Catholic Health World - May 15, 2023

Benedictine president: Pandemic challenges linger in nursing homes

By LISA EISENHAUER

MINNEAPOLIS — Jerry Carley, president and chief executive of Minnesotabased Benedictine, says the challenges brought on by COVID-19 are far from over for skilled nursing care facilities and nursing homes, even as the national emergencies around the pandemic end.

Carley says regulatory demands and workforce pressures are putting the squeeze on a segment of health care that already was shrinking despite strong demand for its services. In an interview in mid-April with Catholic Health World and a brief followup conversation in early May, Carley talked

Trafficking victims get trauma-informed care at CommonSpirit clinics

By LISA EISENHAUER

One of the patients seen at the Human Trafficking Medical Safe Haven Program’s clinic at Dignity Health Medical Group — Northridge in suburban Los Angeles was a woman in her 60s who had been a captive domestic servant for 10 years and spoke no English. The woman had untreated diabetes that had created vision problems. She had a heart attack as those problems were being addressed.

She received outpatient care through the clinic and inpatient care at Dignity Health — Northridge Hospital Medical Center as she transitioned from victim to survivor and on to a new life through the collaboration of her care team, law enforcement and community-based organizations.

Dr. Pamela Davis, the physician group’s medical director and the designated champion of its safe haven clinic, says caring for patients who have endured the trauma of being trafficked and held captive is eye-opening for care providers.

about how Benedictine, which has more than 30 senior living communities in Minnesota, North Dakota, Iowa, Missouri and Illinois, is responding to the challenges. His comments have been edited for length and clarity.

The Centers for Medicare & Medicaid Services announced revised COVIDrelated guidelines for nursing homes that take effect when the public health emergency ends May 11. What will change for nursing homes?

The main change is that for the most part operationally what we knew pre-COVID

Swedish provides inpatient addiction treatment for pregnant people

Jerry Carley, president and chief executive of Benedictine, at his office in suburban Minneapolis. He says state and federal support is needed to help nursing homes attract staff.

Catholic providers aim to reduce harm from adverse childhood experiences

By JULIE MINDA

Decades of research establish that severe, chronic traumas endured in childhood can have far-reaching negative impacts on physical and mental health over a person’s lifetime.

The Centers for Disease Control and Prevention says heart disease, cancer, respiratory diseases, diabetes and suicide — five of the 10 leading causes of death in the U.S. —

are associated with the cumulative, chronic stress caused by multiple adverse childhood experiences, or ACEs.

Individuals who have high scores on ACEs screenings have a higher probability of requiring special education, dropping out of high school, becoming teen parents, experiencing severe depression, and being arrested for criminal behavior.

Preventing severe childhood traumas

Jenny Lao with her son, who was born healthy about two months after she completed the inpatient addiction treatment

By LISA EISENHAUER

SEATTLE — Jenny Lao says the addiction treatment program she entered at Swedish Medical Center saved her life.

“I feel really blessed,” says Lao, now the mother of a preschooler and the stepmother of two other children.

Lao had struggled with substance use disorder since her teens and served time in prison by the time, at age 30, she found herself expecting and dependent on opiates.

“I was so convinced that I would not be able to be a mom,” Lao recalls. “What I didn’t know then was that my disease was just running rampant in my head. All I could hear was if you just take a pill, this is all gonna go away.”

Lao says she knew that she needed care for her substance use disorder for the sake of herself and her unborn child. She also knew that women with substance use disorders often faced harsh judgment when

Black pastors urge colon cancer testing

In an effort to reduce the high rate of colorectal cancer deaths among Black Americans, Providence St. Joseph Health is turning to some trusted and influential voices in Black communities — church pastors.

Thirty Black Los Angeles church leaders are part of an exhibit that encourages preventive screenings. The pastors are pictured on 6-foot-high banners accompanied by a quote from each. The banners will travel among the churches and Providence hospitals in the Los Angeles area.

The American Cancer Society says Black Americans are about 20% more likely than members of other racial or ethnic groups to get colorectal cancer and about 40% more likely to die from it.

The display went up in mid-April at Providence St. John’s Health Center in Santa Monica, California. On hand for the opening was Dr. Anton Bilchik, a surgeon who treated actor Chadwick Boseman.

program at Swedish Medical Center in Seattle in 2018. Lao continues to take part in “medically shared” group meetings with care providers from the program and other graduates.

The star of the blockbuster movie Black Panther, Boseman died of colon cancer in 2020 at the age of 43.

This family received support from A Family Place in Oregon, including parenting classes, kids’ clothes, diapers and access to social services. The aid helped the mother to escape an abusive home situation and stabilize her life. Providence St. Joseph Health’s Oregon region has been providing funding to northwestern Oregon’s Lutheran Community Services Northwest for its A Family Place services.

Drug treatment for pregnant people

From page 1 they sought out addiction treatment during pregnancy.

In what she expected to be a futile, lastminute attempt to get help, Lao called the number she found online for the Substance Using Pregnant People’s Program at Swedish’s Ballard campus in Northwest Seattle. Swedish is part of Providence St. Joseph Health.

“When I called, they just showed me compassion and love and welcomed me immediately,” Lao says. “I think I really needed that because for so long, one day maybe I’d want to get help, but the next day that fear would set in. I think it’s so crucial that when you’re ready and you’re asking for help, that it can happen.”

High stakes inpatient care

Dr. Vania Rudolf is a specialist in addiction medicine, family medicine and obstetrics who has led the Swedish program for 12 years. She says avoiding shaming or belittling of the patients is an intentional part of the treatment protocol.

“When birthing parents admit to our program, we make sure that we celebrate them as moms who have the courage and resilience to work on recovery, optimal health and to make sure they have a healthy pregnancy and baby,” Rudolf says. The program’s team includes Drs. Mollie Nisen, Deedee Paster, Greg Parada, Collin Schenk and Jim Walsh. Rudolf says the substance that patients are misusing when they enter the program varies, but for more than 90% of them it is an opioid; more recently it is often synthetic opioids such as illicitly manufactured fentanyl. The Centers for Disease Control and Prevention report that the number of women with opioid-related diagnoses documented at delivery increased by 131% from 2010 to 2017. Opioid use disorder during pregnancy has been linked with pre-

term birth, stillbirth, maternal mortality, and neonatal opioid withdrawal syndrome.

