Introducing ‘At Work’ 3 Executive changes 7 PERIODICAL RATE PUBLICATION
SEPTEMBER 1, 2021 VOLUME 37, NUMBER 14
PACE providers help keep fragile seniors safe during pandemic Providers flip their operating model to provide more services at home By JULIE MINDA
During the worst of the pandemic and prior to being vaccinated against COVID-19, Vivian Collick, 79, of Philadelphia, was afraid to venture out of her senior living apartment complex for supplies or medical care. Thankfully, as a participant in the Mercy LIFE Program of AllInclusive Care for the Elderly, she had a safe and reliable lifeline. Staff of that Trinity Health PACE program called frequently to check in on her and ask her what she needed. They delivered medications so she wouldn’t have to go to a drugstore, and they sent
PACE participants Lee Rice and David Ahselm enjoy a rose parade event that Providence ElderPlace – Cully in Portland, Oregon, held in June. This PACE program is one of the few in the country with a residential component.
nurses to her apartment for health checks. “It put my mind at ease, not having to go out to go to the (PACE) center and not having to go out where I could get COVID,” Collick says. She is one of more than 55,000 PACE participants nationwide, the vast majority of whom have stayed safe and healthy in their residences during the pandemic through the support of PACE, according to the National PACE Association. At the pandemic’s chaotic start, PACE providers from the Catholic health ministry pivoted quickly from providing services from a central hub to providing most services in clients’ homes or by telehealth. A study by the National PACE Association says most PACE clients have fared better in terms of COVID case rates and Continued on 8
Clinic delivers on Mercy’s promise to invest in Ferguson, Mo.
Continued on 4
Lisa Eisenhauer/© CHA
FERGUSON, Mo. — One of the people who stopped by the Mercy Clinic Primary Care – Ferguson within the first few weeks of its opening in late July was a Black man who couldn’t find a doctor who would accept his insurance. “He felt right off the bat, he’s been incarcerated, he’s diabetic, he’s not going to get any medical attention, any medical help,” recalled Sophia Easterling, the practice manager of the clinic in suburban St. Louis. “I’m like, ‘We definitely can help you. We can figure something out. Don’t just give up.’” She made him an appointment to see one of the clinic’s clinicians to assess his health. When he came to his first
Vectorpus/Shutterstock.com
By LISA EISENHAUER
People enter the Mercy Clinic Primary Care – Ferguson in Missouri for a tour after the ribbon cutting and blessing in July. The clinic is part of a revival underway in the footprint of the sometimes-violent protests against racism and police violence that followed the 2014 fatal shooting of 18-year-old Michael Brown.
Program treats needy for substance abuse that costs them dearly By COLLEEN SCHRAPPEN
Jamie George had been through eight drug treatment programs for heroin dependency when he checked into PROVIDENCE Wa t e r f r o n t Recovery ST. JOSEPH Services on HEALTH Dec. 5, 2018. The date is now imprinted in his memory forever, he says. It was the start of a seven-day detox, followed by two months of residential care, and the first time since he was 19 that George, now 55, felt like his life was his again. “It was a game changer for me,” he said. Continued on 6
Wanda Warmuth credits Waterfront Recovery Services in Eureka, California, with halting her downward spiral due to alcohol dependence. Support from the Well Being Trust and Providence St. Joseph Health’s St. Joseph Hospital helped launch and stabilize the program’s finances. Warmuth shares her story in a video on the treatment program’s website.
Ministry systems commit to spend more with minority- and women-owned vendors By JULIE MINDA
About 20% of small businesses have closed either temporarily or permanently during the COVID19 pandemic. And small businesses that were owned by immigrants, women, and Black, Latino and Asian people experienced sharper cash balance declines and higher closure rates during the pandemic than those owned by white nonimmigrants. That is according to the Healthcare Anchor Network organization, which in June announced that a dozen of its member health systems have committed to increase their spending with minority- and women-owned businesses, to the tune of at least $1 billion collectively through 2026. Bon Secours Mercy Health, CommonSpirit Health and Providence St. Joseph Health are among the systems
that have signed the “Impact Purchasing Commitment.” Signatories also will increase their spending with small businesses that are locally based, employee-owned, cooperatively owned or that are nonprofit. The signatories commit to working with their vendors to create hiring pipelines in low-income communities. And participating health systems will increase environmentally sustainable purchasing. The extent of the changes the systems will be making as part of this commitment “is a big lift, but the work is grounded in our mission, vision Santore and values,” says Ali Santore, senior vice president of government affairs and social responsibility for Providence Continued on 2
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CATHOLIC HEALTH WORLD September 1, 2021
Small business From page 1
St. Joseph Health. Noah Dunlap is Bon Secours Mercy system director of insight, innovation and the project management office. He says, “We believe this economic infusion could lead to health improvements” in Dunlap poor communities, as dollars paid to local vendors go into the paychecks of community members with a potential downstream impact on the social determinants of health. Kathryn Carpenter, Carpenter CommonSpirit vice president of sourcing and contracting, says diversifying the vendor roster is “not just moral and good, it is necessary for us” as a smart business practice.
