Catholic Health World - November 15, 2020

PERIODICAL RATE PUBLICATION

NOVEMBER 15, 2020 VOLUME 36, NUMBER 12

Catholic care providers intensify efforts to elevate inclusion and racial justice Catholic health care Focus on social justice, uses dialogue, therapy, health equity energize education to advance ministry’s outreach racial equity efforts

By JULIE MINDA and LISA EISENHAUER

By LISA EISENHAUER and JULIE MINDA

This spring, when a video of the homicide of George Floyd at the hands of a police officer went viral, employees of CHRISTUS Health were among the countless people who were stunned and heartbroken by what they saw.

To acknowledge the horror of that death along with the deaths of Breonna Taylor, Ahmaud Arbery and many others, and to help employees begin to process their emotions, CHRISTUS held a virtual memorial service.

CHRISTUS has since been encouraging conversation about racial inequity among employees and building awareness of employee assistance programs for mental health for those distressed

Leaders within Catholic health care systems say that amid the push for racial justice in the wake of the police killing of George Floyd and for health equity as the heavy toll the pandemic has taken on Black, Hispanic and Native American communities has come into focus, their ministries have recommitted to and expanded their outreach and community programs that promote racial justice, equity and inclusion.

Among their areas of focus are investing in marginalized communities, increasing the pipeline of people of color seeking jobs in health care and identifying racial disparities in health outcomes to improve care delivery and access.

Continued on 4

As part of CHRISTUS Health’s racial justice education campaign for employees, the system built a web portal populated with information about health equity, diversity and inclusion.

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Caring for patients by caring for the planet, nurses are up for the challenge Age-friendly care

Carrie Berquist, an Ohlone Indian shown here surveying her ranch in Santa Barbara County, inspired her granddaughter Erin Berquist’s commitment to environmentalism. The younger Berquist, a nurse at Sierra Nevada Memorial Hospital in Grass Valley, California, is a Nurse Climate Champion within the CommonSpirit Health system.

Erin Berquist grew up in Santa Barbara, California, spending much of her time at her grandmother’s 160-acre ranch in the mountains nearby. The ranch has no electricity; her grandma, 85, an Ohlone Indian (formerly known as the Costanoans), lives by lamplight and woodburning stove. That lifestyle, and its deep connection with nature, impacted Berquist profoundly, she says.

“It’s my spiritual spot — the reason why I think I’m so passionate about environmental issues,” says Berquist.

Now 39, Berquist has been a registered nurse at Sierra Nevada Memorial Hospital in Grass Valley, California, for 15 years, first as a floor nurse and, for the last five years, working in wound care. Since 2008, she’s also been a charter member of the

framework finds wider embrace

By LISA EISENHAUER

Providence St. Joseph Health, Ascension and Trinity Health, the three Catholic health systems that were among the first to test the concepts behind an initiative to make care for older adults more agefriendly, have since made the framework their own by adding local adaptations.

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ArchCare’s Calvary offers grief support in the time of COVID-19

By JULIE MINDA

Joanna Mills says she is not sure how she would have gotten through the last five months, were it not for Melanie Rae Pappalardi and the virtual bereavement support group Pappalardi runs every Thursday evening on Zoom. Pappalardi is a social worker providing bereavement support under an expansion of services by New York’s ArchCare long-term care system and its Calvary Hospital, an acute palliative care hospital in the Bronx. The Archdiocese of New York sponsors ArchCare.

Mills, of Yonkers, New York, had been one of the main caregivers of her mother, Nora Mills, who had a degenerative heart condition and chronic obstructive pulmonary disease. A massive stroke in March caused a profound deterioration in Nora Mills’ condition, and she spent much of the spring on hospice care at home — with some of her care delivered by ArchCare staff. By Continued on 6

Dr. Cara Ellis discusses fall risk factors with Larry, a volunteer older adult patient, as part of the geriatric mini fellowship at Providence St. Joseph Health in 2018.

Joanna Mills, right, is shown here with her mother, Nora Mills, during one of the many hospitalizations before her death. Mills attends ArchCare at Calvary Hospital’s virtual bereavement group.

Photo courtesy of Providence St. Joseph Health

By RENEE STOVSKY

The framework that is at the core of the Age-Friendly Health Systems initiative is called the “4Ms” for what matters to the patient, mentation, mobility and medication. (See Page 2 sidebar.)

Providence Oregon put it in practice in outpatient care at the regional system, part of Providence St. Joseph Health, in 2017.

The idea, says Colleen M. Casey, associate cliniCasey cal director of Providence Oregon’s Senior Health Program, was to Continued on 2

CATHOLIC HEALTH WORLD November 15, 2020

Age-friendly care From page 1

“train up the workforce” because there simply weren’t enough people trained in geriatric care. Based on census data, projections are that by 2034, there will be more people 65 or older than people 18 and younger for the first time in U.S. history. Meanwhile, the number of geriatrictrained clinicians is expected to grow at a much slower pace than that of the senior population.

“We identified that if we could bring both the skills that would be needed and the framework of the 4Ms to operating frontline clinical care teams, that would be a way to augment the work of the small few of us,” Casey says.

Go big Last year, Providence St. Joseph Health decided to adopt the age-friendly framework for all patients.

Leslie Pelton, senior director at the Institute for Healthcare Improvement and leader of the Age-Friendly Health Systems initiative, says there is worldwide interest in Pelton the framework. “I find out literally every day there’s adoption of the 4Ms in places I don’t know about, which is terrific.”