The inpatient treatment program for pregnant women at Swedish admits about 600 patients per year. It is one of five programs that are part of Washington state’s Substance Using Pregnant People Program that can offer inpatient treatment for up to 26 days. Providence Regional Medical Center Everett is another provider.

Swedish accepts private and public insurance for the program, but coverage is not required for admission. The unit where Swedish’s program is housed has 25 beds, about half of which are for patients who require withdrawal management and stabilization. Patients stay in those beds for just a few days.

A patient’s individualized care plan can include medication-assisted treatment with methadone or buprenorphine, dialectical behavior therapy, psychosocial group therapy, education on addiction and recovery, spiritual care, and intensive case management and aftercare planning.

Self-revelation

Nina Pedro, a withdrawal management

U.S. OPIOID CRISIS: Addressing maternal and infant health

Opioid use disorder can cause many negative health outcomes for mothers and their babies, both during pregnancy and after delivery.

Opioid use disorder during pregnancy has been linked to:

Source: Centers for Disease Control and Prevention

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counselor, says most of the patients stay in the hospital for the full 26 days. The 24-hour nursing care they are provided includes obstetric care. If patients choose to stabilize from their substance use disorder and leave, Pedro says they are invited to return if they find themselves unable to stay clean. “I would say probably eight out of 10 times, that’s exactly what happens,” with patients who leave prematurely, she notes.

“This gives them incentives to do something new in their lives.”

One of the projects she assigns patients is to create an artwork that depicts what their safe space looks like. She says that project spurs conversations among the patients about where they want to be and how to get there.

Jeng says most of her counseling time is spent working one-on-one with a small number of patients to create a plan for each woman’s continued recovery after discharge. She links her patients to agencies that assist with their legal, housing, nutrition, childcare and other needs. “A lot of times they don’t even know that the services are available and they’re so grateful,” she says.

Lao says that by the time she graduated from the program, she had a binder full of information and was stoked by the guidance she had gotten on how to advocate for herself and her baby. She was ready, for example, to stand up for herself if her caseworker from Child Protective Services challenged her fitness to keep her newborn because Lao took Suboxone. The prescription drug contains the opioid buprenorphine and the opioid antagonist naloxone and is used to quell withdrawals and opioid cravings.

Lao never lost custody of her newborn son. “It ended up being not a super positive experience meeting with (the caseworker), but positive enough that it wasn’t traumatizing, like I had feared it was going to be for so long,” she recalls.

Extended postpartum hospitalizations

— Kristina Russell

Most of the patients are in their 20s or 30s, but sometimes teenagers go through the program. Some of the patients do not seek care throughout pregnancy due to stigma and marginalization and enter the program just after having given birth at a different facility. For them, the staff arranges visits with their newborns to support maternal bonding, nursing and engagement.

Kristina Russell is a group counselor in the Swedish program. “I meet with (patients) and work on discharge planning, on why they use and try to get some good coping skills under their belt so that, when they get out, they have some tools to hold onto,” Russell says.

Many of the patients get referred from the legal system or social service agencies. Russell says entering the program and accepting that they need help to address their addiction isn’t easy for any of them.

“None of these moms come in here and are happy that they’re using drugs,” she says. “None of them want to be doing that but they have this disease, and they can’t stop doing it. To come in here in and of itself is just a really hard thing to do.”

Russell says her favorite part of her job is when patients reach their “aha” moment and realize that they have to alter how they are living in order to be a good parent. “When they actually get it and they can go, ‘Oh, I need to change X, Y, and Z to be better for me and my family,’ I love that,” she says. “And that’s what keeps me coming back.”

The art of healing

Socializing is encouraged during art therapy assignments in sessions led by Shelly Jeng.

“A lot of times people come in and they don’t really know who they are or what their hobbies or their interests are,” Jeng says.

After completing the inpatient drug treatment program, Lao got care through the OB Outreach Clinic that Swedish operates for pregnant women with chemical dependency. When she gave birth, she took advantage of a five-day inpatient stay with her baby that is part of the COMPASSION national model. Rudolf developed the model and piloted it at Swedish for mothers who are on medication to reduce opioid cravings. COMPASSION is any acronym for Community of Maternal Parenting Support for Substance Impacted PeOple and Newborns. All 56 birthing hospitals in Washington state are in the process of adopting the model as part of the Washington State Perinatal Collaborative.

“What we find is that the COMPASSION stay on the postpartum floor offers patientcentered, comprehensive family care that facilitates wraparound services, early bonding and positive maternal/parenting engagement. It fosters commitment to offer a whole person treatment to all birthing parents, to promote healthy outcomes and to empower with knowledge, tools and confidence for them to meet the needs of their baby and family,” Rudolf says.

Finding her voice

Masitsa Muhanji finished the treatment program in 2017 and she continues to attend the program’s “medically shared” group visits for mothers in recovery. She credits the program with enabling her to break a heroin dependency that evolved from her having become dependent on the opioid in Percocet 10 years earlier, after the birth of her first child. Program staff also linked Muhanji to housing assistance and other services.

Muhanji has since become a public advocate for compassionate care of pregnant people with substance use disorders. In December 2018, she joined Rudolf and Washington Gov. Jay Inslee at a press conference where the governor rolled out a $19.3 million expansion of his opioid response plan that included funding for treatment of pregnant and parenting women.

Muhanji, holding her baby daughter Nala, told the gathered news reporters that the Swedish program “gave me a second chance, and it showed me I was strong, and I can do this.”

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Masitsa Muhanji and her daughter Nala appeared with Washington Gov. Jay Inslee in 2018 when the governor announced plans to expand his statewide effort to address opioid use disorder. Muhanji says the Substance Using Pregnant People Program at Swedish Medical Center helped her end an addiction to heroin.

