Lightning Willie and Captain Violet 2 Executive changes 7 Addiction and spiritual care 8 PERIODICAL RATE PUBLICATION
MARCH 15, 2020 VOLUME 36, NUMBER 5
Ministry chaplains stay nimble to keep pace with evolving role Health care landscape changing quickly; chaplains must adapt By JULIE MINDA
The sweeping waves of change that have been reshaping health care delivery in the U.S. in recent years also have been fundamentally altering the role of the health care chaplain. Just like their clinician counterparts, health care chaplains have been using metrics in order to quantify their contributions to patient care. They must adhere to standardized protocols, integrate their work with that of clinical colleagues, increase their physical and virtual presence in outpatient care, and respond to expanded expectations for addressing spiritual, emotional and even socioeconomic needs of patients. To stay ahead of these amplified expec-
Medicaid block grant proposal raises fears of funding, service cuts By LISA EISENHAUER
While federal officials are pitching their proposal to offer block grants for Medicaid expansion funding as a way to give states more flexibility over their health care programs and expenses, CHA and others fear
Fr. Eoli Roselada, OFM, a chaplain at HSHS St. Elizabeth’s Hospital in O’Fallon, Illinois, blesses Sammie Story. While bedside patient care remains a vital part of chaplaincy, the role has expanded to include much work outside of hospital walls.
tations and ensure patients and others get the spiritual care that is a hallmark of Catholic health care, chaplains must continually learn and adapt.
“We need to be nimble,” says Tim Serban, chief mission integration officer for Providence in Oregon, a member of Continued on 4
Rural hospitals struggle to keep their footing By LISA EISENHAUER
PHOENIX — Shrinking populations, the shift from inpatient to outpatient care, and the refusal by some states to expand Medic-
aid are among the challenges that researchers link to a wave of rural hospital closures, including 19 last year. Ideas for confronting and withstanding those forces were in the spotlight at
A map created by the North Carolina Rural Health Research Program shows where 166 rural hospitals have closed since 2005.
the American Hospital Association’s Rural Health Care Leadership Conference in February in Phoenix. “For all our rural hospitals and health systems, regardless of how they are positioned, these challenges are not only creating financial instability, but affecting the economic health of the entire community,” Dr. Melinda L. Estes, chairwoman of the American Hospital Association’s board of trustees, said at the start of the conference. CHA and Mercy Virtual, a subsidiary of Chesterfield, Missouri-based Mercy health, were among the sponsors of the four-day event, which drew more than 1,100 people. Estes, president and chief executive of Kansas City, Missouri-based Saint Luke’s Health System, pointed out that rural hospitals — defined as those outside of metropolitan statistical areas — serve as the main source of health care for 20 percent of the nation’s population and often are a
the change will ultimately mean less care and for fewer people. The proposal, called “Healthy Adult Opportunity,” was detailed in January by the Centers for Medicare and Medicaid Services. It focuses on what the agency calls a “limited population” — adults under age 65 whose eligibility for Medicaid is not based on pregnancy, a disability or a need for long-term care. States could apply for waivers of traditional Medicaid rules and seek either an aggregate block grant to cover total costs for
Continued on 7
Continued on 5
A worker helps a resident of Joseph’s Home, a homeless service provider in Northeast Ohio that is exclusively focused on medical respite care. Many of its residents rely on Medicaid. Joseph’s Home is a ministry of Cleveland-based Sisters of Charity Health System.
Critical Conversations 2020 explores Catholic health care’s singular history, future By JUDITH VANDEWATER
ATLANTA — Fr. Charles Bou– chard, OP, CHA’s senior director of theology and sp ons orship, sparked a lively exchange at the a s s o c i a t i o n ’s Critical Conversations meeting here last month Fr. Bouchard when he asked the ministry chief executives in attendance whether they feel ready for the day when there are no women religious working in Catholic health care. Generations of women religious built the Catholic health care ministry into the largest nonprofit health sector in the U.S.,
Patrick McCruden, standing, SSM Health’s chief mission integration officer, converses with Laura Kaiser, SSM Health’s president and chief executive, and Larry LeGrand, SSM Health board chair, during a break at CHA’s Critical Conversations 2020 meeting in Atlanta last month.
and did so while advancing whole person care, Catholic social teaching and Catholic principles of social justice. Although there are women religious on the sponsor boards at most of the largest Catholic systems, the number of sisters active in the ministry continues to decline. Lay men and women have for some time held the top executive and operating posts at the largest Catholic health systems, the vast majority of which are organized as ministerial juridic persons with laity represented on sponsor boards that are responsible for their organization’s Catholic identity and fidelity to church teachings. “It is clear to all of us that whatever happens in the future,
the sisters will not be doing it,” Fr. Bouchard said to the gathering of about 80 ministry leaders, which, in addition to chief executives, included members of sponsor boards and executive mission leaders from across the ministry. The Critical Conversations meeting is convened every two years as a forum for CHA members to share mission-relevant information and expertise and to provide input that will advance CHA’s work. This year’s attendees gave input that will inform the drafting of a strategic plan for FY 2021-23. (See sidebar page 6.) Elizabeth Dunne, president and chief executive of PeaceHealth and a CHA board member, answered Fr. Bouchard’s question Continued on 6
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CATHOLIC HEALTH WORLD March 15, 2020
Captain Violet and Lightning Willie patrol children’s hospital grounds By LISA EISENHAUER
If the new security guards patrolling The Children’s Hospital of San Antonio look like something that only a kid could dream up, that’s by plan. Lightning Willie and Captain Violet stand about 5 feet tall. Their rocketshaped bodies sport markings that were customized in consultation with some of the young patients at the CHRISTUS Health hospital. Lightning Willie has the eyes, nose, paws and dangling tongue of a goofy dog; Captain Violet’s painted-on uniform has a color scheme to match her name set off by a gold security belt. The pair got off and rolling on their rounds in mid-February. Roy Alston, vice president of security for CHRISTUS Health, said the hospital wanted Violet and Willie to fit in with the child-friendly vibe of the hospital, which has panels that cast vibrant colors at night from its 11 stories Alston and a huge mural on the façade that depicts an angel watching over a child. Behind the playful appearance of the robots is the serious purpose of adding another layer of security at a hospital in the heart of a city churning with car and pedestrian traffic, Alston said. “We felt as if this technology was something that would allow us to just provide a much safer environment,” he said. “Being CHRISTUS Health, we kind of embrace innovation and technology, so we decided to employ it and see how it works out.” The robots are on programmed patrol courses 24-7 in a geo-fenced area outside the hospital. The robots have charging stations near their patrol areas where they dock for 20-25 minutes three to five times daily. When they are on patrol, multiple cam-
Cris Daskevich, chief executive of The Children’s Hospital of San Antonio, introduces security robots Captain Violet and Lightning Willie during a ceremony that included a blessing of the robots, which are on patrol duty outside the hospital.
eras continuously snap photos and take video of their surroundings. Humans at a security post can live monitor the video feeds. If the software detects anomalies that might suggest criminal activity — such as a person in a restricted area of the campus — it alerts human security
personnel. The robots are programmed to detect and avoid both stationary and moving objects, such as pedestrians and cars. Visitors can stop them and, with the press of a button, have a two-way conversation with a human security guard.