Pelton has been contacted by health systems in Australia, India and Scotland about how to put the 4Ms in place. “Our aim was to ensure that evidence-based care was practiced everywhere that older adults showed up,” Pelton says. “I think 4Ms as an organizing framework is just the right level of complexity, if you will. It’s very accessible.”

The 4Ms, Pelton says, “are a framework, not a model, not a program, which means we very intentionally left lots of space for local adaptation because the research and IHI’s experience is that if you leave a lot of room for local adaptation, people are more likely to pick this up and make it their own and the change and improvement will be more sustainable.”

Helping avert crisis Providence Oregon used the framework when it standardized the protocols for screening and intervention for fall risk among its 80,000 patients who are 65 and older who are cared for in its primary care practices. Falls are a leading cause of death and disability in older adults. With standardization, the screenings grew from 17,000 patients seen in its clinics in 2016 to 35,000 in 2019.

To expand the use of the age-friendly framework, Casey and her colleague Dr. Marian Hodges, a specialist in geriatric and internal medicine, founded a geriatric mini fellowship. Its four-week curriculum unfolds in one-week increments over the course of a year. Six or seven physicians or nurse practitioners can take part each year. By the end of 2019, 11 graduates of the mini fellowship had together given 50 presentations to colleagues, developed workflows for geriatric care in their clinics, led geriatric improvement projects and provided consultations for complex geriatric cases.

“The idea is that we’re not only training them to change their practice but we’re steeping them in the ingredients of systems change so they become their own change agent, with our help, and become the geriatrics experts by default in their own clinics to continue the ripple effect of change,” Casey says.

Systemwide adoption Last year, the clinical leadership of Providence St. Joseph Health voted to adopt the age-friendly framework not only systemwide but for all patients, while keeping the priority on those 65 and older.

They also added a fifth “M” for malnutri-

tion. The decision came after what Deborah Burton, senior vice president and chief nursing officer, says was a formal debate over whether the initiative was appropriate and scalable for such a big Burton system.

The bundle of practices that the system created under the initiative was set to go in place early this year. However, the plans were delayed when the coronavirus pandemic hit. The initiative began to roll out across the system in late summer, starting in acute care facilities but with plans to bring it into use at all sites and by all providers within months. This fall the system is building a dashboard to monitor related metrics, such as whether goals of care and advanced directives are being discussed with older patients.

“It’s like motherhood and apple pie,” Burton says of the framework. “Who can argue with doing the right thing for the elderly in an evidence-based, and I don’t want to say simple, but certainly straightforward way?”

Denise Staschke, director of post-acute and senior services within Ascension St. Vincent Medical Group in Indianapolis, says nurses doing Medicare wellness Staschke assessments use the 4Ms framework to get a baseline, so that when things do start to change for an elderly patient, the nurses are readily able to pick up on that.

Ascension St. Vincent also started a geriatrics mini fellowship. Primary care

Photo courtesy of Providence St. Joseph Health

2

Dr. Melissa Calhoun and Dr. Eric Webb practice a fall risk assessment with Rachel, a volunteer older adult patient, during a session of the Providence St. Joseph Health geriatric mini fellowship in 2019.

Falls hamper mobility and are one of the major causes of fatal and nonfatal injuries for people age 65 and over. Keeping older patients mobile is one of the focuses of the Age-Friendly Health Systems initiative.

clinics can send their entire staffs for six one-hour sessions that dive into the 4Ms training. Staschke says of the age-friendly training: “We all want this to continue.”

The framework has worked so well in the outpatient setting that Ascension St. Vincent started an inpatient geriatric consultation program called Mobile ACE (Acute Care for the Elderly) that is making use of the framework. Under the program, a team with a nurse practitioner and a nurse get referrals from other providers for older patients suffering from or at risk of problems such as delirium and come up with care plans.

The invisible patient Carrie Hays McElroy is chief clinical

‘4Ms’ frame age-friendly care T

he Age-Friendly Health Systems initiative is based on a simple set of practices called the “4Ms” — what matters to the patient, mobility, mentation and medication.

The initiative was started by the Institute for Healthcare Improvement, a nonprofit focused on motivating and building the will for change, and The John A. Hartford Foundation, a private philanthropy whose goal is to improve the health of older Americans. CHA and the American Hospital Association are partners on the initiative that have worked to promote and expand it.

Julie Trocchio, CHA’s senior director of community benefit and continuing care, says she joined the age-friendly bandwagon early on because she saw its framework as “just basic good care for older people” that is built on evidence-based practices.

“I would say the goal was to close the gap between what we know how to do, what the research tells us and what we actually do,” Trocchio says.

Leslie Pelton, senior director at the Institute for Healthcare Improvement and leader of the Age-Friendly Health Systems initiative, says it was with that prospect in mind that IHI and the Hartford foundation brought thought leaders in geriatrics together to analyze existing geriatric care An initiative of The John A. Hartford Foundation and the Institute for models, consolidate Healthcare Improvement in partnership with the American Hospital Association and CHA. evidence and lessons learned, and collaborate with other health care experts. The result was the 4Ms, described like this: What matters — Know and align care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care.

Mentation — Prevent, identify, treat and manage delirium across settings of care.

Mobility — Ensure that each older adult moves safely every day to maintain function and do what matters.

Medication — If medication is necessary, use age-friendly medication that does not interfere with what matters to the older adult, mobility or mentation.