Rudolf

“

None of these moms come in here and are happy that they’re using drugs. None of them want to be doing that but they have this disease, and they can’t stop doing it. To come in here in and of itself is just a really hard thing to do.”

Safe haven clinics

“I think many people don’t understand or realize that these kinds of trafficking experiences are happening not very far away,” she says.

Safe spaces for care

Jennifer Cox is system director in charge of the medical safe haven program, an offshoot of Dignity Health’s Human Trafficking Response Program. Dignity Health launched the latter program systemwide in 2014 to better identify trafficking victims in health care settings and to provide these patients with traumainformed care. Studies have shown that many victims of sex and labor trafficking have contact with health care providers.

A study done by the nonprofit antitrafficking organization Polaris found that survivors consistently reported disheartening interactions with medical care providers “ranging from a dismissal of their pain or symptoms, snide or insensitive comments or questions, to more overt harassing behavior such as victim blaming, or even abuse by emergency health professionals.”

When the Human Trafficking Response Program began, Cox was working in community health and outreach for Dignity Health. She built relationships with community-based groups offering safe harbor and services to trafficking survivors. Cox worked with the groups to figure out how health care providers and social service providers could improve access to care and services. Among the things she learned in the process was that most trafficking victims got only episodic care, such as in emer-

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What is trauma-informed care?

The core tenets of trauma-informed care, as defined by the Substance Abuse and Mental Health Services Administration, include:

Safety: Throughout the organization, staff and patients should feel physically and psychologically safe.

HUMAN TRAFFICKING IN THE U.S.

10,360 cases identified in 2021 by the National Human Trafficking Hotline

16,710 victims involved in the cases

Types of trafficking cases reported to the hotline

Sex: 7,499

Labor: 1,066

Sex and labor: 400

Demographics of survivors

Adults: 6,642

Minors: 2,365

Female: 8,142

Male: 1,292

Gender minorities: 132

Prosecutions in 2020

2,198 persons were referred to U.S. attorneys for human trafficking offenses, a 62% increase from 1,360 in 2011.

1,343 people were prosecuted for human trafficking, an 84% increase from 729 in 2011.

658 people were convicted of a federal human trafficking offense, an increase of 42% from 464 in 2011.

Sources: National Human Trafficking Hotline and the Bureau of Justice Statistics

gency rooms.

It was while doing that work that Cox met Dr. Ron Chambers, who directs the Dignity Health Methodist Hospital of Sacramento Family Medicine Residency Program in California. Chambers had gone through training as part of the Human Trafficking Response Program. He wanted to use that training to develop a model to provide longitudinal care for trafficking victims in a safe clinical space.

Working on the steering committee with Holly Austin Gibbs, system director of the Human Trafficking Response Program, Chambers and Cox developed the Human Trafficking Medical Safe Haven Program and launched the first safe haven clinic in 2016 at Mercy Family Health Center, a family medicine residency training center on the campus of Dignity Health Methodist. Chambers is the safe haven program’s medical director.

Today Dignity Health has medical safe haven programs with clinics in Sacramento, Santa Maria, Redding, San Francisco and Los Angeles that are connected to threeyear family and internal medicine residency programs. The integrated care model provides trafficking survivors with primary care; prenatal and obstetrical care; newborn, pediatric and adolescent care; mental health support; vaccinations; testing and treatment for sexually transmitted diseases; and other essential services. CommonSpirit, Dignity Health’s parent, plans to start another medical safe haven program in Merced next year.

All of the family practice residents complete a 10-week curriculum on caring for human trafficking survivors. They learn how to identify trafficking victims and survivors and provide appropriate, traumainformed care.

Bases for trauma training

Trauma-informed care emphasizes physical, psychological and emotional safety for both providers and survivors and creates opportunities for survivors to rebuild a sense of control over their lives.

Trustworthiness and transparency: Organizational operations and decisions are conducted with transparency and with the goal of building and maintaining trust among staff, patients and family members.

Peer support: Support from clinical peers is integral to the organizational and service delivery approach and is a key vehicle for building trust, and for establishing safety and empowerment.

Collaboration and mutuality: There is a true sense of partnership between organizational leaders, staff and patients.

dencies. Through 2022, 424 resident physicians had gotten the training and treated 523 trafficking survivors.

The residents get the practice they need to become the experts in their field on care of trafficking victims, Cox says. “The patients get access to the qualified and compassionate physicians they need to get healthy and stabilized,” she adds.

Dr. Kiersten Kelly, a resident in her second year of training at Mercy Family Health Center, says she was excited about the safe haven clinic when she interviewed for the family medicine residency. She says her appreciation for the training she is getting in trauma-informed care continues to grow.

“I have realized how special it is and how applicable it is to not just victims and survivors of human trafficking in our medical safe haven program, but also to all of our patients who we see with histories of trauma and needing or necessitating trauma-informed care,” Kelly says.

‘We make sure everyone is OK’

Kelly and the other 19 residents in the program at Mercy Family Health Center each provide care to about 25 patients through the safe haven clinic. They block off a half-day on their schedules for the safe haven clinic and see just a few patients during that time. The patients bypass the waiting rooms in family practice suites and go into private exam rooms as soon as they arrive. Each appointment lasts 60 to 90 minutes. The time slots are considerably longer than typical medical visits to allow the residents to develop a rapport and build trust with the patients.

The residents get a briefing from the clinic’s staff — which includes a program director, program coordinator and an embedded patient advocate — in advance of appointments. The briefings cover patients’ histories and conditions and any issues that need to be brought up. The residents work to develop a lasting primary care relationship with the patients.

After visits, the residents take part in debriefings to decompress and minimize their own stress and anxiety from caring for patients whose experiences of being forced into sex work, branded, beaten and more can be shocking. As Davis, whose career also includes many years as an instructor in family medicine at the University of California, Los Angeles, and as a program director for family medicine residents, explains: “We make sure everyone is OK. We’ve never had to offer our staff any outside help, but if we needed to, we would.”

