Catholic Health World - January 2022

Executive changes 7 Remembering Sr. Marianna Kosior 7 PERIODICAL RATE PUBLICATION

JANUARY 2022 VOLUME 38, NUMBER 1

Health care executives unite to end assaults against staff

Sisters of Charity Foundation partners on housing complex for homeless youth

By LISA EISENHAUER

Ann Schumacher says she wasn’t surprised by what participants in the roundtable discussion that kicked off the work of the American Hospital Association’s Hospitals Against Violence advisory group shared about incidents of violence in their health care facilities.

By JULIE MINDA

Schumacher

It validated that CHI Health Immanuel in Omaha, Nebraska, and CHI Health Mercy Council Bluffs in Iowa, hospitals she leads, were not alone in experiencing an upturn in aggression against staff in recent years and it reinforced her conviction that health care providers need to mount a coordinated Continued on 6

Bobbi Kinkelaar, chief nursing officer, left, and Chelsea Gouchenouer, manager of surgical care and nursing supervisors, read notes of encouragement from young students sent to workers at HSHS St. Anthony’s Memorial Hospital in Effingham, Illinois. The hospital invited three schools to help it show appreciation for the courage and sacrifices of health care workers during the pandemic.

Battling staff burnout with intentional care

By LISA EISENHAUER

Public safety officer David Hensley looks over live feeds from security cameras mounted around the campus of Mercy Hospital St. Louis.

The COVID-19 crisis has taken an especially harsh toll on the well-being of health care workers. For two years, hospital staff across the Catholic health ministry have treated wave after wave of seriously ill and dying patients, with little or no time to process their grief or regain their personal equilibrium. Nursing home staff are grieving too for the residents lost to COVID. They continue to draw deep into their reserves to offer emotional support and extra kindness

to keep residents who are isolated from loved ones and the outside community from sinking into another winter of loneliness and even despair.

Amid the unrelenting presure of COVID, so many caregivers have resigned from their jobs that there is a human resources crisis. The exodus has left many facilities short on staff and added to the strain on the depleted workforce.

Leaders at five Catholic health systems told Catholic Health World workers are exhausted and burned out.

Continued on 4

About 550 young adults sought homeless services including supportive housing slots and short-term rent subsidies in 2020 in Cuyahoga County, Ohio. Many of them did not receive the housing or services they pursued.

There is a significant gap between the number of young adults who are unhoused in Cleveland and the surrounding county and the resources available to enable them to secure short- or long-term housing, according to Housing First Cleveland. The collaborative, which includes the Sisters of Charity Foundation of Cleveland, has 782 units of permanent supportive housing in 13 buildings for people experiencing chronic homelessness.

To qualify for permanent supportive housing, its clients have a disabling condition and/or have been homeless for 365 consecutive days or a total of 365 days over at least four episodes in three years. Young adults facing homelessness often don’t meet those criteria, even though supportive housing is often the best alternative for them, says Angela D’Orazio, senior D’Orazio program officer for the homelessness focus area for Sisters of Charity Foundation of Cleveland.

To address this conundrum, Housing First Cleveland plans to create a diverse Continued on 8

Community health workers broker trust with medically underserved Workers’ community connections prove vital during pandemic

CHRISTUS delivers COVID care in remote patient monitoring pilot

By JULIE MINDA

By PATRICIA CORRIGAN

Several months after Becky Betts began establishing a population health department for Providence St. Joseph Health’s southeast Washington region, the pandemic exploded in and around Walla Walla, Washington. Particularly Betts hard hit was the large migrant population working the region’s fields and meat processing plant.

Betts says while 11 languages are spoken at the plant, the largest cohort of workers is Latino — a community that registered a distressingly high COVID-19 infection rate.

Betts and the two community health workers she’d just hired spoke only English. They spent hours calling all patients who were awaiting the results

When COVID-19 escalated demands on health care providers in early 2020, CHRISTUS Health developed a remote patient monitoring program to aid uninsured or otherwise vulnerable patients discharged to manage the illness at home.

Support teams that included community health workers distributed thermometers, oximeters and instructions for how to use a cell phone app and then monitored patients’ conditions.

The teams also provided practical and emotional support to the 561 patients enrolled. The program was a success. Now the health system is considering new applications for the remote monitoring program.

Continued on 2

Community health worker Soledad Gomez, right, leaves behind information at a home in San Juan Capistrano, California, on services and programs offered by family resource centers run by Providence St. Joseph Health’s Providence Mission Hospital. This visit took place pre-pandemic, in October 2019.

Several months later, in response to COVID-19, the hospital’s community health workers shifted their focus to migrant worker communities where they share guidance about the virus and vaccines.

What contributed to its success?

“A monitoring program originally used for patients coping with hypertension Continued on 3

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CATHOLIC HEALTH WORLD January 2022

Workers' connections of a COVID-19 test to help them better understand the disease. With Latinos accounting for the vast majority of COVID patients on ventilators at Providence St. Mary Medical Center, Betts convened a committee whose members were part of Latino and migrant groups and asked participants what Providence should be doing to raise health literacy and reduce COVID transmission in the Latino population.

“They told us, they don’t want glossy brochures — they don’t read them — and they said we can’t reach them through our normal channels,” she said. “They said they need (to hear information from) a trusted voice or the message falls flat.”

On the committee’s advice, the population health team began distributing public health information in Spanish through Spanish-language publications, radio and texting platforms, as well as through grocers and churches in the Hispanic community.

Betts hired a Spanish-speaking community health worker and partnered with a local winery to pay the salary of a second Spanish-speaking community health worker who reaches out not only to vineyard workers but also to others in the migrant community, as well as to Latino neighborhoods in Providence’s service area.

The quartet of community health workers immersed themselves in the migrant worker communities and other vulnerable communities and set to work dispelling COVID myths, spreading reliable information about the virus and infection prevention and helping people get tested for coronavirus. The trust they built put them in good standing to promote vaccination in 2021, including at mobile vaccination sites.

Front line of public health Catholic Health World spoke with several ministry members who have asked their community health workers to take on expanded roles related to COVID education and mitigation. These community health workers have leveraged their strong suit: using their credibility as influential members of cultures or ethnic groups that distrust health care providers to change hearts and minds and connect the vulnerable to services.

Community health worker has evolved into a catchall category of sorts. It takes in volunteers and people who are employed by hospitals and health systems, nonprofit agencies and government and public health offices. They are frontline public health workers, who bring various education levels and backgrounds to their jobs.

Many are drawn from the community and culture of the folks they are attempting to influence and educate. Literally and figuratively, they speak their language.