Upping the ante Several dozen health systems — including three Catholic providers — founded the Healthcare Anchor Network about five years ago. This organization guides its 60 members in better positioning themselves as anchors in their communities. The health systems share information with one another on how to use leadership initiatives, innovation, local hiring, local purchasing, community investing and other activity to ground themselves in their service areas and build up struggling communities, explains Pablo Bravo Vial, CommonSpirit system vice president of community health. Those that have signed on to the Impact Purchasing Commitment have agreed to specific purBravo chasing strategies and to dollar figures for their increased spending with minority-owned, women-owned and local businesses, and particularly those in economically struggling communities. Dunlap says the 50-hospital Bon Secours Mercy will be increasing its spending with these vendors and contractors “by tens of millions” over the next five years. Santore of Providence says the figures each member has agreed to amount to a “big, audacious goal” that will require each to make significant changes. Telling the story The Bon Secours Mercy, CommonSpirit and Providence representatives say their systems are assessing how they’re already doing when it comes to this impact investing, developing and implementing standardized policies and protocols to be used throughout their systems for improving practices, creating or improving systems for collecting and analyzing relevant data, categorizing all current vendors through an impact investing lens and developing strategies for making enhancements. Sr. Mary Ellen Leciejewski, OP, CommonSpirit vice president of environmental sustainability, notes that creating the systemwide data collection and analysis systems is essential to establish a baseline against goals and idenSr. Leciejewski tify where improvement is needed. She says, “Data really does help you tell your story better, that is one of the reasons that we went into some of the platforms we have. We had great anecdotal information and stories, but once we got some platforms in there with the data — that just showed us where we’re at and are we getting better or not?” Analytics, artificial intelligence About two years ago, Bon Secours Mercy contracted with Cincinnati-based Versatex,
Pre-pandemic, staff of Los Angeles-based Homeboy Industries disassembles a printer, preparing the metals and plastics for remanufacturing. CommonSpirit Health’s California Hospital Medical Center in Los Angeles contracted with Homeboy in February for electronics recycling as part of its impact investing strategy.
“Data really does help you tell your story better, that is one of the reasons that we went into some of the platforms we have. We had great anecdotal information and stories, but once we got some platforms in there with the data — that just showed us where we’re at and are we getting better or not?” — Sr. Mary Ellen Leciejewski, OP a minority-owned company that manages vendor relations for large organizations. Gerald Sparkman, chief executive of Versatex, says his company is working with Bon Secours Mercy in all its markets across seven states to manage relationSparkman ships with most of its small vendors, including those that are minorityowned, women-owned and locally owned. Sparkman says most of these vendors provide contracted services, such as cleaning, electrical work, plumbing and landscaping at Bon Secours Mercy facilities. Bon Secours Mercy has worked with Versatex to establish a database of most of its existing small vendors — there currently are about 400 in the database. The database includes information related to the health system’s impact investing goals, such as whether the vendors are minority-owned, women-owned, locally based and environmentally responsible. Versatex also is standardizing contracts with all these vendors and establishing methods for Bon Secours Mercy to provide feedback on the vendors’ performance. Versatex will determine how well Bon Secours Mercy’s purchasing activities are lining up with its impact investment goals and commitments, and aid the health system in making needed adjustments. This may include switching out vendors, increasing or decreasing spending with existing vendors and seeking contract alterations with some vendors.
Versatex is advising Bon Secours Mercy’s vendors on how to improve the products or services they deliver and advising the health system on investments it can make to promote the growth of select vendors, says Sparkman. For instance, if analytics reveal that a janitorial company would pair well with a carpet cleaning company, under a merger, Sparkman might advise that and might recommend Bon Secours Mercy provide capital to help the merged company complete the deal and build out its services.
Ripple effect The ministry representatives whose systems are doubling down on impact investing concede there are challenges. Dunlap of Bon Secours Mercy says there will be disruption of some preexisting vendor relationships. Santore of Providence says people in the purchasing departments of Providence
facilities will need to adjust to new practices and protocols. CommonSpirit’s Carpenter adds it is difficult for large systems to strike a balance between the highly efficient, money-saving centralized purchasing formats that focus on massive contracts with large multinational companies and the localized, smallscale contracts that are the focus of this impact investing strategy. Sometimes it costs more to go with the small vendor that is minority-owned and based in a struggling community. But, Carpenter says, it is healthy from a business standpoint to have a mix of large and small vendors, and to diversify how products and services are purchased. Sparkman, the Bon Secours Mercy business partner, says in the end the efforts are about “helping the people who work and live in our zip codes.”
Survey: Pandemic hit small businesses hard — especially those owned by minorities T
he vast majority of small businesses saw sharp declines in their financial health during the worst of the pandemic, with minority-owned businesses faring worse than their white counterparts. That is according to a survey of businesses with fewer than 500 employees, fielded about a year ago by the Small Business Credit Survey. Among the nearly 9,700 firms nationwide responding to the survey, 78% reported declines in revenues in the 12 months prior to the survey period. That survey was administered in September and October of 2020. Nearly half of the survey respondents said they reduced their workforces between the fall of 2019 and the fall of 2020. Some businesses were hampered because employees fearing infection left their jobs. A higher percentage of Asian-owned and Black-owned small businesses said their financial condition was “fair” or “poor” in the fall of 2020 as compared to non-minority respondents. Generally, 57% of respondents characterized their financial condition this way, while 79% of Asian-owned firms and 77% of Black-owned firms did. The pandemic impacted the operations of 95% of survey respondents. About one in four respondents said they closed their businesses temporarily; 56% said they reduced their operations; and 48% said they modified their operations. (Respondents could choose more than one response option to this question.) More than 90% of respondents said they sought emergency funding to weather the pandemic. The federal Paycheck Protection Program was the most commonly used aid source — 82% of respondents applied for that funding. According to the executive summary of the survey, 77% of applicants received all of the funding they sought. Noah Dunlap, Bon Secours Mercy Health system director of insight, innovation and the project management office, says while many small businesses accessed government aid to stem losses, many, including minority-owned service businesses, have been flailing because they do not have financial reserves to fall back on once the aid is spent. Demand for certain services has not rebounded to pre-pandemic levels. For example, corporate cleaning companies lost much business when offices sent workers home to telecommute and no longer required daily cleaning services. Because of the rise of the Delta variant of COVID, many businesses have yet to reopen their offices.