‘Bridge of trust’

The embedded patient advocate at each clinic is employed by the clinic and a partner agency that works with trafficking victims and survivors. The advocates schedule appointments, arrange transportation, accompany patients on their medical visits and advocate for patients with care providers.

That bridge, she says, allows for a smooth flow of services to keep trafficking victims safe while addressing their health, counseling, housing, food and other needs.

Sawan Vaden is executive director of Community Against Sexual Harm, a nonprofit that provides mentoring, housing, employment and other assistance to women who are trafficking survivors in Sacramento. Vaden calls the safe haven clinic a crucial partner to her organization.

She says the clinic gets patients in quickly, usually within 72 hours, and the clinicians provide care without the judgment the women and their children have faced in other interactions with care providers. “It takes away the fear that the women have from their previous experience with medical personnel,” she says.

Many of the women haven’t had regular access to a medical care provider, Vaden explains. “They don’t know how to talk to the doctors,” she says. “They don’t know how to advocate for their own needs.”

Part of the care the women get at Mercy Family Health Center clinic is coaching on having autonomy over their own bodies, which previously had been under the control of their traffickers, Vaden says.

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Cox says graduates of the family practice residency spread their knowledge and skills about treating human trafficking survivors and trauma-informed care across the country as they move on from their medical resi-

Cox says a key to the success of each safe haven clinic is building what she calls “a bridge of trust” between the clinic and other stakeholders who provide resources for trafficking victims, including law enforcement, shelters and social services agencies.

Measuring success

Cox says she and the others leading the Human Trafficking Medical Safe Haven Program are collecting data on its now thousands of patient encounters to monitor its success. One of the metrics they are looking at is the self-sustainability and resilience rate of trafficking victims who become established in the medical safe haven program versus those who do not.

Cox says patients express their gratitude and tell their patient advocates things like: “I’ve never been treated like this before. I have hope. I feel like this is my family.”

She says directors of the residency programs that take part in the safe haven program tell her, “Yes, we’re going to continue this. This is helping our doctors become better doctors. This is healing our general patient population because they’re enacting these trauma-informed best practices. It’s making our communities healthier, and it’s giving us a unique opportunity” to teach a generation of physicians to provide patient-centered, trauma-informed care.

leisenhauer@chausa.org

Many of the women haven’t had regular access to a medical care provider, Sawan Vaden says. “They don’t know how to talk to the doctors,” she says. “They don’t know how to advocate for their own needs.”

Vaden

ACEs

From page 1

or providing interventions and treatments to children and adults whose childhoods have been marred by cumulative trauma could significantly reduce the probability of developing these conditions, says the CDC. ACEs include physical, emotional and sexual abuse or other violence in the home; neglect; a parent with mental illness or substance use disorder; divorce; or having an incarcerated loved one. Preventing ACEs, says the agency, could save almost 2 million people from developing coronary artery disease, spare 2.5 million from becoming overweight or obese and prevent 21 million cases of depression.

Two Catholic health systems are among those intervening to prevent adverse childhood experiences and to lessen the risk of harmful outcomes for children and adults who have experienced significant childhood trauma.

A Trinity Health family medicine clinic and a Providence St. Joseph Health region both have joined with community partners to lessen harms of ACEs with treatments, services and support.

See something, do something

Dr. Rachel Yankey is a family medicine practitioner with Saint Agnes Care, the provider network for Trinity Health’s Saint Agnes Medical Center in Fresno, California. She is a physician champion for an ACEs screening and referral system developed by Saint Agnes and its community partners. She says, “Our population is struggling” with illnesses associated with ACEs and physicians aren’t usually aware of the impact of the ACEs. “They don’t necessarily know about ACEs because the science is relatively new.” Training medical providers

Adverse childhood experiences covered in screening tool

A Saint Agnes Medical Center family medicine clinic and other participants in the Fresno, California, network of care use screening tools from the California surgeon general’s ACEs Aware initiative to assess people’s exposure to adverse childhood experiences or ACEs.

The screening tools are available in multiple languages and are tailored for different age groups.

The tools screen for exposure to experiences in childhood, including:

Physical, emotional or sexual abuse

Physical or emotional neglect

Living in a household affected by:

• Incarceration

• Mental illness

• Substance abuse

• Parental separation or divorce

• Intimate partner violence

Discrimination

Housing instability

Food insecurity

Serious physical illness or disability

Death of a parent or caregiver

According to information from the ACEs Aware initiative, screeners calculate scores by the total number of ACEs categories experienced, not the severity or frequency of any one category. The higher a patient’s ACEs score, the greater the risk for ACEs-associated health conditions. The ACEs Aware initiative materials say that if individuals experience exposure in four or more categories, they are at high risk for the type of toxic stress that can lead to worsened health outcomes.

Information on the screening tools is available at acesaware.org/learn-aboutscreening/screening-tools/.

MENTAL HEALTH CARE

SUPPORTIVE RELATIONSHIPS

ACCESS TO NATURE QUALITY SLEEP

STRESS BUSTERS

violence or other damaging stressors. Break the cycle

Programs that improve parent-child interactions, bolster family stability and increase parent employment have been shown to strengthen family economics, build resilience and lessen the harms of childhood traumas.

MINDFULNESS PRACTICES

Source: ACEs Aware

BALANCED NUTRITION

PHYSICAL ACTIVITY

Clinicians and staff at Saint Agnes Medical Center and at other Fresno, California-area medical facilities screen patients for adverse childhood experiences, or ACEs. Those screeners refer patients with high ACEs scores to community-based organizations that can help them access these “stress-buster” services to mitigate toxic stress.

about ACEs has been an essential part of the screening system rollout, she says.

$112.5 billion price tag

A team of Saint Agnes physicians, family medicine clinic residents and a community benefit leader has been the driving force behind the development and implementation of the ACEs screening and referral system at Saint Agnes.