MHP Salud, a nonprofit that promotes the community health worker model, says it was used in Latin America, where the role is called promotores de salud, before being introduced in the U.S. in the 1960s. There are community health workers in all 50 states and the District of Columbia, and in countries around the world.

During the pandemic, many Catholic health systems are using community health workers — either on a paid or voluntary basis — as part of their directed outreach to vulnerable and vaccinehesitant populations.

Mercy of St. Louis is among those using community health workers to provide COVID education to some of its high-risk communities. Dara Webb, Webb Mercy executive director of care management and quality, says it is important to many people in minority communities that community health workers “look like them, can relate to them and are culturally competent.”

Mercy’s staff of 10 employed community health workers in the greater St. Louis

Photo courtesy of Seven Hills Vineyard

From page 1

Health promotora Maria Remington, far right, distributes educational materials on heart health to seasonal vineyard workers in the Walla Walla, Washington, region. Providence St. Joseph Health covers part of Remington’s salary.

A large number of homes in Meacham Park, a Black neighborhood in a predominantly white suburb, were demolished more than a decade ago to make room for a big-box shopping center. The police killing of the Employees of PeaceHealth and health promotores from its partner Community unarmed Black to Community Development staff a popup COVID-19 vaccine clinic in Bellingteenager Michael ham, Washington, in March 2021. At left is Rachel Lucy, community health Brown in Ferguson director for PeaceHealth in the Pacific Northwest, and in the middle is Australia in 2014 sparked Tobon, a Community to Community promotora. protests that propelled the Black region — four of them are Black, and six Lives Matter movement. are white — hold bachelor’s degrees and/ To reach the vaccine hesitant in these or have experience in public health, health communities and elsewhere, Mercy comeducation, social work and similar fields. munity health workers continue to make Mercy embeds five of its St. Louis-area com- presentations at local venues and go door munity health workers in its emergency to door to talk with people about their perdepartments and five in its clinics. Prior to spectives on COVID. the pandemic, they focused on coordinatThe workers dispel myths community ing patients’ care and connecting patients members may have picked up on social with socioeconomic support programs. media or other channels, says Webb.

Mercy has used community health workers for outreach to vaccine-hesitant, Black Online and door-to-door residents of Meacham Park and Ferguson Community health workers at Provi— communities with low levels of trust in dence Mission Hospital in Mission Viejo, institutions and a lot of vaccine resistance. California, either assist patients with care

In February 2020, Maria Guadalupe Madrigal, at left in foreground, and other community health workers provide information to passersby in San Juan Capistrano, California, on programs and services of family resource centers run by Providence St. Joseph Health’s Providence Mission Hospital. As a pandemic precaution, these workers shifted from in-person to virtual outreach in spring 2020.

and social service coordination or do outreach and education to vulnerable populations. Most of the health advocates in the latter group speak Spanish and either hail from medically underserved, predominantly Hispanic communities or are attuned to the culture of those communities.

Mission Hospital also contracts with Latino Health Access to use its health promotores.

Christy Cornwall, director of community benefit for Mission Hospital, says that before the pandemic the hospital’s health advocates and Latino Health Access employees regularly canvassed lowincome, immigrant communities to talk to residents about how to access health care and social services and to explain the importance of participating in the census.

Eduardo Moreno Cerezo, Mission Hospital healthy communities manager, says because of infection transmission risks — the Latino comMoreno Cerezo munities were hard hit by coronavirus — members of the health advocate team he leads initially had to stop their in-person outreach and provide public health information by phone and social media.

Sanchez Mission Hospital health advocates Jenny Sanchez and Rocio Telumbre say once team members were vaccinated and community infection rates came down they resumed door-to-door Telumbre outreach and in-person pitches at community forums where they encourage vaccination.

When vaccine uptake continued to disappoint, Mission Hospital convened focus groups to find out why. Participants said they did not trust the health system or the government. Those who were undocumented feared the government would trace them if they filled out vaccination forms.

Some had wanted to get vaccinated but were working during clinic hours. Some couldn’t use a computer to register for a shot. Others lacked transportation to get to the clinics.

The health advocates used the input to tailor vaccine dispensing site protocols and access to meet community members’ needs.

Blind spots In the Pacific Northwest PeaceHealth has long involved community health workers in patient care coordination, but it wasn’t until COVID struck that its hospitals in northwest Washington ramped up

January 2022 CATHOLIC HEALTH WORLD

efforts with community health workers specializing in community outreach, says Rachel Lucy, that region’s community health director.

Early in the pandemic, PeaceHealth recognized Lucy that not everyone was getting access to health information and testing and supplies for COVID prevention. “What we learned,” says Lucy, “was that we had a number of blind spots in health access, and we took this crisis as an awakening.”

Remote COVID care From page 1

quickly morphed into one focused on COVID-19 outreach,” said Kala Guidry, program manager of health equity data management and analytics at CHRISTUS Health. For 14 days, COVID-19 patients reported their vital signs twice a day to the support team, either through the Guidry app or by phone.

In addition to teaching patients or family members how to use the app, support team members helped them enroll in insurance programs, coordinated delivery of food and household supplies, found financial aid for everything from medications to mortgages and even located a working refrigerator for one family.

The teams included 15 certified community health workers and case managers, many of whom were responsible for other duties as well. “They all are highly skilled, seasoned individuals, used to multitasking,” Guidry said. “They knew the patients, they knew who needed help and they pushed their sleeves up and did what needed to be done — this is a heroic story of everyone coming together.”

Building better connections Michael Talley, vice president of virtual care and clinical operations at CHRISTUS

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The blind spots were in predominantly Hispanic migrant agricultural worker communities and other minority populations that experienced higher rates of COVID infection and worse COVID outcomes than the white population did.

PeaceHealth responded by partnering with Community to Community Development.

That Bellingham, Washington-based organization engages promotoras, volunteers and others to advocate for the rights of vulnerable groups, espeTobon

cially agricultural workers. Australia Tobon, a Community to Community promotora, says while her organization has deep connections with the agricultural workers and other migrant laborers, it lacked the medical expertise and resources to get them COVID information, protective equipment for those working in food processing plants and convenient access to vaccines.

The partnership forged early this year relied on Community to Community promotoras to get out information to the agricultural workers and other vulnerable minority groups; PeaceHealth administered the vaccinations. Leaders in the farm-

worker community got vaccinated early and taped pro-vaccination testimonials for social media to encourage their fellow workers to get immunized.

