Catholic Health World - August 15, 2021 by Catholic Health Association

Avera sells eCare 3 Executive changes 7 PERIODICAL RATE PUBLICATION

AUGUST 15, 2021 VOLUME 37, NUMBER 13

Care communities face stiff competition to meet their workforce needs

Long-term care providers slowly recovering from pandemic’s financial hits

By LISA EISENHAUER

By JULIE MINDA

Despite offering sign-on bonuses, referral bonuses and starting pay of at least $15 per hour, Avera Health is getting an underwhelming response to postings for job openings at its nursing homes, assisted living communities and rehabilitation centers across the Upper Midwest. At the D’Youville Life & Wellness Community in Lowell, Massachusetts, managers are using more temporary contract workers for aide and nursing positions, and for the first time, for housekeeping openings, until they can find permanent staffers for its skilled care and assisted living facilities that serve a primarily senior population. In Honolulu, the St. Francis Healthcare System of Hawaii can’t fully populate the 111-bed assisted living center called Hale O Meleana that it added early this year. “The need is there. The demand is there,” said Jerry Correa, the system’s chief executive. “The biggest issue is staffing.”

The pandemic has dealt heavy financial blows to long-term care providers and many are still reeling from the impact. That is according to a sampling of leaders from ministry longterm care facilities, who said that sharp run-ups in staffing and supply costs combined with reduced census during the pandemic had a significant negative impact on the bottom line. Rebuilding census will be essential to recovering financially. But, the leaders said, attracting new residents is difficult, given current misperceptions of long-term care facilities. Steven Kastner is president and chief executive of Trinity Health Senior Communities, Kastner which has about two dozen long-term care communities in six midwestern and northeastern states. He said, “I see many long-term care organizations struggling. We’re

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The message on a signboard at Hale O Meleana, an assisted living community in Honolulu that opened earlier this year, reflects labor shortages being felt in the service industry across the U.S. The St. Francis Healthcare System of Hawaii has struggled to find enough employees to fully populate the 111-bed facility.

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Hospitals partner up to offer hospital-at-home services Mercy Medical

Frederick Breedon/© CHA

By LISA EISENHAUER

Jarrod Lowery, a registered nurse with Contessa Health, checks the blood pressure of Clinton Hammock. Rather than continue his cardiac care as an inpatient at Ascension Saint Thomas Hospital Midtown in Nashville, Hammock opted to get hospital-level care at his home in the small town of Pegram, Tennessee.

When the doctor overseeing his care at Ascension Saint Thomas Hospital Midtown in Nashville gave Clinton Hammock the option of finishing his treatment for his cardiac condition at home, Hammock said yes. The 74-year-old had been admitted to the hospital in early June, after a lingering respiratory infection led to a persistent cough and fluid buildup around his heart. Two days later, he was home in Pegram, Tennessee, about 20 miles west of Nashville. Hammock was sent home with a remote patient monitoring kit that included a scale, thermometer, pulse oximeter, blood pressure monitor, stethoscope, and a tablet for virtual doctors’ visits. Nurses monitored his vitals and he was able to see his doctor through a virtual connection every day. He was released from care in early July. Hammock said he thinks getting his medical care at home where he could sleep Continued on 2

Nurse is Texas hospital’s ﬁrst Good Samaritan honoree By LISA EISENHAUER

Cortney Shelton says she wants to believe that anyone with medical training would have responded just as she did when she saw a motorcyclist fly off of his bike on a busy interstate. The registered nurse pulled off the road, gave her two young daughters strict instructions not to leave the car and ran to where the man was lying unconscious. When he woke, she kept him calm and immobilized. He was airlifted to the Tyler, Texas, hospital where she works. Shelton’s level-headed response to the trauma inspired her employer, CHRISTUS Mother Frances Hospital – Tyler, to create a Good Samaritan Award and bestow the inaugural honor on Continued on 3

Police investigate at the scene near Wills Point, Texas, where John Zumbro was badly injured in a motorcycle crash in May 2020. The cyclist credits nurse Cortney Shelton, who works at CHRISTUS Mother Frances Hospital – Tyler, and her then-13-year-old daughter for saving his life.

Center aids in Baltimore’s ﬁght against human trafficking By PATRICIA CORRIGAN

When a first responder or social services provider in Baltimore suspects a person they are aiding is the victim of human trafficking, they have the ability to call in a “blue dot incident” and arrange for a “warm handoff” to a nurse trained in forensic exams and caring for victims of crimes and trauma. Mercy Medical Center in Baltimore has a roster of some 30 forensic nurses who are available around the clock to travel to all 11 hospitals in the city to meet with victims of interpersonal violence, including sex or labor trafficking. Many of the nurses are employed by other hospitals and work on a per diem basis with Mercy Medical Center to perform forensic exams. Baltimore is a hotspot for human trafficking and the COVID-19 pandemic did not drastically decrease the number of patients identified as trafficking victims, said Debra S. Holbrook, the director of forensic nursing at Mercy. From April through mid-July last year, the hospital’s forensic nurses responded to 20 Holbrook blue dot incident calls. The nurses offer empathy as they collect evidence following strict chain of command protocols to ensure admissibility in criminal prosecution. They provide general medical care including prophylaxis for disease for patients who have been trafficked for sex. A case manager may meet with a trafficking victim to make sure he or she has Continued on 8

CATHOLIC HEALTH WORLD August 15, 2021

Hospital at home

ers only as far away as either a phone call or video,” Greenstein said. “We saw it as a great relief for patients and families.”

plans to further facilitate the expansion through a pilot program with LHC Group that diverts recovering patients to at-home care rather than skilled nursing facilities.

