Catholic Health World - April 1, 2022

Low-cost insulin from Civica RX 3 Executive changes 5 Fresh from the hospital farm 8 PERIODICAL RATE PUBLICATION

APRIL 2022

VOLUME 38, NUMBER 6

Relief groups rally For long COVID patients, treatment spans specialties Doctors say symptom to help those cluster differs by patient, so care must be customized sheltering in Ukraine, fleeing the country

Caritas International/Marijn Fidder

By LISA EISENHAUER

Refugees from Ukraine pick up supplies just across the border in Palanca, Moldova. Groups within the Caritas International confederation are helping stock and staff sites inside Ukraine and in bordering nations that provide shelter and necessities for people displaced by the Russian invasion.

By LISA EISENHAUER

The COVID-19 virus had been circulating for only a short time when Dr. Nilam Srivastava and her colleagues at Saint Peter’s Healthcare System recognized that some hospitalized patients would require extensive management of medical complications from the infection after discharge.

“We had already started identifying their Srivastava needs while they were in the hospital, I would say from late May (2020),” said Srivastava, chief of the New Brunswick, New Jersey-based system’s division of general internal medicine.

Dr. José Biller, professor and chair of the department of neurology at Loyola University Medical Center in suburban Chicago and Loyola University Chicago Stritch School of Medicine, co-leads a specialty neurology clinic for long COVID patients that opened in January 2021. Through mid-February, the clinic had evaluated 113 patients. The most common symptoms were chronic fatigue and brain fog.

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Colleagues offer practical aid to overstretched hospital units This type of employee volunteerism didn’t happen widely pre-pandemic Prior to the COVID-19 pandemic, Beth Keehn never would have dreamed she’d be assisting in clinical units at Mercy Health — St. Rita’s Medical Center in Lima, Ohio.

But the director of community and government affairs for Mercy Health — Lima wrote in a December blogpost, “In this moment, what my community needs from me most is to don the scrubs and do whatever I can for those who need us most.”

Keehn is among the many Mercy Health associates who have been stepping up when their system’s hospitals ask for employee

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Joe Poelker/Mercy Hospital South

By JULIE MINDA

Catholic relief groups and other organizations providing humanitarian support to Ukrainians who are fleeing or sheltering in place amid the invasion by Russian forces say the need for assistance is great.

The effort to meet that need is hampered by the closure of major highways as military forces position themselves and by active combat including rocket and missile strikes in urban centers and residential neighborhoods. Relief organizations also face challenges accessing cash inside Ukraine as other nations respond to Russia’s aggression by closing off financial networks.

Mercy talent selection manager Katie Horton stocks supplies at Mercy Hospital South in suburban St. Louis. She volunteered for nonclinical support tasks to ease the COVID-related pressure on colleagues, including those giving direct patient care on COVID units.

Nursing schools graduate more students than ever —but it's not enough An abundance of well-qualified applicants compete for too few slots This much is evident: There is a significant and long-running shortage of nurses; the pressures of the pandemic worsened the problem; and shortages are expected to grow.

Some administrators of Catholic nursing schools say there are intractable reasons that schools can’t keep up with demand including a shortage of teaching faculty, which limits student enrollment. Generally speaking, nurse faculty members can earn significantly more money nursing than teaching. In 2020, 80,521 qualified applications were not accepted at schools of nursing due primarily to a shortage of clinical

Jeff Rhode/Holy Name

By JULIE MINDA

Nursing student Emily Guttierrez checks vital signs on a medical manikin as students learn to hang medication on an IV pole last year. They were in a simulation classroom at the Sister Claire Tynan School of Nursing in Englewood Cliffs, New Jersey. The nursing school is affiliated with Holy Name hospital.

sites, faculty and resource constraints, according to results of a survey conducted by the American Association of Colleges of Nursing.

The association of nursing colleges says the nation’s nursing schools are graduating more nurses than ever before, but it’s not enough.

What is more, nursing shortages in hospitals have a cascading impact. Overworked and overwhelmed nurses are calling it quits at alarming rates, others near retirement have taken that option during the pandemic.

The nursing colleges association report warns: “Insufficient staffing is raising the stress level of nurses, impacting job satisfaction, and driving many nurses to leave the profession.” It adds that nurse retirement and turnover rates are negatively affecting the quality of health care. For instance, a Continued on 6

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CATHOLIC HEALTH WORLD April 2022

Ukraine

is not to send unrequested donations of equipment and supplies.

Representatives from two systems — Bon Secours Mercy Health and Providence St. Joseph Health — shared on the call that they had made money commitments to Catholic Relief Services to support its Ukraine relief efforts. Bon Secours Mercy Health made an immediate pledge of $100,000.

“The situation, as we all know, is very volatile,” Moira Monacelli, director of the Vatican-based aid group Caritas International said March 4. “It’s changing day by day, hour by hour.” Caritas is a confederation of 162 Catholic relief, development and social service organizations operating in Ukraine and over 200 countries and territories worldwide.

Monacelli was among representatives from several international humanitarian aid groups and U.S. Catholic health systems who discussed their efforts to bring in food and medical and other emergency supplies and assist Ukrainians hunkering down in place and those seeking refuge in other nations. They spoke during a networking Zoom call on March 4 that was organized by CHA. Bruce Compton, CHA’s senior director of global health, moderated the call. He said it was prompted by queries from CHA members about how to help a population under siege. “I know this is an extremely emotional time for all of us as we consider what is happening in Ukraine,” Compton said.

The organizations represented on the call shared links to websites giving details on their respective aid efforts in the region and where donations are accepted. Those links can be found at chausa.org/globalhealth/Ukraine. The aid groups that took part in the call included: Catholic Relief Services.

International Catholic Migration Commission.

Jesuit Refugee Service.

MedSurplus Alliance.

U.S. Agency for International Development.

United States Conference of Catholic Bishops.

CMMB. On March 11, a week after the call, the U.S. Agency for International Development reported 549 civilians had been killed in the conflict — although media estimates were much higher as Catholic Health World went to press in mid-March. According to the USAID report, 12 million people were in need of humanitarian aid inside Ukraine and 2.5 million people were fleeing to neighboring countries. The United States is working with other governments and the United Nations to mount a global effort to provide food, shelter and security to Ukrainians in areas under siege and refugees who have fled to Poland and other border nations.

Presenters on the CHA Zoom call discussed the importance of working through established and trusted partners to meet the critical food, shelter, fuel and transportation needs of Ukrainians in conflict zones and those fleeing to the relative safety of bordering nations.

Monacelli said the two member organizations within the Caritas confederation that are providing direct assistance in Ukraine have infrastructure in place in 65 locations in Ukraine and in neighboring countries, including Moldova, Poland, Romania, Hungary and Slovakia, all of which have opened their borders to refugees.

Monacelli said Caritas is providing shelter, transportation and psychosocial support to the traumatized victims of the invasion both inside Ukraine and in border nations.

Aid in various forms Kevin Kostic, director of donor relations for Catholic Relief Services, said his organization is partnering with Caritas and other groups in its relief efforts. He shared photos from Ukraine taken since the Russian invasion began Feb. 24. One image showed elderly men and women sheltering in the cold cellar of a cathedral about 90 miles west of the capital city of Kyiv as bombs

Caritas International/Marijn Fidder

From page 1

A woman and her daughter cross the border from Ukraine into Moldova after waiting for hours on March 1. By March 11, the U.S. Agency for International Development estimated that 2.5 million Ukrainians had fled to other nations in search of safety as the Russian assault on their homeland escalated.