PeaceHealth set up dedicated clinics at times that were convenient to the agricultural workers. Promotoras led the outreach and scheduling, and they accompanied people coming for vaccines. Sometime later, public health agencies and federally qualified health clinics further expanded vaccine access to agricultural workers through mobile health clinics.

Health, added, “The team gets a lot of credit for deploying remote patient monitoring based on its utility and innovation, but what made this program so successful was their thoughtful collaboration Talley and outstanding execution. Because of their hard work, we were able to keep our doors open to those most in need.”

Guidry noted that the remote monitoring program proved its value. “This was an example of crossing over, to be able to truly see continuation of care between in- and out-patient, a program that paved roads that were not there before,” she said. “We’d been meaning to go in that direction for a while, and COVID-19 pushed us more in that direction.”

Yollanda Hilliman, who until recently was program director of virtual care and clinical improvement at CHRISTUS Health, explained that in February or March of 2020, the system was presented with an opportunity from a company that wanted to fund a pilot program Hilliman for remote patient monitoring. “When our managed care leader brought the idea to us, we thought it was perfect as a decompression strategy for our emergency room or inpatient services,” she said.

Hilliman, who left CHRISTUS Health in October, said that the same company that originally provided the remote monitoring devices for home care of COVID-19 patients provided additional devices last sum-

mer for home monitoring of patients with chronic obstructive pulmonary disease and congestive heart failure.

“We’d like to explore (remote monitoring) further and expand the program to patients with pneumonia and the flu,” Hilliman said at the time. “We’re also discussing how to incorporate remote monitoring as a solution for long-term care.”

appreciative patients were,” Hilliman said.

“They told us that with so much unknown, patients knew they had a team they could reach out to, and they knew the team would do everything to help.” One patient wrote, “Thank you for staying with me throughout this scary journey. God bless your program.”

Esmeralda “Mela” Perez, director of community health for the CHRISTUS Santa Rosa Health System, led a team that consisted of herself and two community health workers at CHRISTUS Santa Rosa Hospital – Medical Center and CHRISTUS Santa Rosa Hospital – Westover Perez Hills, both in San Antonio.

Before COVID-19, community health workers had supported physicians by offering information to patients, Perez said. Their role completely changed as they focused on obtaining information from patients.

“We contacted the physician on call if we learned a patient had a fever or their oxygen levels had dropped,” she said. The team also worked to identify issues causing stress, such as the need to connect with a food bank or other resources. “There were so many factors that played into supporting each individual, and sometimes even after the 14 days, we continued to talk with patients.”

Reflecting on the experience, Perez said, “COVID-19 gave us the benefit of learning what we could do when it seemed impossible. We found we were able to provide care for patients way beyond the walls of the hospital. This is what we do — spread the healing ministry of Jesus Christ. I believe we came together successfully to do that.”

Adaptive staff, grateful patients Staffing was a challenge in structuring the COVID-19 remote patient monitoring pilot. Hilliman met with Guidry’s team to brainstorm. “They came up with the idea to use resources already in place — our community health workers, our emergency department navigators and also care management workers at some of our facilities,” she said. Initial conversations about launching the program began in May 2020, and “soon everything was in place as relates to physician oversight, creating protocols, determining eligibility criteria and making changes to our electronic medical records system.”

In July 2020, CHRISTUS Health launched the program at three of its facilities, eventually putting it in place at 10 sites in Texas and one in central Louisiana. “This program provided CHRISTUS Health care providers added confidence to discharge patients who needed ongoing monitoring,” Hilliman said. She paused and laughed, remembering how quickly it all came about. “It was wild,” she said, “but it worked, and it was great!”

Hilliman knew that because patients told CHRISTUS so.

Twelve days after enrolling, patients were asked for their feedback. “Resoundingly across the board, we heard how

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CATHOLIC HEALTH WORLD January 2022

Countering burnout

Damond W. Boatwright

During rounds, Kaiser recalls a nurse manager in an emergency department urging her to ask the public for its help in letting health care workers get some much-needed rest by following protocols like masking, distancing and getting vaccinations.

Kaiser says at every opportunity she has done just that, urging people to follow public health recommendations. “It’s what needs to happen so that there’s additional capacity to rebuild. We all need a chance to recharge our batteries and catch our breath.”

President and chief executive Hospital Sisters Health System Springfield, Illinois

Joseph Impicciche

From page 1

They say mitigating stress and restoring resiliency among the workforce is a top priority. They shared the many ways they are attempting to nurture the emotional, mental and spiritual health of their staffs.

Damond W. Boatwright says the issue at the top of his agenda at Hospital Sisters Health System isn’t a strategic, operational or financial one.

“My number one concern is the overall well-being of my workforce and then the workforce within Boatwright the health care industry overall,” says Boatwright, who took the reins of the Springfield, Illinois-based system in June after seven years of leading SSM Health Wisconsin.

He believes that the best way to stabilize the industry as it continues to reel from the demands of the pandemic is to see to the needs of its workers, including addressing the burnout many of them are experiencing. To that end, he says Hospital Sisters Health System has tried to be creative in reinforcing its gratitude and recognizing staff efforts and sacrifices.

One means of recognition the system started is the HSHS Appreciation Hub. The online staff portal is a space where managers and colleagues can post messages to encourage and celebrate one another. By mid-November, the portal had more than 2,000 posts from the workforce of 12,800.

“A lot of those messages are ‘I believe in you,’ ‘Hang in there,’ ‘We’re going to do it together,’” Boatwright says. “That’s just very inspiring for me and that’s part of what’s helping boost the overall spirits of our staff.”

The system has ramped up its wellness offerings, too. It is using its Live Well intranet site to push out content and promote activities such as webinars on self-care. The site has three parts: HSHS Community to let staff connect so they can encourage and support one another; HSHS Health Now that gives providers a platform to offer advice and information about self-care and wellness; and We Are HSHS to share motivational stories from within the workforce.

Another step the system took early in the pandemic was to review its health plan to make sure that the coverage included virtual visits with mental health care providers. The system also enhanced its employee assistance program to expand the free counseling and purchase more hours of mental health programming.

Boatwright says he has tried to ensure that workers and their families have easy access to well-being resources, too. He’s also made it a personal mission to advocate for their use, even sharing that he has tapped those resources as he’s transitioned to his new role in a tumultuous time.

“As the president and CEO of this organization, I use the employee assistance program for counseling myself, for help with stress and fatigue and self-care tips as well as helping practice overall mindfulness,” he says. “It’s helped me with balancing work with home life.”

