy Enough to fill 20 years old weight infant pregnancy almost 100 Risks are greater if you have more than one factor. For example, women who are Risks younger are greater you more one factor. For example, women thanif20 andhave live in ruralthan areas have the highest rates (about 2 in 5)who are commercial younger than 20 and live in rural areas have the highest rates (about 2 in 5) airplanes! Questions?
Contact the Illinois Department of Public Health
Questions?
Contact the Illinois Department of Public Health DPH.MCH@illinois.gov Women in Illinois are more likely to experience postpartum depression if they: Office of Women’s Health & Family Services
© Catholic Health Association of the United States, April 2021
Office of Women’s Health & Family Services DPH.MCH@illinois.gov
4
CATHOLIC HEALTH WORLD April 2021
Data mining
Truveta partners
From page 1
this pandemic is a sign that we have opportunity to improve,” says Compton-Phillips, president of clinical care at Providence St. Joseph Health. She sees Truveta, the new data-sharing partnership between her system and 13 others, as a step toward harnessing the power of data-driven predictive analytics in health care. The company will curate de-identified patient data from the health systems and sell access to researchers. Trinity Health, CommonSpirit Health and Bon Secours Mercy Health also are part of the partnership, which will compile and assist with analysis of records from tens of millions of patients from 40 states and aggregate analysis of conditions, therapies and prognosis. With the help of artificial intelligence and machine learning, Compton-Phillips and others say the hope is that the data will lead to insights into how care is being provided and spur innovations in treatment and technology. “We thought that by working together collaboratively we could build the tools that we need to continue to advance health care and be in control of our own destiny,” Compton-Phillips says. Truveta was announced to the public on Feb. 11. A week later SSM Health announced that it would be sharing deidentified patient data from its medical records with a research institute at Saint Louis University with a goal to “positively affect patient care and outcomes.” The partnership will mean that records stripped of names, addresses and such from 5 million SSM Health patients will be available to SLU researchers. Dr. Ann Cappellari, chief medical information officer at SSM Health, Cappellari expects the partnership to lead to advances like those that already have been made in detecting abnormalities on X-ray images with the help of computer analysis. “The ability to take gigantic pools of data and recognize trends is something humans can’t do,” Cappellari says. On Feb. 23, Ascension announced that it is starting a pilot project on a new tool developed through its data-analysis collaboration with Google Health that began in 2018. The tool, called Care Studio, will allow clinicians to search information from both inpatient and outpatient Ascension facilities.
A clinician affiliated with the Saint Louis University School of Medicine looks at a screen with information from a patient’s MRI. This photo was taken from a video about SLU’s AHEAD Institute, a research center that is partnering with SSM Health to use de-identified patient data in the hope of advancing patient care and treatments.
“This clinical search capability surfaces the specific information requested and additional contextually relevant information that might otherwise require significant time and effort to uncover,” the system says in a blog post about Care Studio. “This contextualization will directly enhance the provider experience.”
the information that can be mined from the data has the potential to bring much wider benefits such as advances in epidemiology and public health. For example, the information from the patient records could offer added depth to existing public databases to help reveal how infections spread and to make causal connections between conditions such as Data is in demand asthma and air pollution. “We’ve been sitWhile the close timing of the announce- ting on this data for a long time and it’s our ments related to data-analysis collabora- obligation now, I believe, to put it to use to tions might be a coincidence, several forces help improve quality of care in our commuappear to be behind nities and ultimately the move toward “We’ve been sitting on this save lives,” Shipley providing researchsays. data for a long time and it’s ers access to patient data. data, big our obligation now, I believe, Big Marcus Shipley, potential senior vice presiAdvances in anato put it to use to help dent for innovation lytics mean