‘Doing is donating’ On the call just eight days after Russia began its invasion of Ukraine, multiple CHA member health systems indicated they already were providing cash support for humanitarian aid efforts.

Susan Huber is president of Ascension Global Mission, which oversees international aid efforts by the Ascension health system. She said Ascension is encouraging its associates and its suppliers who want to do something to help Ukrainians to stick with cash donations to established aid groups for now.

“Doing is donating because the people on the ground are the people who know what’s needed, what they can get and how to access it,” Huber said.

In time, she said, Ascension will work with its partner MedSurplus Alliance to send medical supplies that are specifically requested by the government or medical organizations in Ukraine. She said the health system bases its policies for aid donations on the best practices outlined by groups such as CHA and MedSurplus Alliance. One of those practices, she noted,

exploded outside.

“What we’re hearing from Caritas Ukraine in particular is that older and sick people are really overwhelmed and often completely on their own,” Kostic said on the call.

In the days following the CHA call, The Associated Press reported that Russia had widened its offensive. Its military had advanced on cities in eastern and southern Ukraine and continued to launch airstrikes on Kyiv and other urban centers. As the toll of dead and wounded climbed, the fighting left many homes and apartment buildings damaged or destroyed and civilians cut off from food, medicine and heat.

The work of Catholic Relief Services includes coordinating aid distribution with leaders of relief efforts in Ukraine and recruiting and mobilizing volunteers to help with humanitarian efforts and transporting children out of violent areas, he said.

Like representatives of other groups participating in the 90-minute CHA meeting, Kostic said the immediate need is for cash to fund efforts already underway.

Avoid harm St. Joseph Community Partnership Fund, a grant-making affiliate of Providence St. Joseph Health, is matching up to $100,000 in donations from the health system’s staffers. That system also plans to work with its partner Medical Teams International to send medical aid for the Ukrainian relief effort once humanitarian corridors have been secured.

“The first thing we want to do is listen to our partners and don’t expect that we have the answers,” said Justin Magouirk Crowe, Providence’s senior vice president for community partnerships. “We’re going to have a bigger impact if we listen first and do second.”

In mid-March, CHA connected Bon Secours Mercy Health to a Polish nonprofit that used a financial donation from the health system to purchase needed medical equipment and supplies. CHA’s Compton said the items arrived two business days after the donation.

In her closing remarks, Sr. Mary Haddad, RSM, president and chief executive officer of CHA, commended the Catholic health ministry for its continued commitment to global health and eagerness to aid the besieged people of Ukraine.

“As we plan our response, we must resist our desire to react,” she said. “We must be intentional and thoughtful in providing coordinated care in order to avoid the pitfalls that all too often are wasteful and have the potential to cause more harm for those on the ground.”

CHA's guidelines and resources for ethical disaster response can be found at chausa.org/disaster-resource-initiatives/ overview. leisenhauer@chausa.org

Upcoming Events from The Catholic Health Association Catholic Ethics for Health Care Leaders: A Deeper Dive into the Key Concepts of Catholic Health Care Ethics

Online: Tuesdays, March 29 – May 3 1 – 3 p.m. ET In-Person Meeting: May 10 (A), May 16 (B) and May 18 (C) St. Louis

Long-Term Care Networking Zoom Gathering April 20 | 3 – 4 p.m. ET Members only

In-Person Meeting: Ecclesiology and Spiritual Renewal Program for Health Care Leaders Invitation Only May 1 – 6

Global Health Networking Zoom Call May 4 | Noon ET

In-Person Meeting: 2022 Catholic Health Assembly June 5 – 7

Diversity & Disparities Networking Zoom Call June 23 | 1 – 2 p.m. ET

Long-Term Care Networking Zoom Gathering July 12 | 3 – 4 p.m. ET Members only

United Against Human Trafficking Networking Zoom Call July 14 | Noon ET

Faith Community Nurse Networking Zoom Call July 20 | 1 – 2 p.m. ET

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April 2022 CATHOLIC HEALTH WORLD

3

Nonprofit drug maker Civica RX to bring low-cost insulin to market by 2024 Current prices are artificially high, say health system executives affiliated with the company

are more likely to be uninsured or underinsured than white people. According to research published in JAMA in 2019, Blacks, Hispanics and Asians have higher rates of diabetes than whites.

By JULIE MINDA

By 2024, the nonprofit drug company Civica RX plans to offer three different types of insulin to patients at a fraction of the price commanded by the three major pharmaceutical makers who have a corner on the market today.

The insulin makers now dominating the market have been increasing prices precipitously — and artificially — for over a decade; driving prices past the point of affordability for many insulin-dependent diabetics. According to a Rand Corp. study published in 2020, not allowing for rebates and discounts, manufacturers’ insulin prices in the U.S. were more than eight times higher than in 32 comparison nations.

That opens the door to Civica RX to disrupt the market to the benefit of consumers.

The drug company was formed in 2018 by a group of philanthropies and health systems, including Catholic health systems.

The ministry systems that have been governing members of Civica from the outset are Catholic Health Initiatives, now CommonSpirit Health; Providence St. Joseph Health; SSM Health; and Trinity Health.

Hospital Sisters Health System is a founding member.

Carter Dredge is lead futurist of SSM Health and a board member of Civica.

Dredge says as insulin prices have spiked, many people have been working on ways to make insulin affordable. “Civica created a vehicle to enable this to happen. We’re bringing people together, we’re bringing companies Dredge together to solve problems.

And we’re bringing the scale needed to break into this market.”

Mohammad “Mo” Kharbat, vice president of pharmacy services for SSM Health,

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PRODUCT

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© Catholic Health Association of the United States, April 2022

Market dominance To promote widespread availability, the University of Toronto, which held the first patent on insulin, gave pharmaceutical companies the right to make the hormone and patent any improvements. Incremental changes to formulations allowed the for-profit manufacturers to extend their patents, block the introduction of generics and ultimately raise prices well beyond the pain point. Currently three makers dominate the market — Eli Lilly, Novo Norodisk and Sanofi. Their formulations are the most commonly prescribed.

Kharbat explains that the Food and Drug Administration has two paths for compaEssential medication nies to enter the insulin market: they can According to the American Diabe- develop and patent a brand new formulates Association’s Diabetes Care journal, tion, or they can develop a “biosimilar” that 30 million-plus Americans have diabetes. has the same basic biological structure, In Type 1 diabetes, a person’s pancreas efficacy and safety as one of the currently available drugs. can’t make insulin, However, the proor enough insulin, a A JAMA Internal Medicine hormone the body cess to complete the study two years ago found many stages to bring Price cut requires to use or store the glucose such drugs to marAmber Starr, 40, of Shawnee, Oklathat as many as 25% of it gets from food. ket on either of the homa, was diagnosed with diabetes in In Type 2 diabetes, paths currently is too 2013. She uses a long-acting insulin twice insulin users skip doses or the pancreas makes costly for for-profit a day and a short-acting insulin periinsulin, but, because take less than prescribed due companies to jus- odically throughout the day. She says she of insulin resistance, especially since would be thrilled if insulin prices were to high costs. People who are tify, the glucose builds up the dominant mak- to come down. She is unemployed and in the bloodstream uninsured or underinsured ers can simply arti- insured by Medicare. She does not have a instead of feeding ficially lower their supplemental Medicare Part D drug plan, are hit especially hard. cells. prices when the new so she must pay the approximately $150 Although Type 2 entrant arrives, to weekly insulin cost out of pocket. She said diabetes is sometimes managed with diet or wipe out its profits. that amount does not include the costs for oral medications, managing severe Type 2 Such market barriers have meant no the pump, monitor, meter and test strips diabetes may require insulin injection. new competition, and thus high prices, says she requires.