Boatwright’s advice to care providers across the ministry is, along with using available self-care resources and assistance, to trust in prayer and divine guidance. He finds comfort in these words of Mother Mary Odilia Berger, founder of the Sisters of St. Mary: “Continue on courageously for the love of God.”

President and chief executive Ascension St. Louis

Dr. Luke Williams, center, chooses a lunch from a delivery cart at CHRISTUS Ochsner St. Patrick Hospital in Lake Charles, Louisiana. The lunches came courtesy of the hospital’s Health Information Management team for frontline workers as the hospital was deluged with a fourth surge of COVID-19 patients last fall.

Laura Kaiser President and chief executive SSM Health St. Louis Laura Kaiser underscores that the stress and trauma the pandemic has created for the health care workforce is weighing upon the thousands under her leadership as president and chief executive of SSM Health.

“There’s been a tremendous psychologiKaiser cal toll and the team is weary, very weary, because it seems unending,” Kaiser says.

Part of the burden is due to the shortage of staff and the burnout that shortage is causing, especially for those on the front lines. When she talks and meets with other health care leaders, Kaiser notes, they all say that their staffs need reinforcements.

“The absolute number one thing that any of us would do, if we could, would be to find staffing relief,” she says. “We would call in the cavalry. But there’s literally no cavalry across the planet because we’re all grappling with the same thing.”

Kaiser says SSM Health closely monitors the results of its quarterly well-being index, a survey tool that measures the level of distress among care providers. The results are informing the tools and programs it is offering employees to foster emotional and spiritual health and overall well-being of team members.

Among the steps the system has taken is to enhance its employee assistance program so workers have unlimited access to counselors. Another is to ensure that the system’s health care coverage encourages workers to connect with psychosocial counselors, including those with trauma training, through in-person or telehealth visits.

A third is a partnership with the Lifespan Research Foundation at Harvard University, a research project focused on improving people’s lives. That partnership allows clinicians to join virtual support groups, participate in virtual chats on a range of wellness topics and take part in “Schwartz Rounds,” sessions for open discussion of sensitive issues with other care providers.

SSM Health’s hospital-based spiritual care and mission integration team leaders have increased their efforts to be more visible to staff — rounding more frequently to meet with clinical colleagues and being visible and approachable at staff gatherings.

Kaiser says she and other executives across the four-state system also are being more intentional about celebrating staff achievements.

Last spring, SSM Health produced an hour-long documentary, “Behind the Mask,” that tells the stories of staff members who have been on the front lines of the pandemic. Kaiser says the movie is a way to acknowledge the extraordinary work caregivers are doing and to urge viewers to do what they can to stop the spread of COVID.

Joseph Impicciche says he’s never been as humbled to be part of Ascension as he has been over the last two years.

“Throughout this pandemic, our associates and clinicians have remained steadfast in their commitment to providing compassionate, personalized care to Impicciche those we are privileged to serve,” he says.

To encourage staff to tend to their own emotional and spiritual needs, Impicciche notes that Ascension has launched several initiatives. One is the “Clinician Well-Being and Engagement” playbook for clinical leaders that the Ascension Medical Group developed. The booklet covers nearly 40 best practices to improve efficiency, personal resilience and wellbeing among clinicians. Among the practices cited is to create mentoring or coaching programs on how to handle stress.

Another example he points to is Ascension’s Create a Positive Workplace initiative. It includes tools and resources such as webinars for nurses and nursing leaders “with the aim of increasing resilience, agility, self-care, self-compassion, and connection, while also mitigating workplace violence, stress, anxiety and burnout,” he says.

Early in the pandemic, the system created a platform called “myCARE” and a website that put in one location links to all of the physical, mental/emotional,

An emotional support dog named Hap gets a belly rub from Samantha Muzzy, a technician who works in the emergency room at HSHS St. Anthony’s Memorial Hospital in Effingham, Illinois. The hospital launched a pet therapy program in partnership with the Alliance of Therapy Dogs. On a weekly basis, certified therapy dogs and their handlers visit patients and workers at the hospital.

January 2022 CATHOLIC HEALTH WORLD

Working with the Sisters of Charity of St. Augustine congregation, the hospital created an employee care fund to help the furloughed staffers. The fund has provided assistance to more than 200 staff members and it continues to accept donations and distribute aid, even though the unpaid leave has ended.

“It’s kind of like the loaves and fishes,” Murphy says. “It’s never run out. It feels like just when we get low a donation comes in that helps get us through.”

At Light of Hearts Villa, a Sisters of Charity memory care facility, managers have been intentional about urging the staff to overcome their hesitancy to use paid time off for fear of neglecting their patients. “There was a great effort at To acknowledge the extraordinary work of caregivers during the pandemic, SSM Health produced Light of Hearts to really say to the staff: It’s “Behind the Mask.” The hourlong documentary aired on the NBC affiliates in all SSM Health markets in important for you to have some time away October. Sports commentator Bob Costas narrates the feature, which can be viewed on SSM Health’s and we encourage you to do that and not YouTube channel. to feel guilty,” Murphy says.

At Joseph’s Home, a homeless service financial, occupational and well-being She recalls that some of her most dif- provider exclusively focused on medical resources available to associates. The ficult days on the job during the pan- respite care, the ministry started a partresources also are accessible in a custom- demic came early on when the governor nership with the nonprofit College Now ized mobile app.

Greater Cleveland to help Ascension set up virtual staff identify career goals spiritual care to make chapand pursue education or lains available at all times to certifications needed to console and counsel assoaccomplish them. The ciates. In addition, Impicpartnership can assist ciche says: “Throughout the with accessing financial pandemic, we have hosted resources. a number of events to help Across the system, leaders and associates Murphy and other leadgather as a community and ers have stepped up their reflect upon, share, process rounding to stay in close and find meaning in our touch with — and offer pandemic experience.” support to — workers Impicciche notes, too, on the front lines of panthat associates who particidemic care. In warmer pate in the system’s medimonths, facilities have cal plan, SmartHealth, have hosted appreciation access to the Ascension events outdoors to laud SmartHealth Well-being staff and give them opporProgram. That program tunities to socialize while offers workers a variety of Nurses paint flowerpots that will be used to hold chrysanthemums at SSM Health Saint still observing COVID-19 challenges, trackers and Louis University Hospital. Each month a different hospital unit gets to take part in an protocols. other resources to support Arts and Crafts For Your Wellness activity.