that even and chief informa- improve quality of care in our the “unstructured tion officer at Trinin patient communities and ultimately data” ity Health, says records, such as one of them is that diagnostic images, save lives.” technologies suplab results and what — Marcus Shipley porting analytics appears in notes have evolved to a fields, can be mined point where they can be applied effectively for information that might point to patterns to medical records. The trove of data that and fresh knowledge or targets for medihealth systems have been compiling and cal research. For Shipley, that holds the storing for decades is in great demand. promise that Truveta’s data could lead to That data “is attracting big tech, it’s breakthroughs that right now are beyond attracting innovators and startups, it’s get- imagination. ting a lot of venture funding coming into it,” “Once we get the technology up and Shipley says. running and we start showing what it can He expects pharmaceutical, biomed do, that’s going to generate all kinds of innoand biotech companies and research insti- vative thinking on other possibilities that tutes to be Truveta’s chief customers. While are yet to even be considered,” he says. some of those data buyers will be looking Cappellari of SSM Health says governto turn their research into profits, he thinks ment initiatives in recent years, especially
New platform aims to make it easier to merge, visualize data
W
ill Snyder is a co-founder of Metopio, a data aggregation company that compiles data from hundreds of verified sources, most of them government agencies such as the U.S. Census Bureau, the Internal Revenue Service and the Centers for Disease Control and Prevention. Metopio provides tools to interpret and visualSnyder ize the information. With a few mouse clicks, Metopio users can layer data from various sources including their own collections; zero in on populations or geographic locations; and create maps, charts and scatterplots that show the results. “Essentially what we’re trying to solve is making data, analytics and visualization easily accessible in one interface that removes risk and helps elevate the work of anyone regardless of their statistical training or data science background,” says Snyder, who has years of experience in community benefit work in Catholic health care systems, including serving as chief advocacy officer at AMITA Health. While Metopio is finding customers from various sectors including academia and real estate, Snyder sees the “sweet spot” for the platform to be at the inter-
section of health care providers and community-based organizations confronting issues such as gun violence and homelessness. The insights from the data can bolster their joint efforts to improve public health and address the social determinants of health, he says.
“I think the ability to interface and interact together with data is going to be really critical to then drive the decisionmaking and investments in programs and partnerships,” Snyder says. — LISA EISENHAUER
Where to prioritize rental assistance and housing support
This scatterplot shows the relationship between: 1. social vulnerability – a measure of human welfare on the x axis. 2. rental priority index – which identifies communities that may need emergency housing support on the x axis 3. and the COVID-19 Positive Test Rate which is the size of the bubbles. By looking at these topics together, we can prioritize outreach not only of vaccines and clinical services but also emergency rent relief and tenant protections. Insight created by Will Snyder (Metopio) last changed March 1, 2021
A scatterplot created by Metopio shows the relationship between social vulnerability (a measure of human welfare) and communities in high need of rental assistance because of the pandemic. The bubbles are sized by the positive COVID-19 test rate in each ZIP code. By accessing the values for all three measures, a user can quickly identify where to deploy housing resources to those in need.
Bon Secours Mercy Health CommonSpirit Health Providence St. Joseph Health Trinity Health AdventHealth Advocate Aurora Health Baptist Health of Northeast Florida Hawaii Pacific Health Henry Ford Health System Memorial Hermann Health System Northwell Health Novant Health Sentara Healthcare Tenet Healthcare
those led by the Centers for Medicare and Medicaid Services, have resulted in the collection of more data through electronic medical records. That data is now extensive enough to point to patterns. “Not only do we capture so much more electronically, we’ve done it for years now allowing some of that trending,” Cappellari says. “I think we’re just reaching a turning point in big data.”