On multiple occasions she has had to Patients with Type 1 diabetes require regu- Dredge. A JAMA Internal Medicine study decide whether she should short her utility two years ago found that as many as 25% lar subcutaneous insulin injections or an infusion from an insulin pump to maintain of insulin users skip doses or take less than bills or buy less food in order to pay for her prescribed due to high costs. People who insulin and diabetes supplies. blood sugar levels.

She says for her and millions of othAccording to statistics from Civica, more are uninsured or underinsured are hit espethan 8 million Americans rely on insu- cially hard. The problem is so severe that ers “this is a common struggle, and it gets lin. Most forms of insulin are injected via President Joe Biden in his State of the Union harder each and every day.”

Visit chausa.org/chworld to read about syringe into body fat. The frequency of injec- Address proposed price caps on insulin.

A SSM Health release on Civica’s insulin the history of insulin as a treatment for tion and the amount and type of insulin needed depend on several factors including investment posits insulin unaffordability as diabetes. blood sugar levels, the type of diabetes and a health equity issue since people of color jminda@chausa.org a patient’s daily diet and exercise. Insulindependent diabetics may test their blood Insulin Supply Chain: A Complex System sugar levels several times a day to determine The insulin supply chain involves numerous players how much insulin to inject and when. in a complicated web of relationships.

Insulin products vary by how fast they begin to work, how quickly they peak and PRODUCT PRODUCT how long they remain effective. There are CONSUMER COST NEGOTIATED PAYMENT five categories of insulin, based on these DRUG CONSUMER PHARMACY WHOLESALER characteristics: rapid-acting, regular or T EN short-acting, intermediate-acting, longPR YM A OD P acting and ultra-long acting. Civica plans to D UC TE T A I T make one long-acting and two rapid-acting O G NE NE GO insulins.

TI AT ED SSM Health’s Kharbat says going without PA YM insulin can land diabetics in the emergency EN T department. “It can be life-threatening to go without insulin” or to take an incorrect dosREBATE age. And there are debilitating and potenREBATE INSURANCE PHARMACY tially life-threatening sequelae from poor NEGOTIATED PAYMENT COMPANY/ BENEFIT DRUG HEALTH PLAN MANAGER COMPANY blood sugar control over longer periods of time that include poor wound healing, Source: The American Diabetes Association’s publication, “Insulin Access and Affordability Working Group: heart disease, circulatory and nervous sys- Conclusions and Recommendations,” Diabetes Care 2018.

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Graphic Design Les Stock Norma Klingsick

tem failures sometimes leading to amputation, kidney failure and blindness.

CONSUMER COST

Associate Editor Julie Minda jminda@chausa.org 314-253-3412

says taking on insulin affordability “is the clearest example yet of why Civica was founded.

Civica’s mission is to make quality generic medicines accessible and affordable to everyone. And Civica is going to great lengths to ensure this insulin will be Kharbat available soon." Insulin will be available at a low price to anyone in the country who has a prescription, "and that will be huge,” Kharbat says.

Kharbat says 20 years ago a vial of insulin that would last half a month cost $10 or $20.

Now, that same vial costs about $300. Civica anticipates it can bring that cost down to $30 per vial.

Utility Dredge said that Civica has engaged numerous philanthropists — including health care, family and individual foundations — through its own foundation to provide initial funds for insulin development. He says since Civica is a nonprofit functioning as a member-funded utility, it does not have a profit incentive. So it does not shrink from the challenge of low margins and high upfront investment with no fast return.

Civica plans to partner with Indian company GeneSys Biologics to refine the formulations for the three insulins: glargine, which will be biosimilar and interchangeable with Lantus; lispro, which will correspond to Humalog; and aspart, which will correspond to Novolog. Civica is building a pharmaceutical-manufacturing plant in Virginia that will produce the insulin as well as other Civica-branded drugs.

Kharbat says as a barrier to Civica’s market entry, the dominant players in the insulin market may try offering sharp rebates on brand name insulin to pharmacy benefit managers.

However, Civica already has contracts with many of its member health systems and partnering nonprofit insurance companies to use the Civica insulin. That should enable Civica to quickly gain market share.

Dredge notes that the mere presence of low-cost options should drive prices down even for consumers not buying the Civicabranded drugs. That already is happening with many of the 50 drugs Civica produces.

Insulin is the first drug Civica is producing that is not primarily for inpatients.

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CATHOLIC HEALTH WORLD April 2022

Long COVID

or RECOVER for short. The goal is to build a national study population and support large-scale research on COVID’s long-term effects. As part of its National COVID-19 Preparedness Plan released in March, the White House pledged “to accelerate efforts to detect, prevent, and treat Long COVID.” Srivastava said Saint Peter’s is collecting data on the patients in its long COVID program for its own analysis and to inform its treatment. It is not partnering on any larger studies, although she said that is under consideration.

From page 1

In August 2020, the system launched its COVID-19 Recovery Program, which Srivastava co-directs with Dr. Amar Bukhari, chief of the division of pulmonary, critical care and sleep medicine, and associate chair for the Department of Medicine at Saint Peter’s University Hospital. The program has coordinated treatment for about 800 patients among primary care doctors and cardiologists, pulmonologists and other specialists. Not all of the patients had had severe bouts of COVID. Some were even asymptomatic in the acute viral stage yet wound up with long COVID symptoms such as fatigue, labored breathing, brain fog, headaches and insomnia that have required ongoing care.

While much remains unknown about COVID and its lingering complications, Srivastava said one thing that is clear is that the complications manifest in different ways in each patient. Symptoms vary in number, duration and severity. Some patients need only one type of treatment, such as respiratory therapy to rebuild lung capacity, while doctors choose from a cafeteria line of therapies for others depending on the specific secondary conditions caused by COVID infection. Some patients receive physical therapy, neurocognitive evaluations, physiatry referrals and/ or undergo mental health counseling for depression and anxiety rooted in COVID infection.

Srivastava said Saint Peter’s works to address all of its long COVID patients’ medical needs and their goals of care in a coordinated way. “The recovery is different in

Machines and pouches of medication surround the bed of a COVID-19 patient in an intensive care unit at SSM Health DePaul Hospital-St. Louis in 2020. Some studies have found that COVID patients with the most severe acute illness are most likely to contend with long-lasting symptoms that disrupt their lives.

Estimates of the incidence of long COVID vary widely.

each person,” she said. “We have to individualize the treatment and that is important.

It’s not one treatment fits all.”

National response Doctors with Catholic systems that don’t have a dedicated long COVID clinic or program said they too are working across disciplines to provide symptom-specific care.

Officially long COVID is called postacute sequelae SARS-CoV-2 infection. The Centers for Disease Control and Prevention defines the condition as “a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19.”

Estimates of how many COVID patients contend with lingering symptoms vary

widely. One CDC study published in September and based on a survey of 698 adults who had tested positive, said that about two-thirds of those respondents selfreported symptoms that lasted beyond four weeks. The CDC study also noted that the prevalence of lingering systems has been reported as being as low as 5%. Even at the low end of the estimate, based on reported COVID infections, the number of U.S. patients with long COVID symptoms of varying severity would approach 4 million. The CDC study calls long COVID “an emerging public health concern.”