In addition to their security work, the robots are ambassadors for hospital visitors. They say “Hello” and “Excuse me” and tell people their names. Over time, Alston said, refinements in their software are planned that will allow them to answer questions like “Which hospital entrance is open at night?” The robots were designed by Silicon Valley-based Knightscope, a company that has customized security bots for use across the country for several years. Alston said the robots will never replace their human counterparts and the security they provide. “It’s an augmentation,” he said of the technology. “What we’re really looking at is what the future of security looks like for facilities like hospitals and other places and just being on the forefront of embracing that technology.” Visitors to The Children’s Hospital have been delighted when they encounter one of the robots. “Almost all the kids gravitate right towards the robot,” he said. “They want to touch it, they want to experience it, they want to take pictures with it.” The robots are programmed to linger long enough for a few questions and a quick selfie, but they don’t stick around long before rolling off to resume their patrols. leisenhauer@chausa.org
2 20 AWARDS
Recognizing Extraordinary Contributions to the Catholic Health Ministry Catholic Health World (ISSN 87564068) is published semimonthly, except monthly in January, April, July and October and copyrighted © by the Catholic Health Association of the United States. POSTMASTER: Address all subscription orders, inquiries, address changes, etc., to Kim Hewitt, 4455 Woodson Road, St. Louis, MO 631343797; phone: 314-253-3421; email: khewitt@chausa.org. Periodicals postage rate is paid at St. Louis and additional mailing offices. Annual subscription rates: CHA members free, others $55 and foreign $55. Opinions, quotes and views appearing in Catholic Health World do not necessarily reflect those of CHA and do not represent an endorsement by CHA. Acceptance of advertising for publication does not constitute approval or endorse ment by the publication or CHA. All advertising is subject to review before acceptance. Vice President Communications and Marketing Brian P. Reardon
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SISTER CAROL KEEHAN AWARD
Jane Graf, President and Chief Executive Officer, Mercy Housing Inc., Denver
SISTER CONCILIA MORAN AWARD
Patricia Casey, Program Coordinator, Special Needs Tracking and Awareness Response System (STARS), SSM Health Cardinal Glennon Children’s Hospital, St. Louis
LIFETIME ACHIEVEMENT AWARD
Johnny Cox, RN, Ph.D., Former Sponsor, Providence St. Joseph Health, Renton, Washington and Chief Ethics Advisor, Alliance of Catholic Health Care, Sacramento, California
TOMORROW’S LEADERS HONOREES
Honoring young people who will guide our ministry in the future
Prub Khurana, Chief Strategy Officer, Providence St. Joseph Health, Irvine, California
Natalie Blum, System Director, Quality and Infection Prevention, PeaceHealth, Vancouver, Washington
Tiffany Parker, Director, Inpatient Behavioral Health, Addiction Services and Domestic Violence Services, St. Agnes Hospital, Fond du Lac, Wisconsin
For boldly championing society’s most vulnerable
For demonstrated creativity and breakthrough thinking
For a lifetime of contributions
Lindsay Flannery, Vice President, Patient Care Services, Avera Sacred Heart Hospital, Yankton, South Dakota Wendy Gaudet, Director, Pharmacy, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana Morgan Griffith, Vice President, Digital Strategy and Transformation, Bon Secours Mercy Health, Cincinnati Karthik Iyer, MD, Chief Medical Officer and Medical Director Critical Care, Mercy Hospital Jefferson, Festus/ Crystal City, Missouri
JOIN US IN ATLANTA JUNE 7-9 To celebrate these remarkable people and find out who will receive the 2020 Achievement Citation!
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Aaron Puchbauer, President and Chief Executive Officer, HSHS Good Shepherd Hospital, Shelbyville, Illinois Nathaniel Schlicher, MD, JD, FACEP, Regional Medical Director, Quality Assurance for Emergency Medicine, CHI Franciscan Health, Tacoma, Washington Bernardita Ureta, Vice President, Mission, Red de Salud UC CHRISTUS, Santiago, Chile
March 15, 2020 CATHOLIC HEALTH WORLD
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Saint Peter’s natural birth center is floors away, but a world apart from its obstetrics unit Birth centers are increasingly popular, according to accrediting agency By JULIE MINDA
Saint Peter’s University Hospital in New Brunswick, New Jersey, has opened a birth center that is in the same hospital building as its labor and delivery unit, but operates independently. According to the new center’s leadership, having the birth center in the hospital provides an alternative for women who want low-intervention births in a nonmedicalized and homelike setting while also having the safety net of a high-tech labor and delivery unit nearby, in case complications arise during delivery. “It is truly the best of both worlds — a stunningly beautiful, quiet and comfortable space to bring a new life into the world, but with all the resources of the hospital, just a few floors away,” Joanne Cunha said in a press release issued following the center’s
opening in November. Cunha is a certified nurse midwife and clinical director of Saint Peter’s midwifery services. Saint Peter’s facility has been accredited by the American Association of Birth Centers. According to that agency, accreditation involves verifying that a birth center has met a high standard of evidence-based benchmarks for maternity care, neonatal care, business operations and safety. The agency says it has a quality improvement program, that, in conjunction with the accreditation standards, confirms the delivery of quality care through the use of external quality measures. The accrediting association says birth centers should provide “a home-like setting where care providers, usually midwives, provide family-centered care to healthy pregnant women.” Currently there are 399 association certified birth centers in 39 states and the District of Columbia. Fifteen of those centers are inside a hospital. The agency notes that “birth centers have consistently displayed charges for care for normal birth that average up to 50% less than
access to a communal lounge area, dining room and kitchen.
Emely Madera and Hassan Hazim admire their newborn son, Zane. Born on Nov. 17, he is the first baby delivered at Saint Peter’s University Hospital’s Mary V. O’Shea Birth Center.
charges for an uncomplicated birth in the hospital.”
Each of the two birthing suites at the birth center has a queen-sized bed, spa tub and shower. The décor is homelike and no medical equipment is visible.