Current events light the fire Current events have been another factor behind the surge in demand for health data. Compton-Phillips says the COVID pandemic “opened our eyes to the fact that health care technology is behind the rest of every other industry in using data and information to transform itself.” With better and broader data analysis, she says, treatments and best practices could have been identified and shared more quickly. The press release announcing the launch of Truveta said if the platform had existed at the onset of the COVID epidemic, the database could have helped answer questions about why African-American men were dying at such high rates from the virus. “In the U.S., why are nearly onethird of the nurses who died of COVID-19 Filipino, even though they represent 4% of the nursing population? Faster answers to these questions could have saved thousands of lives,” according to the release. The Truveta database could be used to identify, measure and monitor race-based disparities in health care and outcomes in order to advance health equity. Accessing the assets The value in the Truveta and SSM Health partnerships will lie in the ability to take bulk data — in this case from electronic medical records — and distill it to answer or reframe and refine complex questions. Compton-Phillips says that at Truveta that data mining process is being run by technologists and overseen by clinicians and ethicists to ensure that the research it is used for is in the public interest. “In order for us to be able to hold our own, and make sure we can do what our patients and our communities expect us to do — which is to protect their rights, protect their privacy, and to return proceeds back into the communities that we serve — we felt we needed to work together,” ComptonPhillips says. The SSM Health partnership has similar ethical and privacy safeguards. While big data analytics is a newer field, Will Snyder, the co-founder of the data aggregation company Metopio, views it as an extension of the same knowledge-based processes that doctors, scientists and civicminded leaders long have used to develop the best treatments for patients and to improve the conditions for neighborhoods and societies. “To me this is such a natural and exciting evolution to get to where we are now, where we’re thinking, ‘What is it that we don’t know about people and communities that we can know?’ and ‘Who are the partners that can help us bring change to alleviate burdens of poverty and hardship?’” leisenhauer@chausa.org
April 2021 CATHOLIC HEALTH WORLD
5
Systems say records platforms have ethical, security safeguards By LISA EISENHAUER
Ethical and privacy safeguards are “baked into” everything Truveta will be doing with patient health data, says Marcus Shipley, senior vice president for innovation and chief information officer at Trinity Health. Trinity Health is one of the 14 systems partnering in the new data analysis venture that will allow Shipley researchers to mine de– identified patient records for insights. “As we created Truveta, all of our health systems had ethics and the ethical use of this data as a requirement for standing it up,” Shipley says. The company will comply with the privacy regulations of the federal Health Insurance Portability and Accountability Act. In addition, the uses of the data will be overseen by a governing board that includes representatives from its founding health systems and by an ethics subcommittee that will ensure that the focus of the research aligns with the missions of the participating health systems, Shipley says.
He adds that Catholic systems that are part of the partnership can have their data excluded from any research project that they see as potentially in conflict with the Ethical and Religious Directives for Catholic Health Care Services.
“If we didn’t allow learning in
Cyber risk management SSM Health is developing its own datasharing partnership with The Advanced HEAlth Data (AHEAD) Institute at Saint Louis University — a new center for datadriven innovation and research. Dr. Ann Cappellari, chief medical information officer at SSM Health, says the virtual data warehouse that will be created will provide state-of-the-art data security. Nevertheless, Cappellari acknowledges that as security measures advance, so do the skills of hackers and their potential to “reidentify” data that’s been through the de-identification process. De-identifying data “alleviates privacy concerns to the best of our ability right now, but nothing is foolproof,” she says. Leslie Hinyard, director of the AHEAD Institute, says researchers’ requests for use of the SSM Health data will have to be narrowly crafted and pass the scrutiny
— Dr. Amy Compton-Phillips
health care, we would never know that controlling blood pressure stops strokes. ”
of an institutional review board and faculty members with expertise in the field of research. “There are a number of levels of people looking at every question along the way to ensure that research questions are ethical and that the data is never misused,” Hinyard says. No researcher will have access to the entire database, only the specific subsets needed for their projects.
Staying transparent Dr. Amy Compton-Phillips is president of clinical care at Providence St. Joseph Health, another of the Truveta partners. She says the partnership is being transparent about its purpose and mission early on, before it starts marketing itself to customers. “The reason we announced this pub-
licly before data started moving anywhere is we want to make sure people know what we’re doing, that we’re doing this above board, we’re doing it in the daylight,” she says. “We’re doing it in a way that protects information so that we can continue to advance health care and not have it be a surprise.” Compton-Phillips says she and leaders of the other systems behind Truveta understand that patients want their personal data kept private and see that privacy as sacrosanct. “That said, we also have to allow learning. If we didn’t allow learning in health care, we would never know that controlling blood pressure stops strokes. We would never know that the antiviral remdesivir and plasma help patients with COVID. That is learning.” Alan Sanders, vice president of ethics integration and strategy at Trinity Health, said of Truveta, “the goal of this is to make use of this data in a more timely fashion — to kind of Sanders speed up research to help solve diseases and hopefully improve medicine.”
Human element While he’s not worried that the data sharing that happens through Truveta will violate patients’ privacy, Sanders does have concerns that as analytics figure more into treatments the human element of medical care may diminish. “I know there’s something to be said about human contact, face-to-face relations, and I think we have to continue to highlight its importance as we evolve” in the use of predictive analytics in patient care, Sanders says. Cappellari also worries about the human element — the therapeutic relationship between clinician and patient — being diminished in health care. However, she sees other factors playing a bigger role in that than data and technological advancements will. Processes driven by artificial intelligence might be impersonal, but they have shown their potential to save lives by reducing errors in areas such as prescribing medications and setting dosage, she says. “Overall, I think the manner in which we allow care delivery to be really driven by a fee-for-service reimbursement model is a far greater risk to losing that human element than AI is,” says Cappellari.
