Catholic Health World - April 2023

PeaceHealth ‘fireproofs’ pain management to cut opioid abuse and dependence

By JULIE MINDA

With opioid overdoses and deaths rising precipitously in the Northwest, PeaceHealth six years ago recognized that the piecemeal efforts of individual clinicians to combat opioid misuse were not stemming the deadly tide. PeaceHealth committed to taking a comprehensive, standardized, systemwide approach to reduce opioid dependence and misuse and did so in no small part by limiting the prescriptions for narcotics written by PeaceHealth physicians.

Although pharmaceutical companies have never acknowledged wrongdoing,

Continued on 2

Widen CMS coverage of spiritual care? Yes, say ministry providers

By LISA EISENHAUER

A proposal that the Centers for Medicare and Medicaid Services cover spiritual care for select groups of patients insured by both Medicare and Medicaid gets a thumbs up from spiritual care leaders in the Catholic health ministry.

A call for CMS to widen its coverage of spiritual care as an optional service for patients insured in capitated managed care plans for dual eligible populations was put forward in January in Health Affairs in the opinion piece “Requiring Integrated Care Plans To Offer Spiritual Care To Dually Eligible Individuals.”

Currently, spiritual care is a covered service only for Medicare enrollees receiving hospice care and for

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Providence Alaska’s training opens doors for refugees

By LISA EISENHAUER

When Suliman Abdalla came to Alaska in 2013 from Lebanon, where he’d taken refuge from the strife in his homeland of Sudan in Northeast Africa, he was alone, didn’t speak English and had no means to support himself in America.

Abdalla had accepted an opportunity to restart his life in Alaska through Catholic Social Services. The organization oversees refugee resettlement across Alaska. It has helped hundreds of people fleeing war, persecution and other misery around the globe get their bearings in America’s northernmost state through its Refugee Assistance & Immigration Services program.

Abdalla got job training as part of the program at Providence Alaska Medical Center. The training led to a permanent position on the hospital’s environmental services staff. Except for two trips back to Sudan that each took him away from Alaska for a few months, Abdalla has stayed with the job ever since. For each trip he resigned and was later rehired. One of his trips to

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Leadership program readies new doctors to meet needs of rural Kentucky

By PATRICIA CORRIGAN

Lung cancer. Heart disease. Diabetes. All three, often complicated by obesity, are prevalent in rural northeastern Kentucky. St. Claire HealthCare in Morehead — a town of about 7,000 — draws patients from 13 counties in the region, 12 of which are said to be medically underserved. The hospital is the largest employer in the region, employing nearly 1,000 staff members and more than 100 medical providers.

Dr. Ashley Brown, a physician in the hospital’s emergency department, is one of them. She has been on staff since 2017. A native of Greenup, a town about an hour from Morehead, Brown is a graduate of the Rural Physician Leadership Program.

The program was founded in 2008 by St. Claire, the University of Kentucky College of Medicine and Morehead State University with the mission of educating doctors to practice medicine in small communities that need health care.

“The idea is that doctors who train in Kentucky will stay in Kentucky,” said Brown, who also serves as the program’s director of admissions and outreach. Medical students in the program complete their first two years at the University of Kentucky’s campus in Lexington and then acquire core clinical experience for one year at St. Claire HealthCare. The fourth year consists of elective clinical rotations in different departments in Morehead and the surrounding counties.

Jean Golden, a participant in the Trinity Health PACE program in Woodlyn, Pennsylvania, called Mercy LIFE Kinder Park, prays in the program’s chapel. Trinity Health and other Catholic health systems use their own funds to offer PACE clients spiritual care services.

From left, Wahidullah Khan, Samar Khan and Zahidullah Miskinyar, refugees from Afghanistan, got job training in laundry services at Providence Alaska Medical Center as they resettled in Anchorage. The training was through the medical center’s partnership with the Refugee Assistance & Immigration Services program run by Catholic Social Services. Many of the refugees who train at the hospital stay on as permanent staff.

Bodie Stevens, center rear, and Dr. Rebecca Todd, at right rear, meet with some of their students in the Rural Physician Leadership Program at St. Claire HealthCare in Morehead, Kentucky. Stevens is site administrator for the program and Todd is its assistant dean.

A volunteer in November 2018 prepares to dispose of needles collected at a homeless encampment in Everett, Washington. Washington is one of the three states where PeaceHealth is using a strategy it calls “fireproofing” to prevent opioid use disorder and guide individuals to treatment and recovery.

Ted S. Warren/Associated Press

Fireproofing against opioid dependence

From page 1

readily available prescription opioids and aggressive, unscrupulous marketing by drugmakers are widely believed to have set off the opioid crisis in the U.S. Some pain patients who became dependent on narcotics switched from pills to less expensive heroin and later to fentanyl, a cheap synthetic street drug that is linked to the catastrophic increase in opioid overdose deaths.

The thrust of PeaceHealth’s effort to reduce opioid use and abuse has been around finding alternatives to prescription opioids in pain management and reducing dosing and duration of opioids to avoid dependency. The system has been providing clinicians with deeper training on evolving federal prescribing guidance and on how to approach conversations with patients who suffer debilitating pain, including chronic pain patients who must be safely tapered off opioids.

PeaceHealth calls the work “fireproofing” because of the focus on addiction prevention, but the initiative also increases the clinical staff’s ability to recognize a patient with opioid use disorder and guide him or her to supportive treatment. At many of its outpatient care sites, PeaceHealth offers medication-assisted therapy to quell opioid cravings.

Mindset change

Dr. Heidi Radlinski is a family and addiction medicine physician at the PeaceHealth Family Medicine Southwest clinic in Vancouver, Washington. She says fireproofing also involves integrating addiction medicine across the continuum of medical care so that no matter where patients impacted by substance abuse enter the PeaceHealth system, there will be resources for them to get help, either within PeaceHealth or through its community partners.