Experience required Like their counterparts in hospitals, the LHC Group’s athome care providers have gotten training on best practices and protocols to prevent the spread of COVID and on how to educate patients and their families on those practices. Doctors visit the hospital-at-home patients via telemedicine while nurses, respiratory therapists and the After two days in the hospital, Clinton Hammock opted to finish like make in-home visits. his acute treatment for a respiratory and cardiac condition at “We look for very experienced home through Ascension Saint Thomas Hospital Midtown in nurses, those that are indepenNashville, Tennessee. Hammock says being home with his wife, dent and are able to function and Vicki Hammock, with other loved ones able to visit, he rested think clearly and be able to coormore comfortably and recovered more quickly. dinate care,” Doga said. Paul Generale, executive vice Pandemic relief president and chief strategy and network A joint venture program between officer at CHRISTUS Health, said that the CHRISTUS Health and at-home care pro- system offers the at-home care option to vider LHC Group works similarly and goes any patient who qualifies from a medical back even further, to September 2017. standpoint. “We see it as not, here’s a comDr. Benjamin Doga, chief clinical offi- fort, to be taken care of at home,” he said. cer with LHC Group, said the program has “We see it as here’s an extension, an access been a blessing during the COVID-19 pan- point of CHRISTUS, regardless of ability to demic. While statistics aren’t available on pay.” how many patients were diverted from hosThough the program has expanded, pitals, he said being able to offer acute care Generale said the number of acute patients at home served as a safety valve for hospi- who got at-home care during the worst tals overwhelmed with patients stricken by days of the pandemic was flat compared to the virus. before the health emergency began. That Lindsay C. Boyd, a registered nurse who was due to the fact that many people who is area executive director for LHC Group needed medical care opted not to seek in San Antonio and Corpus Christi, Texas, treatment because of the virus and because recalled an elderly patient who was sick many non-emergent services were put on with COVID. The patient spent several days hold by the pandemic, he said. in a hospital’s emergency room because the Generale expects the growth to resume hospital’s nursing units were full. Because once the pandemic is over. CHRISTUS of COVID protocols, family members couldn’t visit the patient until Boyd’s team was able to shift the patient to at-home care. “The family was extremely grateful for that because they were able to bring that family member home and put eyes on them and care for them the way that we all want to do when we have family members who are sick,” Boyd said. Bruce D. Greenstein, chief strategy and innovation officer with LHC Group, said most patients offered the at-home care option during the height of the pandemic accepted. “We did not see any reluctance to going home with the pledge of all the help that they would need and having caregiv-

Reimbursement discussion Meanwhile, Generale said CMS, despite its promotion of the care option, is not paying for it at a rate equal to inpatient care. The current reimbursement rates do not adequately cover the cost of the services being provided, he said. Robin Shepherd, vice president and chief nursing executive officer for CommonSpirit Health Southwest Division, oversees the partnership between Chandler Regional Medical Center and Mercy Gilbert Medical Center, both in Arizona, and Contessa to provide at-home acute care. For now, the service is available to patients enrolled in a few private insurance programs. The Arizona Department of Health Services created a three-year pilot program to begin acute hospital care at home for select hospitals that have secured a CMS waiver. Shepherd is hopeful that more private insurers also will add coverage for acute at-home care and a wider discussion will open up about how to adequately reimburse providers. What Shepherd said excites her most about the move to offer acute treatment in patients’ homes is its potential to increase access to care including for those who for whatever reason can’t or won’t come to hospitals. “There are many patients who we see who don’t want to be away from loved ones, so they postpone their care, or they don’t want to be away from beloved pets, or their families don’t have transportation to visit them in the hospital,” she said. “I’m really excited more for the access to care and being able to care for patients where they’re at.”

in his own bed and have his family nearby sped his recovery. “It was all real nice,” said the retiree who likes to fish and tinker with old cars. The hospital-level treatment that Hammock got in the comfort of his home came courtesy of the hospital and its partnership with Contessa Health, a provider of acute home care services. The care model aligns with a growing movement to provide some forms of acute care outside hospitals or nursing facilities.

CMS backing The trend has been propelled in recent months by the Centers for Medicare & Medicaid Services. In November, CMS announced its Acute Hospital Care at Home program to give hospitals “unprecedented regulatory flexibilities to treat eligible patients in their homes.” “The program clearly differentiates the delivery of acute hospital care at home from more traditional home health services,” the CMS announcement said. “While home health care provides important skilled nursing and other skilled care services, Acute Hospital Care at Home is for beneficiaries who require acute inpatient admission to a hospital and who require at least daily rounding by a physician and a medical team monitoring their care needs on an ongoing basis.” Ascension Saint Thomas was an early provider of hospital-at-home care through its joint venture with Contessa. Dr. Greg James, chief medical officer for Ascension Saint Thomas, said that partnership, which started in summer 2019, grew out of an Ascension initiative called Mission-Inspired Transformation. “The Mission-Inspired Transformation work was really all about trying to meet consumers and patients where they are in their health care journey, and how can we explore new care models,” James said. James said that working with Contessa accelerated the setup of the program. “They had great models for how this had been done in other places,” he said. The prep work to set up the program took several months. The first patient was admitted in November 2019. Patient needs, abilities considered Dr. Mark Montoney, senior medical adviser for Contessa, said the company operates in seven U.S. markets. In Arizona, it partners with two hospitals that are part of CommonSpirit Health. Montoney said patients eligible for acute care under its partnerships meet criteria for hospital admission but are at the lower end of the scale in terms of acuity, “meaning that they’re slightly less sick than some other patients in the hospital.” Examples of conditions that can be managed at home under the program include heart failure, dehydration, pneumonia and cellulitis. Montoney explained that before clinicians give patients the choice of moving their care to their homes, an assessment is done by clinicians at the hospital. That assessment takes into consideration patients’ care needs and their physical and cognitive abilities as well as their home environments and the level of nonmedical caregiver support available in their homes. In general, about 10% of patients with acute conditions requiring hospitalization are deemed eligible, Montoney said. The admitting or attending physician makes the final call on whether to present the at-home care options to patients. When the option is offered, James puts the acceptance rate at about 90%. Once patients are in the program, a care coordinator starts putting all the pieces in place. That includes scheduling the athome nurse visits, facilitating the telehealth physician exams, and ensuring that medications and equipment are in the home when the patient arrives.

Frederick Breedon/© CHA

From page 1

leisenhauer@chausa.org

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August 15, 2021 CATHOLIC HEALTH WORLD

Avera says sale of its eCare division will give millions access to telehealth By LISA EISENHAUER

A big reason that Avera Health decided to sell its telemedicine platform, Avera eCare, was so the service could gain wider use, Avera President and Chief Executive Bob Sutton said. On July 30 Avera announced that Aquiline Capital Partners would be purchasing its eCare division. The buyer is a private Sutton investment firm based in New York and London with $6.4 billion in assets under management. The companies expect to close the deal by the end of the year. They are not disclosing the purchase price. “As a Catholic health care ministry, it’s important for us to continue to talk about stewardship and for us to scale this beyond the current 32 states and over 600 sites is difficult,” Sutton said. “But for the acquiring entity, they will look to take this to scale and provide this amazing technology to even more people, which means better patient outcomes for millions of more people in our country.”