The condition has prompted various national responses. The National Institutes of Health in September awarded nearly $470 million in grants for an initiative called REsearching COVID to Enhance Recovery,

After two bouts with COVID, lingering symptoms test man’s endurance

J

ust as he was getting back specialists. “He was my savior to feeling like himself after and my blessing in this whole a bout with COVID-19 that journey with COVID because had sent him to the mat for he referred me to countless months, Michael Heath conspecialists to have me tested tracted the virus again. and treated to check my heart, “That was devastating for to check my lungs, to check me because I’m thinking I just my breathing, my swallowing,” had this battle for all those Heath said of Krszjzaniek. months and now here we go Heath has undergone EKGs, again,” recalled Heath, a social CT scans, MRIs and an ultraworker and freelance photogsound to diagnose and assess rapher who lives in Baraboo, his condition. Some of them, Wisconsin. he said, show no evidence of Heath believes he caught problems — a frustration for COVID the first time while him and the doctors. He started photographing a wedding. He pulmonary rehab to rebuild his Michael Heath says his wife, Deedee, and daughter, Emily, are bucking him remembers waking up the day lung capacity and strength, up during his slow recovery from long COVID. Heath has had migraines, after — March 1, 2020 — and severe fatigue and labored breathing since contracting COVID-19 twice, most then had to take a break feeling extreme exhaustion. because the sessions caused recently in August 2020.

He’d expected to be tired after his heart rate to spike. without being hospitalized with the same logging 29,000 steps the day of the wedStill in the throes of long COVID, Heath advice as the first time. There were no ding. He didn’t expect to be unable to get believes he’s making progress. He’s COVID therapies available at the time. out of bed. hopeful that he’ll return to close to what

By July, Heath said he was feeling like he “It was something I had never expehad been a healthy life. He credits his had turned a corner. Though his headaches, rienced before,” the 53-year-old said. “It wife, Deedee, adviser for the GoldenCare fatigue and breathing problems weren’t came on me that quick.” program for seniors and patient care gone, they had eased considerably.

Over the next few days, he grew more advocate at SSM Health St. Clare Hospital He accepted another photography miserable, with relentless migraines, lack in Baraboo, and their 15-year-old daughassignment that put him in close proximof appetite, night fever, labored breathter, Emily, for helping him stay focused ity to a mother and two teenagers. Even ing, heart palpitations and constriction in on healing and optimistic during his slow before the mother alerted him two days his throat that made swallowing difficult. recovery. later that the kids were sick, he recognized Heath went to the emergency room where He worries, however, that he will never that his acute COVID symptoms were back. a doctor who had greeted him in full-body again be fit enough for strenuous activities It took a few days before Heath’s susprotective gear left the room and then like the long hikes, biking and swimming picions were confirmed by a positive test called the phone in the room to talk to that he used to enjoy a couple of years result. The second time the virus seemed Heath. ago. to clear his system faster than it did the The doctor said that while he was He also is concerned that many people first time, Heath said. The fever and chest certain Heath had COVID, because Heath don’t take the long-term risks of COVID congestion lasted just a few days. didn’t have a fever he couldn’t, under the seriously. It’s one reason why he shares Nevertheless, his body has yet to protocols in place, do a test. The doctor his story. recover from the double blow. He endures also had no treatments for Heath. He “The general community I feel they severe fatigue, breathing and swallowing urged Heath to rest, isolate and continue just think, ‘Oh it’s the flu or a cold and you problems, migraines, heart palpitations and the use as needed of an inhaler that Heath get over it and there’s a 98% or whatever cognition challenges that were not present had for occasional allergy-related asthma. survival rate,’” Heath said. “Yeah, the surbefore his COVID infections.

Until he came down with COVID, that mild vival rate, thank the Good Lord, is high, but His primary care physician — Dr. Randy asthma was Heath’s only health issue. survivors that get long COVID some have Krszjzaniek with SSM Health Dean MediHeath went back to the ER twice more lost their jobs, their livelihoods. It’s really a cal Group in Baraboo — has sent Heath in spring 2020 when he was struggling sad state.” to a neurologist, cardiologist and other to breathe. Each time he was sent home — LISA EISENHAUER

Treating and collaborating Dr. José Biller is professor and chair of the department of neurology at Loyola University Medical Center in suburban Chicago and Loyola University Chicago Stritch School of Medicine. He co-leads a specialty neurology clinic for long COVID patients that opened in January 2021. The medical center is part of Loyola Medicine — a threehospital system within Trinity Health.

So far, about three-fourths of the clinic’s patients have reported “crushing chronic fatigue” and/or brain fog, or the inability at times to comprehend or multitask.

More than half have reported anxiety, headaches and insomnia.

Through mid-February, the Loyola neurology clinic had evaluated 113 long COVID patients. The first step in assessing their health was an extensive intake questionnaire that covers a long list of potential symptoms. So far, about three-fourths of the clinic’s patients have reported “crushing chronic fatigue” and/or brain fog, or the inability at times to comprehend or multitask. More than half have reported anxiety, headaches and insomnia.

Biller is using findings from the clinic’s patients in collaborative studies with other physicians and researchers into the incidences, potential causes and best treatments for long COVID. One of them, published in June in the journal Current Neurology and Neuroscience Reports, includes proposed diagnostic criteria and symptom-based care for long COVID. Biller said it would be premature to point to any definitive conclusions about the cause of long COVID and potential cures. He is, however, confident about some aspects of the condition, such as that it is linked to the novel coronavirus, and not just occurring by coincidence in patients who have contracted the virus. He also is certain that COVID vaccines don’t trigger long COVID, although he said it remains unclear whether those vaccines might offer some protection against the syndrome.

In addition, Biller is certain that the best care for patients is multidisciplinary, because the symptoms often span organ systems, and multimodal, with a mix of medication and other therapies such as those that focus on nutrition, sleep and coping with stress that is tailored to each patient’s needs.

Starting with primary care Bon Secours Mercy Health partnered with The Ohio State University Wexner Medical Center for a symposium on long COVID in April 2021. The system’s physicians, nurses, social workers and other associates were among more than 600 people who spent a Saturday morning learning about risk factors and the constellation of symptoms associated with the syndrome as well as the role of exercise, therapy, pain management and nutrition in treatment.

“I think people walked away realizing this is a syndrome that’s evolving with focus areas that involve different specialties,”

April 2022 CATHOLIC HEALTH WORLD

said Dr. Herb Schumm, Bon Secours Mercy Health’s vice president, medical director education and physician engagement.

Bon Secours Mercy Health is participating in another long COVID educational event on April 2 that is Schumm open to anyone.

Schumm said the system’s doctors are noting similar patterns that have been identified in early studies on long COVID, including that older patients and those with preexisting conditions such as diabetes or compromised immune systems often have the most severe lingering symptoms after a bout with COVID. Bon Secours Mercy Health is relying on its primary care providers to manage treatment for long COVID patients. Those providers have established referral paths to link patients to appropriate specialists, Schumm said.

He expressed concern that since so many providers themselves contracted COVID, the already-depleted health care workforce faces another headwind from long COVID. “From an employer standpoint, I’m not sure we’re ready for this or equipped for this broader range of potential disabilities,” Schumm said.