Radlinski anticipates that some of those community partners will be among the many beneficiaries of the $26 billion four drug companies are to disperse to states and communities as part of a settlement of numerous lawsuits claiming drug manufacturers knowingly fueled the opioid crisis.

Around 2016 PeaceHealth convened a multidisciplinary team that included inpatient and outpatient prescribers throughout the system. Dr. Robin Virgin, chief medical officer of PeaceHealth Medical Group in its Oregon Network, says the multidisciplinary team acknowledged that clinicians in general had played a part in the proliferation of opioids and they agreed that much could and should be done to shift the way prescribers approached pain control.

That same year, the Centers for Disease Control and Prevention had issued guidelines for primary care physicians prescribing opioids in outpatient settings.

The CDC says its aim in 2016 was to make sure that clinicians and patients weighed benefits and harms and considered safer, more effective alternatives to opioids in the management of chronic, acute and subacute pain. In updated guidance issued last year, the agency describes pain as a clinically complex condition with physical, psychological and social consequences. Pain also is one of the most common reasons adults seek medical care in the United States.

The guidance, which is not intended to be an inflexible standard of care, underscores that proven treatments including non-pharmacological therapies can improve patient outcomes and reduce the risk of opioid dependency.

With the update, the agency expanded its audience to take in oral health provid-

Opioid

RATE PER 100,000 PERSONS

Washington Oregon Alaska*

Vancouver-based nonprofit Lifeline Connections. That drug treatment and recovery services agency operates in several regions in Washington state. Lifeline has a substance use peer support specialist at Southwest Medical.

Patients usually are referred to peer support by the provider taking care of them or identified as at risk according to their admitting diagnosis. The Lifeline specialist meets with patients who agree to see them, screens those patients for drug use risk and socioeconomic needs, talks with them about their goals and barriers, and then provides a warm handoff to needed services.

*Data available only through 2020

ers, clinicians managing postsurgical pain in outpatient settings and emergency room physicians writing prescriptions at patient discharge.

Virgin says that when many of the doctors practicing today were in medical school, they were trained to use different dosing for narcotics than is called for now.

She says participants in PeaceHealth’s 2016 summit recognized that the dramatic changes that clinicians would need to make in their approach to pain management would require educating providers as well as the patient community.

Virgin and Radlinski say the system is offering education and resources to both its own prescribers and to patients explaining why opioid prescriptions have been curtailed and offering pain management alternatives.

Provider education

The system’s addiction medicine specialists guide the system’s ongoing work to eliminate problematic opioid prescribing in line with evolving guidelines and recommendations from the Oregon Health Authority, the Washington State Department of Health, the Alaska Department of Health and the CDC.

The addiction medicine specialists educate and train frontline prescribers and other clinicians across the continuum of care in the PeaceHealth inpatient and outpatient sites. Radlinski and Virgin say the provider education explains the landscape and guidelines currently in place, which includes decreasing the number of prescriptions, pills taken and length of time taken as compared to past prescribing patterns. They say the goal is to avoid starting opioids if possible. For established patients, the goal is to reassess, minimize, taper or stop opioid treatment.

Radlinski heads a Vancouver-area program that trains providers throughout that region on protocols for prescribing opiates, screening for drug abuse, the administration of medication-assisted therapy in opioid recovery, the availability of alternate pain relief treatments and the incorporation of trauma-informed practices with patients.

She says anywhere patients enter the PeaceHealth system they’ll encounter providers and other staff with at least a basic understanding of how to get addicted people timely and compassionate help.

Colleague collaboration

PeaceHealth addiction medicine specialists also have spurred the creation of databases that make it easy to identify through the medical record patients being prescribed opiates. Designated clinicians in each PeaceHealth location review the registry to determine that patients are receiving the appropriate dosing. They meet with prescribers who are outliers among their peers in terms of the prescribing guidance. Radlinski and Virgin say the first step is to show the data and simply ask, “Do you know you are an outlier? Why do you think

you are an outlier?” They say this open, conversational approach can lead to the clinicians changing their prescribing pattern.

PeaceHealth also has ensured that providers across its facilities are educated about the use of the opioid overdose reversal medication Narcan so they can teach patients.

The whole system is set up to quickly identify people in inpatient and outpatient care who are experiencing or at risk of addiction, assess them, provide or refer them to treatments or services and set them on a path to better outcomes and/or recovery from substance dependence, either at PeaceHealth or at partner organizations.

Medication-assisted therapy

PeaceHealth also has strengthened its partnerships in all its regions with nonprofits and other organizations that can help address the many needs with which patients with opioid use disorder may struggle. These include access to drug treatment, mental health care, stable housing, transportation and food aid.

One such partnership is between PeaceHealth’s Southwest Medical Center and the

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Collins

Kaylee Collins, Lifeline program director of medication-assisted recovery, says the changes PeaceHealth has been making as part of its fireproofing have resulted in widespread improvement in how PeaceHealth clinicians treat people with opiate use disorder. She says patients are being cared for in a more comprehensive way that gets at the source of the challenges they are facing. When patients are treated as human beings, deserving of compassion, they are more likely to get the care they need, she says.

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Radlinski Virgin

death rates in Washington, Oregon and Alaska Statewide statistics in the three Northwest states where PeaceHealth is located show a recent spike in fatal opioid overdoses.

Sources: University of Washington Addictions, Drug & Alcohol Institute; Oregon Health Authority Opioid Overdose and Misuse Public Health Division; Alaska Department of Health

Rural physician leaders

From page 1

A strategic value

Is the program working? Bodie Stevens, site administrator at Morehead, reports that it is.

The program has tripled in size since it started, and receives about four times as many applications each year as can be accepted. After graduation next month, a total of about 110 students will have completed the program, with all of them trained at St. Claire. After residency training, about half the program’s graduates have chosen to practice medicine in rural Kentucky.