There are three on-ramps that systems can take to join the initiative. Systems can become part of an “action community” that tests the 4Ms framework in hospital and ambulatory settings and shares learnings in a seven-month program; systems instituting the framework can bring IHI in as a consultant; or systems can institute the age-friendly practices on their own initiative and share their approach with IHI. Once hospitals or practices incorporate the 4Ms into patient care, IHI provides them with a toolkit to market themselves as an Age-Friendly Health System.

— LISA EISENHAUER

and compliance officer for Trinity Health PACE, a group of 10 Programs of All-Inclusive Care for the Elderly. Because these programs already incorporated much of the 4Ms framework, McElroy was McElroy involved with crafting the pioneer work within the health system around the initiative. The ability to expand across other Trinity Health ministries has been limited recently, she says, but she is seeing an upswing now, including a push to have it championed by the system’s population health leaders who would share it among the physician practices affiliated with Trinity Health.

“We’re really hoping this is practiced across the continuum, it’s not just in the emergency departments, it’s not just acute care, not just in the nursing home setting, that it’s also in the physician offices,” McElroy says.

Lisa Zapatka, Trinity Health Of New England’s chief nursing officer, oversees a pilot of the age-friendly initiative at Johnson Memorial Hospital in Stafford Springs, Connecticut.

Zapatka When a patient who’s 65 years or older is admitted, caregivers do assessments for mobility, medication and delirium. The care providers also have a conversation with the patient about what matters to him or her.

“The goals of care are then geared toward what that patient really wants, and we want that conversation to happen on almost every encounter,” Zapatka says.

“Sometimes older adults feel invisible. We want them to be visible. We want them to be heard. We want them to know we’re listening to them.”

She hopes the pilot project ends up being replicated at all Trinity Health sites across her region. “It’s not fancy, hightech work but it can really be a foundation of what can keep our patients safer when they do have to come into our hospitals and if that’s continued along the continuum, then it’s just good care for the patient,” she says.

Zapatka thinks the 4Ms should be a topic of conversation with patients just as other aspects of care are.

“What I would love to see, once we have this more hardwired, is that we discuss this with the patient, because quite honestly this initiative really aligns with our beliefs at Trinity Health and I think with other Catholic health systems,” she says.

“That is, we respect the individual and in doing that we personalize their care, we are partners in their care and our basic promise is to keep them safe. Age-friendly care helps do that.” leisenhauer@chausa.org

November 15, 2020 CATHOLIC HEALTH WORLD

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Trials of pandemic underscore importance of spelling out care wishes before crisis strikes

By LISA EISENHAUER

St. Joseph Health, says just as COVID was beginThe challenges and turmoil brought on ning to take its tragic toll, older adults arrived in our by the coronavirus pandemic have reinProvidence St. Joseph emergency center with Health was starting to roll forced the importance and validity of the Knowing what matters out the framework for use Age-Friendly Health Systems, say some COVID-19 and we really didn’t Deborah Burton, senior vice presisystemwide. Because of care providers. dent and chief nursing officer at ProviCOVID, the system put Michelle Moccia, dence St. Joseph Health, says that early Moore have an understanding of that plan on hold until director of the geriatric in the pandemic it was apparent that the what matters to them.” emergency room at St. elderly were at heightened risk of dying this fall. The principles of the framework Mary Mercy Livonia in from COVID. “The focus was on getting nevertheless were already gaining wide — Michelle Moccia Michigan, recalls that the older patients the care that would save acceptance among care providers.

“We realized that the pandemic both early in the crisis she families were unaware of the patients’ them, including intubating them early if reinforced and and her colleagues cared wishes, the care providers in the ER fol- they were at high risk Moccia “We realized that the accelerated our for many critically ill lowed still-evolving best medical prac- for stopping breathcommitment to elderly patients who could not articulate tices, including at times using extraordi- ing in the intensive pandemic both reinforced becoming an Agetheir care preferences and did not have nary interventions such as intubation to care unit,” Burton Friendly Health an advanced care plan or individual with keep the patients breathing. “That was says. and accelerated our System,” Moore medical power of attorney identified in very distressful for many of us,” she says of Sometimes that their medical record. The hospital is part ER workers who had to make major treat- care came without commitment to becoming an said during a webinar in Sepof the Saint Joseph Mercy Health System, a ment decisions on their elderly patients’ conversations with subsidiary of Trinity Health. those patients about Age-Friendly Health System.” tember on the agebehalf.

“Unfortunately, many older adults In recent months, care protocols have whether they wanted friendly initiative.

— Andria Moore arrived in our emergency center with gotten more standardized with intuba- to be intubated, sent The webinar was COVID-19 and we really didn’t have an tions used as a last resort. Meanwhile, to the ICU or even admitted to the hospital sponsored by Modern Healthcare and The understanding of what matters to them. Moccia has come to see the earlier frenzy rather than being cared for at home, she John A. Hartford Foundation, the philanDid they want to be put on a ventilator? as validation of the foundations of the age- says. The way to avoid that in the future is thropy that has funded the initiative.

What did they want their end-of-life care friendly framework, especially the “what to have goals of care conversations with to be? Did they have a surrogate who matters” aspect of care. “It really brought every patient before there’s an emergency, Toll on care providers could help make decisions for them?” it to the head that it’s very important as Burton says.

Moore says as a result of the isolation Moccia says.