“The greatest gift we and encourage their perhave is the gift of each sonal wellness efforts. of Ohio ordered a temporary halt to non– other and by lifting each other up whenTo stay grounded and focused himself, emergency and elective surgeries. That ever that’s needed — because we all have Impicciche says he is trying to start each order created a reduction in demand for different times when we’re at a low ebb — workday with prayer and carve out some service at St. Vincent that led to furloughs I think that has been the most gratifying time for exercise. He encourages others for more than 300 workers, creating emo- work of all,” Murphy says. across the Catholic ministry to develop tional and financial stress. similar habits to create a healthy work-life balance.

He says: “My best advice is to find time to pray, commit to regular exercise, stay connected with family, and do your best to find quiet time to reflect and recharge.”

Janice Murphy President and chief executive Sisters of Charity Health System Cleveland Janice Murphy plans to bring the same focus on staff wellbeing that she has had as president and chief executive of St. Vincent Charity Medical Center in Cleveland to her new lead role at the medical center’s parent, Sisters of Charity Health SysMurphy tem. Murphy took over the system’s top post Jan. 1.

At St. Vincent, she oversaw the creation of “Code Lavender” to provide extra emotional and spiritual support to departments that are especially burdened by COVID-19 care. When the code is called, it summons a team led by a member of the pastoral care staff. The team brings a cart with aromatherapy tools and other relaxation-inducing items. The team also guides their colleagues in prayer.

“Code Lavender is a way for the whole organization to surround a unit with love and prayers and ways that we can help alleviate the stress,” Murphy says.

Staff members at St. Vincent Charity Medical Center in Cleveland enjoy a picnic meal provided by the hospital as a show of appreciation. The medical center is part of the Sisters of Charity Health System.

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George B. Avila System vice president, mission integration CHRISTUS Health Irving, Texas For CHRISTUS Health, the challenges of the pandemic have come in waves across the ministry’s sites in the southwestern United States and those in Mexico, Colombia and Chile.

George B. Avila, the system’s vice president of mission inteAvila gration, says just as one ministry is catching its breath from a COVID surge, another is inundated with new cases.

To address the compassion fatigue within its workforce comprehensively, Avila says the system created a team early in the pandemic with members from various departments, including mission integration, spiritual care, human resources, change management and talent management. Its charge was to take a “holistic mind, body, spirit approach” to associates’ needs.

The team has focused on the three R’s: resources, recovery and response. One resource the team created is an online channel for associates with videos and resources on wellness and resiliency topics. Another is the CHRISTUS Moment, a weekly video reflection shared systemwide in English and Spanish that contains a message of hope and resilience.

On recovery, the team looks at results from employee engagement surveys. At sites or in units where scores fall, action teams of leaders and nonclinical staffers are sent in to round with staff and offer support. In addition, chaplains are deployed to the floors to counsel and pray with colleagues.

Avila says for cases of extreme crisis, CHRISTUS has trained a group of about 60 people on critical incident stress management to respond. They are sent in or connected virtually to debrief staff, defuse the tension and teach coping skills.

CHRISTUS entered a new contract with Stericycle Communication Solutions, a firm the company has long engaged to make wellness checks on patients by phone. Avila says CHRISTUS now also contracts with Stericycle to check in on the well-being of the system’s associates.

“The point of the phone calls is just to say, ‘Hey, we want to say thank you for all that you’ve been doing. We know that it’s been a difficult time,’” he says. Stericycle nurses ask workers about their well-being, posing a question like: “What’s bringing you strength during this time or what’s been difficult?”

If clinicians indicate that they need immediate support, the callers can transfer them to CHRISTUS chaplains or to counselors with the system’s employee assistance program who are at the ready to listen.

The pandemic hasn’t been the only source of trauma within CHRISTUS ministries. Major weather events also have caused destruction and disruptions. The system’s Lake Charles, Louisiana, facilities have been slammed by two hurricanes as well as a separate flood-inducing storm while dealing with COVID. In response, the system helped workers source generators and other necessities and it opened a grocery store where employees and their families could get staples.

Avila says CHRISTUS plans to stay focused on staff well-being and resiliency indefinitely. “We’re not going back to normal, and the impacts of the pandemic aren’t going to disappear once it’s calmed down,” he notes. “At some point, people are going to give themselves the time to deal with the trauma that they’ve gone through and so we just want to make sure that we’ve been thoughtful about developing programs to respond to that.”

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CATHOLIC HEALTH WORLD January 2022

United against violence From page 1

effort to turn the tide of threats and physical violence against staff.

“It was incredible, the very difficult experiences these health care leaders have witnessed and been part of shootings on their campuses, assaults of their teams, loss of team members due to violence,” she recalls of that virtual gathering in 2020. Schumacher, the president of the two CHI hospitals, was the only one of the nine participating health care executives from a Catholic system.

The advisory group’s work led to the release in October 2021 of a compilation of resources to help health care leaders deal with and, ideally, reverse the rising trend in violence.

At least one other group of health care leaders, the CEO Coalition, was formed in recent months to address the medical sector’s worsening trend of violence, borne out by case numbers gathered by the U.S. Bureau of Labor Statistics.

The coalition was created in early 2021 in partnership with the nonprofit Institute for Healthcare Improvement and Vocera, a company that makes mobile communications apps. Its goal is to create a national movement and action plan to safeguard the emotional and physical safety of health care employees and provide “the systems, tools, technologies, and resources they need and deserve to feel safe at work.”

The coalition’s founding members include two top executives from the Catholic health ministry: Laura Kaiser, president and chief executive of SSM Health and chair-elect of CHA’s Board of Trustees, and Dr. Rod Hochman, president and chief executive of Providence St. Joseph Health, and a past chair of the CHA board.

“This is not an exclusive group,” Kaiser says. “This is inclusive and we’re inviting others to lean in. This is a goal that, just like with ending the COVID pandemic, we’re all working toward.”

A worsening trend The relatively high incidence of violence in the health sector is not new. The U.S. Bureau of Labor Statistics reports an uptick that goes back at least to 2011. It notes that in 2018: Health care workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence.

The incidence rate for nonfatal occupational injuries and illnesses involving days away from work due to intentional injury by another person was 10.4 per 10,000 full-time workers in the private health care or social assistance sector, compared to 2.1 for all full-time workers.

Health care leaders and organizations say violence has continued to worsen during the pandemic. A report called “Injury to None” released in February 2021 by the union National Nurses United said about 20% of the 15,000 nurses it surveyed reported an increase in workplace violence since COVID inundated hospitals.

Nurses attributed the increase “to multiple factors including decreased staffing levels, changes in patient population, and visitor restrictions,” the report said.