JUNE 14-15 VIRTUAL EVENT
CHAUSA.ORG/ASSEMBLY
CHA invites everyone to use its free resources at chausa.org/masks to promote mask wearing and protect the health of all. #LoveThyNeighbor
6
CATHOLIC HEALTH WORLD April 2021
Climate alliances From page 1
imperative but also fundamental to our healing mission,” Wenger explains. “We cannot do this work alone. Stewardship of creation calls all of us to do our part to protect the health of people and planet, particularly now.”
Raising the volume In conjunction with Health Care Without Harm, Dignity Health, Providence St. Joseph Health, Kaiser Permanente, the University of California Health and Sutter Health created the legislative advocacy organization that works with policy makers in Sacramento to support the state’s climate goals. “These health care systems represent 107 California hospitals serving more than 20 million patients. Working together in advocacy makes their voices louder,” says Robyn Rothman, attorney and associate director of state policy systems at Health Care Without Harm, a coalition dating to 1996, when the U.S. Environmental Protection Agency identified Rothman medical waste incineration as the leading cause of dioxin emission and a large percentage of mercury pollution. Health Care Without Harm believes the health care industry has a responsibility to “address its own environmental footprint as well as become leaders in society in supporting a sustainable economy and healthy communities.” Health Care Without Harm has influenced policy in a number of areas, including environmentally preferable purchasing and the phasing out of mercury in hospitals and medical devices using polyvinyl chloride. It’s been influential in developing greener hospital and medical
buildings and providing healthier food for patients and health care employees. Arguably one of its most important initiatives, however, has been in playing a leading role in rebranding climate change as a public health issue and supporting the health care sector to lead by example in reducing its carbon footprint. “Health care contributes 13% of California’s economy, so the work of the alliance can play a key role in helping the state meet pollution reduction targets and prepare for the worst impacts of climate change,” says Rothman. She adds: “Alliance members have committed to deeply reducing their greenhouse gas emissions and to driving California’s transition to 100% clean energy.”
Unified front Just a year after the California Health Care Climate Alliance was formed, Health Care Without Harm helped initiate the Washington Health Care Alliance in 2019. It includes Providence St. Joseph Health, Swedish Health Services, CHI Franciscan, Kaiser Permanente and others. Together members represent 40 hospitals in Washington state, 1,000 health care facilities and 9 million patients. They bring their expertise and trusted voices to the legislative and regulatory process to advocate for climatesmart policies related to energy, transportation, food, waste, infrastructure and community resilience. “We greatly feel the need to join with others to raise awareness of the connection between the health of our patients and the health of the planet,” says Ali Santore, senior vice president of government affairs and social responsibility Santore for Providence St. Joseph Health, a founding member in both the Washington and California alliances. Santore says Providence is called to envi-
ronmentalism by its mission to improve the health and quality of life in its communities. She points to both Pope Francis’ 2015 papal encyclical, Laudato Sí, which highlighted the crisis posed by climate change and its unfair burden on the world’s poor and vulnerable, and to President Donald Trump’s 2017 decision to withdraw from the Paris climate accord as having lent even greater urgency to the work. “We realized the need to stay in the game by focusing on a state, rather than federal, level,” she says.
Walking the talk Both alliances, staffed by Rothman, have similar models. Members digest government research, they talk strategy and analyze bills and they vote on what to support as coalitions. And though legislative and regulatory progress slowed in 2020 due to the coronavirus pandemic, Rothman points to several successes. Among them: House Bill 1257, commonly referred to as the Clean Buildings bill, signed by Washington Gov. Jay Inslee in 2019. The objective of this legislation is to lower costs and pollution from fossil fuel consumption in the state’s existing building stock, especially large commercial buildings greater than 50,000 square feet, which includes many hospitals. Washington Clean Fuel Standard legislation passed by the House of Representatives but not the Senate. It calls for a 20% reduction of the carbon intensity of fuels by 2035 over a 2017 baseline. A groundbreaking executive order issued by California Gov. Gavin Newsom in September to require that, by 2035, all new cars and passenger trucks sold in California be zero-emission vehicles, and that all medium- and heavy-duty vehicles be zero emission by 2045. Transportation currently accounts for more than 50% of the state’s greenhouse gas emissions. California Assembly Bill 841, signed
by Newsom in October. This legislation expedites the installation of charging stations for electric vehicles across California, and aims to restore the vibrancy of the clean energy and clean transportation sectors, which have lost more than 16% of their workforce due to the pandemic. It also creates a School Energy Efficiency Stimulus Program to update ventilation and ensure clean air in public school buildings — also an important policy in combating COVID-19. “In addition to our advocacy work on the state level, we, as health care providers need to have fearlessness in the positions we take internally,” says Santore. “At Providence, for instance, we are focused on becoming carbon negative by 2030, and realize that industries need regulatory flexibility and economic incentives to achieve similar goals.”