Dr. Shephali Wulff, system director of infectious diseases at SSM Health, also has taken note of long COVID’s impact on care providers. She has seen nurses struggle to return to demanding 12-hour hospital shifts. Some of those nurses have had

LONG-HAUL COVID A study analyzing the health insurance records of nearly 2 million COVID-19 patients found:

23%

of COVID-19 patients had long-haul COVID

19%

of asymptomatic patients had long-haul COVID

The five most common post-COVID conditions across all ages: Pain, breathing difficulties, hyperlipidemia, malaise and fatigue, hypertension Source: "A Detailed Study of Patients with Long-Haul COVID: An Analysis of Private Healthcare Claims."

A FAIR Health White Paper, June 15, 2021.

fatigue as long as nine months after recovering from acute phases of COVID. Just how long long-term COVID symptoms last is one of the many unknowns about the condition, Wulff said. “It’s still an area of growing science and so I think we’re all learning together from our patients.”

‘When will I feel better?’

SSM Health doesn’t have a long COVID program, per se; its primary care providers make referrals to specialists based on patients’ symptoms. To inform their care, Wulff said SSM Health clinicians are watching closely how their long COVID patients respond to treatments, taking part in CDC trainings and staying on top of studies pub-

5

lished by JAMA and other trusted sources to inform their care.

Wulff said long COVID patients are proving to be less resource-intensive than patients with severe cases of COVID. Few of them require hospitalization. Nevertheless, she said, while knowledge around the condition evolves, the lingering symptoms are frustrating for patients and clinicians.

“Everyone wants to know ‘When will I feel better? When will these symptoms go away? When will I go back to normal?’ and we don’t know and that’s a really difficult place for both the patient and the clinician,” she said. leisenhauer@chausa.org

Research team finds four early indicators of long COVID A

team at the Institute for Systems Biology, a nonprofit biomedical research organization affiliated with Providence St. Joseph Health, has identified four factors that can be measured at the point of a COVID-19 diagnosis that indicate whether the patient will have lingering illnesses related to the virus.

The team published a paper on its findings titled “Multiple early factors anticipate post-acute COVID-19 sequelae” in the journal Cell on Jan. 24. The paper’s findings have been cited in many media reports, including by The Wall Street Journal, The New York Times and The

Scientist magazine.

The factors the team identified are: The presence of certain autoantibodies, which are antibodies produced by the immune system that are directed against one or more of the body’s own proteins.

Preexisting Type 2 diabetes.

The level of the COVID-19 virus in the blood.

The level of Epstein-Barr virus in the blood.

Dr. Jim Heath is president of the Institute for Systems Biology and a co-author of the research paper. In a Q and A that

COMMUNITY BENEFIT 101:

appears in the spring 2022 edition of the CHA journal Health Progress, Heath says the research found that patients with any of the risk factors had odds greater than 90% of having long COVID with three or more symptoms.

The study also pointed toward potential treatments. For example, Heath says in the Health Progress article: “I think it is worthwhile to begin exploring whether drugs that are effective for lupus erythematosus might also have a role in treating patients with long COVID.” — LISA EISENHAUER

KEEPING UP

THE NUTS AND BOLTS OF COMMUNITY BENEFIT

Join us for the Virtual Program!

Christman

Community Benefit 101: The Nuts and Bolts of Planning and Reporting Community Benefit

“The information about the CHNA and CHIP was so essential and will be invaluable in my role.”

OCTOBER 25, 26 & 27, 2022

Each day from 2 to 5 p.m. ET

CHA’s CB 101: The Nuts and Bolts of Planning and Reporting Community Benefit, a virtual conference, will provide new community benefit professionals and others who want to learn about community benefit with the foundational knowledge and tools needed to run effective community benefit programs.

Attendees will receive a copy of CHA’s A Guide for Planning and Reporting Community Benefit

“CHA has great resources that were used as part of the program and I can already use the information presented in my day to day activities.”

What you will learn: Taught by community benefit leaders, the program will cover what counts as community benefit; how to plan, evaluate and report on community benefit programs; accounting principles and a public policy update.

Who should attend: v New community benefit professionals who want a comprehensive overview of all aspects of community benefit programming. v Staff in mission, finance/tax, population health, strategic planning, diversity and inclusion, communications, government relations, and compliance who want to learn about the important relationship of their work and community benefit/community health. v Veteran community benefit staff who want a refresher course to update them on current practices and inspire future activities.

WE HOPE TO SEE YOU THERE! LEARN MORE AT CHAUSA.ORG/COMMUNITYBENEFIT101

Francis

PRESIDENTS AND CEOS Organizations within CommonSpirit Health have announced these changes: Tim Bricker to interim president of the Dignity Health Misko Southwest Division.

Prior to assuming the position, he was a consultant for various health care ventures and for McKinsey & Company. Mariann Doeling to president of CHI St. Alexius Health Devils Lake in North Dakota, from interim president. Prior to this appointment, Doeling was president of CHI St. Alexius Health Carrington Medical Center in North Dakota.

ADMINISTRATIVE CHANGES Travis Christman to chief nursing officer of HSHS Sacred Heart Hospital in Eau Claire, Wisconsin, and HSHS St. Joseph’s Hospital in Chippewa Falls, Wisconsin.

Dr. Brandon Francis to chief medical officer of Mercy Health Saint Mary’s of Grand Rapids, Michigan, effective in mid-May. The facility is part of Trinity Health.

Ashley Misko to executive director of the Mount St. Mary’s Hospital Foundation, part of Catholic Health of Buffalo, New York.

GIFT St. Mary Medical Center of Langhorne, Pennsylvania, has received an anonymous gift of $750,000. The facility will use the funds for equipment and software upgrades to the cardiac catheterization labs in the St. Mary Heart and Vascular Center. The gift supports the St. Mary Initiatives Fund, which helps ensure new technology, advanced methods and top practitioners are available at St. Mary, part of Trinity Health.

6

CATHOLIC HEALTH WORLD April 2022

Nursing shortage From page 1

study cited in the report found that higher patient loads were associated with higher hospital readmission rates.

Same old song Although the dynamics of the nurse workforce and nurse faculty shortage were amplified by the pandemic, the conditions are not new, says Mary Ellen Smith Glasgow, dean and professor at Pittsburgh’s Duquesne University School of Nursing and vice provost for research for the university’s Office of Research and Glasgow Innovation.

She adds, “Nursing entered 2021 with a shortage, which has been exacerbated by the resurgence of COVID-19 worldwide and the resultant mental health strain on health care providers, the exodus of many providers, including nurses, and the growing public dissension related to the pandemic.”

McKinsey & Company said 22% of the 400 frontline nurses participating in its 2021 Future of Work in Nursing Survey, conducted early last year, said they might leave their current job within the year. Six of 10 respondents in this group said they were more likely to leave since the pandemic began.

According to a May 11 article on the survey and on the nursing workforce published on the McKinsey website, the desire to move on is “driven by a variety of factors, with insufficient staffing, workload, and emotional toll (of the pandemic) topping the list.” Of those nurses who said they may leave their jobs, over half said they were seeking another career path, a nondirect care role, or were planning to retire or leave the workforce entirely.

Julie Trocchio is CHA senior director of community benefit and continuing Trocchio care, and she convenes the deans of Catholic nursing schools several times a year to network and share strate-

Nursing student Taylor Turman practices inserting a nasogastric tube on a trainer manikin in January 2021. Turman is a student of the St. Mary's School of Nursing and Health Professions in Huntington, West Virginia.

gies. She says the nurse shortage problem is especially pressing in long-term care facilities, which can have trouble competing against acute care sites when it comes to pay. President Joe Biden said in his state of the union address that the White House is proposing new staffing requirements for long-term care sites, including increased nurse staffing.