After the sale closes, the company will be renamed Avel eCare. Avera eCare’s chief executive, Deanna Larson, will assume the same post in the new company. The 230 people who work for Avera eCare will move to the new company, whose headquarters will remain in Sioux Falls, South Dakota. Sutton said those employees include a small number of clinicians as well as people in sales, technology and other areas whose jobs support the platform. Avera said there will be no disruption of services for patients. The service lines — behavioral health, correctional health, emergency, hospitalist and senior care — will continue under Avel eCare. Sutton said that Avera will be a customer of Avel eCare with Avera clinicians using the platform to continue to provide telemedicine services. He said the decision to divest from the eCare platform came at the suggestion of Avera’s sponsoring congregations — the Benedictine Sisters of Yankton Sacred Heart Monastery and Sisters of the Presentation of the Blessed Virgin Mary — and after months of discernment. “In the end it was based on, we have this

“In the end it was based on, we have this great resource that has changed thousands of lives and led to better health outcomes and saved millions of dollars for patients and for our delivery system and (we asked ourselves) ‘Are we being good stewards by keeping it as limited as it is?’” — Bob Sutton great resource that has changed thousands of lives and led to better health outcomes and saved millions of dollars for patients and for our delivery system and (we asked ourselves) ‘Are we being good stewards by keeping it as limited as it is?’” Sutton said. He noted that Avera has been an innovator in virtual care since it ventured into telemedicine two decades ago. Like those of other health systems across the country,

Avera’s eCare services have been in wider demand since the start of the pandemic, he said. Sutton said owning the delivery platform does not give Avera a decided advantage over telehealth competitors. Sutton said Avera will use proceeds from the sale to develop other innovative treatment models and to expand the system’s care. He said the system could partner with Aquiline in some of those future innovations. He said the change in ownership of the eCare platform will not interrupt or diminish the system’s commitment to providing care — including through telemedicine — to its largely rural service area, including through its American Indian Health Initiative. “We have some opportunities for growth within and contiguous to our footprint here in the Upper Great Plains and we believe that delivering health care where people want to receive it, as close to home as possible, is incredibly important to our patients but also a big part of our strategic plan,” he said. leisenhauer@chausa.org

‘Heartbeats in a Bottle’ comfort grieving family members By JULIE MINDA

When a patient dies in the intensive care unit at Mercy Medical Center in Springfield, Massachusetts, nurse Maria Hermanson gives the patient’s nearest family members an expression of sympathy she calls “Heartbeats in a Bottle. ” These are tiny glass bottles with a printout of the patient’s heart monitor rhythm strip visible inside. Hermanson says she creates the mementos as a way of communicating to patients’ loved ones that “we cared about your family member and we care about you.”

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Nurse Maria Hermanson, who works at Mercy Medical Center in Springfield, Massachusetts, creates mementos for the loved ones of patients who have died in the facility’s intensive care unit.

Hermanson, who works the overnight shift in the Trinity Health hospital’s ICU, says patients there sometimes have very long stays. The unit’s staff often bond with the patients and their families. This connection has been especially important during the pandemic, when many patients have been unable to have visitors due to infection prevention protocols. The unit’s staff has been an essential communications link to family members. When a patient who has been in the ICU for at least 24 hours dies, Hermanson prints off a miniature copy of a portion of their digital heart rhythm strip. She trims off excess paper and seals the strip in an inch-high bottle. The heart waves are visible through the glass. Hermanson says she cries every

Nurse hero From page 1

Shelton. Shelton is director of surgery preop at the hospital. Shelly Welch, chief nursing officer at CHRISTUS Trinity Mother Frances Health System, said, “Jesus teaches us to serve one another, and that’s exactly what Cortney did in this situation.”

Circumstances align Shelton said she was headed home to Tyler after visiting her mother in Wills Point, Texas, about 50 miles away on that day in May 2020. She and her daughters had started back earlier on a different route but went back to Wills Point because her mother had left her purse in Shelton’s car. When they headed out of Wills Point for the second time, Shelton gave in to her daughters’ request that they take Interstate 20 because the girls knew they would have better Internet access for their mobile devices. “It’s not really a route that I would normally have taken just because the other way is quicker,” Shelton said. As she drove onto the interstate ramp, Shelton said she saw a motorcyclist ahead of her. She turned away from him as she prepared to merge onto the busy freeway, but her 13-year-old daughter, Kylie, who was beside her in the front seat, was looking in the direction the motorcycle had headed. “She saw him being thrown from the motorcycle and of course said ‘Mom, stop, stop!’” Shelton turned her head just in time to see the airborne motorcyclist land in tall weeds on the roadside. She said her first thought was the safety of her daughters as she made the split-second decision to leave

Cortney Shelton and John Zumbro at an awards ceremony at CHRISTUS Mother Frances Hospital – Tyler in east Texas. Shelton was honored for coming to Zumbro’s aid at the scene of a motorcycle crash that broke his neck.

them in the car on the shoulder of the interstate ramp and administer first aid. “That’s just in me, to help somebody. So, I pulled over, made them stay in the car and got over as far as I could so we wouldn’t get hit.”

Remembering trauma training Shelton found the motorcyclist on his back, unconscious and, fortunately, still wearing his helmet. From her training as a trauma nurse early in her career, she knew not to let the man turn his head, so she braced it between her knees as she called 911 and waited for help. In the 20 minutes or so that it took the ambulance to arrive, the rider regained consciousness. “He was disoriented,” she remembered. “I just tried to remind him, ‘You can’t get up, you just had a motorcycle accident.’ He was like, ‘I’m not on a motorcycle,’ and I’m like, ‘Well, not anymore.’” Doctors at CHRISTUS Mother Frances told the motorcyclist, John Zumbro, that his injuries included a broken neck. Had

time she writes the sympathy card to go with the heartbeats bottle. She learned to assemble the bottles about two decades ago from a clinician at a hospital in Holyoke, Massachusetts. That clinician would keep track of who owned which stethoscope by attaching a bottle with the owner’s name in it to the tool. At another hospital where she worked, Hermanson saw the palliative care team gift the bottles — with copies of the patient’s heart rhythm strip inside — to family members of deceased patients. Hermanson estimates that she has made several hundred heartbeats in a bottle, about 50 of them for the bereaved families of Mercy Medical ICU patients.

he moved his head, they told him, he might have been permanently paralyzed. Shelton reached out to Zumbro several weeks after his accident. She wanted to let him know that she could fill him in on what happened, in case there were gaps in his memory due to his injuries and trauma. Zumbro and his wife quickly responded and started to correspond with Shelton. She didn’t meet Zumbro in person again until the award ceremony in May, about a year after the crash, when he surprised Shelton by coming to thank her.