September 1, 2021 CATHOLIC HEALTH WORLD
Fueled by empathy, social worker finds housing for patients Editor’s note: This is the first in an occasional series in which people will talk about their jobs in the Catholic health ministry. We invite readers to recommend themselves or colleagues for stories that will show the diversity of jobs, skills and people that make the ministry vibrant. To do so, send an email to jvandewater@chausa.org with “At Work” in the subject line. By KATHLEEN NELSON
To help people who are homeless, Emily Corey must have two work homes. Corey is the first hospital AT WORK homeless service coordinator for SSM Health Saint Louis University Hospital, working for and with a provider of services for people who are experiencing homelessness or housing insecurity. “Health systems need to keep up to date with needs of the community, and I’m glad that SLU hospital is doing so,” says Corey. Following a community needs assessment, SSM Health looked for ways to commit resources to address violence, food insecurity and homelessness. Situated near downtown St. Louis, the hospital’s emergency department treated five to seven patients a day with nowhere to go upon discharge. The department’s social workers lacked the connections or tools to help them find a place for patients to sleep for a day, a week or a month. The heightened needs through the pandemic prompted Bryan Walrath, SLU hospital’s vice president of operations, to reach out to St. Patrick Center Chief Executive Anthony D’Agostino, who directs the largest provider of services to the homeless in St. Louis. Walrath hoped to build on a pilot program known as Hospital to Housing, which the center started with another health system. It connects patients who frequently visit the emergency department seeking food or shelter with housing, medications and social services with the goal of reducing unnecessary trips to the emer-
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Emily Corey
gency department for patients not there for direct medical attention. Though Corey is officially listed as an employee of St. Patrick Center, her position is funded through SSM Health, and she does the bulk of her work at SLU hospital. She graduated in 2020 from Saint Louis University’s master of social work program. Though she gained experience as a student working with veterans and survivors of trauma and sexual violence, building this position from the ground up is her first full-time job. “I like the fact that I literally meet clients where they are and branch out with the resources we are able to provide,” she says.
A typical day Her first duty most days is to check for new or pending referrals of patients who reported housing insecurity or homeless-
ness. She meets with those patients for an running into these barriers?” She also spends time at her second intake assessment. “Being at the hospital, I can respond office at St. Patrick Center to review cases within a matter of minutes,” she says. with her co-workers and check in with the clients who receive “When I meet with services there. them, I know very “If I feel frustrated by the “One of the most little about them, rewarding things which is good. I barriers but have access to has been meeting a don’t have a bias a phone and a professional patient who might about them. We’ll not want to share discuss their housnetwork, how much more certain details,” ing needs and goals, she says. “But I love where they’ve tried difficult must it be for a watching the transto obtain housing person who is experiencing before, and what formation over barriers they have a period of time, homelessness who is always encountered.” being their first The initial inter- running into these barriers?” touchpoint, getting them connected view takes about — Emily Corey and advocating in 45 minutes. At that the medical system point, she works to coordinate shelter placement, connecting for them. I couldn’t do that if I worked only with family or friends, transitional housing within the walls of the hospital.” When she is out of the hospital, she or other community services. “Because I’m an employee of St. Patrick remains in touch with the emergency Center and work at SLU hospital, I know department, to increase accessibility and the people I’m referring them to,” she says. to conduct intakes by phone before dis“We make the calls together. I know exactly charge if necessary. She also maintains a who can help them with housing or job or separate phone number for her clients, so behavioral health. People respond better they have immediate access to her, rather to a word-of-mouth connection, rather than a confusing voice-automated system than a name on a sheet of paper. or hotline. “Working within the constraints of a fractured shelter network in St. Louis, I Success leads to expansion still find it difficult to find a bed because of From the time Corey was hired in Octolimited availability and the procedures to ber through July, the program received secure one,” Corey says. “If I feel frustrated 144 referrals; more than 85% of the people by the barriers but have access to a phone referred have accessed community serand a professional network, how much vices through St. Patrick Center or another more difficult must it be for a person who is nonprofit for housing, employment, shelexperiencing homelessness who is always ter, transitional housing or skilled nursing facility; or are living with a family member. Clients receive services from Corey for three to six months. The program is expanding and has rebranded as Hospital to Healthy Housing. St. Patrick Center has hired two full-time coordinators to work in parallel positions with BJC Health and Mercy, another ministry member based in St. Louis. “When you’re looking to build a program from the ground up, it’s tricky to hire an ideal fit,” Walrath says. “Emily has taken ownership and pride in the role. Positions like this and people like Emily can provide tremendous value to hospitals willing to be a little creative.”