Like home The Saint Peter’s facility’s two birthing suites look like bedrooms. All the décor is soothing — there are paintings of nature scenes on the walls, and the rooms’ color scheme is in soft hues. And there is no visible medical equipment, said Pam Harmon, director of women and Harmon children’s services at Saint Peter’s and administrative director of Saint Peter’s new facility, which is called the Mary V. O’Shea Birth Center. It is named in memory of a longtime New Brunswick resident who bequeathed a portion of the funds for the $2.1 million center; Saint Peter’s provided the remainder. Each birthing suite has a standard queen-sized bed, spa-sized tub and shower as well as space and furniture to accommodate the family members attending the birth. Patients and their families have
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Natural process The birth center’s approach is rooted in the philosophy that birth is a natural process and that medical intervention should only be used when necessary. The birth center follows the midwifery model of care. Midwifery is childbirth assistance by a trained professional. The New Brunswick birth center staff of about a dozen includes three certified nurse midwives — with more to be hired in the near term — as well as patient care technicians who are trained as doulas to provide physical and emotional support, plus nurses and office administrative staff. Patients sign on with the center early in their pregnancy and then attend classes there in the ensuing months to get to know the center’s staff and to learn about the center’s midwifery model of care and natural approach to labor and pain control. The expectant moms work with the clinical staff to develop a birth plan. Cunha said the center’s approach is holistic. “We spend time. We educate. It’s an inclusive, personalized, one-on-one approach.” Patients receive regular prenatal exams from the midwives at the center, including to verify their pregnancy continues to be low-risk. An abnormal blood pressure or blood sugar level, for instance, could make a woman ineligible to give birth at the center. Go time A midwife, a registered nurse and a doula assist in each delivery. Unlike in the labor and delivery unit, women laboring in the birth center cannot opt to have an epidural or other pain medication. Center clinicians offer hydrotherapy, aromatherapy, nerve stimulation and massage. Patients are not tethered to their bed by fetal monitoring equipment, so they can walk around as they wish. Clinicians use handheld instruments to periodically monitor babies’ heartbeats. If a delivery at the center becomes complicated, say a mother requires an emergency cesarean section, clinicians can immediately transport the patient to Saint Peter’s labor and delivery unit where an oncall physician will take over care. Harmon said that freestanding birth centers must transport patients by ambulance in the event of a serious complication. Courting the community Saint Peter’s has well-established labor and delivery services. With about 5,200 births last year, the hospital logs the most births in the region. Harmon credits Dr. Elizabeth Cherot, an obstetrician, for suggesting that the hospital open an in-house birth center. Cherot noted a growing interest in lowintervention births and a lack of options locally for women who preferred a less technical approach to birthing, but didn’t want to deliver at home. Saint Peter’s assembled a committee to study the local market, and it confirmed Cherot’s thesis that many women wanted to have the control that home delivery affords, but they feared the potential risk that comes with a home birth, should complications arise. The American Association of Birth Centers said the number of birth centers has increased 82 percent since 2010, and the industry is continuing to grow. Harmon said the committee found that women contemplating home births or natural births could be a new market for the hospital. The center had delivered 10 babies as of early March. Since it is so new, it does not yet have a large patient base. But Harmon said there is much interest and excitement from the community. “We’re getting lots of positive attention,” she said. jminda@chausa.org
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CATHOLIC HEALTH WORLD March 15, 2020
Chaplains From page 1
Victoria Schmidt
Providence St. Joseph Health. “We must accept change even if we don’t understand it,” says Tweeter Henseler. She is manager of chaplaincy at Avera Sacred Heart Hospital in Yankton, South Dakota. “We have to be creative,” says Joby Brown, staff chaplain at Ascension Columbia St. Mary’s Hospital Ozaukee in Mequon, Wisconsin. “Chaplains have to have the mindset and the heart-set to meet patients and families where they’re at — we can’t get set in a
Chaplain Joby Brown, center, meets with intensive care unit associates during a team huddle at Ascension Columbia St. Mary’s Hospital Ozaukee in Mequon, Wisconsin. He gets updates on existing patients and learns about newly admitted patients. This helps him to prioritize his work.
Mercy of Northwest Arkansas is part of the Mercy health system of Chesterfield, Missouri. Maddock says because the majority of health care is provided on an outpatient basis, the Mercy system has been active in expanding chaplain serMercy Chaplain Chuck Russo, at left, takes part in vices throughout its growing clinic system a blessing ceremony at Mercy-GoHealth Urgent and into its home care service line. Saint Louis University Hospital is Care in Oakville, Missouri, on Sept. 6. Chaplain increasingly embedding chaplains into presence is increasing in outpatient venues. specialty clinical teams, including neurology, transplant, trauma, triage and the specific way of doing ministry,” says Art intensive care unit. Dey says the hospital Maddock, manager of pastoral services for is greatly benefitting from doing so. Mercy Northwest Arkansas. “We have to Henseler says Avera Sacred Heart is be flexible.” providing dedicated chaplain time in its cancer center, in eldercare facilities and Credentials and standards in hospice and palliative care. Brown says Organizations including CHA, the Ascension uses chaplains with specializaNational Association of Catholic Chaplains and the Association of Professional tion in such areas as cardiology, oncology, Chaplains have been contributing to the rehabilitation and behavioral health. He development of professional standards Specialization by diagnosis says that pastoral education and accreditand educational and training expectaAs systems and facilities are recogniz- ing agencies offer advanced certifications tions. (See sidebar for a related CHA ing the value of chaplain care, they are for such work. Chaplains with advanced initiative.) seeking to expand chaplains’ presence — training in palliative care and hospice may Requirements and prerequisites to be a especially into areas of service line growth. be helpful to late-stage oncology patients, he says. chaplain have increased, says Brown notes that the Maddock. There is more clarAscension system is aimity and definition around what chaplaincy is and the protoing to offer spiritual care in an on-demand capaccols chaplains should follow in delivering their services, says ity in acute and outpatient Serban. settings. Many chaplains are taking Chaplains are increascontinuing education courses ingly connecting with pato close knowledge gaps, says tients online through teleSue Kellett, a chaplain at SSM health platforms. “Whether Health Saint Louis University we are pulling up a physical Hospital. or a virtual chair, what we are The push toward betdoing is creating that sacred space to hear the patient,” ter defined roles, credentials Maddock says. and standards has included Chaplains also are increased research nationincreasing their ministry to ally into chaplaincy’s impact staff. Maddock says chapon patient outcomes, and this research is providing evilains provide affirmation and dence for the value of chaplain Art Maddock, manager of pastoral services for Mercy Northwest Arkansas, blesses an attentive ear. Serban says the hands of co-workers at Mercy Hospital Northwest Arkansas in Rogers. chaplains offer emotional encounters, says Serban. Henseler adds that this quest to show value is happening on a facility level too. She and other chaplains are using metrics to track their activity and aim to tie that activity to patient outcomes. Hospital, agrees that chaplains are gaining increased acceptance and respect from administrators and clinician colleagues, for what they can add to a patient’s experience. Chaplains are participating in interdisciplinary care teams to a greater degree than in the past. Henseler of Avera Sacred Heart says chaplains’ integration into multidisciplinary care teams is reflected in the spiritual care screening questions posed in the medical intake process, so that patients with pressing spiritual needs can be referred to a chaplain. Chaplains also are being included in unit huddles on quality patient care. Chaplains routinely exchange information with their clinician counterparts through the electronic medical record, and verbally.
support as the staff deal with the stresses of delivering care, often to people in trauma. Henseler educates staff on self-care and helps staff tend to their emotional health after painful experiences, such as the death of a patient.