Interconnectivity Adds Wenger: “If anything, given where we are now in terms of multiple viral and economic pandemics, civil unrest and racial inequities, our alliance must use its voice and size to weigh in on meaningful policy solutions. Health care and its focus on social determinants cuts across all of it, bringing home the message of an inextricable connection between health and environment.” For its part, Health Care Without Harm would like to replicate its state alliance model elsewhere in the U.S. Massachusetts launched a structurally more informal model in 2018, says Rothman, working within health care facilities to prioritize policies. But the recent increase in the number and destructiveness of natural disasters — fires in California, Colorado and Oregon, hurricanes and flooding along the Gulf Coast — are evidence that global warming requires global initiative. “A broad-based, national and international coalition of health care organizations,” says Rothman, could help both amplify, and codify, reform.
NEW
Sponsor Resource A VALUABLE GUIDE
about the distinctive role of sponsors for the health ministry of the Catholic Church.
The guide highlights the vocation, personal qualifications and ongoing formation of individual sponsor members. It also outlines core competencies of the sponsor body and explains the development of ministerial juridic persons and evolving models of sponsorship.
AVAILABLE AT CHAUSA.ORG/STORE
April 2021 CATHOLIC HEALTH WORLD
Evictions by order of the Centers for Disease Control and Prevention. The agency says its intent was to slow the spread of the virus by keeping people safely housed. The CDC moratorium was set to expire Jan. 31, however the Biden administration pushed that back to March 31. Federal judges in Texas and Ohio have ruled against the moratorium but neither has issued injunctions to halt the CDC’s order. As Catholic Health World went to press in mid-March, the moratorium had not been extended. The National Low Income Housing Coalition, a nonprofit focused on finding housing solutions for the poorest Americans, says the federal moratoriums and similar orders by states have protected millions of renters who otherwise might have been forced out of their homes. CHA is among dozens of organizations that have signed on to the coalition’s Opportunity Starts at Home campaign. Other supporters include CommonSpirit Health and Catholic Charities USA. In a letter to the CDC director in December, the supporters of the campaign called for extending the moratorium through the duration of the pandemic. The letter cited a study indicating that the brief lapse in the moratorium over the summer “led to more than 400,000 more COVID-19 cases and nearly 11,000 additional deaths.” The coalition’s letter also cited census data in noting the racial impact that lifting the moratorium could have. That data shows that almost 20% of renters — a disproportionate number of them Black, Latino and Asian as compared to white renters — are behind on their rent. “Experts estimate that these households will owe between $34 billion to $70 billion in back rent when the moratorium is lifted,” the letter says. “Without federal intervention, up to 30 million to 40 million renters could lose their homes.”
Low supply, high cost Rachelle Reyes Wenger, vice president of public policy and advocacy engagement for CommonSpririt Health, says: “CommonSpirit’s activism on homelessness is in response to an estimated shortage of
AP Photo/Andrew Harnik
From page 1
Signs that read "No Job No Rent" hang from the windows of an apartment building during the coronavirus pandemic in Northwest Washington in May. The pandemic has prompted authorities around the U.S. to initiate policies protecting renters from eviction.
7 million affordable homes for the more than 11 million families who are on the nation’s lowest income rung and the fact that about one in four renters spend more than half their income on housing. This is clearly a justice issue. One that we cannot be silent about. “Hospitals and health systems are critical partners in addressing housing insecurity and supporting community stewardship of land and housing,” Wenger says. “As locally rooted institutions, we are committed to partnering to solve these critical community challenges to improve health and well-being.”