Guardian angel Zumbro spoke at the ceremony and taped his account of the crash for the hospital. He remembered losing control of his bike and praying “Dear God, help me” as it slipped off the entry ramp, and waking up on his back in “horrendous pain.” He was unable to move his neck because Shelton had immobilized it. “I guess it was the way the sun was shining through and the way she was looking down at me, but I thought I’d finally found my guardian angel,” Zumbro said. Zumbro gave Shelton two angel pendant necklaces at the award ceremony, one for her and one for Kylie. “There is not enough I could ever do for that woman and her child. They saved my life, literally,” he said. “I mean, how do you pay someone back for that?” Shelton said: “I hope people are Good Samaritans at all times, especially any of us in health care. I think it’s part of our due diligence to help others and part of our mission work to help anybody in need.” leisenhauer@chausa.org

CATHOLIC HEALTH WORLD August 15, 2021

LTC staffing challenge

aides. As of mid-July, about 15 of those positions were vacant. While the aides are typically in limited supply, the current shortage is the worst in his 10 years at the helm of the system. On the Facebook page for Hale O Meleana, many of the posts are advertising open positions. The facility has openings for nurses, nursing aides and food service workers. The managers of St. Anthony Nursing Home, a facility in Carroll, Iowa, that is affiliated with a hospital but not part of a larger system, offered a number of reasons they suspect nurses and nursing aides have become harder to find since the start of the pandemic. The reasons include continued concern about medical field jobs because of COVID, greater health needs among patients than in years past because many are waiting until later in life to enter facilities, and the physical and mental toll of the work. St. Anthony is using radio advertisements and online sites including LinkedIn and Indeed to recruit job candidates. It is offering bonuses to new hires and referral bonuses to staff who help fill openings.

From page 1

The Catholic health care organizations aren’t alone in their workforce challenges. A researcher with LeadingAge, the association of nonprofit providers of aging services, is hearing similar reports of employee shortages elsewhere. “A lot of members, like other people in aging services, are having difficulty recruiting and retaining frontline staff,” said NataBryant sha Bryant, managing director/senior research associate at the LeadingAge LTSS Center @UMass Boston that studies issues related to long-term services and supports.

Critical challenges Last fall, an agency within the Department of Health and Human Services posted a report called “COVID-19 Intensifies Nursing Home Workforce Challenges.” The report noted that operators of skilled nursing facilities have in recent years “faced critical challenges” in recruiting and retaining their workforce of 1.2 million health care personnel and support workers. The report said the pandemic has made that challenge worse. “While many people join the field with a desire to provide compassionate, hands-on care for residents, physical and emotional demands and low wages drive high rates of turnover among direct care workers,” the report says. “The onset of the COVID-19 pandemic has intensified workforce shortages to crisis conditions, putting the safety and well-being of both vulnerable residents and nursing home staff at risk.” The crisis is reflected in data from the U.S. Bureau of Labor Statistics, which have shown that health care overall is losing workers. In June, the number of people employed in the sector dropped by 7,000 from the previous month, the bureau reported. The same agency projects that the health care sector will add about 2.4 million new jobs, growing 15 percent, from 2019 to 2029. Fewer candidates, higher wages Executives and human resources officers confirm that the labor challenges from 2020 have carried over. They said those challenges have been intensified as the worker shortage drives up wages across the economy. At D’Youville, Kathy O’Brien, director of human resources, said the rate of staff turnover this year is slightly up over last year. In April 2020 it was O’Brien 2.15%, while this April it was 3.98%. Last May it was 4.55%, while this May it was 4.58%. What’s different is the reasons people are leaving and the dearth of replacement candidates. O’Brien said workers who left last spring and summer cited concerns about on-thejob exposure to the COVID-19 virus and nonwork demands, such a lack of child care services when schools closed. This year, with vaccines available and concern about the virus easing somewhat, more workers are simply accepting higher-paying positions elsewhere. Naomi Prendergast, D’Youville’s president and Prendergast chief executive, said the competition for entry-level staff is intense. She has seen Dunkin’ Donuts post signs that offer new hires $16 an hour. Leading– Age says federal statistics put the median hourly wage nationwide for nursing assistants at $13.90. While executives report that low-skill jobs generally are the most challenging to fill, wage escalation is being seen higher up the pay scale, too. Prendergast said a

A poster at D’Youville Life & Wellness Community in Lowell, Massachusetts, features photos of staff members and residents giving a thumbs up as part of a campaign called We’ve Got This! The goal was to boost spirits as the COVID-19 pandemic created new challenges for the facility and its staff.

social worker who left D’Youville to work for another health care provider this summer mentioned that her salary was going to jump by $20,000. “The wages have just gone way up and it’s really difficult for us to compete because our reimbursement is stagnant in that like most nursing homes we rely heavily on Medicaid and Medicare and other insur-

ances. We simply can’t just raise our rates to offset the cost of wages,” Prendergast said.

Correa

Vacancies linger Correa said that St. Francis Healthcare em– ploys about 40 nursing

Trying out new strategies Anthony Erickson is vice president for senior services for the Sacred Heart region of Avera that includes Yankton, South Dakota. He said the nationwide labor shortage means “you’ve got to Erickson figure out and do whatever you can to retain any new person that comes to your door.” Erickson said that even though there had been no cases of COVID among those being cared for at nursing centers in his region of Avera for more than six months, the pandemic has had lingering effects on hiring. While the pandemic was raging, hiring needs and processes were reassessed and recruiting was interrupted. “We’re actually just starting to go back to interviews on-site, bringing staff on board, and starting to get back to that new normal as far as how you process employees,” Erickson said. In November, Avera raised its lowest hourly wage for any worker to $15 to stay competitive with other employers. In