Spiritual triage With chaplains now taking on expanded responsibilities and increasing their presence throughout the continuum of care and with colleagues, they are pulled in many directions, says Serban. There’s a limited number of chaplains to meet increasing demand in a growing number of venues, says Brown. Maddock says the situation has forced chaplains to prioritize the patients who receive services. Many chaplains used to go room to room in hospitals visiting patients to determine whether an individual was receptive to spiritual counseling. Nowadays, there is little time for those casual conversations. Ministry facilities increasingly rely on screening systems to identify patients in crisis or with serious illness, who may be most in need of chaplaincy services. At Saint Louis University Hospital, an urban academic medical center with a high-acuity patient population, Kellett says many patients require extensive support for socioeconomic and mental health needs too. She says she and her chaplain colleagues work collaboratively with social services staff to help such patients access the help they need. Dey says this is increasingly important to meeting patients’ complex needs. Ascension’s Brown finds the changing demands and responsibilities of the chaplain role exhilarating. “The fact that I don’t know what I’ll face every day is pure joy. I see new people and new things every day. And I am overjoyed by the different experiences I’m having — and humbled. I’m learning all the time.” jminda@chausa.org
CHA to provide resources on chaplain competencies, staffing
Team players Serban says chaplains are demonstrating they can be important patient advocates and help people anticipate the emotional, spiritual and practical struggles they may encounter as they cope with chronic or progressively debilitating illness. Chaplains can help them develop plans to lessen those struggles. Kellett says as chaplains establish the value of their services, they are earning more responsibility in the patient care process. Charlie Dey, the chaplain team manager at SSM Health Saint Louis University
C
HA is developing resources to guide Catholic health systems and facilities in determining how to appropriately staff their spiritual care departments and how to prioritize their chaplains’ time, given the level of services the organizations wish to deliver. CHA’s pastoral care advisory committee has been working with representatives of several ministry organizations to create the resources. The group began by polling and talking with some CHA member organizations about the work of their chaplains. Using the results, the committee identified the top 15 essential services of chaplains.
The committee then created an online tool for ministry facilities to use to calculate how many chaplains they should have on staff to deliver various levels of spiritual care services. Users of the tool plug in information, including the number of annual adjusted patient days for their facility. The tool’s algorithm calculates the number of chaplains the facility should have to provide spiritual care services at each of four different levels. Several ministry organizations are piloting the tool and helping the committee to refine it. CHA expects to debut the resources, including the list of essential chaplain services and the staffing level
calculator, within the next month. The resources will be available on the member section of the CHA website. Carrie Meyer McGrath, CHA director of mission services, has been leading the project. She says the effort is in response to member requests for practical ways to implement the evolving standards and requirements put forth by the National Association of Catholic Chaplains and the Association of Professional Chaplains. Both are chaplain credentialing and education organizations. — JULIE MINDA
March 15, 2020 CATHOLIC HEALTH WORLD
Medicaid block grant
5
Likewise, at St. Vincent Charity of the block grant proposal that Medical Center in Cleveland, was part of the repeal and replace From page 1 one of the system’s subsidiarlegislation found that Medicaid spending “would be cut by 35 ies, the percentage of patients covered by Medicaid has grown the demonstration population or a per cap- percent over 20 years and cause approximately 22 million benefisince the expansion, Stoll said, ita grant based on the number of individuals and the hospital’s percentage of enrolled. ciaries to lose coverage across the charity care has decreased. Medicaid is funded as an entitlement country by 2026.” While the Healthy Adult and provides health care insurance for the The American Academy of Opportunity plan could entice one in five Americans who meet its criteria Family Physicians, which is part the 14 states that have yet to as low-income, elderly or disabled. The fed- of the Partnership for Medicaid, expand Medicaid coverage to also issued a separate denunciaeral government and the states have shared responsibility for financing the program, tion of the Healthy Adult Oppor- Medicaid provided coverage for Emily Nienaber, who faced complications with do so, Stoll and others, includwith the federal government legally com- tunity proposal. The academy her pregnancy and delivered early at Mercy Hospital St. Louis in Creve Coeur, ing CHA, are concerned that the flexibility it promises to states mitted to match state spending on all autho- said the block grants would be a Missouri. Nienaber’s story was featured as part of CHA’s Medicaid Makes It “disruptive” financing mechato craft services is paired with Possible campaign, which was launched in 2018 to raise awareness about the rized program costs. the ability to limit access to prevalue of Medicaid to America’s health care system. nism that “would reduce access to care in rural and other medically Concerns about disruption scription drugs and impose new Paulo Pontemayor, director of govern- underserved areas; increase strain on state president of external affairs for the Cleve- copays on patients. “Those changes will and local governments, land-based Sisters of Charity Health Sys- disproportionately affect people with more ment relations for CHA, said the proposal is physicians and other cli- tem, said her system shares the concerns serious health issues,” Stoll said. a more limited version of the Trump administration’s plan to repeal the Affordable Care nicians, and patients; and that the new block grant proposal, even Act and replace entitlement funding for its ultimately increase un- with its initial limited scope and promise Innovation, but with strings of flexibility, could be the start of a wave of Medicaid expansion provision with fixed compensated care costs.” Executives at CHI Memorial in Chatchanges that erodes the safety net provided tanooga, Tennessee, are keeping a close block grants. That plan fell short of passage to low-income individuals and families by watch on the block grant plan. Tennessee by one vote in the Senate in 2017. Shifting the burden Medicaid. While the Healthy Adult Opportunity submitted a proposal last fall to become the to states Stoll “We are deeply concerned the proposal plan is, unlike that earlier plan, optional for nation’s first state to convert its entire MedHeather Stoll, vice will constrain the abil- icaid program, known as TennCare, to block states, Pontemayor said it poses the same risks, including the potential ity of states to adequately grant funding. That proposal, which is still loss of coverage or services for current finance their Medicaid pro- being reviewed by CMS, goes well beyond beneficiaries and lowered reimbursegrams and jeopardize Med- the scope of the Healthy Adult Opportunity ments for care providers. icaid beneficiaries’ access plan. Tennessee is not among the Medicaid A detailed statement on the plan to care,” Stoll said. “The expansion states and its block grant prothat CHA crafted for members urges federal Medicaid funding posal wouldn’t specifically change that, but caution. “Capped funding arrangecap simply shifts the cost TennCare’s director has said that any savburden onto local and state ings the switch to block grant funding genments, such as those proposed by this governments, providers erates might allow for a narrow expansion of guidance, are likely to lead to suband individual beneficiathose who are eligible for stantial reductions in federal support coverage. for the program and would require ries, ultimately leading to a Andrew McGill, senior states to assume financial risks loss of Medicaid coverage vice president of strategy, related to