Andria Moore, nursing practice and and drop in support services due to the we grow older that we have these discusIf they couldn’t reach families or if the sions with our family members about our quality program manager for Providence pandemic, caregivers noticed an accelerated decline in many older patients, such as decreases in mobility along with an increase in falls, more incidences of delirium and a worsening in their overall mentation. Those issues along with monitorNOW AVAILABLE ing medication and knowing what matters to patients are among the main focuses of the age-friendly initiative and its goal of giving older patients the healthiest and most satisfying life possible.

The demands of the pandemic exacerbated by the prohibition on visits by loved ones of terminally ill patients also took a toll on clinicians, Moore says. “They were demonstrating signs and symptoms of NEW moral distress not only related to COVID online selfand everything that that brought onto them, but also about whether they were assessment tool able to meet our patients’ true needs and with coaching having to function not only as the role of prompts the nurse but as the family members, the hospice provider, etcetera,” Moore says.

She says the pandemic highlighted for those clinicians the value of the foundational elements of age-friendly care, especially the importance of identifying and keeping sacred what matters to patients.

It also brought to the fore new challenges, such as how to honor patients’ wishes when their condition is worsening rapidly, and no advocate is at their side.

The pandemic’s lessons are being incorporated into the trainings and discussions Providence St. Joseph Health is using as it puts the age-friendly initiative into wider practice.

Moore and Burton say another lesson from the pandemic is how useful telehealth can be, especially for those who don’t want to leave their homes or congregate living centers during the pandemic.

NOW “We learned to use telehealth and to do WITH TIERS things we had never really done before for entry-, midwith keeping people well supported, cared and executive-level for and safe in their homes,” Burton says. mission leaders As painful as the pandemic has been, Burton says it has brought Providence St. Joseph Health together in many ways, including sharing the evidence-based practices of the age-friendly initiative and breaking through silos to work across the care continuum to improve patients’ FIND OUT MORE AT outcomes. “We are a stronger, more unified, more patient-centric organization CHAUSA.ORG/MISSIONLEADERCOMPETENCIES because of COVID. I wouldn’t want to relive COVID to get there again but it is a certain gift we got from COVID.”

“Unfortunately, many

end-of-life care and choosing someone to speak for you in case you can’t speak for yourself,” she says.

2020 Mission Leader Competency Model

leisenhauer@chausa.org

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CATHOLIC HEALTH WORLD November 15, 2020

Racial equity From page 1

— all to help associates to work through the trauma of racism. Efforts include outreach to Hispanic employees, who may experience a different brand of toxic racism than Black employees.

Angela M. MacDonald, system director of mission integration for CHRISTUS, says of the emotional weight of processing toxic racism, “these are painfully traumatic experiences and MacDonald when you think of the sum total of those experiences … you understand the need for self-care for associates.”

Like CHRISTUS, most Catholic health systems and facilities have found a fresh impetus in 2020’s civil unrest to take on inequity anew. These systems are redoubling their efforts to help employees harmed by inequity and racism, and bolstering cultural sensitivity training and education of all associates, providing staff with more resources on diversity, equity and inclusion.

Processing emotions Like CHRISTUS, CommonSpirit Health has been facilitating formal dialogue among associates to process ideas and emotions around the nationwide clamor for racial justice. Corinne Francis, system vice president of mission integraFrancis tion, said these conversations started organically at a facility in the system’s Northern California re– gion and then Common– Spirit hosted “meaningful conversations” across the system. Francis says in small groups employees Chukunta openly voice their perspectives and are encouraged to learn from others.

Tabiri Chukunta, executive director of community outreach and diversity and inclusion officer for Saint Peter’s Healthcare System, says that by late October, that system had held two focus group sessions with Black employees and was preparing to hold sessions with its Hispanic and, separately, its Asian associates.

Chukunta says, “We continue to look at ways to further our culture of diversity and inclusion; as such, Saint Peter’s is holding focus groups to gather feedback from our minorities/employees of color. Listening and learning from them is critical.”

PeaceHealth has been encouraging such conversations through preexisting affinity groups. PeaceHealth has five such groups and is developing more, to bring together employees across all of its facilities who have common backgrounds and interests. Currently there are groups for Latino employees, Black employees, and people who identify as LGBTQ. The groups have become increasingly active during the pandemic, hosting virtual events that reach caregivers across PeaceHealth’s markets.

New affinity groups are being formed.

PeaceHealth also has started offering group support sessions for its employees who are people of color. Called “Healing Racial Trauma for Black, Indigenous, and People of Color Caregivers,” the sessions provide emotional support for people who are struggling with stressors connected with racial identity, racism and discrimination, says Joline Treanor, PeaceHealth executive vice president of people and culture.

PeaceHealth licensed behavioral health therapists provide one-on-one “culturally responsive psychological first aid” to employees who are people of color. Treanor explains that the approach, along with other efforts in this vein, are in line with “a holistic view of our people and culture at PeaceHealth.”

A photo montage of Black people killed by police or as a result of a hate crime on display during a CHRISTUS Health videoconference for employees, one of a series of such sessions on topics having to do with health equity, diversity and inclusion. Presenters Warren Chalklen, CHRISTUS manager of cultural competence, diversity and inclusion programs, and Angela MacDonald, CHRISTUS system director of mission integration, are in the upper righthand corner, along with a participant.

Similarly, at CHRISTUS, says MacDonald, leadership is encouraging associates who have been emotionally and spiritually impacted by racial inequity to take advantage of free therapeutic care offered by the system.

Reviewing policies, practices Some systems have also been scrutinizing their policies to see if they need to be revised to ensure equity in areas including recruitment and promotion.