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CATHOLIC HEALTH WORLD September 1, 2021
Mercy in Ferguson
Promises kept
being realized through the area and I’m so grateful that clinic and the work of Health + we can continue to keep Homes. promises.” Health + Homes’ first project has been to improve the Investing in revival largely commercial section of Mercy spent $2.8 million Ferguson along West Floristo construct and equip the 5,500-square-foot clinic. It is sant Avenue that includes the one of several new buildings site of the clinic. For months on West Florissant Avenue. after Brown’s death, protestA $12.4 million, ers took over the street daily. 26,000-square-foot Boys & Although the protests were Girls Club that opened in largely peaceful by day, there August 2019 is next door. were incidents of looting and The Ferguson Commuarson at night. The distressed community found itself at the nity Empowerment Center center of national discussions opened in 2017 by the Salvaabout police violence and tion Army and Urban League racial injustice and disparities. of Metropolitan St. Louis is Data from the Centers for three blocks away. That cenDisease Control and Preven- Mayor Ella Jones speaks during the opening ceremonies for the Mercy Clinic ter, which offers a range of services such as job placetion show the average life Primary Care – Ferguson in July. She sits on the community council that advises expectancy for Ferguson resi- Mercy on clinic services. She said she expects the clinic “will benefit the residents ment and children’s programs, was built on the site dents is in the low- to mid-70s, of Ferguson for decades and generations to come.” of a convenience store that 10-15 years below that of some other parts of St. Louis County. Census announced in July that will go toward add- burned down in 2014 during the protests. data puts the median household income ing gutters, curb cuts and bus shelters on Speaking before the blessing of the in Ferguson at $40,000, compared to West Florissant Avenue. Mercy clinic, Ferguson Mayor Ella Jones $67,420 for the county. “You all can remember what this block called it “an opportunity for collaboraIn recent years Health + Homes has looked like many years ago,” Sorensen tion, for partnership, for cooperation that spearheaded efforts to get grant fund- told the crowd of local leaders and activ- will benefit the residents of Ferguson for ing for infrastructure improvements, ists at the clinic’s official opening. “It was decades and generations to come.” Jones is a member of a community including $10 million in federal funding our passion and promise to improve this
Whitney Curtis/© CHA
Donn Sorensen is executive vice president of operations at Mercy and chairman of the board and chief executive of Health + Homes, a nonprofit he set up with a handful of area business Sorensen leaders and that Mercy financially supports. The nonprofit’s mission is “to provide access to healthy lifestyles and neighborhoods and affect change for those who seek to strengthen their community through the inclusion of all persons.” Sorensen said at the clinic’s ribbon cutting that Mercy made a commitment to residents of Ferguson to help them transform their community. That pledge came in the wake of the sometimes violent and fiery protests that followed the police killing of Michael Brown, an unarmed Black teenager, in the summer of 2014. The outrage Brown’s death unleashed, and the government’s show of force to quell protests, put Ferguson in the national spotlight and propelled the Black Lives Matter movement. Sorensen told the audience that Mercy’s commitment to the city is
Cathy Jenkins, owner of Cathy’s Kitchen, speaks with a customer at her restaurant in Ferguson, Missouri. The popular restaurant withstood the turmoil that roiled the city on the outskirts of St. Louis following the fatal police shooting of Michael Brown. Civic and nonprofit groups are leading a turnaround in the protest-scarred section of the city.
Lisa Eisenhauer/© CHA
appointment, he was asked, like all new patients, to fill out a questionnaire on various needs, including whether he is able to afford his medications and whether he has stable housing. His answers were shared with his care providers as well as with a community health worker who is based at the clinic to help meet patients’ social needs. Easterling and her colleague Victoria Thompson, a nurse practitioner, said the man was exactly the sort of underserved patient that Mercy hoped to reach when it opened the clinic in the predominantly lowincome African-AmeriEasterling can community. Its staff also includes a full-time primary care physician and a licensed social worker. The clinic’s goal is to offer immediate assistance by way of primary Thompson care and to help patients with long-term needs, such as disease management and accessing prescription or rental assistance. Thompson said the clinic staff wants patients to know “We see you, we hear you. We want to be partners in giving you the care you need.”
Whitney Curtis/© CHA
From page 1
Mercy Clinic Primary Care – Ferguson is next to the Teen Center of Excellence opened in 2019 by the Boys & Girls Clubs of Greater St. Louis on West Florissant Avenue in Ferguson. The latter organization says the club serves a population that desperately needs safe places, positive mentors and life enhancing programs.
September 1, 2021 CATHOLIC HEALTH WORLD
council that Mercy set up to advise the health system, which is based in the St. Louis suburb of Chesterfield, on the design of the clinic and what services should be offered there.
Stakeholder buy-in The clinic’s main services are adult and pediatric primary care and women’s health care. Its other services, some of which were still being added in midAugust, are: A nutrition center with a nutritionist on-site one day a week to advise on eating for disease management and wellness. A licensed clinical social worker coordinating with the Mercy psychiatry team to ensure patients receive quick access to care from behavioral health providers. Education offerings such as parent-
ing classes, care for the caregiver opportunities, smoking cessation classes, and grief counseling. Tesh Jewell, vice president of operations for adult primary care for Mercy St. Louis, facilitates the community council, which met monthly for much of the last two years. The Ferguson council has representatives Jewell from various stakeholder groups, including local governments, businesses and schools. It remains in place to advise Mercy on the clinic’s operations, though it is no longer meeting monthly. Jewell said the council helped Mercy better understand the specific needs of Ferguson residents. She credits the council with persuading Mercy to add the wrap-
around services at the clinic that address patients’ social needs. “I’ll be honest, we didn’t have the same rich understanding about the priorities of the community until after we engaged with our council,” she said. Jewell expects the community council model or some similar communityengagement effort to be used in the planning of future Mercy projects. “Ferguson’s process worked for Ferguson,” Jewell said. “I can’t say it would work for every other community but how we get that community input I think is something we have to continue to master and evolve for any project’s unique needs.”
Committed to community In the first weeks of operation, appointments at the Ferguson clinic are filling up with walk-ins and others who book ahead.