More threats amid pandemic Jason Grellner is executive director of public safety for Mercy, a health system based in suburban St. Louis with facilities in four states. Grellner says he has seen violence and threats spike in his four years with Mercy and especially since the start of the pandemic. Where before such incidents happened mostly in behavioral health units or emergency departments, he says they are now being reported in clinics and pharmacies.

“One hospital has had three occasions in the last 12 months where individuals have threated to come on campus with firearms and shoot multiple workers and we’ve had to involve local, state and even federal authorities in some cases,” Grellner says.

Pillars of safety The Hospitals Against Violence advisory group is working to improve safety in health care facilities nationwide. The group helped the American Hospital Association craft a framework called “Building a Safe Workplace and Community” that is based on four pillars: a culture of safety at health facilities, mitigation of potential risks, violence intervention and trauma support.

The board and the association A security officer enters a security office substation near the main entrance at Mercy Hospital St. Louis. The hospital developed resources around has another substation near the busy entrance to its emergency department. The main security office is elsewhere on the framework that include an the hospital campus.

11-page guide called “Creating Safer Workplaces,” case studies, are too few beds in drug rehab and behav- a podcast and a blog. ioral health programs, he says. He also cited The initiative urges a number of practices the normalizing of “street narcotics” such on health care campuses, including creatas marijuana, which can make some users ing policies to increase safety and educatmore prone to violence; the shrinking pool ing staff on how to spot threats and training of medical workers that results in over- them on violence prevention. stretched staff; and the coarsening of diaSchumacher says another piece of the logue and increased factionalism across U.S. initiative is to collect and share data “so that society as contributing factors. we can understand better the depth and “We’ve had clinic spaces where people breadth of violence in health care as well as have threatened our staff because they were have the ability to start measuring outcomes unhappy with service, because they were for some of these interventions.” frustrated with their day,” he says. “They Part of what’s driving the Hospitals took it out on our co-workers and what nor- Against Violence effort, she says, is a desire mally would have been ‘I’m sorry, I’m hav- to take responsibility for and deliver on ing a bad day’ becomes ‘I’m going to assault efforts to address violence. “I think by takyou, spit on you, punch you.’” ing a stand the American Hospital AssociaMercy, like many other health care sys- tion and this advisory group are saying, ‘We Sarge the security dog and his handler Pat tems, has taken a number of steps to deter are accountable, we are going to come to McKenna, part of the Providence K-9 Security and respond to violence. It has added secu- the table and we are going to transform the Program, are dressed for the holidays as they make rity cameras so there are now more than workplace,’” Schumacher says. the rounds to spread cheer at Providence Sacred 6,000 systemwide as well as panic alarms The group is encouraging health care Heart Medical Center and Children’s Hospital in that staff can use to summon security offi- leaders to partner with their communities Spokane, Washington. cers; invested in or explored other technol- and with other organizations, such as the ogy such as robotics and geolocation sys- International Association for Healthcare Even though none of those threats resulted tems; and expanded staff training on how to Security and Safety, in their efforts. in violence, he says the fear and uncertainty react in the event of an armed intruder and they induce add to the stress on health care other threats.

Heightening awareness campuses.

“We want Mercy to be a safe place to The Hospitals Against Violence initiative He suspects the rise in violence in health work, a safe place to receive care, and a safe and the CEO Coalition hope to draw more care facilities is related in part to a lack of place to shelter when you can find no other attention to the increasing risks faced by community mental health resources. There safe place,” Grellner says. health care workers, spurring answers and action.

Kaiser says many people are surprised to learn that health care has a much higher prevalence of workplace violence than other sectors. That violent incidents are on the rise at SSM Health as at other health systems is tragic, she says.

The declaration of principles that Kaiern Rennier instituted some new practices at CHRISTUS St. Frances Cabrini in ser and fellow founders of the CEO CoaliAlexandria, Louisiana, that he credits with improving security and reducing the risk tion drafted to guide their work lauds the of violence there. He did it without adding to the staff he’s overseen “selfless acts of courage, care, and compassince taking the job of security manager two years ago after retiring sion” by health care workers during the panfrom the city’s police force. demic. It also acknowledges the pandemic His main change in tactics has been to increase his team’s visibilhas “exacerbated the factors contributing ity on the hospital campus. One way he has done that is by dividing to workplace violence, created an environthe campus into zones and assigning security officers to cover them ment of unprecedented stress, and exposed in three-hour stints. “They go in, make checks, sign books to confirm the impact of systemic inequities and racial that they did the security rounding,” he says.

Rennier injustice on the well-being of healthcare Then, the officers shift to a different zone. That switch increases team members.” the chance that staff, patients and visitors see more than one uniformed security

Security chief at CHRISTUS hospital relies on visibility, vigilance V

person.

One of the zones is the hospital’s parking areas. To patrol them, the security team added a cruiser that looks like those used by police. The officer driving it keeps its blue and red lights on, but not flashing. Rennier says that before those patrols began, cars on the hospital lots were frequent targets of burglars. In the last two years there has only been one car burglarized and it was an unlocked vehicle.

He and his team also check in with the staff in the units to hear concerns about potential threats. If any are identified, Rennier says, they increase their rounding.

“What we’ve noticed, since we’ve done that, is we have less and less incidents that occur,” he says.

Rennier notes that the COVID-19 pandemic has brought new stressors, including visitation limits and mask mandates, that at times have heightened tension on the hospital campus. He and the hospital’s leaders have looked for simple ways to defuse that tension. One practice they started is to have security officers carry a baggie of face masks. When someone challenges masking rules, the officers politely explain that face coverings are a health care mandate and offer them one.

“We haven’t had any issues,” he says. “We haven’t had to escort anybody off our premises or anything like that since.”

Rennier says the new practices have given hospital staff a stronger sense of security. One new nurse told him that as she was weighing job offers, her sense that St. Frances Cabrini was safer than the other hospital in Alexandria proved to be the deciding factor.

“That was a pretty awesome story to hear from someone that was why they chose to come to work here,” Rennier says.

He adds: “Our security team at CHRISTUS St. Frances Cabrini is equipped with great de-escalation training and has been given the tools to be successful.”

— LISA EISENHAUER

A lead role for Catholic systems The coalition’s declaration urges developing and sharing strategies and best practices around the pillars of safeguarding psychological and emotional safety, promoting health justice and ensuring physical safety of workers.

Kaiser sees the coalition’s focus on health justice as an aspect of improved security that aligns with CHA’s We Are Called initiative to promote health care access and equity. It’s an area of the coalition’s effort where she believes the Catholic health ministry can play a lead role.