“We’re in the process of actually going through all our policies and looking at them through a different lens,” says Hunter Richardson, chief human resources officer for Franciscan Missionaries of Our Lady Health System. The goal, he says, is to root out any unintended exclusions or bias.

In addition, Richardson says the system is reviewing its hiring and promotional practices because FMOLHS wants to be certain it is making intentional efforts to ensure those practices are Richardson fair and advance diversity.

“Whether it’s age, race, gender, religious affiliation, regardless, we want to ensure that we have intentional efforts to support hiring within those specific groups,” he says.

Hospital Sisters Health System has put in place implicit bias training for all its colleagues in an effort to expose and root out prejudices that affect the work environment. The system is setting up a diversity council to reinforce that training and raise issues related to inclusion and equity, says President and Chief Executive Mary Starmann-Harrison.

HSHS has also crafted a “very well laid out” compensation plan for all employees and leaders, Starmann-Harrison says.

“It’s about as tight as it can get in not allowing anyStarmann-Harrison body to pay somebody more than anybody else in the same job,” she says.

Building knowledge Odesa Stapleton, chief diversity and inclusion officer of Bon Secours Mercy Health, says that system is providing training for all 60,000 of its associates to fight racism, including through sessions on how to recognize and interrupt one’s Stapleton own discriminatory thinking and actions. The system offers related information and videos on an online learning portal and promotes formal and informal conversations about race among its associates and communities.

MacDonald says CHRISTUS has a web

CHA IS WORKING with its members

on an initiative to address racism and health equity. As Catholic health care, we are committed to achieving equity in the health care we provide, in the communities we serve, and in the nation as a whole. Our ministry is uniquely positioned to be a leader in this effort based on our long history of caring for everyone regardless of race or socioeconomic status and our deep commitment to the social teachings and moral principles of the Catholic faith. Stay tuned over the coming months to learn more about the initiative.

Visit wearecalled.org to learn more (member login required).

portal with videos and learning modules aimed at combatting discrimination by CHRISTUS associates. The portal connects employees who want to take part in book clubs that explore social justice topics.

Providence St. Joseph Health hosts a webinar series for staff that focuses on efforts both by the health system and by others in the communities it serves to reduce health disparities impacting people of color and people in marginalized communities, including and especially those facing longstanding socioeconomic challenges.

Sometimes the speakers are patients

Vice President Communications and Marketing Brian P. Reardon

Editor Judith VandeWater jvandewater@chausa.org 314-253-3410 Associate Editor Julie Minda jminda@chausa.org 314-253-3412 Associate Editor Lisa Eisenhauer leisenhauer@chausa.org 314-253-3437 Advertising ads@chausa.org 314-253-3477

who have gotten care within the system.

They discuss their experiences with caregivers and whether they received helpful information and any follow-up care they needed, says Dr. Rhonda Medows, president of population health management at Providence St. Joseph Health.

“When we really listen to our patients, caregiver colMedows leagues and people in our communities, we are better able to answer the call of patients as they ask us to ‘Know me, care for me, and ease my way,’” Medows says.

At PeaceHealth, Treanor says, the Center for Inclusion, Diversity, Equity and Access leads work to educate employees on unconscious bias and diversity. This center is coaching leaders on how to hold conversations on race. And it is developing programming to increase employees’ understanding of the interplay and influences that contribute to racial injustice. Treanor says the work ahead will not be “easy, or comfortable. We anticipate a degree of discomfort and confusion. Despite this, we know we must stay the course towards respect and social justice.”

Treanor says of the work to promote an inclusive culture, “this pursuit is a journey and not a destination. For change to be truly lasting, we know that we will need to sustain these efforts on all levels, from leadership to our caregivers and treatment of our patients.” jminda@chausa.org, leisenhauer@chausa.org

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November 15, 2020 CATHOLIC HEALTH WORLD

Social justice outreach From page 1

Local investment Dr. Sam Ross, chief community health officer for Bon Secours Mercy Health, says that system is looking closely at its supply chain and trying to identify minority vendors in the communities it serves with whom it can contract. The goal, he says, is “creating better and deeper relationships with them so that they can grow their businesses and they can hire others and Ross improve economic conditions in our communities.”

Ross says Bon Secours Mercy Health is also evaluating how it can make “placebased investments” in communities to address social needs such as affordable housing and food security. To make the impact of those investments as broad as possible, the system is partnering with other like-minded community groups.

“The fact is none of us alone have enough resources to address the deeper root causes of structural racism and things that are impacting communities today,” he says.

“But we are moving forward so as long as we make the commitment to that journey, knowing that there are some quick wins, so to speak, around social needs, but there are longer-term commitments that have to be made and long-term investments that have to be made to truly address the structural issues and the root causes.”

Odesa Stapleton is chief diversity and inclusion officer for Bon Secours Mercy Health. She says another way that system is engaging with its local communities to promote positive change is through “community conveners.” Bon Secours Mercy Health facilities invite community members, politicians and other stakeholders in marginalized communities to gather for conversation about working together to address area needs.

Lydia Jumonville, president and chief executive of SCL Health, stepped up this summer as one of 30 chief executives in Colorado to form the Colorado Inclusive Economy. The organization is “dedicated to envisioning and operationalizing a Colorado that is more equitable Jumonville and inclusive.” The group will provide a forum for open dialogue so the executives can share best practices for improving equity and inclusivity among all the enterprises.