Joey Trader is vice president of the St. Mary’s School of Nursing and Health Professions and he directs the nursing school. The programs are affiliated with Trader St. Mary’s Medical Center of Huntington, West Virginia, part of the Mountain Health Network. Trader says many health care facilities must pay overtime and travel nurse salaries to fill out staff rosters.

He says despite challenges, he’s not had a problem recruiting faculty or nursing students, thanks in part to Mountain Health Network’s nursing tuition assistance program announced in late January.

Great prospects is strong, thousands of qualified applicants Trader and other nursing school admin- are being turned away from four-year colistrators say interest remains high in nurs- leges and universities.” ing as a career.

Edilma Yearwood chairs the department Feeder systems of professional nursing practice and is an Hospital-affiliated nursing schools were associate professor in the School of Nursing created to keep a steady flow of new nurses and Health Studies at Georgetown Univer- to replenish staff. Although it’s the rare hossity. She says, “We saw more applications pital that has its own nursing school now, last year than in prior years, though we are the feeder system may be even more imporlimited in how many students we can take tant as competition for nurses intensifies. in. As I talk with students, I hear them say Before the pandemic, Cannistraci says, that they feel very strongly that they are in St. Peter’s two nursing schools had forged a the right place, and they are fully commit- relationship with the College of Saint Rose ted to do what they need to do as a nurse. in Albany, New York. Students attend St. The pandemic has unleashed a deeper Peter’s schools to earn an associate degree.

Those who choose to pursue a bachelor of commitment for the mission.”

Trocchio, who is a graduate of George- science in nursing and enroll at the Coltown’s nursing school, says when nursing is lege of Saint Rose to do so can complete taught in the context of mission, both nurs- their clinical hours at St. Peter’s health care facilities. ing and health care benefit.

St. Peter’s Samaritan also offers a Patricia Cannistraci, 12-month program that leads to a licensed dean of the Samaritan Hospractical nurse certificate. “LPNs helped pital School of Nursing, to bridge some staffing needs in the acute says, “Our school is graduatcare setting during COVID,” Cannistraci ing a steady group of nurses says. “Hospitals are now considering bringwho are workforce-ready, and we have had — even ing LPNs back into acute care on a regular Cannistraci through the pandemic — basis.” an incredibly high pass rate for nursing Administrators from Catholic nursing boards.” Samaritan is one of two nursing schools that are owned by or in the same schools within St. Peter’s Health Partners in system as hospitals say the movement of Troy, New York. St. Peter’s Health Partners staff between the schools and hospitals has is part of Trinity Health. Its other nursing allowed for some protection from the more school, St. Peter’s Hospital College of Nurs- severe faculty and clinician shortages.

As hospital nurse shortages have worsing, is affiliated with St. Peter’s Hospital in Albany, New York. ened during the panThe nursing colleges demic, the level of part"The pandemic has association found in a surnership between the hospitals and nursing vey conducted in fall 2020 unleashed a deeper schools has intensithat there were significant commitment for the fied. Cannistraci says increases in enrollment in entry-level baccalaurestaff and students at St. mission."

Peter’s nursing schools ate, master’s and doctor — Edilma Yearwood — including Cannistraci of nursing practice proherself — volunteered grams. (The report did not for shifts at the hospital. And the hospital mention associate nursing degrees.)

Nursing programs offered at the bac- and nursing school started a program that calaureate degree levels and above have enabled students to work as patient care seen more than 15 years of continuous technicians in units strapped for clinicians. enrollment growth. The association said in The students gained valuable experience — a press release that “though interest in bac- and confidence, says Cannistraci.

Similarly, faculty and students at the Siscalaureate and graduate nursing programs ter Claire Tynan School of Nursing at Holy Name hospital of Englewood Cliffs, New Jersey, volunteered at the hospital at COVID screening sites, in the COVID intensive care unit and in monoclonal antibody treatment hospitals to continue offering nursing units, says nursing school director Donna school programs if the TRAIN Act does not M. Penn. pass.

Catholic nursing schools seek increased funds for nurse education

N

ursing schools do not have the capacity to educate more nursing students to meet the high demand, and this is in large part because they do not have the funds to hire enough faculty.

Catholic nursing school leaders are calling upon government entities at the federal and state level to increase funding for nurse education. This includes scholarship and grant dollars as well as fixes to payment systems, they say.

Edilma Yearwood chairs the department of professional nursing practice and is an associate professor in the School of Nursing and Health Studies at Georgetown University. She says the school plans to seek additional funds from the Health Resources and Services Administration, part of the U.S. Department of Health and Human Services.

“Everyone is aware that we have a shortage (of nurses), so the time is now to have deep conversations and state clearly what we need — scholarship dollars — to support students coming into the profession,” she says. Those scholarship dollars, when paid as tuition, would help boost the school’s financial position, paving the way for more hiring.

Patricia Cannistraci, dean of the Samaritan Hospital School of Nursing, one of two nursing schools within St. Peter’s Health Partners in Troy, New York, says, “Catholic health care needs to be around the table of policymaking where decisions are made.”

The nursing schools are doing some of the lobbying directly and some through associations including the American Nurses Association and its American

Nurses Credentialing Center as well as the National Coalition of Hospital Associated Schools & Colleges of Nursing.

Cannistraci says St. Peter’s nursing schools have been part of the chorus calling for HHS and the Department of Education to increase funding so that more faculty can be educated and hired. Nursing schools have been lobbying for the Health Resources and Services Administration to develop nurse residency programs and/or to develop a nursing center of excellence to take a comprehensive approach to the issue.

Donna M. Penn, who directs the Holy Name medical center Sister Claire Tynan School of Nursing in New Jersey, says that nursing school is among many organiPenn zations supporting the Technical Reset to Advance the Instruction of Nurses, or TRAIN, Act. The legislation would correct payment issues of the Centers for Medicare & Medicaid Services.

According to a letter the American Hospital Association sent to U.S. senators to support the TRAIN Act, Medicare has been making incorrect payments to both hospital-based nursing and allied health education programs and direct graduate medical education programs due to miscalculations. CMS has called for the recalculating of the formula and a recouping of misallocated funds, a move that critics say will financially harm the facilities. The TRAIN Act would stop the clawback.

Penn says it may be difficult for some

Joey Trader is vice president of the St. Mary’s School of Nursing and Health Professions and he directs that Huntington, West Virginia, nursing school. He says nursing schools in that state have been successful in lobbying for some funding — West Virginia Gov. Jim Justice has allocated $48 million in grants to expand the schools’ capacity. The grants will fund faculty recruitment and retention efforts.

St. Mary’s also is applying for grant dollars through the Higher Education Policy Commission of West Virginia.

Yearwood and Cannistraci say their schools are looking into seeking additional philanthropic funds to bolster nursing programs.

Yearwood notes that Georgetown has been intentional in encouraging its nursing students to join advocacy efforts to secure financial resources from governmental agencies.

She says of the nursing students, “We always encourage them to step out of their comfort zone and do more in the larger community.”

Yearwood adds that in this way the nursing school prepares students “for the long fight by helping them to learn the tools needed to have a voice in multiple arenas in the health care space. As faculty, our job is to expose them to these issues, support their passion for advocacy and help them see that the student voice is and can be powerful.”