“Who better than Catholic health care to be in the midst of that work, asking for it, driving it, making it happen?” she asks.

Kaiser and Schumacher say that efforts to stem violence in health care workplaces need and deserve widespread public support.

Says Kaiser: “I think this is just the beginning of a much larger conversation and movement.” leisenhauer@chausa.org

January 2022 CATHOLIC HEALTH WORLD

7

Bon Secours Mercy changes leadership structure for two Ohio markets Bon Secours Mercy Health’s Lorain, Ohio, and Youngstown, Ohio, markets are beginning the new year with a new cross-market leadership structure.

Dr. John Luellen, the Luellen president of the Mercy Health – Youngstown market, also became president of the Mercy Health – Lorain market and heads the cross-market leadership team. Ed Oley retired Jan. 1 as president of the Mercy Health – Lorain Market.

These individuals were promoted to positions covering Mercy’s Lorain and Youngstown markets: Stacie Call to chief nursing officer for Mercy Health – Lorain and Mercy

Call

Crawford

Kravec

Health – Youngstown.

Michelle Crawford to chief financial officer for those two markets.

Dr. James Kravec to chief clinical officer for those two markets.

Martin Tursky to chief operating officer for those two markets.

Additionally, Mercy announced these changes: Dr. Gil Palmer to president, Mercy

Tursky

Palmer

Wray

Heath – Lorain Hospital. He had been chief clinical officer for Mercy Health – Lorain.

Charlotte Wray will become president of St. Joseph Warren Hospital in the Youngstown market when Kathy Cook, the current hospital president, retires in April.

Wray is chief nursing officer for the Mercy Health – Lorain market and she has left her position as president of Mercy Health – Allen Hospital.

Jankowski

Dennison

Carrie Jankowski, who was vice president of ancillary and support for Mercy Health – Lorain, is now administrator for Mercy Health – Allen Hospital.

Cindy Dennison, who was chief financial officer for Mercy Health – Lorain, is now the facility chief financial officer for both Mercy Health – Lorain and Mercy Health – Allen Hospitals.

HSHS founder dies at age 99; she was among pioneers in consolidating ministry Sr. Marianna Kosior, OSF, died Dec. 11 at St. Francis Convent in Springfield, Illinois, at age 99. She led the founding of Hospital Sisters Health System of Springfield in Sr. Kosior 1978 and was the organization’s first president, heading the system until her retirement in 1989.

In an announcement on Sr. Kosior’s

death, Damond Boatwright, HSHS president and chief executive, said she “led an incredible life that was focused on serving others, and HSHS is grateful for her vision that has allowed our health care ministry to grow and evolve.” HSHS now has 15 hospitals in Illinois and Wisconsin.

Sr. Kosior attended St. John’s Hospital School of Nursing in Springfield before earning a earning a bachelor’s degree in food and nutrition from Fontbonne Col-

lege in St. Louis. While she was HSHS president, Sr. Kosior earned a master’s degree in administrative sciences from Notre Dame University in Indiana.

She was a dietitian and dietary department manager in Hospital Sister hospitals from 1950 through 1962 then was superior and administrator at Hospital Sisters’ hospitals in Effingham and Decatur, Illinois, before joining her congregation’s leadership in 1969. She was provincial from

1973 to 1979.

In the 1970s, Sr. Kosior and other congregational leaders developed a plan for bringing together the 12 U.S. hospitals founded

by Hospital Sisters. They created a structure that would allow for lay management while also enabling the sisters continued involvement in sponsorship and governance. The resulting organization, HSHS, was incorporated Dec. 26, 1978.

Sr. Jomary Trstensky, OSF, said Sr. Kosior had an “unwavering belief that the future of Catholic health care would be built on strong systems and lay leaders. With no blueprint she established Hospital Sisters Health System and entrusted others to give life to her vision.” Sr. Trstensky is chair of Hospital Sisters Ministries, the public juridic person of HSHS. She was HSHS president from 1989 to 2006.

Sr. Kosior had said of her ascension from dietitian to health system president: “I was open to the Holy Spirit and waited to see where the Lord was calling me.”

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CHA is seeking a director of member engagement. CHA advances the Catholic health ministry of the United States in caring for people and communities. Composed of more than 600 hospitals, 1,600 long-term care, and other health facilities in all 50 states, the Catholic health ministry is the largest group of nonprofit health care providers in the nation.

This position proactively promotes the value of being a member of CHA and serves as the primary liaison with CHA members.

Responsibilities include deepening relationships with members and shaping the member value proposition. The position oversees development, design and implementation of member engagement and retention plans and utilizes data to identify member needs and wants, as well as satisfaction with CHA services. The position informs association planning and communications and develops internal channels for sharing the information with staff across CHA. The director also participates in initiating new programs in collaboration with CHA staff. Some travel may be required.

CHA is seeking candidates with a minimum of five years working in a related position within a membership association or similar organization and knowledge of Catholic health ministry organizations. This position requires a bachelor’s degree or equivalent work experience.

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

Interested parties should direct resumes to: Cara Brouder, Sr. Director, Human Resources Catholic Health Association 4455 Woodson Rd. St. Louis, MO 63134 Phone: 314-253-3498 Email: HR@chausa.org

for Health Ministry Leadership

admissions@ai.edu | 314.256.8801

CHA is an equal opportunity employer.

8

CATHOLIC HEALTH WORLD January 2022

early 20s who have not established credit or a work history even if they have the money to cover first and last month’s rent and a damage deposit.

Cotton adds that when it comes to people of color — including minority youth — “our economy has been very broken and unjust due to a history of poverty and systemic racism.” She says, too, that behavioral health issues, running away from home, sex trafficking and other circumstances connected with being unhoused “are often consequences of homelessness, not causes.”

She notes that foster youth are more vulnerable than other young people “because more often than not, they aren’t provided with concrete support systems and are easily subject to instability.”

Housing homeless youth From page 1

continuum of housing options for young people including supportive housing and to offer more short-term rental assistance.

Construction is expected to begin in late spring and finish in the summer of 2023 on a new 50-unit supportive housing complex specifically for homeless adults age 18 to 24. Younger teens may be accepted for tenancy under certain circumstances, says D’Orazio.

She adds the foundation expects that tenants will get the assistance they require to rebuild or start their adult lives. “We see housing as a stepping-stone,” she says.

Near jobs, retail D’Orazio says Housing First Cleveland selected a building site in the city’s St. Clair Superior neighborhood with input from the REACH Youth Action Board, an advisory committee of six young people who have been homeless. That board has engaged in the planning process for the new housing development. The group said they wanted access to high-frequency transit, job and educational opportunities and childcare; and they also prioritized safety and diversity.