Filling the pipeline Damond Boatwright, SSM Health’s regional president of operations in Wisconsin, created and is leading SSM Health in Wisconsin’s Inclusion, Equity and Diversity Advisory Council. Among its Boatwright tasks is recruiting a workforce that “represents and is reflective of

Les Hirsch, foreground, president and chief executive of Saint Peter’s Healthcare System, joins Pandit Ramdular Singh, right, in a 2019 Diwali (festival of lights) ceremony. The event was intended to increase understanding among people of different backgrounds.

the communities that we serve” and doing community engagement work to improve the quality of life and health outcomes of people of color.

“I wanted this to be more than just words,” Boatwright says of the council. He intends it to be “a challenge to our organization that we can and should do better. We are looking at very tangible metrics associated with our recruitment based on demographics and other statistics” to measure progress.

Angela M. MacDonald, system director of mission integration for CHRISTUS Health, says that system is aiming to encourage more people of color to consider

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professions in Catholic health care as a promising career path. She says a way to do this is to be more intentional about working with universities to groom upcoming talent for leadership careers in mission, ethics and administration. This includes work with Xavier University in New Orleans, the nation’s only historically black college that is Roman Catholic.

PeaceHealth has similar efforts underway, including minority recruitment programming that already is resulting in the increased hiring of people of color, says Joline Treanor, PeaceHealth executive vice president of people and Treanor culture. In development are administrative fellowships and summer enrichment programs for first year graduate students to encourage minorities in career tracks that can lead to executive roles.

PeaceHealth also is partnering with the University of Oregon’s Phil and Penny Knight Campus on a program called “Accelerating Scientific Impact.” The initiative aims in part to provide a path to careers in science and medicine for populations underrepresented in those fields.

Care equity Providence St. Joseph Health in September committed to a five-year, $50 million investment to address racial disparities and achieve equity in health care. The investment is starting by responding to the disproportionate impact of COVID-19 on communities of color, “by expanding outreach and education, increasing the COVID testing supply to marginalized populations, expanding access to care, and ensuring equitable distribution of treatment as well as a safe and effective COVID vaccine, when it becomes available,” says Dr. Rhonda Medows, president of population health management for Providence St. Joseph Health.

At CHRISTUS Health, an initiative called Equity of Care that started in 2018 as a pilot in one region has been expanded systemwide. Linda Townsend, the system’s vice president for advocacy and public policy, says the initiative pairs a group of patients who have hypertension with a patient navigator who does a social assessment and then tries to help them past social and economic barriers to managing their condition, such as poor access to nutritious foods or the high cost of medications. Many of those in the cohort groups are minorities, Townsend notes.

“This initiative is getting at the way that some of these inequities have played out because obviously they’re impacting people’s health,” she says.

Saint Peter’s Healthcare System long has aimed to identify and address care disparities, including by dispatching mobile health units to marginalized communities to improve their care access. This summer, when the system saw that COVID was having a significantly worse impact on minority communities, it provided care kits in those areas that contained personal protective gear and informational handouts, says Tabiri Chukunta, executive director of community outreach and diversity and inclusion for Saint Peter’s.

PeaceHealth’s Treanor says that system uses a targeted approach to combat racebased care disparities amid the pandemic.

It organized drive-thru testing events for Latino, Black and Chuukese communities in Vancouver, Washington, this summer.

The system gave away cloth masks, sanitizer and COVID informational materials at the events.

In partnership with community organizations, PeaceHealth is developing a comprehensive strategy for equitable distribution of COVID vaccine, when it becomes available. A dual goal is to ensure marginalized communities have access to a vaccine and that they have the trust in the health care system to take advantage of that access. leisenhauer@chausa.org, jminda@chausa.org

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CATHOLIC HEALTH WORLD November 15, 2020

Bereavement support

in nursing homes were in New York City, according to data from the New York State From page 5 Department of Health.

ArchCare nursing homes had recorded 295 patient deaths from COVID-19 by late early June, she was so debilitated that she no longer could be cared for at home, and October.

Fr. John Anderson is ArchCare’s vice she was admitted to Calvary, where she president of mission integration. He says died June 18.

Joanna Mills says the trauma of witness- that while ArchCare’s nursing homes have ing her mother’s deterioration, the deep access to a team of staff chaplains and social grief that her death has brought, along with workers who provide bereavement supongoing family battles surrounding her port, the system did not have enough staff to mother’s illness and death have left her in a keep up with the extraordinary level of need very dark place emotionally. Although Mills amid the pandemic. was allowed compassionate visits before Prior to the pandemic, Fr. Anderson her mother died, an had been in converexception to visitasation with Maria Georgopoulos, tion restrictions that Calvary director of was made at all Archbereavement serCare sites in line with state health departvices, about how Calvary might partment guidelines, she still felt robbed of ner with ArchCare’s precious hours with long-term care sites her mother. on bereavement The bereavement services. support group props Georgopoulos Mills up in her stillsays the onset of the fresh grief. She looks pandemic put those forward to Thursconversations on the fast track, and in days, when she can a matter of a month, join a dozen or so Calvary and its corgrieving adult children who empathize porate parent Archwith and support Care had come up each other in their Joanna Mills and her mother Nora Mills in a photo with programming sorrow. that they have since taken early this year.

While Calvary al– expanded. Calvary ways has offered bereavement services, it shifted Pappalardi’s time, which had been wasn’t until the pandemic hit and New York devoted solely to Calvary, to ArchCare’s shut down in-person gatherings that Cal- long-term care sites, and hired additional vary moved all of them from in-person for- staff.