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Easterling and the clinic’s community health worker are helping with outreach, by setting up tables with brochures at community events and popping into nearby businesses to talk up the clinic’s services. The clinic takes appointments until 6:20 p.m. three nights a week and is open one Saturday a month to offer access to workers who can’t take time off during the workday. Thompson said she and the clinic’s primary care physician, Dr. Nana Atsina, have worked at other Mercy facilities near Ferguson and are in the community by choice and plan to stay there. “We all know the scars that are in this area from everything that happened,” she said. “But we want everybody to know that we’re making a commitment here.” leisenhauer@chausa.org
Toolkit offers guidance on how hospitals can make community investments By LISA EISENHAUER
A resource produced by the Center for Community Investment in partnership with CHA aims to help hospitals and health systems make investments that benefit their communities and provide returns that can generate more investments. The partners released the 48-page investment guide called “Investing in Community Health: A Toolkit for Hospitals” last fall. The toolkit: Defines community investment. Explains how health care organizations can integrate community investment into their community health improvement strategies. Explores how health care organizations can create a community investment strategy. “The scale of transformation that we’re after in our communities is just too big to be achieved by grants or by government subsidies alone,” said Robin Hacke, executive director of the Center for Community Investment. “Anchor institutions and community partners really need to Hacke deploy all of the assets that we have — financial investments, land and grant money — in order to make the differ-
ence that we’re hoping to make.” The center is a program within the Lincoln Institute of Land Policy, a nonprofit based in Cambridge, Massachusetts, that works to improve quality of life through the effective use, taxation and stewardship of land. Hacke discussed the community investment toolkit in March during a session at the American Hospital Association’s virtual Accelerating Health Equity conference. Kendra Smith, vice president of community health at Bon Secours Mercy Health, joined her in the discussion. Bon Secours Mercy Health, CommonSpirit Health’s Dignity Health and four other health systems or hospitals are part of the Center for Community Investment’s Accelerating Investments for Healthy Communities program launched in February 2018. The program is advancing models for investments like those that the toolkit is designed to encourage. Smith talked about investments Bon Secours Mercy Health has made in recent years that align with the system’s mission of improving life for those in the communities where its facilities are located. “At the very core of the work we do is making sure that we are serving the underserved, the poor and the dying and really having an opportunity to not just impact patients but really impact the communities that we serve,” she said.
One of the three projects she spotlighted is Unity Properties in West Baltimore. The 802-unit project that provides affordable homes for families and seniors has been developed over the last 30 years. It is owned and operated by Bon Secours Mercy Health. All of the units are within walking distance of Bon Secours Community Works. That social services center offers Head Start programming, employment skill building and financial counseling. The apartments and townhouses are near bus and rail transit, shopping, recreation and public green space. “For us, maintaining this portfolio of housing has been a key innovative measure to spur other investment and other interest in this community,” Smith said. “So now we see nonprofit organizations, we see small nonprofit developers, community lenders and community development financial institutions saying, ‘How do we partner to grow this?’” Finding reliable partners for community investment projects is one of the keys to success, Smith and Hacke said. The toolkit offers tips on how to identify potential partners, such as local faith communities, foundations and banks. Julie Trocchio, senior director of community benefit and continuing care at CHA, said the toolkit can help Catholic health ministries build upon the community benefit work they already are doing.
“It’s really, I think, a giant step forward for dealing with both equity and addressing the social determinants in our country because it’s a way to be more creative at using the health systems’ resources to improve the economic engine of a community,” she said. Investments, unlike grants, can’t be counted toward the community benefit projects required of nonprofit health systems to meet federal mandates, Trocchio said. But unlike grants, investments provide financial returns that can fuel other projects. Hacke said investments offer an additional option to grants, which are best used for things like salaries, child care subsidies and transit passes that don’t provide any monetary return. “What we’re seeing is that by using investments, more dollars flow to making the kinds of long-term changes — like affordable housing, like access to fresh food — that we want to see in our communities,” she said. “We can also, by using investment dollars where they’re possible to use, save those precious grant dollars for the things like food banks and emergency relief that can’t be funded in other ways.” The toolkit is available for download at centerforcommunityinvestment.org/ resources. leisenhauer@chausa.org
An illustration used by the Center for Community Investment shows the goals and principles behind investments in community health with examples from Bon Secours Mercy Health.
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CATHOLIC HEALTH WORLD September 1, 2021
Dr. Ruby Bayan, left, medical director of Waterfront Recovery Services, makes a presentation during a meeting with stakeholders from local government, medical and mental health agencies and law enforcement. Bayan has worked in psychiatric and substance abuse treatment for more than three decades.
Substance dependence recovery From page 1
The program offers the only medically managed detox and treatment in Northern California that cares for indigent patients — and that’s what made the difference for him, George said. Waterfront Recovery Services opened in November 2018 in Eureka, a port city about 100 miles south of Oregon. But without the financial support of organizations such as St. Joseph Hospital in Eureka, California, Waterfront Recovery Services may not have come to be, much less survived long enough to be the refuge it has been for patients like George.
Shift in treatment Initially, an investment of $1.2 million was made through the Well Being Trust to provide the drug and alcohol treatment program with funding to hire a medical director and nursing staff. The Well Being Trust was launched by Providence St. Joseph Health in 2016 to advance the mental, social and spiritual health of the country. St. Joseph Hospital is part of the Providence St. Joseph Health system. Medically based programs, such as the one at Waterfront Recovery Services, are becoming more common as the thinking behind how to treat substance use disorders has shifted toward an integrated care model of mental and physical heath. George said that unlike Waterfront Recovery Services, the first eight treatment programs he went through did not have a medical doctor on staff. He credits Dr. Ruby Bayan, a psychiatrist who is medical director of Waterfront Recovery Services, and the suboxone treatment he began there with allowing him to achieve and maintain sobriety. He said the suboxone eliminates his drug cravings. An important premise that underpins this type of treatment is that addiction is a medical, not criminal, problem. And it’s not an uncommon one: According to the National Institutes of Health, more than 20 million Americans have a substance abuse disorder. Keeping the wheels turning The idea for Waterfront Recovery Services began taking shape about five years ago. Fatal drug overdoses were happening at three times the rate in Humboldt County, where Eureka is the county seat, as they were in the rest of California. Patients were visiting the emergency room for drug-related problems twice as often as elsewhere in the state. “We had seen the effects of the lack of treatment in our community and in our hospital,” said Martha Shanahan, the manager of community health investment for St. Joseph Hospital. Shanahan said when funding for Drug
Jesse Pearson, a kitchen manager at Waterfront Recovery Services, prepares a nutritious meal. Homemade mole and a piñata for Cinco de Mayo and a special brunch including chocolate dipped strawberries on Mother’s Day are examples of some of the food-centered celebrations the kitchen produces to make residents feel like they're part of a community.