“The program is a strategic value on several levels,” said Dr. William Melahn, senior vice president of quality and clinical affairs at the hospital. “In the short term, it helps us attract physicians of the caliber that they are able to become faculty at a medical school and teach. In the long term, we demonstrate that top high school and college students who live in eastern Kentucky can have the opportunity to have a highly competitive medical school to apply to in eastern Kentucky. We are teaching them that highquality medicine happens here.”

Connecting to community

While at St. Claire, the medical students routinely become involved with the community, said Dr. Rebecca Todd, associate dean of the program. They work at a free clinic one day a week, they partner with the library to promote public health literacy and they present educational programs for addiction recovery organizations and at a domestic violence shelter.

“In their fourth year, students partner

‘Amazing’ event gets city moving

A crowd of 1,112 runners, walkers and wheelchair users took to the streets of downtown Baton Rouge, Louisiana, for Our Lady of the Lake Children’s Health Eighth Annual Amazing Half Marathon, 5K and One-Mile Family Fun Run on March 4. The focus of the event is on encouraging children and families to develop a lifetime of healthy habits. Our Lady of the Lake is part of the Franciscan Missionaries of Our Lady Health System. Clockwise from left: Destin Ware is cheered across the finish line by Danny Hyunh, a volunteer with Ainsley’s Angels of America, an organization dedicated to inclusivity in endurance events. Adrian Brumfield, health educator at Our Lady of the Lake Children’s Health, leads a warmup for young racers along with Dash, a big blue gator who is the event’s mascot. A throng of participants charges across the starting line as the event begins.

with local nonhospital-based organizations to do community needs assessments and then present their findings to the other medical students,” said Todd, who has been with the program since the first graduating class in 2012. Others have developed online resources such as a blog on health care topics and a Twitter account that offered healthy recipes. Todd added, “Some speak to high school students throughout the region on depression, suicide prevention and the dangers of vaping.”

Brown, the emergency department doctor, is one of the medical professionals at St. Claire who volunteer to work with the students in the Rural Physician Leadership Program. While she was a student in the program, Brown particularly had appreciated the opportunities for one-onone, hands-on experience under a doctor’s supervision, a benefit of the small class size. Brown now makes that expe-

rience possible for leadership program students.

While in the program, Brown also determined that emergency medicine suited her better than surgery, which she had considered.

“My job is a perfect fit, and really fun,” Brown said. “I get to talk to people of all ages, help them with minor and major injuries, even sometimes help them in grieving — and because this is rural medicine, I realize I may be the only doctor they see.” That’s just one difference between practicing medicine in a rural area versus an urban area.

Todd pointed out another. “Often, it all comes down to distances,” she said. “When you run out of supplies in an urban hospital, you can get what you need from another facility. If you run out of something in a rural area, you may have to send a police car to pick it up an hour’s drive or more away, so you have to practice with

the mindset of conserving resources, using everything in an efficient and frugal fashion.”

‘I feel like I’m home’

Another difference is that doctors, medical students and program staff often encounter patients at local stores, festivals or just out for a walk. That appeals to Sheyanne Trent, 25, a thirdyear medical student from Breathitt County. “I love the family environment here,” she said. “When I first came to Morehead, I fell in love with the campus, with the program and with its mission. I feel like I’m home.”

Trent arrived in Morehead with an abiding interest in women’s health, and she’s sticking with her goal to become an obstetrician/gynecologist. She recalled how satisfying it was one day in training to help a young single mom having a planned cesarean section delivery. While another medical student assisted the physician, Trent sat with the woman, talking and holding a cold cloth on her head when she struggled with nausea.

“I got to know more about her, and I found her so inspiring,” Trent said. “Also, when the older ladies came in for their breast exams or other cancer screenings, by the time they left, I knew all about them, and we were friends. That human connection is so important.”

After her graduation in 2024, Trent will seek out a medical residency in her chosen field, she said. After that, she intends to practice medicine in rural Kentucky, maybe even in her home county. She said, “I’m so grateful for all the people who have been involved in my becoming a doctor, and I want to come back and help take care of them, bring accessible care to them.”

Dr. Ashley Brown, right, demonstrates a respiratory procedure on a medical manikin for a group of students in the Rural Physician Leadership Program at St. Claire HealthCare in Morehead, Kentucky. Brown is an alumni of the program, which was developed to give young doctors a taste for practicing medicine in rural areas of northeastern Kentucky.

Trent

Spiritual care

From page 1

patients at Department of Veterans Affairs facilities. CMS established three specific health care billing codes in 2020 so the VA could monitor and evaluate the spiritual care services it provides.

In the Health Affairs commentary, coauthors Dennis Heaphy and Sasha Shenk argue that spiritual care services “are an oft neglected but important part of comprehensive care.” The patient advocates maintain that providing spiritual care to dual eligible clients would promote health, wellbeing and health justice for people with complex care needs.

“Spirituality at its core is about meaningmaking amidst physical, psychological, and social challenges such as poverty and discrimination,” the article says. “Evolving models of integrated care for dual eligibles, if they are to be person-centered and advance health equity, must, in the words of (psychiatrist and author) Viktor Frankl, address the ‘unheard cry for meaning’ among low-income people with disabilities and elders.”

Heaphy and Shenk say spiritual care could be “seamlessly integrated” into capitated managed-care plans such as the Program of All-Inclusive Care for the Elderly, known as PACE. The Kaiser Family Foundation estimates the number of dual eligible clients in Medicaid managed care plans at 3.4 million.

Ministry-funded care

Teresa Galvin Anderson is mission leader for Trinity Health PACE and Trinity Health At Home. Anderson says she is in “absolute agreement” with Heaphy and Shenk that CMS should be reimbursing providers for spiritual care provided to PACE clients. Trinity Health already offers spiritual care to the about 3,200 clients in

Chaplain’s care guided grieving widower to ‘a deep peace’

Teresa Galvin Anderson recalls how, over the course of 10 years, a chaplain helped a participant in one of Trinity Health’s PACE programs cope with grief, estrangement from children and his complex medical condition to find what she calls “a deep peace” before the end of his life.