increased program spendfor millions of individuals.” business development Stoll and others worry ing,” the statement said. “As a result and advocacy for CHI that the block grants pose of these new financial realities, states Memorial, said the hospia particular threat to the that adopt capped funding will likely Medicaid expansion proneed to make significant cuts to covtal stands with the TennesMcGill erage and benefits in order to avoid grams that Ohio and a see Hospital Association large increases in state spending.” majority of other states in calling for more discussion on the state’s The Partnership for Medicaid, a already have adopted plan, even if it gets CMS approval. Before the nonpartisan coalition that includes under the ACA. plan would be adopted, the state legislature CHA and several organizations repData from the Ohio would have to approve it. Specifically, the Department of Medicaid association said changing to a block grant resenting doctors, health care proshows a steep drop in the should maintain access, coverage and benviders and safety net health plans, uninsured rate for low- efit levels for the current population insured also pans the block grant proposal. Its income adults in the state by TennCare so as not to increase hospital statement on its position notes that a Kaiser Health News/Sources: George Washington University study/Women’s Health Issues journal, The Kaiser Family Foundation; October 2017. since the ACA expansion. and other providers’ charity care costs. Congressional Budget Office analysis CHI Memorial has satellite hospitals in Hixson, Tennessee, and Fort Oglethorpe, Georgia. McGill said 5.4% of the whole system’s care goes to those insured by Medicaid, a figure that increased 13% from the previous year. (The percentage does not include patients who are insured by both Medicare and Medicaid.) “In Tennessee, TennCare pays 60 cents on the dollar for care, so anything that further degrades that, it’s another hill to climb to maintain the care that we want to make certain that we can maintain for our fellow Tennesseans,” he said. Tennessee’s proposal is being called a Sponsor Formation Faith Community Nurse Mission in Long-Term Care “nontraditional” block grant. That’s because Program for Catholic Networking Call Networking Call it has provisions for funding adjustments May 5 | 3 p.m. ET June 25 | 3 p.m. ET Health Care over time based on population and inflation as well as easing of some regulations and Session Two: March 26 – 28 other modifications that could allow MedicWhat Counts as Community Human Trafficking (Invitation only) aid funds to be used to treat a wider populaBenefit Webinar Networking Call tion than it currently does in the state. May 19 | 2 p.m. ET July 17 | Noon ET How to Talk About Climage McGill said he and others see “a whole Change — CHA’s 2020 host of things that, just on the surface, could 2020 Catholic Health International Outreach Earth Day Webinar be good but on the other hand, the details Assembly Networking Call Co-sponsored by the Catholic behind those requests are fairly significant June 7 – 9 | Atlanta Aug. 5 | 3:30 p.m. ET Climate Covenant and unknown.” April 13 | 2 p.m. ET Among the specific unknowns is how Essentials for Catholic Health what the federal government calls “shared savings” that could result from the switch Leading Mission in Catholic Association and The Task International Outreach to block grants would be used. McGill said Force for Global Health Joint Health Care Networking Call hospitals and care providers in Tennessee Sept. 9 – 11 | St. Louis Global Summit April 29 | 3:30 p.m. ET want assurances that the savings will go to June 9 – 11 | Atlanta improvements and enhancements in Medicaid services in the state and not get shifted into non-health programs. “We applaud that notion of trying to be innovative and to get some freedom to do it chausa.org/calendar in a way that those who are behind this think can be impactful, but let’s just make sure that it works out for the best for those who need the care,” he said.
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CATHOLIC HEALTH WORLD March 15, 2020
Members provide feedback on issues A
Sr. Mary Ann Dillon, RSM, answers a question during a session at the Critical Conversations 2020 meeting on strengthening Catholic identity and church relationships. She is Trinity Health’s executive vice president of mission integration and sponsorship. Other panelists include Tessie M. Guillermo, chair of the CommonSpirit Health Board of Stewardship Trustees, and Scott McConnaha, president and chief executive of Franciscan Sisters of Christian Charity Sponsored Ministries. Fr. Charles Bouchard, OP, left, CHA’s senior director of theology and sponsorship, moderated the panel.
Critical Conversations From page 1
about the transfer of leadership responsibility from vowed religious to laity with an anecdote: “I had a colleague who, when I first came into Catholic health care, said, ‘Liz, are you ready to take that big Dunne burning ball of accountability from the sisters?’ Now that is a visual,” Dunne said. Dunne’s answer? “Absolutely not, but what I’m ready to do is to make the commitment to work in community, to work in partnership and to ask for help.” Sr. Laura Wolf, OSF, is on the sponsor board of Franciscan Calais Ministries, the ministerial juridic person of FrancisSr. Wolf can Missionaries of Our Lady Health System. She is past president of Franciscan Sisters of Christian Charity Sponsored Ministries. She said that while Catholic health care started and flourished as the work of religious congregations, for the last 50 years it has been transitioning to become an independent ministry of the church. “It isn’t the sisters’ ministry anymore, it is the church’s ministry,” she said. After several lay leaders expressed wistful trepidation about the declining number
of women religious active in their health Crowder Bjoring Center for Nursing Historicare ministries, Sr. Jean Rhoads, DC, chair cal Inquiry at the University of Virginia. Her of Ascension Sponsor, offered reassurance. full presentation is online at chausa.org/ She said lay leaders of Catholic health care chworld. have demonstrated a sense of call and the It was bookended with a panel discusability to take risks focusing on the needs sion featuring representatives from Invenio of those who are poor and vulnerable. “So, Genetics, the Innovation Institute and Civplease don’t underestimate yourself and all ica Rx. Each of these technologically innothat God is calling you to do,” she said. “Your vative companies have ties to the Catholic hearts are already there — health ministry and are producing products 1,000% there.” or services to improve care and drive value. Laura Kaiser, president Meeting participants discussed how and chief executive of SSM to promote innovation and manage both Health, offered that she is ongoing and disruptive change while keep“really optimistic” about ing true to Catholic identity. the future of the Catholic Sr. Doris Gottemoeller, health care ministry and RSM, vice chair of Bon Kaiser its mission to provide speSecours Mercy Ministries, offered that Catholic imagicial consideration for those who are poor and vulnerable. “There is more conversanation must come into play when providers consider tion today about social determinants of how to deliver compassionhuman dignity than ever before,” said the CHA board member. “Now we have to fig- Sr. Gottemoeller ate care in an age of virtual ure out how we go to Washington” and get care, artificial intelligence and remote call policies enacted that provide for a payment centers where unseen staff arrange for bed transfers for hospital patients who are hunstructure that supports whole person care. “We should be thinking of some differ- dreds of miles away. “How do we make sure ent ways to be talking and making sure our the mission is part of that interaction? … I think we have a long way to voices are heard,” Kaiser told the Critical go,” she said. Conversations participants. Sr. Patricia Eck, CBS, chair of Bon Secours Imagination and innovation Mercy Ministries, said for The meeting included a keynote preher a central question is sentation on courageous innovation by how to ensure that Cathowomen religious throughout the history of Catholic health care in the U.S. The speaker, lic health care uses the Barbara Mann Wall, directs of The Eleanor Sr. Eck time recaptured through the efficiencies of technological innovation “to create ways to make sure that compassion stays at the center of everything we do.”