Medi-Cal, the Medicaid coverage for substance use disorder treatment, was delayed from January 2019 to July 2020, it put Waterfront Recovery Services in jeopardy. “We thought, ‘Can we keep the wheels turning on this?’” St. Joseph Hospital provided $500,000 in bridge funding that kept the treatment facility afloat for those 18 months. Now four out of five Waterfront Recovery Services patients use Drug MediCal coverage to pay for treatment. Previously, low-income or uninsured people with substance-use disorder had few options except to go to the emergency room. But after detoxing at the hospital, they would be right back where they started — often with untreated mental health issues, physical problems and no prospects for a job or education. Waterfront Recovery Services addresses all of those factors during treatment. Residents stay for 30, 60 or 90 days, engaging in therapy, family treatment programs, even yoga and art workshops.
Covering the cost It’s effective, but expensive, said John McManus, executive director of Waterfront Recovery Services. “Treatment programs are tasked with solving one of society’s largest problems, but the resources thrown at the problems are miniscule,” McManus said. Not having a program like Waterfront, which provides medical detox, McManus residential treatment and help with transitioning to sober housing, is even more expensive, though. Before it opened, “we had ‘hyper-utilizers’ who rolled through services and could never get what they needed in a timely manner,” he said. A nine-bed Victorian home, called C Street Detox, was one of the few local options for residential treatment, and it was crumbling. McManus headed
C Street Detox, and also oversaw two other longer-term treatment programs, one for men and one for women. The building that houses Waterfront became available in July 2017 and the local government agreed to lease it to Waterfront for a dollar a year. With the startup funding from St. Joseph, support from Humboldt County and grant money, Waterfront was able to open with 56 beds, doubling the capacity of the other three programs and folding them into one location. “We would not have survived without help from St. Joseph,” said McManus.
Reaching the neediest Waterfront has been mostly unfazed by
the pandemic. Patients and staff undergo weekly testing for COVID-19. The facility did have to decrease its bed capacity to meet social distancing requirements but has otherwise continued operations under the guidance of the California Department of Public Health. The administrators encourage everyone who is part of the program to be vaccinated; proof of vaccination is required for visitors. With the Drug Medi-Cal program up and running, McManus feels secure that he and the Waterfront team will be able to continue to reach those most in need: seven out of 10 of those receiving treatment at Waterfront are homeless. He commends Bayan and the rest of the staff of almost 50 for helping patients such as George remain successful even after their stay at Waterfront is over. “We prepare them for social challenges when they leave,” said Bayan, who has worked in psychiatric and substance abuse treatment for more Bayan than three decades.
Detoxing and coping skills Waterfront provides two kinds of treatment: withdrawal management that uses medication protocols to make detoxing as comfortable and safe as possible and residential treatment of up to 90 days to help patients understand addiction, learn healthy coping skills and prepare for return to the community. In addition to participating in group and individual therapy sessions, patients in residential treatment at Waterfront start on a path toward work or returning to school. They are guided through getting replacement documents including Social Security cards, driver’s licenses, even birth certificates that may be necessary to land a job or be approved for government aid. George, who had been living in a van for years before his stay at Waterfront, now has an apartment for himself and his dog, Shunka. He bought a motorcycle and enrolled in addiction studies at the College of the Redwoods. He works at Waterfront as a counselor. “Dr. Bayan saw something in me,” said George. He’s not the exception, though. It’s what she recognizes in all her patients, and what keeps her going: “People work here not to earn money. It’s not a high-paying job,” Bayan said. “When you see the most broken person, when you see the light in their eyes, the humanity, it makes it worthwhile.”
PAU S E . B R E AT H E . H E A L .
Joy in Sadness For just this moment, bring your attention to your breath. INHALE deeply and settle yourself into your body. EXHALE the stress and tension you feel.
In these days of sadness, a moment to pause is both a gift and a necessity. GENTLE YOUR BREATHING, your gaze and your heart as you consider:
Where have I found joy in the past days? THINK FOR A MOMENT.
In these days of sadness where have I found joy? [Pause to consider] Even now, God is with you, as near to you as your breath. Continue giving yourself the gift to pause, breathe and heal, knowing you are not alone.
Weeping may stay for the night but rejoicing comes in the morning. PSALM 30:5 For more prayer resources visit chausa.org/prayers © Catholic Health Association of the United States
September 1, 2021 CATHOLIC HEALTH WORLD
SCL Health starts work on new Lutheran Medical Center near Denver SCL Health is building a $650 million replacement hospital for its Lutheran Medical Center in the Denver suburb of Wheat Ridge. The system broke ground on the project on June 9. The hospital is expected to be in full operation in 2024. The new site of about 28 acres is on Interstate 70 about 3½ miles west of the current hospital. This project addresses the growing need for high-quality health care in Jefferson County, Colorado, and the surrounding communities, SCL Health said in a release about the new hospital. The population of the county grew 9% from 2010 to 2019, census data shows. “This replacement hospital will meet the demand for a more flexible and patient-centered facility that delivers high-quality, advanced care more efficiently,” said Lydia Jumonville, SCL Health president and chief executive. The medical center now is licensed for 338 beds. The new hospital will have about 210 beds, in line with actual use, SCL Health said. Most patient rooms will have the ability to be converted to intensive care unit standards if needed. The hospital’s design will maximize workplace efficiencies, including through the use of decentralized nursing pods to put nurses closer to the bedside. Most areas will have floor-to-ceiling glass, allowing for more natural light.