—JULIE MINDA

Matchmaking CHA aims to play a role in encouraging relationship-building between Catholic hospitals and nursing schools. Loren F. Chandler, the association’s chief operating and finance officer, says ministry chief executives report their systems are finding it difficult to match up with nursing schools looking for hospitals where students can complete practicums. As a result, their facilities are losing out on the opportunity to build connections with nursing students that could give them a leg up in recruiting new nursing grads.

CHA is convening Catholic health care executives to explore ways to establish a stronger pipeline between both Catholic and secular nursing schools and nearby Catholic health care facilities. They’ll develop messaging that distinguishes Catholic hospitals from competitors. One goal of stronger school-hospital affiliations would be to grow the enrollment capacity of the nursing schools.

CHA’s Trocchio says, “Connecting Catholic health care with Catholic and other schools of nursing is an important step toward addressing our workforce needs.

In the years CHA has convened the deans of Catholic schools of nursing, many have expressed hope that the tie between education and practice could be even stronger.”

Visit chausa.org/chworld for information on how these schools have maintained operations during the pandemic. jminda@chausa.org

March April 1,2022 2022 CATHOLIC HEALTH WORLD

Pitching in From page 1

volunteers to provide nonclinical assistance to units and services overstretched during COVID-19 caseload surges. Mercy Health is part of Bon Secours Mercy Health.

Late last year, in responding to such a call, Keehn filled in as a patient sitter, remaining in the room of a middle-aged man rendered seriously ill by the virus.

She held his hand, listened as he spoke — though she said his words were mostly jumbled and nonsensical — and “tried to assure him he would be OK and that we were doing everything we could to help him. And when he got very scared and confused and tried to pull out his oxygen, I had to convince him to let it be,” she said in the blogpost.

Many hospitals across the U.S. have been entreating employees — including those without a clinical background — to come to the aid of units strained to capacity. Ministry associates who are coordinating the volunteerism said the arrangement has given clinicians desperately needed support.

Employees who volunteered for nonclinical tasks said they came away with a lived understanding of their hospitals’ mission and a deeper appreciation for the commitment of clinical staff. They bonded with colleagues they otherwise may have never met.

Surge-driven Greg Till, Providence St. Joseph Health chief people officer, said that while some type of role-sharing is fairly typical at rural facilities and some long-term care sites, Till having large numbers of employees volunteering for responsibilities far outside of their own wheelhouse is unusual in most hospitals.

Jeremy Bradford, president of SSM Health Good Samaritan Hospital–Mount Bradford Vernon, Illinois, said leadership team members and others have always stepped in to aid colleagues. Before the pandemic senior executives did stints as patient

safety sitters, for instance. But the pandemic prompted SSM Health to create a formal volunteer process for staffers.

He added that it’s not just executives and administrators pitching in at his hospital and across the system. Any SSM Health employee can offer to fill a shift in a nonclinical job.

According to Betty Jo Rocchio, senior vice president and chief nursing officer of Chesterfield, Missouri-based Mercy, the exigencies of the pandemic have spurred health care providers to use approaches never widely tried before. Surges of the virus — particularly during the omicron wave — meant record admissions, even as clinicians themselves got infected and had to go home sick, and that left many units very shorthanded. “Given the situation we face, we’re asking co-workers who normally aren’t involved in patient care to help in nonclinical roles, giving our clinical teams more time with patients,” she was quoted as saying in a January press release from Mercy.

Amplifying the staff shortages was the lack of outside volunteers, noted Monica Eckhardt, chief nursing officer for Trinity Health Mid-Atlantic. Hospitals have not been allowing outside volunteers to work during surges. But many hospital administrators added that a lot of the tasks being done by staff would not have been assigned to non-staff Eckhardt volunteers.

Till said that it became obvious early in the pandemic that not every Providence facility was going to be hit with surges at the same time — the system has operations in seven Western states — and that spurred the idea for labor sharing. He said it helps when government agencies relax existing barriers to labor sharing, to ensure hospitals can staff effectively.

Cross-training It is a complex task to identify employees willing, able and available to help on short notice; match them with units in need of extra hands; and ensure the volunteers and other staff arrive equipped for success.

Eckhardt said as part of the 88-hospi-

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staff to assist with everything from cleaning for infection control, to feeding and walking patients.

All employees get thorough instructions on how to do the tasks they are unaccustomed to performing.

Some have clinical backgrounds, some do not. Many colleagues from the Peace- DeSpain Health system office are regulars in the temporary labor pool. DeSpain said she has seen many salaried system office employees work their usual 40-hour week and then volunteer a day on the weekend. “It’s really appreciated and valued” by the clinicians in the units, she said.

Jeremy Bradford, president of SSM Health Good Samaritan Hospital — Mount Vernon, Illinois, operates a carpet cleaning machine at the hospital as he pitches in to support the hospital’s environmental services department.

tal Trinity Health system’s pre-pandemic disaster planning it had set up protocols and developed a tool kit for hospital units to use if and when labor sharing became necessary. Under the approach, unit staff train clinicians and other staff from different units and departments to prepare them to step up in times of short staffing.

During the pandemic, Trinity Health facilities stood up systems for assessing the skill sets, interests and availability of colleagues to work in other units. Individuals who received training were eligible to volunteer to do jobs other than the one they were hired for.

Eckhardt said COVID units were most in need of help, and staff volunteers changed linens; delivered patient meal trays, supplies and pharmaceuticals; and answered phones.

Jodi DeSpain is a nurse manager who helps handle staffing and other needs for PeaceHealth Southwest Medical Center in Vancouver, Washington. She said the resource center where she works created a labor pool that centralizes coordination of

Let’s reunite for Assembly 2022

INDIANAPOLIS JUNE 5 – 7

TO REGISTER GO TO CHAUSA.ORG/ASSEMBLY

Turkey link Keehn of Mercy Health — Lima said St. Rita’s has had the highest patient censuses in its history during COVID surges. During one big surge, the hospital repurposed a sign-up system for a Thanksgiving event to solicit volunteers and then plug them into open assignments.

Both clinical and nonclinical colleagues have signed up to be patient sitters, to restock supplies, to answer call lights — anything that can free up exhausted clinical team members.

As market foundation board coordinator for St. Rita’s, Mary Ann Bailey had not spent much time on patient floors pre-COVID. But since volunteering about a dozen times for Bailey temporary shifts assisting in nursing units, she’s felt more a part of the hospital’s work.

Till said Providence invited caregivers to fill out a survey listing their skill sets and certifications and how they’d be willing to help, if called upon.

The facilities use that information to solicit volunteers for both clinical and nonclinical temporary assignments. If nurses pick up open clinical shifts, they are paid for that work; but if volunteers perform nonclinical tasks on a temporary and/or emergency basis, they generally do so without remuneration.

Switching gears Much of the volunteerism is aimed at offloading administrative tasks from nurses, so they can focus on clinical work. Till himself was a volunteer — he worked in vaccine clinics, helping to log people in, taking temperatures and running supplies. “In these times, it’s all hands on deck,” he said.

Mercy hospitals also asked salaried employees to sign up to stock supplies; transport patients; and assist patients with bathing, feeding, grooming and toileting.

“It’s no surprise with Mercy’s culture that hospital administrators are pushing wheelchairs, accountants are emptying trash cans and marketing professionals are serving meals,” said Steve Mackin in a release about associates pitching in to help their colleagues. On April 6, Mackin becomes president and chief executive of the system.

The executives said that the staff volunteerism during the health emergency has lessons for the post-pandemic era.