CHA moving forward with strategic planning I ATLANTA — n teeing up a conversation on the development of CHA’s next strategic plan at the Critical Conversations meeting, Sr. Mary Haddad, RSM, CHA’s president and chief executive, explained the process is grounded in what is going on in the country and in the health care industry. Sr. Mary Among the challenges she identified is the newly enacted “public charge” rule that will deter immigrants seeking permanent residence status from enrolling in Medicaid or continuing their coverage for fear that it will negatively impact their immigration status. Sr. Mary said CHA has voiced opposition to Medicaid block grant waivers that will cap Medicaid spending in states that seek the lump sum payments. CHA will increase its efforts to educate the public about the essential role of Medicaid. Protecting the Affordable Care Act continues to be a major focus for CHA’s advocacy department and its public policy committee, Sr. Mary said. “We also know that access alone isn’t enough — we have to talk about affordability. Affordability is going to be a battle cry for us in the next couple of years.” Sr. Mary brought meeting participants up to date on progress in the development of the association’s next strategic
plan. Foundational work began in February 2019 when the CHA Board of Trustees under then-chair Michael Slubowski went through a process of defining the elements necessary to ensure a thriving ministry. Slubowski is president and chief executive of Trinity Health. Kevin Sexton, who succeeded Slubowski as board chair, wrote a document delineating the elements of a thriving ministry. Sexton is the retired president and chief executive of Holy Cross Health. Sr. Mary said characteristics of a thriving ministry include: Being clearly appreciated and respected as a ministry of the church The ability to deliver high-quality care and have a significant impact on community health Being innovative and broad in its approach to health care Productive partnerships with other Catholic organizations such as Catholic Charities USA Public awareness of, and strong support for, Catholic health care The ability to use broad support to play a greater-than-expected role in influencing public policy The strategic plan is expected to be brought to the CHA board for final approval in April, and, if approved, it would be voted on by CHA members at the Catholic Health Assembly in Atlanta in June. — JUDITH VANDEWATER
Catholic identity Speaking as a panelist in the closing session on strengthening Catholic identity and church relationships, Tessie M. Guillermo called on Catholic health care providers to see themselves “as more authentic representatives of Catholic social teachings — social justice in particular — so those we touch on an everyday basis see us as an asset, as individuals relating to other individuals whether it is at the registration desk or in the cafeteria or out in the community where we do a lot of our works that define us as Catholic.” Guillermo chairs CommonSpirit Health’s board of stewardship trustees. Her fellow panelist Scott McConnaha, president and chief executive of the Franciscan Sisters of Christian Charity Sponsored Ministries, said Catholic identity is best measured in “whether the people who come to us, whether Catholic or not, walk away from that experience and say, ‘I was treated with dignity.’” Fr. Bouchard, who moderated the panel on church relations, asked for the panelists’ thoughts on stories in the media that define Catholic health care by the women’s health treatments and procedures not offered, rather than by its contributions to the health and well-being of communities. Panelist Sr. Mary Ann Dillon, RSM, executive vice president of mission integration and sponsorship for Trinity Health, said the media clearly recognize Catholic
s part of its information gathering for the association’s FY 2021 – 2023 strategic plan, CHA surveyed members in January to get their input on the top issues that are impacting their ministries. More than 1,200 members, representing a cross section of the membership, completed the short survey, which was created based on feedback from board members and those attending CHA’s Joint Committee meeting in November. Those serving in pastoral care, mission, board, sponsorship and executive leadership positions represented the highest percentage of respondents. In addition to gathering quantitative responses, the survey also collected hundreds of comments and story ideas that CHA is using to inform its strategic direction for the next three years. There was clear consensus among survey respondents that enhancing affordability, access and quality of insurance coverage for all, with special attention to individuals who are low-income and vulnerable, should continue to be the leading priority for Catholic health care in the U.S. A strong majority of survey respondents described Catholic health care in the U.S. as “healthy” or “thriving,” while a similar percentage of respondents agreed/strongly agreed that civic leaders in their communities appreciate the contributions that Catholic health care makes to overall health and wellness. In addition, a strong majority of respondents said their own organizations have good relationships with Catholic leaders in their communities. Respondents were also asked about their level of concern around several areas. The top concern was about health care policies enacted at the federal, state and local level that adversely impact operations and/or financial stability. Another top concern was the ability to recruit for mission roles over the next five years. On the question gauging concern about what impact the clergy sexual abuse and leadership crisis is having on Catholic health care, there were differing opinions with respondents split among those who are concerned and those unconcerned. Survey participants were also asked to give a priority ranking to five focus areas, but the question did not yield a statistically significant difference that would establish a clear priority among those areas. The focus areas presented for consideration were palliative care; mental illness and substance abuse treatment; end-of-life care; social determinants of health, and advancing care innovations. While this was not intended as a comprehensive list of CHA’s focus areas, the survey was an opportunity to see if any one of these areas rose above the rest in terms of member priorities. CHA’s Chief of Staff Angela Botticella presented top-line results from the survey at the Critical Conversations 2020 meeting, which was held Feb. 1213 in Atlanta. Following her presentation, attendees provided additional input on the topics covered. The feedback from the Critical Conversations meeting and the survey results were then shared with the CHA Board of Trustees during their strategic planning session in late February. — BRIAN REARDON
health care’s role in attending to the needs of people who are poor and vulnerable and in taking care of the whole person, body, mind and spirit. “People celebrate that.” She said the negative press coverage is narrowly focused on women’s reproductive health and particularly around sterilization, which is forbidden by the Ethical and Religious Directives for Catholic Health Care Services. “These are real issues for women in our world, they are real issues for women who work for us,” Sr. Dillon said. She recommended that CHA members work with the bishops to understand the issues more fully.
March 15, 2020 CATHOLIC HEALTH WORLD
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KEEPING UP PRESIDENTS/CEOS
ADMINISTRATIVE CHANGES
Gabrielle Finley-Hazle to president and chief executive of Dignity Health St. Joseph’s Hospital and Medical Center of Phoenix and Dignity Health St. Joseph’s Westgate Medical Center in Glendale, Arizona. The facilities are part of CommonSpirit Health of Chicago. Previously, Finley-Hazle was chief executive of Tenet Healthcare’s St. Mary’s Medical Center and Palm Beach Children’s Hospital, both of West Palm Beach, Florida. James Tracy to president of Maristhill Nursing & Rehabilitation Center in Waltham, Massachusetts, part of Covenant Health of Tewksbury, Massachusetts. Previously, Tracy was executive director of three Masschusetts facilities: Wingate at Sudbury in Sudbury, Walpole Healthcare in Walpole, and Golden Living of Norwood. Organizations within the Mercy system of Chesterfield, Missouri, have made these changes: Dr. Jennifer McNay to president of Mercy Clinic Springfield Communities, Springfield, Missouri. She was a practicing physician and vice president of primary care for Mercy in Springfield. And Craig McCoy to president of Mercy Springfield Communities. He was chief executive of Bon Secours St. Francis Health System in Greenville, South Carolina.