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KEEPING UP
Ekeren
Markham
Trautman
Lim
An architect’s rendering shows the new Lutheran Medical Center in Wheat Ridge, Colorado. Plans call for the replacement hospital being built by SCL Health to be in full operation in 2024.
With 2,000 staffers, Lutheran Medical Center is the largest employer in Wheat Ridge. Lutheran Medical Center has been in its current location for more than 100 years. It has evolved from a tuberculosis sanitarium into an acute care hospital with a Level II trauma designation, a stroke center and a neuroscience critical care unit. Once the replacement hospital is open, Lutheran Medical Center will stop acute hospital operations at its current site, SCL Health said. Lutheran Hospice will remain at that location. The system expects the
remaining property to be sold and developed, guided by the city of Wheat Ridge’s master planning process. Lutheran Medical Center’s behavioral health program will continue, likely in a new location. “The replacement hospital will expand access to emergency and critical care for families in Jefferson County and the West Denver suburbs,” said Grant Wicklund, Lutheran Medical Center president. “We will elevate care in our community, with a state-of-the-art medical facility to meet the health care needs for the next 100 years.”
PRESIDENTS AND CEOS Doug Ekeren to regional president and chief executive of Avera Queen of Peace Hospital in Mitchell, South Dakota, from interim regional president and chief executive. He also will continue as regional president and chief executive of Avera Sacred Heart Hospital in Yankton, South Dakota. Chad Markham to president and chief executive of HSHS St. Anthony’s Memorial Hospital in Effingham, Illinois, effective Sept. 7. He was chief operating officer with UnityPoint Health’s St. Luke’s Hospital in Sioux City, Iowa. Robert Trautman to president of St. Luke’s Health-Brazosport in Lake Jackson, Texas, part of CommonSpirit Health. He was interim chief executive of St. Joseph Hospital in Fort Wayne, Indiana. Dr. Kevin W. Yingling to chief executive for Mountain Health Network and president of Cabell Huntington Hospital and St. Mary’s Medical Center. The facilities are in Huntington, West Virginia. Mountain Health Network is the parent company of Cabell and St. Mary’s.
ADMINISTRATIVE CHANGE Deacon Paul Lim to vice president of mission integration for WVU Medicine Wheeling Hospital in Wheeling, West Virginia.
GRANTS AND GIFTS The Scripps Mercy Family Medicine Residency Program at Scripps Mercy Hospital in San Diego and Chula Vista, California, will receive $2.85 million in grant funding from the Health Resources & Services Administration. The residency program will use the funds over the next five years to enhance physician training in family medicine, obstetrics and maternal and child health along the U.S.-Mexico border of San Diego and Imperial counties. The Health Resources & Services Administration’s Rural Communities Opioid Response Program has awarded a $1 million grant to the L.E. Phillips-Libertas Treatment Center, a service of HSHS St. Joseph’s Hospital in Chippewa Falls, Wisconsin. The HRSA grant, combined with a $15,000 grant from the Hospital Sisters of St. Francis Foundation, will fund an opioid response plan for four northwest Wisconsin counties. The response includes community education, drug takeback events, youth addiction prevention programs, drug screenings and treatment, recruitment and professional development of alcohol and drug treatment providers, enhanced collaboration with law enforcement and first responders, use of integrated treatment models, development of a recovery community and data collection. The Salah Foundation has granted $500,000 for the renovation and expansion of the congestive heart failure clinic at Fort Lauderdale, Florida-based Holy Cross Health. Capacity will be expanded to include the addition of patient exam rooms and support space for a patient/family consult area. Holy Cross is part of Trinity Health.
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CATHOLIC HEALTH WORLD September 1, 2021
PACE pivots in pandemic
cal care, socialization and check-ins. Staff is delivering groceries and other necessities to some clients. Many PACE programs deliver hot meals or microwavable meals to clients who would have dined at the center prior to the pandemic. Cooper of Ascension Living says this flexible approach is enabling PACE providers to maintain uninterrupted care and support for clients.
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mortality rates than their peers in nursing homes during the pandemic. Ministry PACE providers credit staff ingenuity and commitment for this. Brian Cooper, vice president of PACE operations for Ascension Living, says, “We discovered that we have some very creative and talented associates that have really stepped up to the plate to find compassionate and thoughtful ways to provide for the needs of our participants while also keeping them and our associates safe.”
Vaccine scramble Carrie Hays McElroy, chief clinical and compliance officer at Trinity Health PACE, says that when COVID vaccine rollouts began in late 2020 and early 2021, PACE providers did not fit neatly into the categories of nursing home operator, hospital, pharmacy or other organization qualified to obtain and dispense vaccines. McElroy says PACE centers to secure appointments at community vaccination sites and get clients there. All these ministry representatives say their PACE programs have vaccination compliance levels upwards of 75% among clients. When it comes to staff, Ascension and Trinity Health are mandating vaccination and St. Bernards is strongly encouraging it. All Providence St. Joseph caregivers are required, where permitted by state law, to get vaccinated and show proof of vaccination, according to the system. Those unable to be vaccinated will be required to sign a declination and follow additional protocols. Requirements may include enhanced COVID testing, mandatory vaccine-related education/discussions, and/or other infection prevention steps in accordance with Providence St. Joseph’s policy, CDC or state and local public health government mandates.