Pappalardi and the other master’s premat to virtual format, expanded the breadth of its services, and tailored some of those pared therapists now call loved ones of services specifically for the close survivors every newly deceased resident of an Archof ArchCare nursing home patients who Care nursing home to offer them bereavedied during the pandemic. ment support and resources. They’ve made more than 700 such calls since April (in some cases, they call multiple family memHotspot ArchCare has five nursing homes and a bers of the deceased). network of other programs in New York City and Upstate New York. Four of their nursing Not alone homes are in New York City.

The therapists making the calls offer Roughly half of the state’s confirmed one-on-one bereavement counseling and and probable COVID deaths that happened access to the bereavement support groups

and resources helpful in the grieving process. Pappalardi says a goal is to ensure families know they are not alone in their grief. All the services are available to loved ones of any client of ArchCare, whether or not the client died of a COVIDrelated cause.

Pappalardi says she and the other therapists who offer the one-on-one phone counseling provide “client-centered therapy, where we meet them where they are emotionally and support them with empathetic listening, and there is no judgment.” Over the course of a few calls, a therapist will encourage the client to share stories of their loved one, to talk about how they are processing their grief and to set goals for their progress in healing. After providing this initial support, counselors can refer the clients to a bereave- Nora Mills visits with her nephew in her apartment. ment support group at Calvary or other providers who can offer longer-term participant has the opportunity to describe their loss and how they are experiencing the grief counseling. grief process.

Mills says Pappalardi often will give Group support “homework assignments” in advance of the Prior to the pandemic, Calvary had consessions, sharing topics she plans to bring ducted about 30 in-person bereavement groups — sessions were categorized by the up for discussion. For instance, Mills says, type of relationship the client had to the the group soon will be talking about how deceased, and were offered at no cost. Any- they plan to navigate the holidays, with the one could attend, whether or not their loved sadness of not being able to celebrate the season with their loved one. one had died at Calvary.

Mills says that, like her, many in the Calvary switched all of those groups to either telephone conference or videocon- group struggle with guilt, sadness and ference mode after New York shut down regret around what they lost out on, in-person gatherings amid the pandemic. because of COVID restrictions. Her mother Calvary also added support groups specifi- never tested positive for coronavirus, but cally for those who had lost a loved one to because of the restrictions intended to limit COVID. According to Pappalardi, Calvary viral spread, Mills only could visit when her added those groups in recognition of the mother was on the brink of death, and then “additional impact COVID has made in the only briefly.

“It was killing me not to be able to be grieving process.”

The people whose loved ones died at there with her” the whole time she was at an ArchCare nursing home can choose the Calvary, Mills says, adding that the group support group from among Calvary’s offer- therapy is helping her. “I’m now talking ings that best fits their circumstances, just about my mother’s death, and I’m starting to do a little better now.” as anyone else in the community would.

Visit chausa.org/chworld to learn about Mills takes part in the virtual sessions for people whose parent or parents have died. bereavement training.

Each week there is a mix of familiar and new faces. After introducing themselves, each jminda@chausa.org

Amid coronavirus, recreational therapists become Skype coordinators, family counselors

I

n early March, recreational therapists at the ArchCare at Terence Cardinal Cooke Health Care Center in New York City were busily organizing the annual St. Patrick’s Day celebration for residents — booking a band, planning decorations and party food — while juggling the numerous ongoing social activities at the 600-bed continuum-ofcare facility.

But a COVID-19 surge in New York City threw a wrench in all such plans.

Residents could not safely congregate even in small groups. And the ArchCare long-term care system discontinued nonessential visitation at all five of its nursing homes on March 12, including Terence Cardinal Cooke, because of COVID infection concerns. (Recently, the Terence Cardinal Cooke home resumed in-person visitation on a very limited basis; and it is restarting social activities involving 10 or fewer residents.)

When the pandemic hit full force in New York City in the late winter, recreational therapists were pressed into new duties that sometimes challenged their resilience. They consoled lonely and isolated residents and they facilitated sometimes fraught phone calls between residents and their loved ones. They got peppered with questions about treatments or prognosis that the therapists were unprepared or legally not allowed to answer.

Similar scenes played out at every one of ArchCare’s facilities, according to Thomas McDonald, director of therapeutic recreation and volunteer services at Terence Cardinal Cooke.

Because of a severe shortage of

ily dynamics that go well beyond the scope of a recreational therapist’s training.

“They could be in the room for one horrific video call then immediately have to take the tablet into the next resident room for the next call” with no time to decompress emotionally, says Fr. John Anderson, ArchCare vice president of mission integration.

Heads together

Fr. Anderson established ArchCare’s wellness committee in the spring to find ways to mitigate against the emotional distress of staff and patients alike. He chairs the committee, which meets weekly. Made up of directors and other managers of recreational therapy, pastoral care and departKimmy Diaz, left, a recreational therapist at ArchCare at ments across all of ArchCare, Terence Cardinal Cooke Health Care Center in New York City, the committee tackles concerns sets up a Skype call between resident Dorothy Forbes and her raised by staff, patients and family. family members. It functions as a liaison between frontline staff and system-level personal protective equipment in the late executives. winter and spring, recreational therapists The committee provides guidance and did not have full PPE when they held comtraining for recreational therapists and puter tablets near the faces of patients other staff striving to compassionately for video calls to loved ones — a situation care for residents and families under that put both patient and staff member at extreme pressure. It wrote protocols and potential risk of infection. ArchCare has informal scripts for recreational therapists ample PPE now, and, at the recommendato use when difficult situations arise durtion of a Wellness Advisory Committee, ing resident calls with family members. the nursing homes have wheeled devices Recreational therapists now know how with an extendable arm that can hold the tablets in position for residents engaged in to refer family members to the residents’ nursing team for clinical questions. And, video calls. they’ve learned how to deescalate tense Occasionally, the calls become emoconversations and connect willing family tionally charged, unpacking complex fam-

members and residents to ArchCare pastoral care team members, social workers or bereavement counselors from Calvary Hospital in the Bronx.