LeadingAge report suggests how to stabilize direct care workforce A

Enhance education and training so report called “Feeling Valued Because The report says the median hourly wage They Are Valued” that was released in for direct care workers — home care aides, professional caregivers will feel well preJuly by LeadingAge says that to ensure home health aides, nursing assistants, and pared to carry out increasingly complex that the nation’s direct care workforce can certified nursing assistants — is $12.80, up care tasks, and so nursing homes, assisted meet the growing needs of an aging popu- only 19 cents over the last decade; median living communities, home care organizalation those workers need competencyannual earnings for the workers is $20,300, tions, consumers, and their families will based training, living wages and benefits, in part because many are employed part have confidence in those caregivers. Facilitate career advancement so and career-development opportunities. time; and 15% of the workers do not have The report is subtitled “A Vision for health insurance while 36% receive health caregivers can advance in careers in longProfessionalizing the Caregiving Workinsurance through Medicaid, Medicare, or term services and support that offer them force in the Field of Long-Term Services other public coverage. a variety of opportunities. Increase compensation so direct care and Supports.” It was written by Natasha To stabilize the workforce, the report Bryant, managing director/senior research offers several suggestions: professionals can earn a wage that covers Expand the pipeline of potential careassociate at the LeadingAge LTSS Center basic living expenses such as housing and @UMass Boston, and her colleague Robyn givers by recruiting nontraditional workers, food. Train “universal workers” on a core I. Stone. such as high school students or those who Bryant said the challenges of hiring and have been displaced from other fields, and set of competencies set at the federal retaining direct care staffers — nursing foreign-born workers. level. These workers would then have the assistants, personal care flexibility to work across setaides and home health tings and even across state aides — preceded the boundaries. Reform the financing COVID-19 pandemic but were exacerbated by it. system, which now is largely “The frontline staff reliant on Medicaid, by using certainly do not receive insurance-based dollars to high wages. They don’t provide additional and more always get the superviconsistent funding. sion and the training that “I think we as a sector they need to do complex need to create jobs that jobs,” Bryant said. people want and that at the “They don’t have career end of the day is what we NOTE: Total LTSS expenditures include spending on residential care facilities, nursing homes, home health services, and home and community-based waiver services. Expenditures also include spending on ambulance providers and some post-acute care. This chart advancement opportunihave to do,” Bryant said. does not include Medicare spending on post-acute care ($83.3 billion in 2018). All home and community-based waiver services are attributed to Medicaid. ties, so it can be difficult SOURCE: KFF estimates based on 2018 National Health Expenditure Accounts data from CMS, Office of the Actuary. to get people to come — LISA EISENHAUER This graphic was originally published in “Medicaid Home and Community-Based Services Enrollment and Spending,” by Molly O'Malley Watts, MaryBeth Musumeci and Priya Chidambaram, (KFF, Feb. 4, 2020), tinyurl.com/jsatd63k. into these jobs, let alone stay in these jobs.”

August 15, 2021 CATHOLIC HEALTH WORLD

response to the current crunch, the system is looking at other ways to ways to recruit and retain staff. For one, Avera is exploring retention bonuses to keep its current employees from accepting outside offers. The system also is readying a pilot program called Direct Hire at its largest hospital, Avera McKennan Hospital & University Health Center in Sioux Falls, South Dakota. Under the program, a dedicated Direct Hire talent acquisition team will manage the entire hiring process for high-volume service positions including food services and housekeeping, from sourcing candidates to making the hire and assisting in onboarding. Jane Miller, the lead human resources officer for two Avera regions, said the goal of Direct Hire is to reduce the number of management hours devoted to interviews and Miller to give hiring managers more time to work with their staffs. “We’re aware that another system is doing it and they’ve had great successes with it,” Miller said. “The leaders really appreciate the time that they can round now with their employees.” Avera operates its own temp agency, Avera Education & Staffing Solutions, through which it deploys temporary workers across its own system and contracts for them with other employers. Even so, the system taps outside agencies to fill some openings. Through one of those agencies, Avera hires nurses from the Philippines for temporary assignments. Some of those

O’Brien said the system also has sent direct mail appeals to former employees to see if they are interested in returning and to applicants who turned down job offers to see if they are in the candidate pool again.

Hailey Gukeisen, a certified nursing assistant at Avera Brady Health and Rehabilitation in Mitchell, South Dakota, visits with resident Genevieve Gray. Gukeisen has been a CNA at the facility for about one year.

nurses have stayed on permanently.

‘Infused enthusiasm’ D’Youville is looking at creative new strategies to recruit workers. The senior leaders have started a strategic initiative to work with department leaders to ensure that job applicants receive a quick response. It also is reviewing its interviewing process to make sure managers know how to recruit

prospective hires. “It’s really the role of anybody doing an interview to infuse enthusiasm in job candidates about why D’Youville really is the place they want to work,” Prendergast said. “We actively talk about how our mission of compassionate care is not just about how we treat those we care for but about how we treat each other,” Prendergast said. “We actively work on the culture here.”

Slow financial recovery

Flexibility and gratitude Representatives of several systems said they are or are planning to collaborate with local colleges and universities to better align their need for workers with education programs. Correa said St. Francis Healthcare hopes a collaboration it has in the works will create career pathways for entrylevel workers that enable and encourage them to get the education and credentials required for higher-paying positions in nursing and social work. While that partnership with local colleges is taking shape, Correa said that his system is being especially attentive to the personal needs of its 250-member workforce. The system is offering flexible schedules and holding events to thank workers for their service. Correa said he and other managers at St. Francis are aware that competitive wages are just one of the factors that attract workers and build loyalty. “It’s being able to spend time with family,” he said. “It’s their work-life balance. It could be things like recognition.” As to how to fill the system’s many openings, Correa said he welcomes new ideas. “I’m all ears if there’s different ways of recruiting,” he said. “I’d love to find out and see how other people are being successful at it.” leisenhauer@chausa.org

that campus had budgeted for its usual supplies, “and then out of nowhere, or seemingly, we had an enormous need for personal protective equipment and of course early in the pandemic in particular, the costs were outrageous.” D’Youville’s foundation raised about $75,000 from the community to soften the blow. Kastner of Trinity Health Senior Communities noted that the cost of COVID tests and screenings also took an unexpected bite out of the supply budget.

From page 1

all trying to rebuild census, but it is a long climb, and it doesn’t happen overnight.” To help rebuild census, said Allison Q. Salopeck, “what I really think is needed is to change the narrative about long-term care services and supports” so that people understand that most such facilities are high-quality places to live, with staff who truly care for residents. Salopeck is Salopeck president and chief executive of Jennings, which offers a continuum of care in the Cleveland area.