Two-pronged assistance “It’s really two pronged,” Lucas Swanepoel, a director of government relations at CHA, says of what’s needed to keep the nation’s homeless population from spiking as the pandemic plays out. First is making sure renters can’t be removed when financial hardship leads Swanepoel to nonpayment of rent, and, second, is trying to give renters the resources so they can pay their rent and stay in their housing. The American Rescue Plan includes $27.4 billion for rental assistance, $5 billion
Share of Workers with Some Concern Their Household Will Experience Eviction or Foreclosure in Next Year
Source: Color Change, National Employment Law Project, Time’s Up, ILR Worker Institute. “Foundations for a Just and Inclusive Recovery.” 2021
Campaign for affordable housing The National Low Income Housing Coalition’s Opportunity Starts at Home campaign seeks to:
Bridge the growing gap between renter incomes and rising housing costs. Provide aid to people experiencing job losses or other economic shocks to avert housing instability or homelessness. Expand the affordable housing stock for low-income renters. Defend existing rental assistance and other targeted housing resources from harmful cuts. for housing vouchers, $5 billion in homeless assistance, $10 billion to help homeowners avoid foreclosure and $5 billion for utility assistance, according to a fact sheet from the National Low Income Housing Coalition.
Continuing unemployment Luiz Barbosa directs family stabilization services for Catholic Charities of the Archdiocese of Chicago. He says requests from tenants for financial assistance to cover their rent has ballooned over the past year. “Some of the people we assisted six months ago are now coming back for more assistance because they Barbosa were unable to return to work,” Barbosa says. “Many of their employers closed because most of them work in restaurants and other small businesses.” Using state, federal and private funding, Catholic Charities administers grants to lowincome individuals to cover housing needs if those needs can be shown to be related to the pandemic, he says. In one example, the agency was able to give $6,700 to a mother of four school-aged children who lost her job as a nanny and faced foreclosure. The aid was enough to keep the bank from taking legal action against the woman, but she remains thousands of dollars in arrears on
CHRISTUS St. Vincent programs assist associates with housing F
or CHRISTUS St. Vincent, addressing the issue of housing insecurity has included offering assistance to its own associates for down payments on homes. In recent months, that aid has been expanded to provide grants to workers at risk of losing their homes or falling behind on other basic living expenses due to the pandemic. Sandra Dominguez is vice president of human resources for the regional system based in Sante Fe, New Mexico. She says CHRISTUS St. Vincent has worked with a nonprofit called Homewise since 2012 to provide down payment assistance of up to $5,000 for associates. Any staffer whose annual household income does not exceed $250,000 can apply. In addition to the grants, the staffers get coaching on the homebuying process and finanDominguez cial counseling from Homewise, Dominguez says. The assistance can be a major bonus for families struggling to find housing in a market where realtor.com puts the median home price at $439,500.
“It’s very well received,” Dominguez says. “New associates are introduced to it at our general orientation.” In June, CHRISTUS St. Vincent converted what had been a $1 million loan to Homewise to a grant. The money is the second phase of an assistance program that already has helped about 100 of the health system’s associates become homeowners. Early in the pandemic, CHRISTUS St. Vincent started an initiative to assist financially challenged associates. The initiative gets funding from the system; its partner Anchorum St. Vincent, a nonprofit community health impact organization; its foundation; and private donations, including many from staffers. Associates of the system can apply for up to $1,200 in grants to cover expenses they’ve fallen behind on because of the pandemic, such as rent, house payments and utility bills. An in-house committee reviews the requests. So far, dozens of associates have gotten grants and Dominguez says the assistance will be available as long as the funding keeps coming in. “It’s very touching, just the amount of donors,” she says. — LISA EISENHAUER
7
her mortgage. Once the crisis and the funding ends, Barbosa worries about all the tenants and homeowners who will still be in debt or unemployed. “When the moratorium is lifted, that’s going to be a major problem for us because I think we are going to have more clients in an urgent situation of becoming homeless and there is no (long-term) plan for them,” he says. “They can’t go to another landlord. If they don’t have a job, they cannot rent another apartment.”