Anderson, mission leader for Trinity Health PACE and Trinity Health At Home, shared the details of the man’s final decade to illustrate the impact spiritual care can have on quality of life and health outcomes for the frail elderly. She did not name the man or the chaplain out of concerns about federal health care privacy laws.

Anderson

The chaplain worked with the man and his medical providers on interventions to address the unresolved grief he’d experienced since the death of his wife and the stress of his complex medical needs. The services the chaplain provided included grief counseling and support, assistance enrolling in a smoking cessation program and aid in crafting an exercise regimen the client could do in his wheelchair that helped restore some of his vigor.

children. The man was at the bedside when the son took his final breaths. The daughter was again part of her father’s life when it ended. She even got grief support from the same chaplain who had cared for him.

“I think the care helped him die at peace and it helped her carry forth her grief afterwards to resolve that in a healthy way because it was complicated,” Anderson says.

The African American widower was in assisted living when he joined Trinity Health PACE, at about age 70. A military veteran, he had supported himself and his three children as a short-order cook after the death of his wife when he was about 38. He had once been athletic and a coach but was using a wheelchair and largely immobile when he enrolled in PACE.

The man had taken an “authoritarian approach” to parenting that, Anderson says, caused a rift with a daughter that had persisted into her adulthood. He also had become distant from a son who had contracted HIV/AIDS at a young age.

The chaplain helped the man become a regular at a Baptist church, where he restored a faith connection that he had let lapse amid his grief and anger.

Anderson says the chaplain provided encouragement and arranged supportive services such as transportation that led to the man reconnecting with his estranged

the 12 PACE programs it owns or manages at 21 centers across nine states.

Those programs all have chaplains, most of whom are full-time employees. Their services include conducting spiritual assessments, working with clinicians to develop interventions to improve clients’ health outcomes, assessing goals of care, and assisting in advance care planning and in identifying surrogate decision makers.

Anderson says the chaplains are unofficial members of the interdisciplinary PACE care teams of clinicians, therapists, aides

Trinity Health provides spiritual care to its PACE participants without outside reimbursement because the system recognizes that the care can have a major impact on their well-being, Anderson says. She supports a call for the Centers for Medicare and Medicaid Services to expand its very limited coverage of spiritual care so that more participants in PACE or other integrated care programs have the option for the services.

“If we can work out the right reimbursement, then programs can hire chaplains to do this important work in these integrated health settings,” she says.

— LISA EISENHAUER

and social workers. Right now, chaplains’ services come courtesy of Trinity Health as part of its Catholic mission.

If CMS integrated direct payment of chaplaincy care into federal health coverage for dual eligibles, Anderson says researchers could mine the related data to assess impacts on health outcomes.

“The chaplain often has the unique skills in communication and listening and assessing the values and the hopes and fears of each stakeholder,” she points out, adding that stakeholders in PACE programs

Authors’ call for spiritual care coverage springs from personal experience

By LISA EISENHAUER

Dennis Heaphy finds it egregious that, even with evidence linking spiritual wellness to overall well-being, there is very limited support for designating spiritual care as a health care service.

“We know that spiritual wellness is key to self-perception of one’s health outcomes and yet we don’t address it in the health care system,” says Heaphy, a health justice advocate and researcher at the Disability Policy Consortium, a Massachusetts-based disability rights advocacy organization.

Heaphy is the co-author with Sasha Shenk of an opinion piece published online Jan. 31 by Health Affairs that urges an expansion of the Centers for Medicare and Medicaid Services’ direct reimbursement for spiritual care provided to patients insured in capitated managed care plans for people eligible for Medicare and Medicaid. Shenk is a senior research technician at the Jonathan Garlick Lab and Center for Integrated Tissue Engineering at Tufts University.

The article is part of the Health Affairs Forefront series intended to “inform policies on the state and federal levels to advance integrated care for those dually eligible for Medicare and Medicaid.”

In their piece, Heaphy and Shenk maintain that CMS could require providers in Fully Integrated Dual Eligible Special Needs Plans, known as FIDE SNPs, and Programs of All-Inclusive Care for the Elderly “to provide enrollees with spiritual assessments and spiritual care as optional services.”

Even though adding spiritual care to the blanket of services the programs provide wouldn’t necessarily increase the amount of public funding they get, the authors say such a step by CMS would confirm the value of spiritual care and, through the related

codes, create valuable data for research purposes.

Personal, professional insight

Heaphy is a person with a disability and is enrolled in the Massachusetts One Care plan. The integrated care program for people ages 21-64 with disabilities will be transitioning into a FIDE SNP. He is a member of the Medicaid and CHIP Payment and Access Commission. As chairman of the Massachusetts Implementation Council set up to ensure that One Care met enrollees’ needs, Heaphy testified last year before the U.S. Senate Special Committee on Aging about the value of integrated care.

While the authors extoll the benefits of spiritual care as a component of primary care, in a recent interview, Heaphy says he first saw the value of spiritual care during a hospital stay. The chaplains who came to his bedside, he says, addressed a need for understanding and meaning that would have otherwise gone unmet.

“When I sustained a spinal cord injury in 1985, chaplains were vital to my journey toward wholeness,” Heaphy says. He later became a chaplain certified through the Association of Professional Chaplains and worked in spiritual care in a number of settings. Heaphy, who is Catholic, has a master of divinity and a doctorate of ministry in

transformational leadership from Boston University and master’s degrees in public health and education.

Shenk says her appreciation for the importance of spiritual care stems in part from her work in a research lab focused on scleroderma, a group of rare autoimmune diseases that can cause hardening of skin and connective tissue. Systemic scleroderma can cause problems in the blood vessels, internal organs and digestive tract. Because there is so far limited treatment for the disease, Shenk says she has seen scleroderma patients struggling to cope and relying on support groups for hope.

“It goes to show that people are creating this in their own way, because it’s not offered as a service, to even just connect with other human beings to really talk about what they’re going through,” she says.