‘Really horrible’ situation Dr. Vincent Mor is professor of health services, policy and practice and the Florence Pirce Grant University Professor in the Brown University School of Public Health in Providence, Rhode Island. During the pandemic, he has led a research team that has been using data anaMor lytics to understand the long-term care resident experience and to help long-term care facilities with decisions around COVID protocols. He recalled that at the start of the pandemic, “things were really horrible” in long-term care. No one knew much about coronavirus, there was great anxiety about its trajectory, there was inadequate protective equipment and insufficient testing supplies. Facilities were receiving confusing information from government sources, and virus-related cases and deaths were escalating in the facilities. Providers scrambled to put in place protective measures, including lockdowns, to safeguard residents and staff. Residents of long-term care facilities were given high priority when mass vaccinations began eight or nine months ago and vaccination rates have been high among residents. Infection rates and death rates have plummeted as a result, and this, along with falling infection rates in communities, allowed a gradual reopening of facilities to visitors

D’Youville Life & Wellness Community in Lowell, Massachusetts, created a Garden of Resilience & Renewal during the pandemic as a calm space where staff and residents can unwind. The aspersorium and aspergillum were used in a blessing ceremony to hold and sprinkle holy water.

and a relaxation of infection protocols, Mor said. The financial impact of this year-plus of upheaval has been significant, he said. “Everyone has been losing money. Revenues are down. I’m expecting to see bankruptcies.” He said the only reason bankruptcy has been held at bay for many long-term care facilities is that they received an influx of government money during the pandemic. Survey results released June 29 by the American Health Care Association and National Center for Assisted Living reveal that more than half of the 616 U.S. nursing homes and nearly half of the 122 assisted living communities responding to the survey said their organizations are operating at a loss. Just one quarter of respondents

said they are confident they can last a year or more. An analysis earlier this year by the American Health Care Association and National Center for Assisted Living concluded that the nursing home industry is expected to lose about $94 billion over the course of the pandemic, and more than 1,800 facilities could close.

Unexpected costs Ministry long-term care leaders said the greatest financial pressures during the pandemic have related to staffing, unanticipated supply costs and loss of revenue due to decreased census. Naomi Prendergast, president and chief executive of D’Youville Life & Wellness Community in Lowell, Massachusetts, said

Census down, revenues down A more intractable source of financial stress had to do with fluctuating census. “Long-term care facilities make money when beds are full and lose money when occupancy rates drop,” said Mor. According to a report from the National Investment Center for Seniors Housing & Care, occupancy rates at U.S. skilled nursing facilities as of May were 13.7 percentage points below pre-pandemic levels. Prendergast said D’Youville had “months where we were severely down on census,” which hurt revenues. Kastner said within the Trinity Health Senior Communities organization, the greatest occupancy declines were in the skilled nursing facilities, which had to discontinue admissions during lockdowns. Independent and assisted living admissions also slowed because many prospective residents wanted to wait out the pandemic before moving. Salopeck of Jennings said that not being able to offer tours of independent and assisted living facilities during lockdowns decreased the stream of prospective residents. Salopeck added, when hospitals temporarily discontinued elective surgeries at the pandemic’s start, that reduced the count of Medicare-reimbursed short-term rehab patients coming to Jennings. Infusion According to analysis by AARP, threefifths of the fees of the nation’s 1.3 million nursing home residents are paid by Medicaid. Medicare pays for limited stays in skilled nursing facilities for qualified patients who have been discharged from a hospital, and according to the analysis, it is a major source of income due to Medicare’s Continued on 6

CATHOLIC HEALTH WORLD August 15, 2021

Slow financial recovery higher reimbursement rates. The decrease in payments from both government insurance programs during the pandemic as patient census declined put a significant dent in providers’ revenues. The ministry leaders who spoke to Catholic Health World said their facilities benefited from a variety of government allocations, including Coronavirus Aid, Relief, and Economic Security Act stimulus dollars; loans from the Paycheck Protection Program; and Federal Emergency Management Agency funding. Prendergast said the relief “was really crucial. The additional funding coming in was truly a lifesaver.” Jerry Correa, chief executive of St. Francis Healthcare System of Hawaii, said the government funding “was huge” in terms of its impact. The system would have had to reduce staff count, he said, were it not for the money it received in Paycheck Protection Program loans and CARES stimulus. “It allowed us to retain staff and help the community,” he said.

Repositioning long-term care The ministry leaders said their census numbers are slowly returning to near pre-

Photo courtesy of The McAuley

From page 5

From left, Jim Messina, Ramona Beckius and Harry Davidson — all residents of The McAuley in West Hartford, Connecticut — take a break from a putting competition on the campus’ “19th Hole.” The McAuley is part of Trinity Health Senior Communities. Steven Kastner, president and chief executive of that system, says admissions to independent and assisted living facilities had slowed during the worst of the pandemic but are rising again.

pandemic levels. They added that while they have no immediate sustainability fears — as many of the respondents of the American Health Care Association survey had — they do have concerns about their ability to fully restore their finances. Salopeck said the fact that Jennings is well diversified in terms of the levels of care

it offers on its campuses has helped protect it during the pandemic. But she said Jennings like most other long-term care sites “is not out of the woods yet.” Kastner said Trinity Health Senior Communities facilities are aggressively managing costs and focusing on expenses to recover financially.

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Kastner said increasing resident counts across the continuum of care will be essential to restoring long-term care, but facilities are being hampered by public perception problems that existed before the pandemic and in many cases worsened over the past year and a half. Salopeck said while the public seemed to have a great deal of admiration for long-term care staff and the commitment they showed during the pandemic, the industry sustained “black eyes” when nursing home outbreaks and resident deaths were covered in a way that laid blame entirely on the facilities. Kastner said Trinity Health Senior Communities is focusing on the message that, given that Trinity Health is mandating vaccination among staff, those long-term care facilities are the safest places to be now. Salopeck said Jennings, too, is countering a false narrative. She said aging in one’s home and staying there until death is not an option for everyone. Frail elderly people who do not have healthy caregivers and supportive services are very vulnerable when they live in isolation in their own homes. On the other hand, she said, in high-quality senior care facilities, they can receive care and companionship. “People are thriving in our residences,” Salopeck said, and it’s important for people to know that. jminda@chausa.org

August 15, 2021 CATHOLIC HEALTH WORLD

HSHS drive-thru lets patients access services without leaving their cars Patients in need of lab tests, vaccinations and blood pressure checks can get them from the HSHS Medical Group in Decatur or O’Fallon, Illinois, without getting out of their car. The physicians group, part of the Hospital Sisters Health System, opened the HSHS Drive-Thru Care sites this spring. They are the first facilities of their kind for HSHS. The sites are cooled by large fans on warm days and have heaters for cold weather comfort. To use the drive-thrus, patients need either an order from an HSHS Medical Group provider or an appointment made through HSHS’s MyChart portal. The onestory buildings have two bays that can fit three cars each. Patients need only roll down their window for throat swabs, injections or blood draws. The stand-alone facility in Decatur is in a residential area on the outskirts of Decatur and not on the campus of any other HSHS facility. The one in O’Fallon also is located in a residential area — in a converted carwash. Both facilities are open from 7 a.m. – 2 p.m. weekdays. Dr. James Bock, HSHS Medical Group chief physician executive, said the plan for the labs was inspired by the drive-thru and mobile clinics set up by hospitals and other Bock care providers during the COVID-19 pandemic to offer services without requiring patients to come into buildings and risk infection. He said the initial plan was for the drive-thrus to just be a place to have lab