Mercy Health’s Keehn said, “We have always had a culture of ‘chipping in’ and working together. But, I think this has shifted our understanding of what is possible and just how much we can lean on each other when needed. While we sure hope we can remain in normal operations from here on out, we now know we can switch gears quickly and do whatever needs done for the community.”

Bradford of SSM Health’s Good Samaritan said: “We came together as a work family and are rising to the occasion. We’re all working together to ensure our patients are well taken care of. It’s brought us all closer together as a work family, and we have a lot to be proud of.”

Visit chausa.org/chworld for a Mercy video on labor sharing. jminda@chausa.org

8

CATHOLIC HEALTH WORLD April 2022

Farm programs keep growing at St. Joe’s hospitals in Michigan Gardens complement care by offering nutrition courses and therapeutic opportunities

By LISA EISENHAUER

Detroit Free Press/Kimberly P. Mitchell

T

Amina Alnaji, a volunteer, picks eggplant off the vine at the farm at St. Joseph Mercy Oakland Hospital in Pontiac, Michigan, last fall. Opened in spring 2021, the 1.3-acre farm is a satellite of the 12-year-old farm at St. Joseph Mercy Ann Arbor.

Dane Mazzaro, a volunteer, helps winterize a farm bed with compost at the farm at St. Joseph Mercy Oakland Hospital last October. The farm operation includes a food share program in partnership with local farmers that provides weekly boxes of fresh produce to subscribers.

gardening programs that complement patient care.

Heart of a wellness initiative The 1.3-acre farm is a satellite of one that opened in 2010 at St. Joseph Mercy Ann Arbor, the largest of Saint Joseph Mercy Health System’s five hospitals in Southeastern Michigan. The system, commonly known as St. Joe’s, is part of Trinity Health.

The original farm was established under Rob Casalou, who as then-president of the Ann Arbor hospital recognized how lifestyle is a major factor in health and wanted a means to demonstrate to the community the importance of good nutrition to good health.

Casalou is now president and chief executive of Trinity Health Michigan and Southeast regions.

The Farm at St. Joe’s won CHA’s Achievement Citation in 2013.

In an article about the farm that he wrote for the March-April 2019 issue of the CHA journal Health Progress, he says: “The Farm at St. Joe’s serves as the

purpose extends well beyond the crops they produce. “Our mission today is to grow a healthy community by empowering people through food, education and relationships,” she says.

She is modeling the programs at the Oakland farm on those at the older, well-established one in Ann Arbor. That operation donated more than 6,300 pounds of produce to 3,600 medical workers and 1,300 patients in 2020.

Support for family farms In its first year, the Oakland farm started a collaborative farm share program like the one at St. Joe’s Ann Arbor that supports small community farms. Participants get a box of fresh produce grown on local farms every week for 36 weeks during the growing season. The produce varies as crops ripen, with tomatoes, lettuce, carrots, beets and herbs among the typical contents.

Sweetman says the Ann Arbor farm share started with 30 subscribers and has grown to more than 1,100. The hospital’s farm

program subsidizes memberships for people who can’t pay the full price of $875 for a full season pass and $476 for a half season of 18 weeks. In 2020, it covered or assisted with memberships for just over 100 people.

Last summer, a woman getting federal food assistance stopped by as Sweetman and the farm manager were packing produce boxes. When they found out that the woman was food insecure, they immediately signed her up for the food share program.

“She got to go home with a box of fresh fruits and vegetables from local farms,” Sweetman says.

Those who get the food boxes aren’t the only beneficiaries of the collaborative programs.

Sweetman says the programs serve as financial anchors for small-scale agriculture, giving family farmers a foundation to build from and scale their operations to provide locally grown produce across their communities. In 2020 the Ann Arbor farm share generated $200,000 for local farms.

“It’s a really easy, high-reward way for farms to move food,” Sweetman says. “We are one of the largest consistent wholesale buyers in our community. People have started businesses because they know that they’ll be able to sell to the farm.”

Amanda Sweetman, director of farming and healthy lifestyles at Trinity Health Michigan, oversees the farms at St. Joseph Mercy Ann Arbor and St. Joseph Mercy Oakland Hospital. She says their mission is “to grow a healthy community by empowering people through food, education and relationships.”

Complement to patient care The farms have partnerships inside the hospitals as well. The hospitals’ electronic medical records have a referral path to the farms. So, for example, a doctor could direct patients newly diagnosed with diabetes to the farm for some fresh produce and a lesson on what foods they should consider including in their diet and how to prepare those foods.

At St. Joe’s Oakland, the hospital’s inpatient rehabilitation team huddled with the farm staff

Detroit Free Press/Kimberly P. Mitchell

heart of our wellness initiative, a place to grow a healthy community and catalyze positive changes to the ways we live, eat and restore ourselves.”

Amanda Sweetman, director of farming and healthy lifestyles at Trinity Health Michigan, oversees both hospital farms. She says their

Detroit Free Press/Kimberly P. Mitchell

he farm that opened in spring 2021 on the campus of St. Joseph Mercy Oakland Hospital in Pontiac, Michigan, is right outside the entrance for medical staff.

Shannon Striebich, the hospital’s president and senior vice president of operations for Trinity Health Michigan, says the farm’s gardens give workers a bit of serenity as they come and go. She hopes they also Striebich nourish the idea of nutrition and green space as aspects of health and healing.

“We’ve been pretty intentional about creating a space that’s beautiful, that anybody and everybody can come and be a part of, that people can volunteer in, that people can use to gain access to a better lifestyle through diet,” Striebich says.

The farm produces fruits and vegetables and gifts them to staff and patients. It has a flower garden and during set hours visitors can snip blossoms for bouquets.

Its operators work with other hospital staff on nutrition and

over the summer to discuss creating garden spaces where patients can perform tasks such as planting and pruning as part of their therapy.

The Ann Arbor farm already has a similar program for patients with traumatic brain injuries. That farm also has a wheelchair-accessible hoop house, or indoor growing space, where patients and clinicians can garden.

Sweetman hopes to soon partner with community groups to assemble and deliver “good food boxes” to patients who have chronic health conditions and are food insecure. The deliveries would come every other week and include a bag of locally grown produce and a box of pantry staples.

While each farm has a small paid staff who oversee the agricultural work and related programs, Sweetman says they welcome and rely on volunteers from within the

Liz Tylander, manager of the farm at St. Joseph Mercy Ann Arbor in Michigan, moves a crate of fresh produce for delivery to the hospital as part of a program that provides fresh produce to patients. In 2020, the farm donated more than 6,300 pounds of produce to 3,600 medical workers and 1,300 patients.

hospitals and their communities.

And while the farms have gotten seed money through grants from Trinity Health, they rely on community support for funding.

Mission alignment The St. Joe’s Oakland farm is in the footprint of a patient tower that was torn down several years ago. Striebich says the farm and gardens are part of a deliberate effort in recent years to create a rejuvenating environment in and around the hospital.

“We’ve largely rebuilt the campus and the notion of creating sacred spaces that people can heal in has been kind of a guiding principle,” she says.

Striebich says the farm and the programs it supports align with needs identified in community benefit assessments, such as food insecurity, and deliver on the mission of Trinity Health to be a transforming healing presence in the communities it serves.

“I believe in the idea of a traditional hospital becoming a partner in keeping people healthy and, frankly, out of the hospital,” she says. “It is different and energizing and unique and yet consistent with our mission and vision as a Catholic health care system.” leisenhauer@chausa.org