Justice and racial dimensions

In their commentary, Heaphy and Shenk call out access to spiritual care as a health justice issue. They maintain that the care is especially important to people with disabilities, who experience disproportionate levels of isolation and loneliness compared to the general population and make up an estimated one-third of the dual eligible population.

Heaphy says faith traditions have too often linked lack of faith and sin with dis-

ability and notes there are examples of this in Judeo-Christian Scripture. He says faith communities can also convey this message in their preaching or in how they engage with persons with disabilities. Spiritual care from trained chaplains, he says, may provide an opportunity to bring healing to those who have had negative experiences with organized religion or have internalized a feeling of sinfulness.

The authors also assert that spiritual care can be of particular importance to African Americans and other minority populations.

Heaphy, who is white, explains that the literature on spiritual care shows that for many African Americans, their spiritual, religious or faith community can serve as a source of resiliency in the midst of systemic racism. He describes how systemic racism is evident in the level of health disparities and inequities experienced by African Americans and how integration of spiritual care may be a means of countering inequities.

Heaphy says insurance coverage of spiritual care is a touchy subject for many reasons, starting with the health care system’s discomfort with spirituality and all things that cannot be empirically measured. There are also concerns and confusion among some about spiritual care being government support for religion, he says. Another issue is whether adding another benefit would drive medical costs even higher.

“Health care advocates have an obligation to challenge the current barriers to spiritual care to ensure people have access to person-centered care that values people as mind, body and spirit,” Heaphy says. “It is imperative that this need be met among persons with disabilities who already face systems that deny their personhood.”

leisenhauer@chausa.org

Heaphy Shenk

“When I sustained a spinal cord injury in 1985, chaplains were vital to my journey toward wholeness.”

— Dennis Heaphy

“The chaplain often has the unique skills in communication and listening and assessing the values and the hopes and fears of each stakeholder.”

— Teresa Galvin Anderson

include participants, their families and members of their care teams.

Life-enhancing support

Trinity Health chaplains are from various faith traditions. If they haven’t gone through formal clinical pastoral education on Catholic teachings and the Ethical and Religious Directives for Catholic Health Care Services, Anderson says the health system gives them orientation, mentoring and other help to ensure they are aware of Catholic spiritual and social traditions.

In their roles as spiritual caregivers, she says, Trinity Health chaplains don’t proselytize but rather follow standards set by professional chaplaincy groups to give compassionate, respectful and appropriate care. “The goal is to provide the spiritual assessment interventions that are relevant and of support to meet people where they are, not to in any way push them towards us,” Anderson says.

The 826 participants in Ascension Living’s three PACE programs also have access to spiritual care services. The programs employ chaplains even though the services they provide are not billable, says Bob Smoot, chief mission integration officer, because Ascension Living considers spiritual care to be “an important service that enhances the lives of our PACE participants.”

“We believe spiritually centered holistic care helps sustain and improve the health of individuals and communities,” Smoot notes.

He adds that Ascension Living would back a CMS initiative to make spiritual care a covered service in PACE.

Search for meaning

CHA offers resources focused on the essential services for spiritual care at chausa.org/essentials. Those tools don’t encourage religious rites or practices specific to Catholicism but rather call on spiritual care providers to “adequately provide for the spiritual needs of our patients, families and caregivers.”

Tim Serban is a member of the CHA continuing care subcommittee that created resources on essential services for spiritual care in acute care and continuing care settings. As system executive director of spiritual health for home and community care at Providence St. Joseph Health, Serban supports more than 100 chaplains who offer spiritual care to people in PACE or under palliative, skilled nursing or hospice care in home and community settings.

Providence chaplains are required to have a graduate degree or equivalent in Catholic theology or their faith tradition. They must have 1,600 hours of clinical experience or have completed a yearlong clinical chaplaincy residency, be board certified by a chaplaincy organization and take part in continuing education.

Serban says chaplains are professionals trained in meeting a person’s religious and spiritual needs, an important distinction. He refers to religious care as a formal way of practicing one’s faith, whereas spiritual care is the search for meaning that may or may not involve religion.

Chaplains in health care settings, he says, have a special role in that they are offering spiritual care to people who are often in circumstances not of their choosing and in a vulnerable state.

“Chaplains are there to create a safe space to protect that vulnerability and to dive into how do people find meaning in the midst of this circumstance or situation,” Serban says. “This is meeting a need of where people are as opposed to trying to impose something on them.”

He considers the work of chaplains to be an enhancement and complement to the medical and mental health care provided by others on a patient’s care team. Spiritual

care, Serban says, has been vital during the COVID-19 pandemic when people have been overwhelmed by sickness, death, isolation and grief.

“Those are key areas where chaplains walk with people in the midst of their journey and do that in a professional way,” he says.

Affirming an ongoing effort

While researchers assess the impact of the limited coverage of spiritual care that CMS has so far approved for reimbursement, Serban points out that studies already have found connections between spiritual care and improved health outcomes.

The piece in Health Affairs links to many

such studies and analyses. One is a comprehensive literature review that found support for spirituality “as a coping method among individuals experiencing a variety of illnesses including hypertension, pulmonary disease, diabetes, chronic renal failure, surgery, rheumatoid arthritis, multiple sclerosis, HIV/AIDS, polio and addictive illnesses.”

Serban says he felt proud on behalf of all chaplains when he read that a poll done by Gallup last year found one in four Americans have been served by chaplains. Most of those who had interacted with chaplains reported that they found the experience valuable.

In Serban’s view, the expansion of spiritual care coverage that the Health Affairs piece urges aligns with policies he and others across Catholic health care have long championed. He says the expansion would be a move toward CMS acknowledging the link between spiritual health and overall well-being.

“I think that it’s a great opportunity to affirm what we are already doing,” he says.

Serban and Anderson both say that for health systems like theirs that already offer spiritual care, the biggest challenge to establishing it as a covered service might be logistical. For example, appropriate codes would need to be incorporated into electronic medical records systems.