Marta Dale-Wilder gets his blood pressure checked through the window of his car by medical assistant Makayla Smith-Valentine at HSHS Drive-Thru Care in Decatur, Illinois. The facility opened this spring.

tests done. When it became clear during the pandemic that most patients were not only receptive to but more comfortable getting some routine medical services outside traditional settings, the physicians group decided to include blood pressure checks and vaccinations. “This is about meeting patients where they’re at and trying to serve their needs,” Bock said. Even before the drive-thru in Decatur officially opened in April, HSHS put it to use for daylong vaccine clinics. Having the facility meant that staff didn’t have to work on parking lots and under tents, Bock said, and it gave patients the convenience and

safety of staying in their cars. The O’Fallon site opened in May. The labs are staffed by nurses, medical assistants and a patient services representative, with a physician, physician’s assistant or nurse practitioner supervising from off-site. Bock said the labs are attracting a range of patients, including older people with mobility issues and those with young children in their care. The services available at the sites likely will grow, he said, as the physicians group answers the question, “What can we do here to expand access to people who either can’t or won’t access us in more traditional ways?”

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KEEPING UP

Garrison

Caster

McGovern

Edwards

PRESIDENTS AND CEOS Tina Garrison to president of SSM Health DePaul Hospital in Bridgeton, Missouri. She was president of SSM Health St. Clare Hospital in Fenton, Missouri. Andrea Gwyn to administrator of Mercy Health – Perrysburg Hospital in Perrysburg, Ohio, part of Bon Secours Mercy Health. She was a hospital operations subject matter expert with Mazars Healthcare. Under a Mazars contract, she was chief operating officer for a hospital and skilled nursing facility in Washington, D.C.

ADMINISTRATIVE CHANGES Trinity Health of Livonia, Michigan, has made these changes: Dr. Mark LePage to senior vice president of medical groups and ambulatory strategy for Trinity Health. James Moffett to president of the Holy Cross Medical Group, a multispecialty physician group. Moffett also will be part of the senior leadership team of Holy Cross Health of Fort Lauderdale, Florida. Jason Szczuka to chief digital officer of Bon Secours Mercy Health of Cincinnati. CommonSpirit Health has made these changes: Sebastien Girard to senior vice president and chief people officer of Centura Health, Centennial, Colorado. Tiffany Caster to chief operating officer for Dignity Health’s Saint Francis Memorial Hospital and St. Mary’s Medical Center in San Francisco. Dr. James McGovern to medical chief medical officer of the PeaceHealth Oregon network and Dr. Melissa Edwards to surgical chief medical officer for the network.

GRANTS AND GIFTS St. Louis-based Ascension has pledged $3 million to support a new online Acute Care Adult-Gerontological Nurse Practitioner Program within the Conway School of Nursing at the Catholic University of America. In an announcement on the grant, Ascension President and Chief Executive Joseph Impicciche said Catholic University is a leader in educating nurse practitioners. He said Ascension’s investment will help increase the pipeline of nurses with the skill level most needed in the future. The funding will help with program expenses and will support two faculty positions and a staff position for the program. The philanthropic foundation of the Panda Express restaurant chain has pledged $1 million to HSHS St. John’s Children’s Hospital in Springfield, Illinois. The hospital plans to use the funds to develop the Panda Cares Center of Hope outdoor healing garden and playroom. The funding also will support programming at the hospital to improve the mental, emotional, spiritual and physical well-being of patients and their families. Panda Cares Center of Hope is a nationwide initiative involving Children’s Miracle Network Hospitals. The Los Angeles County Department of Public Health has awarded Community Health Investment, a division of Providence Southern California, a grant of more than $870,000. The grant will fund a community health worker outreach and vaccine distribution program.

CATHOLIC HEALTH WORLD August 15, 2021

Human trafficking food, a shower, and a safe place to sleep at a location unknown to the trafficker. While the case manager also can help arrange treatment for drug dependency, the emotional and physical damage resulting from trafficking may be long-lasting. “Human trafficking, for sex or labor, is ugly and it’s tragic, and those victimized by it suffer from the experience across their entire life,” Holbrook said. The stand-alone hospital coordinates care for all victims of interpersonal violence in the Baltimore area including military personnel. “Trafficking is modern-day slavery, and it’s the second biggest criminal industry in the world, a $50 billion business in 2015,” she said.

Photo illustration/Shutterstock

From page 1

Since March 2020, Mercy Medical Center’s forensic nurses have met with more than 100 victims of human trafficking. “That may not sound like many, but it’s huge, because most cities are helping maybe 10 to 12 people a year,” Holbrook said. “One of Mercy’s missions is to take care of the most vulnerable, and if we missed this, we’d be missing one of the most vulnerable populations.”

Breaking down silos Holbrook chairs the medical subcommittee of the Baltimore City Human Trafficking Collaborative. Founded in 2017, it operates under the auspices of the Mayor’s Office of Neighborhood Safety and Engagement. The collaborative is made up of representatives from 45 agencies, including city and state government offices, health care professions, law enforcement, the fire Blinders off department, the judiciary, prosecutors, Susan Finlayson, Mercy Medical Cenpublic defenders, survivors’ groups and ter’s senior vice president numerous organizations that provide supof operations, said, “Deb’s port to them. team is committed and The collaborative is charged with raising innovative, working to awareness of human trafficking, especially provide victims with comamong people who may be in a position to passion, dignity and jusintervene. It does this through education, tice, and helping them to law enforcement training and the media. Finlayson move on to another path.” It supports prosecutions of traffickers and “Our hospital is small takes a victim-centered, trauma-informed but mighty, and we don’t try to be all things approach to caring for victims. to everybody,” Finlayson continued. Since “We don’t have much else in common, its founding almost 150 years ago, Mercy but we all interface in the criminal justice Medical Center has stayed true to the missystem,” Holbrook said. “We’ve embraced sion of the Venerable Catherine McAuley, the mindset that we’re going to work foundress of the Sisters of Mercy, to care for together, rather than in our respective silos, the sick no matter the circumstances. “Takand we are being open enough and humble ing care of trafficked indienough to ask how we can fix the problem. viduals throughout the The collaborative is brilliantly designed, city is part of being a good and it’s effective,” she said, adding that a community health care research study will be launched soon to partner,” Finlayson said. determine how victims of trafficking aided No other major city by the collaborative are faring. has a coordinated proMercy first offered its anti-human trafgram as broad as BaltiStack ficking training program in 2007. Called the more’s human trafficking Blue Dot Initiative, its goal was to teach staff response, said Thomas Stack, human trafmembers to recognize victims of trafficking ficking coordinator for the Mayor’s Office and intervene. Eight years later, the hospi- of Neighborhood Safety and Engagement. tal launched a pilot program to help other He co-founded the collaborative with BalBaltimore-area hospitals identify the tell- timore City Councilman Kristerfer Burnett, tale signs of trafficking that are often over- and together they serve as co-chairs. Stack looked. (See sidebar.) and Holbrook often share the stage at con-