The group had responded to a call to action by California’s first surgeon general, Dr. Nadine Burke Harris, who identified ACEs as a public health priority and established the state’s ACEs Aware initiative. The initiative uses grants to equip health care and social service providers to screen their patients and clients for ACEs and to connect people to the interventions they need to recover from the trauma and live more healthfully.

Saint Agnes physician champions challenged medical residents in one of the hospital’s clinics — a family medicine clinic treating a large percentage of low-income patients and patients covered by the MediCal state Medicaid program — to develop a workable screening program to earn one of the ACEs Aware initiative grants. Several family medicine residents took on the challenge. They developed the framework for the program and wrote up and presented a white paper citing estimates that California spends about $112.5 billion annually to treat the consequences of adverse childhood experiences. The residents’ efforts earned a $100,000 ACEs Aware initiative grant to fund the medical provider training that was needed to start the screening program.

Expanded network

In June 2020, Saint Agnes’ community health and well-being department and the hospital’s family medicine residency program launched a pilot screening and treatment referral program devised by the residents. Residents in training at the family medicine clinic, attending physicians and medical assistants completed hybrid online and in-person training. The curriculum defined ACEs, described the health consequences of chronic activation of the body’s stress response system during childhood, taught providers to use an ACEs screening tool developed by the ACEs Aware initiative and covered how trauma-informed care can mitigate harm for patients who have been impacted by ACEs.

The clinic adopted the ACEs screenings and interventions as an ongoing program. Additional medical assistants are in training now to administer the screening tool.

The Saint Agnes team collaborated with Fresno-area health care and social service organizations to win a $2.6 million ACEs Aware initiative grant in 2021. They used

it to create a “network of care” that relies heavily on more than 30 community health workers who are employed by Saint Agnes and some of the participating organizations. The community health workers help individuals with high ACEs scores to get mental health care and other services from Saint Agnes and other providers.

The network includes Saint Agnes and six other medical providers, as well as community-based organizations serving very vulnerable populations: undocumented immigrants, refugees, people with mental illness, people who identify as LGBTQ+, Black pregnant women and infants, human trafficking victims, foster children, domestic violence survivors and families with children who have special needs.

Tailored questionnaire

The family practice clinic hopes to screen all of its pediatric and adult patients who give consent. Medi-Cal reimburses for one ACEs screening for adults and one per year for children insured under Medi-Cal.

Questionnaires are tailored to the patients’ ages — there’s one form for adults, another for teens and one for parents or guardians to fill out for children.

Since the screening program’s inception, more than 200 Saint Agnes patients have been linked to follow-up services to address the impacts of childhood trauma. The community health workers track the patients’ progress through the medical record system. Saint Agnes plans to expand the use of the screening tool to other hospital departments.

Yankey says ACEs can affect people’s ability to cope with life’s challenges over the long term but mitigating the impacts of the trauma through intervention can reduce the harms.

“This is part of the shift in medicine from simply treating illness to working more to prevent people from getting the illnesses,” she says.

Going upstream

To reduce the incidence of childhood abuse and neglect and to promote stability among families undergoing severe hardship and trauma in northwest Oregon, Providence Health & Services helps support A Family Place relief nurseries in three Oregon communities. The nonprofit Lutheran Community Services Northwest uses state and private funds including the Providence Health & Services grants to operate the relief nursery services.

Emily Garrick-Steenson, advancement manager for Lutheran Community Services Northwest, says the relief nurseries are the “last, best chance” for families plagued with trauma, homelessness, mental health problems, substance dependency, unemployment, food insecurity, poverty, domestic

Garrick-Steenson says the relief nursery model originated in Eugene, Oregon, more than 40 years ago. To be classified as a relief nursery in the state, facilities must be certified with the Oregon Association of Relief Nurseries. Garrick-Steenson says relief nurseries have been shown to increase children’s ability to build social and emotional competencies and to increase caregivers’ ability to support their children’s emotional development.

Expanding services

Lutheran Community Services Northwest opened the first A Family Place in McMinnville in October 2013. It has expanded its network to include relief nurseries in Newberg and Willamina — all three cities are in Yamhill County, Oregon.

The programming aims to strengthen families and support positive childhood development through mental health counseling, therapeutic classroom instruction for children from age 18 months until kindergarten, and courses that improve parents’ mental health and parenting skills.

A Family Place also offers home visits by a teacher interventionist, a trained navigator for families with babies. Teachers may make visits to the homes of their preschool students. The Lutheran Community Services’ Safe Families for Children can arrange temporary foster care placements for children while their parents receive intensive services.

In 2022 A Family Place served more than 600 children.

Mike Antrim is senior communication manager for Providence Health & Services in northwest Oregon, which is part of Providence St. Joseph Health. He says Providence has given about $700,000 to Lutheran Community Services Northwest, including for ongoing mental health and refugee services. About $200,000 of that amount has funded relief nursery and mental health services in Yamhill County.

The health system also has lent its staff’s fundraising expertise, helping A Family Place to access and leverage state funding. Providence support helped A Family Place to lay the groundwork for its 2021 expansion into Willamina, a logging community that had gone through an economic bust.

Garrick-Steenson says there had been a lot of unaddressed mental health issues linked to family financial stress in Willamina including increased depression, substance abuse and child abuse and neglect.

The grants from Providence are helping pay for a doubling of the classroom space for the Newberg relief nursery and a tripling of Lutheran Community Services Northwest’s mental health offices in the same building.

For the coming school year, Lutheran Community Services Northwest is expanding school-based mental health services it offers at Newberg elementary and middle schools. That work is done in partnership with Providence, which provides schoolbased mental health services at the high school level.

To increase outreach to the Latino community in Yamhill County, A Family Place is intent on hiring more Spanish-speaking staff.

One client, featured in a promotional video, says she had a young child and a baby on the way when she first connected with A Family Place. A Family Place staff provided clothing for her children, connections to social services, and parenting education — the first step to a foundation that allowed her to escape an abusive relationship. “I now have a safety net,” she says.