Anderson says she is unsure of all the steps that might be necessary to get to where spiritual care is a reimbursable service, “but I think it needs to be taken seriously.”

leisenhauer@chausa.org

KEEPING UP

PRESIDENT

Shane Knisley to president of Bon Secours Maryview Medical Center in Portsmouth, Virginia, from president of Mercy Health — Clermont Hospital in Cincinnati. Maryview Medical and Clermont are part of Bon Secours Mercy Health.

ADMINISTRATIVE CHANGES

Ascension Saint Thomas in Nashville, Tennessee, has made these changes: Robyn Morrissey to chief strategy officer and Ruth Portacci to vice president of joint ventures and chief integration officer.

Diane Lobdell to vice president of patient care services and chief nursing officer at Buffalo, New York’s Sisters of Charity Hospital, Main Street and St. Joseph campuses. Sisters Hospital is part of Catholic Health of Buffalo.

Ashley Thurow to vice president of finance for St. Mary’s Medical Center in Grand Junction, Colorado. St. Mary’s is part of Intermountain Health.

Smoot

Serban

Morrissey Thurow

Portacci Lobdell

“Chaplains are there to create a safe space to protect that vulnerability and to dive into how do people find meaning in the midst of this circumstance or situation. This is meeting a need of where people are as opposed to trying to impose something on them.”

— Tim Serban

Pellegrino center newsletter applies teachings of its namesake to ethical issues

By LISA EISENHAUER

When the Edmund D. Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center in Washington started its ethics newsletter in July 2020, the nation was in the thick of the COVID-19 pandemic and roiled by racial unrest over the police killing of George Floyd.

Dr. Allen H. Roberts II, editor-in-chief of the newsletter called The Pellegrino Report: Bioethics in Practice, said the launch at a time when health care equity and racial justice were at the top of the national conversation was coincidental. The newsletter had been in the conceptual stages for months.

Nevertheless, the newsletter jumped right into the conversation, with a first report titled “Pandemic and Pandemonium: Navigating Multiple Levels of Upheaval.” The piece was by Dr. Myles Sheehan, a Jesuit priest. He holds the David Lauler chair of Catholic health care ethics and is a professor of medicine at Georgetown University School of Medicine. Fr. Sheehan directs the Pellegrino Center.

In the article, Fr. Sheehan exhorted practitioners to show the same compassion and regard to people imperiled by structural racism as they have for those stricken with COVID.

“Lives were saved, and those who died from this illness were treated with respect and reverence for their dignity and value as human beings,” Fr. Sheehan wrote. “Our response to the events that have followed the murder of George Floyd, and others, needs to be as focused on the value and dignity of those whose lives are most threatened by systemic racism, structural vio-

Refugee assistance

From page 1

his homeland was to marry a woman who he hopes will someday be able to join him in Anchorage, now that he has stability and legal residency.

Abdalla says his prospects were forever changed for the better by Catholic Social Services and its partnership with Providence Alaska Medical Center, part of Providence Alaska. “New country, everything new, but that’s long ago and we know how to do things right now and we are good,” says Abdalla.

Model partnership

In the fiscal year that ended in October 2021, the Refugee Assistance & Immigration Services program aided 460 refugees. The refugees get a warm reception upon arrival in Alaska: case management, and assistance with housing, education and employment services, applying for citizenship and family reunification. They can stay in the program for up to five years.

Brigit Reynolds, the program’s refugee education and employment manager, says that while the number of enrollees goes up and down, it is currently on the upswing with 194 people newly enrolled from October 2022 through January. Many of the newest arrivals that Catholic Social Services is helping are fleeing the war in Ukraine or the Taliban takeover of Afghanistan.

Providence has been a partner in the Refugee Assistance & Immigration Services program for more than 12 years. The collaboration was suspended briefly early in the pandemic. The partnership has given dozens of refugees an opportunity for entrylevel job training and led to long-term

lence and inequality.”

Protecting the vulnerable

In the 2½ years since its founding, the monthly newsletter has continued to provide reflections and guidance on ethical issues from a Catholic perspective. The newsletter was specifically developed as a resource for practitioners at MedStar Georgetown University Hospital, Georgetown’s academic health system partner.

The hospital’s clinical ethics committee collaborated in the newsletter’s creation.

About 1,400 medical staff members and more than 500 resident physicians get each edition by email and a link to it is shared in weekly communications from hospital leadership. The newsletter also is available online for anyone with an interest in Catholic health care ethics to read.

Roberts noted that while other groups and health care facilities have created newsletters that delve into ethics — among them is Health Care Ethics USA, a quarterly produced by CHA in partnership with Saint Louis University — The Pellegrino Report is unique in that it specifically applies the teachings of the Pellegrino center’s founder and namesake to practical matters.

Pellegrino was a physician, philosopher and ethicist. Considered to be one of the founders of modern bioethics, he published more than 600 articles and wrote or co-wrote more than 23 books on medical science, philosophy and ethics. He was the founding editor of the Journal of Medicine and Philosophy. He died in 2013.

In Roberts’ view, Pellegrino took a logical and scientific approach to framing medical ethics. “He has set the medical principles in the light of Catholic thinking and all of his writing is for the protection and the safety of individual patients,” Roberts said. “More importantly, or as importantly perhaps,

is protecting the vulnerable among us to ensure the sacredness of every human life.”

In short, Roberts said, Pellegrino believed that ethical medical care should be focused on providing “the right and good healing action and decision for every patient in every clinical encounter.”

Religious directives explained

In addition to emphasizing the teachings of Pellegrino, Roberts said the newsletter’s content aligns with and illuminates the Ethical and Religious Directives for Catholic Health Care Services established by the United States Conference of Catholic Bishops. Roberts called the directives “beautiful, practical testimony” to the Catholic faith.

Valuable experience

The experience is valuable even for the trainees who move on afterward, Reynolds says. Going through the onboarding process at a large employer prepares them for what to expect elsewhere and having the Providence name on a resume can open other doors.