Julie Norton to chief financial officer of Avera Health of Sioux Falls, South Dakota. Facilities within CHRISTUS Health of Irving, Texas, have made these changes:
James Davidson to chief operating officer of CHRISTUS Ochsner Health Southwestern Louisiana in Lake Charles, and Katy Wilkens to chief nursing officer for CHRISTUS Shreveport-Bossier Health
Ministry mourns Catholic health leader Sr. M. Therese Gottschalk Sr. M. Therese Gottschalk, SSM, died Feb. 24 at SSM Franciscan Courts in Oshkosh, Wisconsin, at age 88. She had served in Catholic health care facilities from 1960 to 2019, including in the chief executive position Sr. Gottschalk at facilities that now are part of St. Louis-based Ascension. She had played a key role in the consolidation of health care facilities in 1989 to form Marian Health System, which later joined Ascension. A remembrance posted on Ascension’s website cited her vision in helping to bring about Marian’s founding. Sr. Gottschalk was born June 21, 1931, in Bavaria, Germany, the second oldest of
14 children. She entered the congregation of the Sisters of the Sorrowful Mother in Germany in 1952, immigrated to the U.S. in 1953 and made first vows in 1954 at a convent in Milwaukee. She began her nearly 60-year career in Catholic health care as a pharmacy director at the now-closed St. Mary’s Hospital in Roswell, New Mexico, where she was later chief executive. In 1974, she became president and chief executive of St. John Medical Center in Tulsa, Oklahoma, which had been founded by the Sisters of the Sorrowful Mother. Under her leadership, the hospital expanded significantly. She also headed the St. John Health System from 1982 to 2010 as it grew to include not just the flagship Tulsa hospital but also four small hospitals. Sr. Gottschalk was a key player in the joining of that health sys-
Rural hospitals main employer in small communities.
Supporting Medicaid expansion Brandtley Adams is executive director of regional outreach and administrative special projects at Tulsa, Oklahomabased Saint Francis Health System. He said Saint Francis supports Adams a Medicaid expansion effort underway in Oklahoma. Backers of
tem with the health care facilities of two other Sisters of the Sorrowful Mother provinces to form the Marian Health System in 1989. She headed that system until it joined Ascension in 2013. She was a senior executive adviser to Robert J. Henkel, who was president and chief executive of Ascension Health. Sr. Gottschalk sat on numerous health care facility and association boards, including the CHA board. In its online remembrance, Ascension paid tribute to Sr. Gottschalk’s “faith-filled life of service,” noting that “Sr. Therese was always at the forefront of expanding services to meet the growing needs of the community, especially those living in poverty and most vulnerable.” Visit chausa/chworld to view a memorial video.
his hospital is not immune from the pressures most small-town hospitals face. This includes those that relate to government policy such as the amount paid for Medicaid reimbursement.
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Economic anchors A study published in 2006 in the journal Health Services Research confirms the strong local economic role of rural hospitals. The study found that, on average, the closure of the sole hospital in a rural county reduced per capita income by $703 or 4% and increased the unemployment rate by 1.6%. Since 2005, many communities have suffered that economic blow, with 166 rural hospitals shuttering, according to the North Carolina Rural Health Research Program at the University of North Carolina at Chapel Hill. The largest number of closures in one year during that period was the 19 in 2019. In the first few weeks of 2020, four more rural hospitals locked up. The rural health research program at the university’s Cecil G. Sheps Center for Health Services Research cites several reasons for the closures, including: Population losses that decrease the market for health care. Hospital and health system mergers that create referral patterns that exclude rural hospitals. Government policies, such as states refusing to expand Medicaid coverage under the Affordable Care Act. Technology advances that allow many services to be delivered on an outpatient basis. A 2018 report on rural hospital closures by Congress’ nonpartisan Government Accountability Office cites similar woes and causes. The report says the hospitals’ financial distress “has been exacerbated in recent years by multiple factors, including the decrease in patients seeking inpatient care and across-the-board Medicare payment reductions.” It noted that more rural hospitals closed in states that declined to increase Medicaid eligibility and enrollment under the ACA.
System of Shreveport, Louisiana. Dr. Steven Nemerson to chief clinical officer of Saint Alphonsus Health System in Boise, Idaho, part of Trinity Health.
Nicole Gerleman, surgery coordinator at Avera Merrill Pioneer Hospital, talks to visitors touring the operating room during the public grand opening last spring for the new hospital in Rock Rapids, Iowa. Some of the guests are reflected in the monitor behind her. The town has a population of about 2,500 and is the county seat of Lyon County, which has a population of about 11,800.
the initiative have turned in petitions with enough signatures to trigger a statewide vote on expanding Medicaid under the ACA and are now waiting for the governor to decide when the measure will go on the ballot. “We believe that the increased funding for this sort of gap population that isn’t currently covered under the state’s Medicaid program will help keep these rural hospitals open,” said Adams, who attended the Rural Health Care Leadership Conference. Oklahoma ranks third in rural hospital closures with nine since 2005, behind Texas, which had 24 hospital closures, and Tennessee, which had 13. Saint Francis Health System bought a struggling hospital in Muskogee, Oklahoma, in 2016. Adams said the hospital is now financially stable. He credits that to investments the system made to upgrade the facility and better align its services to community needs. One change, for example, was to renovate its outdated behavioral health care unit. As some of the speakers at the conference pointed out, aligning with larger hospitals or health systems is one of the options that have helped save some rural hospitals. Another helpful step they mentioned has been for hospitals to join accountable care organizations, a network in which Medicare providers can coordinate care and reimbursements.
Getting a new start Craig Hohn, chief executive at Avera Merrill Pioneer Hospital, said some of the concerns plaguing other rural hospitals were addressed during the planning stages for his hospital in Rock Rapids, Iowa, which opened last May. The hospital, part of the Avera Health system, replaced a decades-old one that largely focused on inpatient care for the Hohn community of about 2,500 in the northwestern corner of Iowa. “We actually built the new facility to be much more robust in the outpatient and clinic areas,” said Hohn, who attended the Phoenix conference. The new hospital has only 11 staffed inpatient beds, three fewer than the old one. In addition, the hospital’s clinic offers well-used services that had not been available on-site at the old hospital, such as 3D mammography, bone-density scanning and chemotherapy and infusion. Hohn said his hospital also has the advantage of being in an area that is growing, thanks largely to its proximity to booming Sioux Falls, South Dakota, about 30 miles away. About half its patients have private insurance, a higher percentage than that of many other rural hospitals. Even with its advantages, Hohn said
Agenda for change The American Hospital Association has crafted a “2020 Rural Advocacy Agenda” that urges several changes from policymakers. One proposal calls for new payment and delivery models to support rural health care. A specific request is for the federal government to create a “Rural Emergency Hospital” designation under the Medicare program to “allow existing facilities to meet a community’s need for emergency and outpatient services without having to provide inpatient care.” The agenda also calls out Medicare and Medicaid for paying what the association says is less than 90 cents for each $1 that hospitals and health systems spend on care for patients insured by those programs. “Given the persistent and emergent challenges of providing care in rural areas, reimbursement rates across payers need to be updated to cover the cost of providing care,” the agenda says. Kathy Curran, CHA’s senior director of public policy, said the association is aware of the “enormous challenges” rural hospitals face and the need for relief. “CHA supports efforts to improve rural reimbursement by allowing more facilities to become critical access hospitals, to provide funding to address the rural health care workforce shortage and to expand the use of telehealth services in rural areas,” Curran said. Continuing distress A report released in February by the Chartis Center for Rural Health, run by the hospital advisory firm the Chartis Group, adds urgency to the need for increased government support for rural hospitals. The report found that of the about 1,840 rural hospitals still in operation nationwide, 453 are at risk of going under based on nine variables that the report calls “statistically relevant in determining the probability of closure,” including the proportion of outpatient to inpatient revenue and their occupancy rates. “As policymakers and rural health advocates work to stabilize the rural health safety net, questions inevitability arise with regard to how many hospitals may be forced to confront difficult decisions about maintaining operations,” the report said. “This research suggests that a sizeable portion of the country’s rural hospitals are vulnerable to closure.”