Visit chausa.org/chworld for videos explaining ACEs and for more on the Fresno network’s accomplishments. jminda@chausa.org

Hospital Sisters Health System

Ministry systems join initiative to speed uptake of evidence-based medicine

By JULIE MINDA

Four large health systems with Catholic facilities are among the 42 organizations taking part in a new initiative aimed at more quickly using scientific research in health care practice.

The initiative is from the PatientCentered Outcomes Research Institute, an independent nonprofit organization authorized by Congress in 2010 to fund research that enables patients and clinicians to make better-informed health care decisions. The Health Systems Implementation Initiative the institute announced in March provides

Jerry Carley

From page 1

is going to go back into place. So all these rule waivers that were in place will cease to exist, essentially. For example, the threeday hospital rule that requires patients to spend three consecutive inpatient days in a hospital before they qualify for Medicare coverage of skilled nursing care, that’s coming back. But some of the requirements put in place during COVID are going away, too. One is the requirement for routine COVID-19 testing of residents and staff. That ends at the end of the public health emergency.

We’re still required to educate on and offer residents and staff the vaccine at least until May 21, 2024. Another continuing rule is that masks will still be required when there’s been a potential exposure. And then there’s also a requirement for reporting items related to COVID, such as the vaccination status of residents and staff. That’s going to go on forever, unless additional regulatory action is taken.

Is the new guidance appropriate and necessary in your opinion?

I think so. I think it’s a good start to getting back to normal.

Are there any particular state or federal policies that could be revised or added that would make it easier for Benedictine to serve its communities?

There’s no reason to bring back the three-day hospitalization rule. None. Medicare Advantage plans don’t use it. The only payment source that uses it is Medicare. We have gone three years without it, but now the waivers are going away and it’s going to come back again.

I’m also questioning a little bit the requirements for CNA certifications within four months of hiring. We’ve gone three years without it. (CMS) waived that so that nursing homes could get workers into the buildings. We still need to get workers into the buildings. But that waiver goes away at the end of the public health emergency.

How challenging has inflation and the push for higher wages been for Benedictine?

Minnesota since the pandemic has seen over 20 nursing homes close. Iowa has seen over 20 nursing homes close. What seems to be driving it is inflation, higher wages, use of agency staff and Medicaid and Medicare reimbursement methodologies that have not kept up with those rising costs. There has been this gradual closing of nursing homes for the last 20 to 25 years, but this has really accelerated it. And I don’t see an end in sight.

Benedictine has not had any closures. We’re not anticipating any closures as a result of this, primarily because we have a diverse portfolio with assisted living and independent living, which is not necessarily limited by Medicaid and Medicare reimbursements. They tend to be more private pay. The ones that are really struggling are the standalone skilled nursing facilities.

funding to speed uptake of comparative clinical effectiveness research findings at health care facilities across the U.S. The institute initially is investing $50 million in the effort.

According to a press release on the initiative, the institute aims through the work to “cut the estimated 17-year lag between the publication of (research) results and their uptake in practice.”

The 42 participants in the Health Systems Implementation Initiative represent about 800 hospitals and 6,400 primary care locations across 41 states and the District of Columbia. Three CHA members —

Ascension, CommonSpirit Health and Mercy — are participating in the initiative. Intermountain Health, which has CHAmember facilities, also is taking part.

Participating health systems will collaborate, share information and establish best practices for implementing research learnings and for using metrics to gauge success.

The institute will provide funding ranging from $500,000 to $5 million per project to promote the providers’ use of specific evidence from institute-funded research studies. The institute has funded a wide variety of research, including on organ transplantation, weight management, bar-

iatric surgery, mental illness, child abuse, heart failure, diabetes, Parkinson’s disease, cancer and obstetrics.

According to an institute blog post on the Health Systems Implementation Initiative, by conducting projects to implement evidence-based practices, “health systems will be leaders in refining, employing, and demonstrating workable strategies to improve care in real-world settings.”

The institute plans to scale up the Health Systems Implementation Initiative nationwide based on learnings from the initial 42 participating systems. jminda@chausa.org

Are you able to meet the demand for beds from patients who need skilled nursing care?

We are not able to meet the demand because we do not have the staff to care for them. What has happened during this latter part of the pandemic, specifically the last year or so when we had the great resignation, is a lot of nursing homes started to either limit or completely restrict admissions because they just simply didn’t have the nurses or certified nursing assistants to care for them. The nursing homes are sitting 75% occupied. There’s plenty of capacity, but the staff just aren’t there.

Until we take a stand at the state level or the national level to increase and help with reimbursement methodologies that can get us to become competitive again in the workforce, that problem is not going to solve itself.

What is the breakdown on reimbursement nursing homes get from Medicare, Medicaid and private pay?

Depending on where you’re at you could have care centers that are 70-80% Medicaid. In a couple of the states that we’re in, Minnesota and North Dakota, there’s rate equalization, which means that we can’t charge private pay more than what we get reimbursed from Medicaid. In other places, we can do that, so you can somewhat offset some of those costs by passing it on to the private pay.

There are still logjams in places with patients waiting to move from hospitals to long-term or rehabilitative care. Are you aware of efforts to address that?

We’re actually seeing a couple of hospital systems that have reached out to us that said, “If we help pay for staff to supplement whatever the costs are for the agency workers, can we create these arrangements and agreements?” We’re being innovative and

creative on how we are working in partnership with hospitals to help decompress their bed availability, because they’re full. They need to discharge patients so they can admit people.

Has the staffing crisis eased since the height of the pandemic?

There’s all kinds of graphs out there that show that the nursing home industry is the only sector in the United States that has not recovered to pre-pandemic employment levels. Everybody else has recovered to some degree and maybe even is doing a little bit better.

There’s not the staff for us. I will hire you today to do whatever you want to do in one of our nursing homes. It’s that dire and there’s not a full understanding by our elected officials of how bad it is.

Is the nation ready to meet the needs of its aging population?