Laarni Competente Power is community partnerships coordinator for Providence Alaska, which is part of Providence St. Joseph Health. She says Providence Alaska Medical Center places its trainees in environmental services, laundry or food and nutrition services. The workers can jump right into positions in those departments because the duties are easy to learn, the jobs don’t require certifications and the departments usually are in need of staff.

Power says the training typically lasts three to six months. Catholic Social Services staffers accompany the trainees during their orientation and on their first day on the job. The nonprofit also provides interpreters as needed.

The number of refugees in training at the medical center varies. In late February, the hospital had one trainee with two others about to start. Three former trainees transitioned to permanent jobs in the second half of last year.

Fr. Sheehan has written several pieces for the newsletter that explain or reflect on the directives. For the January 2023 edition, he focused on the section about social responsibility. He wrote that the section encourages Catholic health care providers “to reflect on the fact that we work in a system where there are health care disparities, where a person’s ZIP code may tell you if they will live a longer or shorter life, and where the legacy of racism and discrimination can still spread its poison, even if we do not notice it.”

Along with Roberts and Fr. Sheehan, Marti Patchell, administrative consultant to the Pellegrino center, and Maria Maisto, academic and program specialist at the center, round out the newsletter’s editorial board. They meet twice a month to discuss topics for the publication. Roberts extends invitations for article submissions to people at the center, the university and the hospital based on those topics.

Recent newsletter topics have included the connection between ethics and hope, the dilemmas created by the absence of a medical surrogate and caring for premature infants.

Inspiring the next generation

Roberts’ medical career has included 20 years in the U.S. Navy Medical Corps and serving as White House physician under President George H.W. Bush before becoming a professor at Georgetown University Medical Center and a physician executive at MedStar Georgetown University Hospital. He says he never expected his resume to include “editor-in-chief,” but is pleased to be a part of a worthy endeavor. “We want to keep Pellegrino and his work alive in the imaginations of the next generation,” he said.

leisenhauer@chausa.org

and don’t know anybody,” she says.

Resettlement for some of the refugees from warmer climes is probably a bit more challenging in Alaska than it might be in the lower 48 states, Power acknowledges. One recent trainee left the state for a more temperate one. Long, dark, frigid and snowy winters can be too taxing for some people, she says.

Crystal “Nikki” Brayboy, manager of the environmental services department at Providence Alaska Medical Center, has watched refugees thrive after being trained in her department. Many of the workers have stayed on long term and others have shifted to other areas of the hospital, including supply chain and sterile processing.

Some refugees who started as housekeepers or janitors have learned the skills or earned the certifications needed to move into positions such as nursing assistant and patient care technician. “We’ve had people come in and flourish and we share the wealth with Providence,” Brayboy says.

Two-way learning

employment for many of them.

Reynolds says that while Catholic Social Services has several employer partners throughout Alaska, the partnership with Providence Alaska Medical Center is a model one. The hospital pays the workers at the same scale it does other entry-level employees, something not all the employers do. It also hires many of the workers and offers them continued training and advancement opportunities.

“It just provides a really good opportunity for growth and for a good paying job right out of the gate,” Reynolds notes. “That is not always super common and available.”

Power says the refugees take jobs that have grown increasingly challenging to fill. The hospital’s human resources department counts on them and managers want to see them succeed, she says.

Sharing the wealth

Providence’s participation in the refugee assistance program delivers on its commitment to serve the poor and vulnerable, Power says. “I can’t think of anything greater than helping someone who has been displaced from their home through no choice of their own and had to relocate to a community that’s completely foreign to them in which they have language barriers

In addition to being grateful for their jobs, the refugees on her staff are eager to bond with their co-workers and overcome cultural barriers in their new lives, Brayboy says. The co-workers generally reciprocate, she says, helping the refugees with language skills and inviting the newcomers into their homes and on outings.

“I kind of have to give a lot of credit to my caregivers,” she says. “They’re the ones who help me a lot with bridging the gaps.”

In addition to Ukraine and Afghanistan, Brayboy’s trainees’ countries of origin have included Sudan, Iraq, Somalia and Bhutan. She calls her staff “a big melting pot.” They foster in each other an appreciation for the diversity of cultures, traditions and challenges around the world. “To me it’s all a big learning and compassion-filled adventure,” Brayboy says.

leisenhauer@chausa.org

Roberts

Suliman Abdalla, who fled from strife in his native Sudan, got job training and then a full-time position at Providence Alaska Medical Center in Anchorage.

This portrait of Edmund D. Pellegrino, a founder of modern bioethics, hangs at Georgetown University Medical Center. He is the inspiration behind the Edmund D. Pellegrino Center for Clinical Bioethics and its ethics newsletter.

Reynolds

PeaceHealth marks centennial in Ketchikan, Alaska

Feb. 22 was the 100th anniversary of the official start of the Sisters of St. Joseph of Peace health care ministry in Ketchikan, Alaska. On that date in 1923, Bishop Joseph Crimont, the vicar apostolic for Alaska, dedicated the Little Flower Hospital to the island community, and that hospital served as the foundation for the sisters’ ministry that since has expanded significantly in Ketchikan.

PeaceHealth will be commemorating the centennial with a historical display at PeaceHealth Ketchikan Medical Center this spring, an April event at a local museum, and a community barbecue in August. The health system produced a documentary on its 100 years of serving the Revillagigedo Island community. The borough has a population of nearly 14,000.

Three Sisters of St. Joseph of Peace were dispatched to Ketchikan to staff Little Flower Hospital. The sisters sold $10 tickets to loggers that entitled the purchaser to health care services for a year.

By the 1960s, Little Flower Hospital had become outmoded. Sr. Andrea Nenzel, CSJP, a director of the PeaceHealth board and the congregational leader of the Sisters of St. Joseph of Peace, explains in the documentary that the sisters and the city of Ketchikan entered into an agreement that had the city building and owning a new hospital and the sisters running it.