Problem delayed For many tenants, the eviction moratorium has only delayed their rent bill. Once orders are lifted, those tenants will have to figure out a way to cover their current and past due rent. Hilda Bahena, who directs the legal assistance department of Catholic Charities of the Archdiocese of Chicago, says that expense could prove beyond the means for many workers even if their jobs return. Before the pandemic, many lowincome wage earners were already living paycheck to paycheck and unable Bahena to build up any savings, she says, and they will be in the same straits once back on the job. “One of the things we’ve known is that there is a higher-than-usual level of stress that is taking place in our environment based on the pandemic, based on the job losses, income reduction, isolation,” Bahena says. “The way we’re seeing it effected specifically in housing is that because of this high level of stress, emotions and frustration are high. People are asking: ‘How do I see the light at the end of the tunnel?’” She and her staff are working with both tenants and owners to try to craft resolutions. In some cases, she says that even when money for back rent is available, it is being rejected because of the tension between the parties that has built up during the pandemic. That tension heightens a crisis that had left many people on the brink of homelessness even before COVID became an issue. To end the ongoing crisis will require broad action and not just temporary relief, Bahena says. “This is a complex issue because it’s not just about the pandemic. There were eviction issues before,” she says. “It’s about looking at how as a society we are supporting each other to ensure that people have opportunities to live, to eat, to have a roof over their head.” leisenhauer@chausa.org
KEEPING UP
Little
Catania
PRESIDENTS/CEOS
Steve Little to president of Holy Family Memorial Medical Center of Manitowoc, Wisconsin. He succeeds Brett Norell, who departed as president Feb. 28. Little was Froedtert Health senior vice president of network development. As of March 1, Froedtert Health has a majority interest in Holy Family Memorial, and the two organizations are affiliated. Holy Family is part of Franciscan Sisters of Christian Charity Sponsored Ministries. Joseph M. Catania is retiring Sept. 30 as chief executive of Catholic Health Services of Lauderdale Lakes, Florida, after leading that eldercare system for 30 years. He is the only chief executive that system has had.
8
CATHOLIC HEALTH WORLD April 2021
Catholic eldercare facilities cheer new guidance that more fully opens visitation Long-term care sites have high vaccination rates, low COVID caseloads By JULIE MINDA
Meygan Martin, left, and her grandmother, Eula Goff, in a photo taken before the pandemic.
good!!!,” Martin wrote in a Facebook update. “Got to spend the afternoon chatting and laughing with my BFF. Couldn’t have been a better day! The biggest blessing of 2021 thus far.” The family is among the many nationwide benefitting from resumed visitation at long-term care sites that had been closed to visitors as a precaution against the introduction or spread of COVID.
Setting the rules And new guidance issued by the Centers for Medicare and Medicaid Services on March 10 holds the promise of even greater openness in the near future. CMS says nursing homes should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident, or visitor. (At the time of her visit with her granddaughter, Goff was fully vaccinated and Martin had received the first of two shots.) CMS says it is recommending easing visitation restrictions because vaccination rates are high in eldercare facilities and COVID-19 caseloads are decreasing sharply. The next steps are for state and local public health agencies to develop regulations
Amr Alfiky/The New York Times/Redux
O
n March 11, Meygan Martin received the long-awaited news that residents of the Ascension Living Sherbrooke Village assisted living facility in St. Louis could receive visitors. After 372 days of separation from her beloved grandmother, she wrote in a Facebook post, “I thank God every day for keeping her safe and could not be more grateful for this news. Less than 48 hours! She’s going to kick me out for crying a river of happy tears in her room.” COVID-19 rates had fallen to a level that would allow the resumption of indoor visits in long-term care and assisted living facilities, while following infection prevention protocols. While Martin had been told she’d have to wait two days to visit, her grandmother, Eula Goff, insisted she come the following day. Martin says the March 12 reunion was a joyful occasion for the two. Their long physical separation had been very difficult. Martin had grown up two doors down from Goff, and as an adult, she’d made it a point to visit her grandmother every couple of weeks. “Reunited and it feels sooooo
Donald Kirsch, administrator of Good Shepherd Nursing Home in Wheeling, West Virginia, checks on residents in their rooms in February. Amid falling COVID caseloads, the Catholic long-term care site recently eased many of its lockdown protocols. Kirsch, who has led the nursing home for nearly 40 years, describes the coronavirus pandemic as the greatest challenge of his career.
based on CMS’ guidance and for long-term care facilities to adjust their own policies and protocols to those regulations. Shelley Bhola, a regional nurse specialist/infection prevention specialist for Duluth, Minnesotabased Benedictine, says she thinks that once the new policies take effect, “residents and their visitors will be able to hug and touch each other as long as they are wearing a well-fitted mask and have performed hand hygiene before and after.” She anticipates eldercare facilities will continue using health screening questions with visitors and follow infection prevention protocols. The new guidance is a big step on the hard road back to postpandemic normality. Daniel Stricker, president of St. Louisbased Ascension Living, said, “We envision a day when we can celebrate Mass as a community in our chapels. We look forward to a day when our team Stricker members and residents can see each other smile and our residents can fully enjoy the many amenities and services we offer.”