We can’t meet it today. There’s a fairly significant disconnect in what is happen-

Minnesota since the pandemic has seen over 20 nursing homes close. Iowa has seen over 20 nursing homes close. What seems to be driving it is inflation, higher wages, use of agency staff and Medicaid and Medicare reimbursement methodologies that have not kept up with those rising costs.

ing. It was reiterated again this week with the Biden administration talking about staffing mandates. They are saying, “If you don’t hit certain retention numbers, we’re going to reduce your Medicare reimbursement,” which just makes it worse.

Developers are going to continue to build nice large private pay assisted living or independent living centers for those that can pay for it. But if we’re not going to get adequate reimbursement for Medicaid and Medicare, we’re not going to see that side of the equation be developed.

We at Benedictine have zero plans for building any new nursing homes because the financial modeling doesn’t work in its current environment, which is a challenge because that’s part of our mission.

Are the needs and desires of people coming into long-term care today different from those in the past and, if so, is Benedictine adjusting its services or policies?

The needs and desires are much different. I’ve been doing this for over 30 years. When I got in this business, a lot of the nursing home residents then would be assisted living residents today. That’s where there’s been a shift.

We’re moving much more heavily into assisted living and independent living, moving away from skilled nursing facilities. We’re not going to fully move away from skilled nursing facilities because there’s still a need there. But that need is so much less today versus 30 years ago because of the assisted and independent living options.

A lot of eldercare providers are getting away from nursing homes just simply because of the regulatory environment and the punitive nature of that particular space. I think we’re going to continue to see that shift going forward.

leisenhauer@chausa.org

Bentley gets a pet from Sr. Bernadette Kostrzewski while on a visit to Benedictine Living Community-Crookston in northwestern Minnesota. His owner, Jennie Mason, right, has been on staff for 26 years. Masking requirements remain in place in nursing homes when there has been potential COVID-19 exposure.

KEEPING UP

PRESIDENTS/CEOS

Bob Sutton will step down as Avera president and chief executive Sept. 30. According to a press release, his departure will be due to a recently diagnosed serious medical condition that requires an intensive treatment regimen. Avera is retaining an executive search firm to conduct a national search in the coming months for the next Avera leader.

Tim Prestridge to president of Cincinnati-based Mercy Health — Clermont Hospital, from chief financial officer of Mercy Health — Anderson Hospital. Mercy Health is part of Bon Secours Mercy Health.

Dr. Guy Hudson stepped down as chief executive of Providence’s north division on April 1 and will depart as president and chief executive of Swedish Health Services on Sept. 30. Dr. Elizabeth Wako will continue to oversee Providence Swedish operations in King County as the chief executive for the Central Puget Sound service area, while Kristy Carrington will continue as chief executive for the North Puget Sound service area and maintain responsibility for Providence Swedish operations in Snohomish County and Providence Regional Medical Center Everett.

ADMINISTRATIVE CHANGES

Dr. Brian Chesebro is the first medical

Prestridge McMurtrie Rhodes Harper Leggio

director of environmental stewardship for Providence St. Joseph Health.

Bon Secours Mercy Health organizations have made these changes: Shiley Harper to chief financial officer of Mercy Health — Clermont Hospital in Cincinnati. Danny Warren to chief financial officer of Mercy Health — Kentucky.

Dr. Robert McMurtrie to chief medical officer for Mercy Fitzgerald Hospital of Darby, Pennsylvania, and Saint Francis Hospital of Wilmington, Delaware. The facilities are part of Trinity Health.

Amy Leggio to executive director of the PeaceHealth St. John Foundation of Longview, Washington.

Maureen Rhodes to executive director of the foundation for St. Mary’s Healthcare of Amsterdam, New York.

ANNIVERSARY

CHRISTUS Ochsner St. Patrick Hospital,

Lake Charles, Louisiana, 115 years.

CAMPUS EXPANSIONS

St. Luke’s Health of Houston has opened the O’Quinn Medical Tower at McNair, the latest addition to the Baylor St. Luke’s Medical Center McNair Campus. The 12-story, 420,000-square-foot facility includes an ambulatory surgery center with 12 additional operating rooms and 10 endoscopy suites. The tower expands the Dan L Duncan Comprehensive Cancer Center by tripling its size with an additional 80-bay infusion center, more than 70 exam rooms, and imaging and radiation treatment equipment.

CommonSpirit Health, St. Luke’s parent, invested $426 million in the expansion.

Ascension Seton of Austin, Texas, broke ground in March at its Ascension Seton Medical Center Austin campus on a $320 million tower. Women’s services will be moved from the main medical center to

the new tower. The construction will add 28 inpatient rooms to the campus and the facility will have the capacity for 7,500 deliveries annually. The facility will house private neonatal intensive care unit rooms, cesarean section suites, clinical space where minimally invasive gynecologic surgeries can be performed, expanded antepartum space, a dedicated obstetrical and gynecological emergency department and an education center.

GRANTS AND GIFTS

Holy Rosary Healthcare of Miles City, Montana, part of Intermountain Health, has received a $6 million grant from the Leona M. and Harry B. Helmsley Charitable Trust. Holy Rosary will use the grant to build a cancer center. The center will provide radiation and medical and surgical oncology services. The center will be built on the Holy Rosary campus in Miles City. Construction began this spring, and the $17 million project is expected to be completed in late 2024.

The Leona M. and Harry B. Helmsley Charitable Trust has granted $682,498 to Avera and Access Health to purchase ultrasound machines as part of a $26.4 million ultrasound initiative in Minnesota. Seven new ultrasound machines will be purchased for three Avera hospitals and three Access Health clinics.

Ministry facilities provide private spaces for nursing moms at tourist destinations

By JULIE MINDA

Finding a private place to nurse or pump breast milk at tourist destinations can be a challenge. Two ministry facilities are meeting this need as part of broader partnerships with tourist sites in their communities.

The foundation of Saint Joseph Hospital donated a freestanding lactation privacy pod to the Denver Zoo. And Chesterfield, Missouri-based Mercy has partnered to locate five baby care and nursing stations at the Silver Dollar City theme park near Branson, Missouri.