Tim Walker, supply chain manager at PeaceHealth Ketchikan, says in the video that the city “understood the value of hav-

ing the sisters here, so they created a unique facility among all the PeaceHealth facilities — where we’re owned by and belong to the community.”

In the 1970s, the hospitals that the Sisters of St. Joseph of Peace had founded across the western U.S. — the Ketchikan hospital included — incorporated under a system structure. In 1994 that organization was named PeaceHealth.

Since 2011 the Ketchikan facility has been called PeaceHealth Ketchikan Medical Center. Today the hospital is a 25-bed critical access facility with 29 long-term

care beds. The hospital has an average daily inpatient census of 10 patients. The hospital employs 468 people and has a medical staff of 54. Among the services the facility offers are emergency medicine, general surgery, orthopedic surgery, obstetrics, laboratory services and home health care.

Multiple commentators in the documentary note that PeaceHealth Ketchikan is much better staffed and equipped than most hospitals that are in small, remote communities. They attribute this to several factors. For one, given the island’s long history of dangerous industries — including mining, timber harvesting and commercial fishing — the hospital has had to build up strong trauma capabilities.

Since the island is only accessible by air, the sisters and the community continually have pushed for the hospital to get advanced technology not commonly available in small community hospitals on the mainland — often the upgrades were funded by community philanthropy.

Lanetta Lundberg, PeaceHealth Ketchikan foundation board chair, says in the documentary that the sisters’ strength, determination, tenacity and commitment to Ketchikan propelled the medical center and helped make it the impactful facility it has been for a century.

ASSOCIATE EDITOR, CATHOLIC HEALTH WORLD

The Catholic Health Association seeks an experienced journalist to fill an associate editor position at Catholic Health World, its awardwinning, tabloid format newspaper. Published up to 20 times annually in print and online, the specialty newspaper has content that advances the Catholic health ministry’s work in caring for people and communities. CHA’s members comprise the largest group of nonprofit health care providers in the nation and operate more than 600 hospitals, numerous outpatient facilities and 1,600 long-term care facilities as ministries of the Roman Catholic Church.

This position is based in CHA’s St. Louis office, where the association’s publications are produced. The primary function of the CHW associate editor will be as a senior staff reporter covering the Catholic health ministry. Strong writing skills are essential. The associate editor must be a self-starter with a beat reporter’s capacity to generate compelling stories tailored to an audience of senior hospital executives. Working in close communication with the CHW editor, the associate editor reports and writes clear, accurate and engaging features, news, and analysis pieces on deadline; writes headlines; and edits and proofreads copy.

The associate editor produces multimedia content for CHW’s online edition and social media accounts.

The associate editor performs some administrative tasks essential to the production of CHW and its web edition. This position generates story ideas for execution by self or others and solicits story ideas from members and CHA’s content leaders. Some travel is required.

A minimum of five years’ reporting experience on newspapers, newsletters or other rapidly recurring publications required. Knowledge of nonprofit health care, the health care industry, health policy and Catholic teachings on health care and social justice is desired. Experience in social media and video storytelling is a plus.

This position requires a bachelor’s degree or equivalent work experience in journalism or communications.

Interested parties should direct resumes to

Attention:

Cara Brouder Sr. Director, Human Resources Catholic Health Association CHA is an equal opportunity employer and offers a competitive salary and a comprehensive benefits package.

To view a more detailed posting for this position, visit the careers page on chausa.org.

For consideration, please email your resume to HR@chausa.org

In 1953, members of the Ketchikan chapter of the Beta Sigma Phi social organization present a new incubator to representatives of the city and the hospital.

Sisters of St. Joseph of Peace show off their catch in Loring, Alaska, in the late 1950s.

Sisters of St. Joseph of Peace archives

Courtesy of Ketchikan Museums

Recognizing Extraordinary Contributions to the Catholic Health Ministry

LIFETIME ACHIEVEMENT AWARD

For a lifetime of contributions

SISTER CAROL KEEHAN AWARD

For boldly championing society’s most vulnerable

SISTER CONCILIA MORAN AWARD

For demonstrated creativity and breakthrough thinking

TOMORROW’S LEADERS HONOREES

Honoring young people who will guide our ministry in the future

Dzenan Berberovic, MA, CFRE, Chief Philanthropy Officer, Avera Health, Sioux Falls, South Dakota

Brian Li, System Director, Community Health Strategic Initiatives, CommonSpirit Health, San Francisco, California

John R. Albright, Jr., Director of Home Care and Georgia Infirmary, St. Joseph’s/Candler Health System, Inc., Savannah, Georgia

Jessica Darnell, MSN, RN, CENP, Vice President Nursing and Chief Nursing Officer, Ascension Saint Thomas Hospital Midtown, Nashville, Tennessee

Elliott Bedford, PhD, Director, Ethics Integration, Ascension St. Vincent, Indianapolis, Indiana, Ascension Via Christi, Wichita, Kansas

Sr. Linda Werthman, RSM, PhD, Past Member of Trinity Health Board, Trinity Health, Livonia, Michigan

Rod Hochman, MD, President and Chief Executive Officer, Providence St. Joseph Health, Renton, Washington

Sr. Catherine O’Connor, CSB, PhD, Congregational Leadership Team of Brigidine Sisters and Covenant Health Board, Covenant Health, Tewksbury, Massachusetts

John Kohler, Sr., MD, MBA, Southern Illinois Regional Chief Medical Officer, Medical Group President, SSM Health, Saint Louis, Missouri

Zachary Melick, Director of Business Transformation, PeaceHealth, Vancouver, Washington

Tyler Limbaugh, Regional Integration Officer, Ascension Florida and Gulf Coast, Jacksonville, Florida

Lauren King, Senior Director, Talent Strategy and Innovation, HR, Ascension, Saint Louis, Missouri

Ratish Kumar Mohan, Biomedical Engineer, Hospital Sisters Health System, Springfield, Illinois