Flipped script Normally, PACE programs operate from one location, providing a wide range of recreational, social, medical, mental health, nutritional and spiritual services (see side- Gertrude Sorrell, at left, a participant of St. Bernards Total Life Healthcare in Jonesboro, Arkansas, bar) to clients in a center, with other ser- receives treatment from physical therapist Nanci Price. Total Life is the health system’s Program of Allvices provided on an ad hoc and limited Inclusive Care for the Elderly. basis in clients’ residences. When the pandemic began, PACE pro- Association. vied up client lists so team members could “We revamped our way of thinking,” says do wellness checks by phone or home visit, grams had to “turn this model upside down,” says Susan Tuller, executive director Chad Whitehead, program integrity man- stratified their client lists by urgency of need of Providence Elderager at St. Bernards and strategized how to meet those needs. Close communication proved essential. Total Life Healthcare, Place in Seattle. a PACE program in Providence ElderPlace PACE locations in Following state and Jonesboro, Arkansas. local guidance and/or The vast majority the direction of their of the PACE programs parent systems, the whose representatives PACE programs had were interviewed for to temporarily susthis article shut their pend attendance at adult day programs for their centers and rapseveral days or weeks idly determine how early last year to put to maintain all the infection prevention essential services while protocols in place that keeping PACE parwould allow them to ticipants safe in their Ben Davis, a PACE participant at St. Bernards reopen their day care homes. They came up Total Life Healthcare, plays bingo at the programs to the frailwith workarounds in ClubPACE center. keeping with guideest patients, many of lines from government health agencies whom had dementia and were deterioratand direction from the National PACE ing rapidly at home owing to the isolation. The centers remained closed to most clients for several months to over a year depending on local infection rates. The programs have been redeploying staff to deliver essential services in participants’ homes or A staff member serves morning beverages to clients of the Program of Safe and sound via telemedicine when their clients can’t All-Inclusive Care for the Elderly center in Baton Rouge in Louisiana. According to a survey come into their centers. reported in February by As vaccination levels have risen and Washington and Oregon used donations the National PACE Association, both the infection levels have decreased this year, and grants to purchase 125 GrandPads tab- COVID case rate and the COVID mortality the day centers have slowly been increasing lets so clients able to use the technology rate for PACE participants are one-third the capacity to allow more clients to come in. could communicate from home with PACE rate for nursing home residents. The minThe PACE representatives who spoke with staff and with loved ones. istry PACE representatives say their proeveloped in the San Francisco area in Catholic Health World say that while they Government agency guidance dictated grams saw similar results, and they add that the 1970s, the PACE program enables are monitoring the highly infectious delta to what degree and when PACE centers they also had consistently low emergency nursing home-eligible people aged 55 strain of COVID now spiking infection rates could reopen in each state. Several of the department admission rates, hospital readyears and over to receive services and in parts of the U.S., at this point renewed PACE representatives interviewed for this mission rates and fall rates for PACE particisupport so they can remain as indepenscale-backs of in-person services have not article say they have been keeping their pants during the pandemic. dent as possible. For lower-income indibeen necessary. medical clinics open on a very limited basis Becky McDaniel, St. Bernards execuviduals, who make up 90% of PACE enrollfor critical client needs only. To maintain tive director, notes, however, that there was ment nationally, the voluntary program is social distancing and minimize infection some decline in participants’ overall physiUninterrupted service funded through Medicare and Medicaid. At the onset of the pandemic, minis- risk, some PACE programs have been allow- cal and mental health because of the cutoff PACE stands for Programs of Alltry PACE center teams developed service ing only one client into their medical clin- from day center participation. She says the Inclusive Care for the Elderly. According to delivery plans that prioritized client and ics at a time. Telehealth visits replaced in- gradual reopening of day center services the National PACE Association, the PACE now is enabling some clients to regain some staff safety, scrambled to secure hard-to- person health checks for many. model is centered on the concept that “it In addition, PACE frontline workers are lost function. find personal protective equipment for all is better for the well-being of seniors with Tuller of Providence PACE says the staff as well as for clients who needed it, div- coming to clients’ homes to provide medichronic care needs and their families to successes the programs have achieved in be served in the community whenever maintaining clients’ health and safety are possible.” a validation of PACE’s intent and design to Normally, PACE programs operate on keep people safe and functioning at their a hub and spoke model, with most clients fullest capacity at home. receiving shuttle transportation to a Daniel Drake, president and chief execucenter where they get care and services tive of Trinity Health PACE, says since many from a multidisciplinary team. At such PACE programs proved their value over the centers, participants normally can receive last year and a half, some states that had adult day care; physical, occupational and recreational therapies; meals; nutritional eschewed the program in the past or had counseling; medical care provided by undervalued it, are taking a second look. “It a PACE physician; prescription drugs; was a tough time, but our colleagues really social services; medical specialties, gave it their all. We embraced new ways such as audiology, dentistry, optometry, of serving” our clients that reaped posipodiatry and speech therapy and mental tive results, and those new approaches will health care. The PACE team also provides remain in use in the future. clients access to home care, emergency For more information visit chausa.org/ or hospital and nursing home care when chworld.
PACE model offers support to keep frail seniors in the community D
necessary. There are 140 PACE organizations in 30 states. About two dozen of those organizations are wholly or partially sponsored by Catholic organizations.
jminda@chausa.org The care team of Ascension Living PACE Michigan in Flint hold signs they made for a vehicle parade to cheer program participants. The group gathered on the parking lot before driving by PACE participants' homes.