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CATHOLIC HEALTH WORLD March 15, 2020
St. Mary’s spiritual care providers reach out to people with substance abuse disorder By JULIE MINDA
Brendan Smialowski/AFP via Getty Images
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Huntington, West Virginia, police officer Dakota Dishman searches the belongings of a woman who was suspected of acting under the influence of heroin in April 2017 in Huntington. Huntington has been described as the epicenter of the opioid crisis. On Aug. 15, 2016, over a six-hour period, 28 people there overdosed on heroin laced with fentanyl, a synthetic opioid.
ple using heroin and other injectable street drugs can trade used syringes for sterile replacements, without fear of arrest. That harm reduction program is open five days a week, and the spiritual care team members are present for two, four-hour shifts each week. Rev. Creasy says providing a reli-
Trained 40 hospital staff, local clergy and other responders to use motivational interviewing and other methods to aid people addicted to opioids. Hosts support groups for loved ones of people with substance abuse disorders. Has self-care programming
Mike Brady/St. Mary’s Medical Center
Members of the spiritual care and mission team at St. Mary’s Medical Center in Huntington, West Virginia, hold a department meeting. The team has made it a priority to address spiritual needs related to opioid dependence. Rev. Greg Creasy, the team’s director, is at the head of the table.
The hospital’s spiritual care department too has upped its response to the opioid crisis, creating education programs for staff and community, devoting a chaplain full-time to aiding people with substance abuse disorder, launching a support group for loved ones and working to combat what Rev. Creasy says has been a lingering and pronounced stigma around opioid abuse. As St. Mary’s and the community have been navigating their response to the drug crisis, the spiritual care department has continually advocated to ensure spiritual care is at the heart of the hospital’s response. People abusing opioids “are individuals with a spiritual nature in them, and we must connect with that,” Rev. Creasy says.
The spirit moves Prior to PROACT’s opening, St. Mary’s spiritual care department’s outreach around opioid abuse included assigning spiritual care staff members to CabellHuntington Health Department’s needle exchange site, where peo-
long term can be stressful. Has a debriefing protocol to aid hospital staff following the death of a patient from an opioidrelated cause.
Getting to know you Rev. Rodney Adkins, the St. Mary’s chaplain assigned to PROACT, says the program averages about 86 new clients a month for drug treatment and recovery. As part of an initial Rev. Adkins intake process, a therapist screens clients for spiritual care needs and refers those interested in spiritual care to Rev. Adkins. The chaplain says he also spends a great deal of time mingling in PROACT’s common areas, introducing himself to clients, building familiarity and relationships with them and establishing trust. Rev. Adkins says newcomers are often afraid he’ll proselytize, but they quickly learn that is not his style. Most of his client base results from informal one-on-one interactions with PROACT clients. PROACT clients interested in receiving spiritual care at the center have a formal meeting with Rev. Adkins where he asks questions and uses active listening to learn about their spirituality, spiritual path, sense of purpose and meaning, their faith tradition, and
Healing connections Rev. Adkins says a common theme with people who are substance dependent is that they have experienced “pain, trauma, abandonment, spiritual issues and mental health issues.” That’s why a spiritual approach can be so vital to getting at the root of drug addiction. He adds, “As I work with clients regarding where they are and where they want to go spiritually, I often realize they are disconnected from themselves, from others, from the world, and from a higher power.” He says this is because substance addiction very commonly involves people becoming increasingly isolated and losing the connections that once were important to them. A big part of Rev. Adkins’ role is to help clients reestablish important relationships or build substantive new ones. He may refer a client interested in reviving a lapsed faith or religion to a church or member of the clergy he knows will be supportive. Rev. Adkins counsels and walks with clients who feel hopeless and daunted at the prospect of rebuilding their lives. He says, “I try to be a loving presence. I encourage them and help them see they’re valuable and important.” He says he is deeply gratified when clients tell him they are feeling more peace, and more hope, and more grounded in their recovery.
Child of God Rev. Creasy says research shows that spiritual care has a positive impact on the success of able, nonjudgmental presence for hospital staff and frontline drug abuse treatment. He sees the at the needle exchange site has responders worn down by the results of the spiritual care departsmoothed the way for some of the number of patients with subexchange’s clients to seek spiritual stance abuse disorder and the ment’s outreach in the increasing care and drug treatment through unrelenting nature of addiction. number of St. Mary’s patients and St. Mary’s. Caring for these patients over the PROACT clients doing the work in He adds the spiritual recovery programs to care department — which regain their lives and includes five full-time become productive chaplains, six per-diem members of society. associate chaplains and The individuals five full-time chaplain touched by St. Mary’s residents — wanted to efforts have expressed do more. So, around how much it has meant the time of PROACT’s to them to be treated as launch, spiritual care staff valued human beings. studied up on the opiRev. Creasy says, “No matter what is going oid issue and networked on with them, we treat with local organizations them with respect and involved in the commudignity because they nity response, clergy and are a child of God. We other St. Mary’s respondtreat everyone with ers to better understand the same loving care as the landscape. Christ would, and that They developed and is what fuels our work.” have been implementing Visit chausa.org/ a plan for a strong spirichworld for informatual component to the response to the opioid tion about a study on epidemic. The hospital: spiritual care and opi Provides a full-time Paraphernalia for smoking and injecting drugs found during a police search in April 2017 in Huntington oid recovery. is arrayed on the car hood. chaplain for PROACT. jminda@chausa.org Brendan Smialowski/AFP via Getty Images
est Virginia has the nation’s highest ageadjusted rate of drug overdose deaths involving opioids — its rate is three times higher than that of a statistically standard U.S. generally. And the city of Huntington has been described by politicians, media outlets and others as the epicenter of the nation’s opioid epidemic. “It’s everywhere here — the situation knows no bounds,” says Rev. Greg Creasy, director of the department of spiritual care and mission at Huntington’s St. Mary’s Medical Center. He says the crisis has devastated the community. A steep escalation of opioid use documented around 2014 and an alarming rash of 26 opioid-related overdoses and two deaths one day in August 2016 spurred the community to action. The mayor’s office has put in place new treatment and recovery, drug prevention, law enforcement and drug control policies. And, the 393-bed St. Mary’s joined with other hospitals, health systems and health agencies to, in October 2018, open a “one-stop” treatment facility called the Provider Response Organization for Addiction Care & Treatment, or PROACT.
beliefs and practices. In ensuing one-on-one appointments, Rev. Adkins delves more deeply into the clients’ spiritual lives, moving at their pace, helping men and women think through spiritual goals and supporting them in pursuing those goals as part of their recovery. In December, Rev. Adkins introduced himself to 79 clients in PROACT common areas, conducted assessments with 12 clients and had substantive followup conversations on spiritual topics with 41 people.