D’Orazio says the chosen site checks all those boxes.

Sisters of Charity Foundation convened the Housing First Cleveland partners now involved in the transitional age youth development and helped secure about $12 million in private, government and donor funding commitments. Total development costs are projected at just over $12 million.

The Housing First Cleveland collaborators heading the project are CHN Housing Partners, which is the lead developer and co-owner of the property; EDEN Inc., the co-developer, co-owner and property manager; and FrontLine Service, which will coordinate supportive services at the facility. The Cuyahoga County Office of Homeless Services and the Cuyahoga Metropolitan Housing Authority will provide rent subsidies. (See sidebar for more on some of these partners.)

Youth-designed Kai Cotton, 25, is the lead youth navigator at A Place 4 Me, a Cleveland nonprofit that provides services to homeless youth. A Place 4 Me is a partner in the youth housing project. Cotton, who had aged out of the foster system at 18, first connected to A Place 4 Me through their Opportunity Passport program, which teaches financial literacy and matches savings for young people who have been in foster care at least once after the age of 14. She went back to the agency when she faced housing issues. “They helped me with emergency assistance funds once I found a place to move into,” she said.

She tops the REACH Youth Action Board that has been advising Housing First on everything from design of the individual living quarters to wraparound social services that will be offered on-site.

In line with the advice of the peer panel, the units will have simple amenities that most people take for granted. For example, residents will be able to open and close the windows and to adjust the thermostats in their individual units.

The complex will have 38 one-bedroom apartments that each are up to 806 square feet. Twelve two-bedroom units of 1,113 square feet will be reserved for residents with children. About 25% of young adults who are homeless are parents, according to information from Sisters of Charity Foundation.

Supportive services — potentially in– cluding medical and mental health care, education and employment support and family mediation counseling — will be available on-site. The complex also may have an on-site training kitchen, indoor and outdoor play areas for kids, outdoor recreation areas and a computer room for

jminda@chausa.org Kai Cotton, right, the lead youth navigator at Cleveland’s A Place 4 Me, heads a board of formerly homeless young people that is giving input on the design of dwellings and programs at a supportive housing complex expected to open in the summer of 2023. A Place 4 Me, a nonprofit that aids homeless youth, and the Sisters of Charity Foundation of Cleveland are among the project’s partners. With Cotton is Shajuana Gaston, foster care youth navigator at A Place 4 Me.

job and school activities.

In accordance with the underpinning housing first philosopy, applicants generally will be approved for tenancy without having to meet many preconditions, such as achieving sobriety. Case managers, a therapist, a supportive employment specialist and other social service providers will be on-site to encourage residents to establish and pursue goals, which might include seeking mental health care, receiving addiction treatment, earning a degree, or securing a job.

D’Orazio says residents with jobs will pay up to 30% of their income toward rent.

Residents will be able to stay as long as they wish, but D’Orazio expects many to gain stability and then to move elsewhere, freeing up units for other unhoused young adults.

Resident empowerment D’Orazio notes that diversity will be welcomed, particularly since about 75% of homeless young adults are African American and an estimated 40% of transitionalage youth identify as lesbian, gay, transitioning or questioning.

“We want the residents to be very much involved as leaders, and we want

Housing First Cleveland partners Among the 17 organizations partnering in the Housing First Cleveland collaborative are:

AIDS Taskforce of Greater

— Angela D’Orazio

Cleveland — An AIDS service organization that provides social and medical services to people with HIV and prevention services to people at great risk for acquiring the virus that causes AIDS.

The facility’s culture will encourage all residents to have a voice in how the complex functions.

“We want the residents to be very much involved as leaders, and we want this to be a vibrant, youth-led place,” says D’Orazio.

CHN Housing Partners — A nonprofit organization that works with other organizations in Ohio and other states to increase capacity for affordable housing. CHN owns property that is funded by the U.S. Department of Housing and Urban Development.

this to be a vibrant, youth-led place.”

Consequences, not causes Cotton says there are many reasons young people may struggle with housing instability. They may age out of foster care, as she did, with few resources or skills and nowhere to go; they may have been raised in poverty and their family may be unable to feed or support them. She says landlords in the private market may be reluctant to rent to teenagers or people in their

Housing First Cleveland says it has almost ended homelessness for chronically ill in Cuyahoga County Leadership of the Housing First Cleveland partnership that is building the complex for transitional age youth says that collaborative has nearly achieved its goal of helping to end homelessness for chronically ill, chronically homeless adults.

Seventeen Cleveland-area organizations including the Sisters of Charity Foundation of Cleveland began meeting around 2002 to discuss the problem of chronic homelessness in their community, and then in 2006 they partnered as Housing First Cleveland with the lofty goal of ending chronic homelessness in Cuyahoga County.

Since then, Housing First Cleveland has built 13 supportive housing complexes that together have nearly 800 units, but none of those are expressly for young adults.

Housing First Cleveland also has made available more than 280 scattered site units — that is, housing outside of large complexes — for homeless adults. According to Angela D’Orazio, 95% of residents in Housing First Cleveland are now stably housed, meaning that they no longer are experiencing chronic homelessness. D’Orazio is senior program officer for the homelessness focus area for Sisters of Charity Foundation of Cleveland.

Housing First and its founders have secured more than $132 million in funding from the U.S. Department of Housing and Urban Development and other sources.

Over the past 23 years, the Sisters of Charity Foundation has donated more than $3.5 million toward solutions for the unhoused.

The city of Cleveland.

Cuyahoga County.

Cuyahoga Metropolitan Housing Authority — A chartered public housing authority that owns and manages property and administers rent subsidy programs for low-income people.

EDEN Inc. — A nonprofit housing provider that owns and manages housing for individuals and families who are affected by mental illness or who are chronically homeless. EDEN owns property that is funded by the U.S. Department of Housing and Urban Development.

Enterprise Community Partners — A national nonprofit that helps secure capital and undertake community development to increase the availability of affordable housing.

FrontLine Service — A nonprofit service provider that supports people in Northeast Ohio. Its areas of focus are ending homelessness, preventing suicide, resolving behavioral health crises and helping people overcome trauma.

Sisters of Charity Foundation of Cleveland — A health care conversion foundation with an endowment of nearly $100 million.

U.S. Department of Veterans Affairs.

A rendering of the 50-unit transitional age housing complex specifically for homeless adults age 18 to 24. Construction is expected to begin in the spring.