Trafficking victims keep mum to protect themselves

he Polaris Project, which operates the National Human Trafficking Hotline, reports that the number of people being trafficked worldwide for sex or labor is estimated to be 25 million. With a population of about 2.3 million, Baltimore is considered a hotspot because of its size and also its proximity to Washington, D.C., which routinely tops lists of most cases per capita of human trafficking. In the U.S., in addition to sex workers, victims may include hotel workers, gardeners, landscapers, produce pickers and employees at nail salons, massage parlors, strip clubs or hair salons. Elderly individuals may be trafficked by people who steal their financial benefits. It’s rare that an individual will voluntarily identify themselves as a victim of human trafficking when they are talking to a health provider or a first responder, said Debra S. Holbrook, the director of forensic nursing at Mercy Medical Center in Baltimore. “When asked a screening question, they won’t answer because they’ve been taught to distrust almost everyone.” They fear if they tell anybody anything, their captor or pimp will beat, starve or torture them or withhold drugs, shelter or sleep. In some cases trafficking victims may have reason to fear that by speaking to authorities, they will put family members at risk. It’s common for victims who require medical attention to be accompanied by a trafficker who handles all the paperwork and does all the talking. Victims who do respond to a caregiver’s question about their safety and well-being may sound rehearsed. Trafficking victims may be malnourished or sleep-deprived. They may have scars or bruises in various stages of healing, sexually transmitted infections or symptoms of drug withdrawal. “For all of us working in Baltimore to help victims, our reward is when we are able to help someone get out of the life and onto a different path,” Holbrook said. — PATRICIA CORRIGAN

ferences, educational programs and events held to raise awareness about trafficking, and other cities now seek advice from the collaborative on mounting an effective, victim-centered response. “We’re all really proud of what we’ve done here — when it comes to fighting human trafficking, Baltimore is rocking and rolling,” Stack said. “Out of 100 people that show signs of being trafficked, only two or three may let us help right away, but as Deb always says, we must plant the seed. I say you can lead a horse to water and though that horse may not drink, eventually it will get thirsty. In Baltimore, we always have water.” Because victims typically avoid eye contact and are not forthcoming about their situation when speaking with authorities, recognizing the signs of human trafficking requires training. Lt. Colleen Lull, who sits on the collaborative’s Lull medical subcommittee with Holbrook, works at the Baltimore City Fire Department’s Emergency Medical Ser-

vice Training Academy, where she oversees continuing education and certification for paramedics. Lull incorporates information on human trafficking in her training programs, and her counterpart does the same in classes for Baltimore’s emergency medical technicians. “I start with stereotypes versus the reality, discussing preconceptions about what people think prostitution is, for example as portrayed in the film Pretty Woman, and what it really is,” Lull said. “Most prostitution is pimp-controlled, through force, fraud or coercion — and that makes it trafficking. These women are not making voluntary choices and they are not in control of their lives. Plus, I always point out that the average age of entry into the life is between 11 and 14. Children are being lured in and they do not have a path out.”

Easy does it Lull also teaches paramedics what else to look for when out on calls with firefighters or ambulance crews: Poor living conditions with multiple people in a crowded space, few furnishings and a lack of personal possessions. “Every time we have the class, someone remarks that they have seen all that, but didn’t know what it was,” Lull said. Because victims of trafficking have been taught to fear police, but not firefighters, sometimes paramedics and EMTs out on a call can start a quiet conversation with a trafficked individual who may eventually agree to meet with a forensic nurse. Lull said for that reason, she teaches effective interview techniques. “You have to slow everything down and speak in a reassuring tone, with no direct questions, or the victim will shut you down,” she said. “When you offer help, you want to explain that the victim will make choices from the available options. That gives them back some control.” Lull added, “This is a whole new way of saving people’s lives.”

An architect’s rendering shows the Love Family Women’s Center, which is under construction at Mercy Hospital Oklahoma City.

Mercy begins work on women’s hospital in Oklahoma City Mercy Hospital Oklahoma City is building a $98 million four-story women’s center to meet a growing need for labor and delivery and postpartum services. The hospital is part of the Chesterfield, Missouri-based Mercy system, which said it expects Love Family Women’s Center to open in fall 2023. The Mercy BirthPlace, which the new center will replace, occupied the fifth and sixth floors of Mercy Hospital Oklahoma City. It was designed to handle around 3,000 births a year, Mercy said in its announcement about the new center. Nearly 4,000 babies were delivered annually there each of the last two years. The new 175,000-square-foot center will have 73 patient rooms, 30 more than the current space. “We want to be able to serve every pregnant mom and newborn that needs us, but the reality is that our existing facility is not designed to support our current volume of patients,” Jim Gebhart, community president of Mercy Hospital Oklahoma City, said in the Mercy announcement. “We simply need more space.” The Love Family Women’s Center will be on the hospital’s northwest side. Its three large Caesarean-section suites will connect

to the surgery suite in Mercy Hospital Oklahoma City. The proximity “allows for quick, safe access to additional services if there are any medical emergencies during delivery,” Mercy’s release said. The Love Family Women’s Center will have an emergency department staffed by obstetricians. A sky bridge will connect postpartum rooms on the third floor of the women’s center to the hospital, where the neonatal intensive care unit is located. Mercy said the new facility will have Oklahoma’s first hospital-based low-intervention birthing unit. The unit will be run by certified nurse midwives in collaboration with obstetricians. The Mercy Health Foundation Oklahoma City is providing 40% of the funding for the new obstetrics hospital. The Tom and Judy Love family gave a $10 million lead donation to the project. The couple are the founders of Love’s Travel Stops & Country Stores. Judy Love is co-chair of a campaign that, including her family’s donation, has raised more than $30 million toward a goal of $40 million. Mercy said the fundraising campaign is the largest in its history.