Denver Zoo

The $35,000 Mamava-brand lactation pod came courtesy of Saint Joseph Hospital Foundation’s NICU/Family Health fund. It is prominently located inside an entrance to the zoo’s giraffe house. To access the private space, a mother signs into the Mamava app and gets the code to open the door.

The large pod, which was put in service in July, accommodates a double-wide stroller. It is wheelchair accessible. The pod has a changing table, seating for mothers and babies and electrical outlets to power a breast milk pump.

Photos of baby mammals — including human, rhino and giraffe — and their mothers decorate interior and exterior walls. The women who are featured in lactation stories displayed in the pod delivered their babies at Saint Joseph and consulted with the hospital’s lactation specialists.

Katie Halverstadt, clinical manager of lactation and family education for Saint Joseph, says that as a designated BabyFriendly Hospital, Saint Joseph has committed to support new moms in successfully feeding their babies, including after their discharge from the hospital.

Before the pod was installed, women were left to their own resources to find a quiet, clean, safe place to feed their babies or pump breast milk for them. Halverstadt says women in Saint Joseph’s breastfeeding support groups have told her they appreciate the convenience and privacy of the pod. It allows them to enjoy a family outing while sticking with their breastfeeding goals. Halverstadt says participating in wholesome social activities can counter postpartum depression and anxiety.

The family lactation pod is part of a sponsorship that Saint Joseph’s former parent company SCL Health forged with the zoo. Intermountain Health, which merged with SCL Health in April 2022, has continued the sponsorship.

collaboration that Mercy and Silver Dollar City announced in spring 2022. The southern Missouri theme park, which welcomes an average of 2 million-plus visitors each year, says it consults with its “official health care sponsor” Mercy on meeting the health

needs of park visitors. Mercy has more than 40 acute care, managed and specialty hospitals across Missouri, Arkansas, Oklahoma and Kansas.

Also as part of the sponsorship, Mercy provides and brands numerous courtesy hand sanitizing stations throughout the park.

Mercy and Silver Dollar City worked together to create a family calming space, a room at the park where families can bring their children who have sensory processing disorders. The room has a subdued color palette; soft seating; low lighting; books; and a “crash pad” for kids to use to rest, roll around or play on.

A highlight of the park is artisans who demonstrate to visitors how products were made in the 1880s. Some of those craftspeople created the décor in the family calming space. They made a large, textured wall mural portraying the Frisco Silver Dollar Train that traverses the park. The wall has dimensional layers of smooth and rougher surfaces, artificial grass, wood for the railroad ties, stone for the tunnel and glass beads for the sky. According to information from Mercy, some kids with developmental disabilities find comfort in touching textures. The mural was designed with them in mind.

jminda@chausa.org

Saint Joseph staff present two educational events annually at the zoo to highlight services for expectant and new parents. Saint Joseph also has provided free zoo tickets to families who delivered at the hospital or who participated in the hospital’s breastfeeding and toddler support groups.

Silver Dollar City

In addition to sponsoring baby care stations at the Silver Dollar City theme park near Branson, Missouri, Mercy health system also sponsors this family calming space, where kids with sensory processing disorders can take a break from the stimulation of the park to rest or play.

A foundation connected with Saint Joseph Hospital of Denver provided funding for this family lactation pod, which is located in the giraffe house of the Denver Zoo. Mothers can enjoy privacy as they feed their babies or pump breast milk.

Katie Halverstadt says women in Saint Joseph’s breastfeeding support groups have told her they appreciate the convenience and privacy of the pod.

The five baby care stations that Mercy sponsors at Silver Dollar City are part of a

Mission Leadership Institute

Congratulations, graduates.

After a 17-month journey dedicated to Mission centered leadership development, the inaugural cohort of the Providence Mission Leadership Institute has completed the program. Participants were honored with a two-day celebration in seven locations across our ministries, including a celebratory Mass and graduation ceremony.

Rod Hochman, M.D., Providence president and CEO, shared with the graduates, “Today’s celebration is a testament to your dedication to the Mission and marks a key milestone in our commitment to advancing the healing ministry of Jesus. We are expressions of God’s healing, inclusive love and you are a treasured gift to our organization. Whether you enter today with a faith tradition or without an organized religious practice, you are a valued member of the Providence family. Welcome.”

Thank you.

On behalf of the Mission Leadership Institute and our first graduating cohort, we would like to thank each of the luminaries who partnered in what has become a world-class Mission centered leadership development program based on the seven elements of the Shared Statement of Catholic Identity:

INAUGURAL COHORT LAUNCH: Chris Lowney, Chair of the Board, CommonSpirit Health

• DIGNITY: Ira Byock, M.D., Palliative Care Physician

• WHOLE PERSON: Carolyn Woo, Retired President and CEO, Catholic Relief Services

• VULNERABLE: Maureen Bisognano, President Emerita and Senior Fellow at the Institute for Healthcare Improvement

• COMMON GOOD: Sr. Mary Haddad, RSM, President and CEO, Catholic Health Association of the United States

• JUSTICE: Sr. Patricia Talone, RSM, Mission Advisor

• STEWARDSHIP: Lindsay Sudeikis, Spiritual Director and Educator; Mary Anne Sladich-Lantz, Formation Consultant

• MINISTRY: Sr. Donna Markham, OP, President and CEO, Catholic Charities USA; Mary Anne Graf, President and Founder, Health Care Innovations

TOP THREE PHOTOS: Puget Sound and Discerning Mission Leaders pods at celebratory Mass St. James Cathedral, Seattle, Washington March 16, 2023

BOTTOM PHOTO: Sr. Rosa Nguyen, a member of the Discerning Mission Leader pod, receives her certificate from University of Providence President Fr. Oliver Doyle Christ Our Hope Church, Seattle, Washington March 17, 2023

For more information: www.missionleadershipinstitute.org

Chris Lowney Sr. Patricia Talone, RSM

Ira Byock, M.D. Lindsay Sudeikis

Carolyn Woo Mary Anne Sladich-Lantz

Sr. Mary Haddad, RSM Mary Anne Graf