Opening doors The new CMS guidance comes about a year after that agency issued a memorandum recommending that in order to prevent viral spread of COVID-19 among the frailest elderly, long-term care facilities should immediately restrict all visitors and nonessential staff from entering their buildings. Compassionate exceptions could be made for visits at the end of life. Nevertheless, COVID continued to ravage nursing homes and assisted living facilities, causing extraordinarily high fatality rates. The sudden ban on visitors and the social distancing and isolation required to control infection and safeguard residents put a heavy emotional burden on patients, their families and staff. In May, the agency offered the prospect of a slight easing of restrictions on visitation tied to caseloads in the community and in an individual facility, staffing levels and the availability of COVID testing at the facility. In September, CMS encouraged
Alverno resident Mary Wendel wins a NASCAR-inspired "Race to the Finish." The Alverno is a Trinity Health Senior Communities-sponsored skilled nursing facility in Clinton, Iowa.
eldercare sites to facilitate outdoor visitation and allow for tightly controlled visitation indoors. The March 10 guidance says that “responsible” visitation at long-term care facilities can take place in resident rooms, in spaces set aside by the facility for visits and outdoors. The facilities should continue infection control measures, including physical distancing. Visitation should be restricted among unvaccinated people if COVID cases rise above 10% in the county where the facility is located, according to CMS. Visitation also should be halted for residents who are COVID-positive or in quarantine following exposure. The relaxed visitation guidelines follow a March 8 easing of social distancing guidelines for vaccinated adults by the Centers for Disease Control and Prevention. That agency said fully vaccinated people now can visit with
other fully vaccinated people without wearing a mask and without social distancing and can visit unvaccinated people from one household with no mask and without distancing, provided the unvaccinated individuals are at low risk of serious COVID complications.
Joy, relief A sampling of ministry eldercare facility leaders reported in early March vaccination rates among residents were around or above 90%. At that time, vaccination uptake lagged among staff, with those rates falling between 50% and 70%. Stacey Johnson is vice president of quality for Trinity Health Senior Johnson Communities, which has 33 eldercare facilities. Johnson says with widespread
Source: The American Health Care Association/National Center for Assisted Living
vaccination of residents accomplished, “there is a big sense of relief, joy and gratitude” among staff, residents and family members. People have been mentally preparing for seeing grandchildren and for celebrating when the time is right for large gatherings. David Becker is vice president for post-acute care for Covenant Health of Tewksbury, Massachusetts, which has 12 long-term care facilities. He says many staff members view widespread inoculation “as a turning point, Becker a first step toward a new normal.” “People are just anticipating the change when we can open up again, and happy days are here again,” adds Jeri Reinhardt. She is vice president, clinical services and performance excellence for Benedictine, Reinhardt which has 32 eldercare sites.
Transition time Becker says throughout the pandemic Covenant facilities have been working hard to give residents safe opportunities to socialize. Over the past few months, the facilities’ units have been treated as bubbles, with each bubble taking turns having socially distanced dining and activities in common spaces. Limited visitation has been allowed. Residents and their families have been “respectful but impatient” about an easing of visitation restrictions as widespread vaccination is achieved both among residents and among their family members. The facilities are awaiting state updates to regulations before they lift restrictions. Reinhardt notes that at Benedictine residents’ deep longing for in-person contact with their loved ones and staff’s desire to diminish the suffering caused by loneliness and isolation is balanced by caution. She says some staff feel “like momma bears. Because we’ve held our residents so close and worked so hard for a year now, while we want to relax, we still want to ensure our elders are safe.” She says with the promised easing of visitation prohibitions and the onset of warmer weather, there is a sense of rebirth and gratitude. “I think this will be an Easter like no other. We think of the resurrection of Christ, and our hope is so poignant.” jminda@chausa.org