Recreational therapists soon will get training from a bereavement counselor on how to respond to the needs of grieving residents and their loved ones.

“The reality is that recreational therapists have been doing a very different job than they were trained to do,” Fr. Anderson says. “A lot of their work in the past was done to build community, and that is still the goal,” but now they are on the frontlines of helping residents and families in crisis.

Onslaught

As a result of the committee’s input, ArchCare began biweekly systemwide update calls — one for staff and one for residents’ families. Fr. Anderson started a weekly virtual prayer group that McDonald says has greatly comforted staff members. The system added resources to support staff and reduce the risk of burnout.

In late October the committee’s focus was on the safe resumption of limited visitation and the reintroduction of group recreational therapy activities.

McDonald calls the recreational therapists at ArchCare heroic and says that once they were given the support they needed, the therapists “hit a groove. They’ve all really stepped up in a difficult situation, and they have been doing a great job.”

Visit chausa.org/chworld for an extended version of this story.

— JULIE MINDA

November August15, 1, 2020 CATHOLIC HEALTH WORLD

Share the joy of the season with a Christmas message to the ministry

COMING SOON

CATHOLIC HEALTH ASSOCIATION’S

2020 Advent Reflection series is coming soon!

This year, we’ll be offering a reflection and short video for every single day of Advent, plus Christmas Day. We’ll also have a downloadable coloring sheet for children.

Include your organization’s Christmas message in the Dec. 15 issue of

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Stay tuned to CHAUSA.ORG/ADVENT for this annual complimentary set of resources.

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Catholic Health World invites you to extend a holiday greeting to your employees and to colleagues in the Catholic health ministry.

Visit chausa.org/Christmas for more details. Send an email to ads@chausa.org to reserve your ad space.

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2 21 AWARDS

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Nominate an Exceptional Person or Program Today!

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SUBMISSION DEADLINE: DEC. 16, 2020 For more information or to submit an entry, visit chausa.org/awardnominations

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Recipients of these awards will be celebrated next June at the 2021 Catholic Health Assembly.

LIFETIME ACHIEVEMENT AWARD For a lifetime of contributions

Upcoming Events from The Catholic Health Association Virtual Legislative Advocacy Conference

Nov. 16 | 11 a.m. – 1 p.m. ET

2020 Mission Leader Virtual Seminar: Our Competencies in Today’s Context Nov. 17 – 18

Investing in Community Health: A Toolkit for Hospitals Nov. 19 | 1 – 2 p.m. ET

Mission in Long-Term Care Networking Call Dec. 15 | 3 – 4 p.m. ET Members only

Human Trafficking Networking Call

Dec. 16 | Noon – 1 p.m. ET

2021 Online Foundations for Catholic Health Care Leadership

Seven Consecutive Thursdays, Jan. 14 – Feb. 25

ACHIEVEMENT CITATION For innovative programming that changes lives chausa.org/calendar

7

8

CATHOLIC HEALTH WORLD November 15, 2020

Nurses caring for the planet

Challenge accepted But last year, Berquist says she was fortunate to attend a CleanMed conference for leaders in health care sustainability. There, she listened to a Practice Greenhealth presentation and learned about the Nurses Climate Challenge, an online educational program that focuses on establishing a foundational understanding of the health impacts of climate change and the opportunities for nursing action.

She enrolled in the program, became a Nurse Climate Champion upon completion, and used its resources to create a 90-minute class, “Climate Change Represents the Greatest Potential Threat of the Century,” which she co-presented with the public health officer of Sierra County, Dr. Ken Cutler, for 28 local physicians at Sierra Nevada Memorial on Jan. 27.

It was a personal and professional achievement for her, and one she hopes to repeat.

“The Nurses Climate Challenge has been eye-opening for me. There was no template for my environmental work before; I always felt like I was creating as I went along. This program made so much wonderful material available to me. Because I am dyslexic, I’m really nervous about public speaking.

But the combination of my passion and this kind of support gave me the confidence to do the presentation,” says Berquist.

Ailing planet, sicker people The idea for the Nurses Climate Challenge began in 2017 when Shanda Demorest, a faculty member at the University of Minnesota School of Nursing, reached out to Health Care Without Harm and the Alliance of Nurses for Healthy Environments to forge a partnership to Demorest increase nursing engagement around climate change.

Climate change, reasoned Demorest, is linked to so many health impacts. “Poor air quality can exacerbate asthma and COPD. The spread of vector-borne disease can worsen outbreaks of malaria, Lyme disease and West Nile virus. Heat-related illnesses, heightened allergies, malnutrition and diarrhea can be more prevalent,” she says.

“And mental health issues, such as anxiety, depression and PTSD, can result from

Kale Riley weeds corn plants at Mountain Bounty Farms, a 50-acre family farm on San Juan Ridge near Nevada City, California. The farm supplies organic produce to Sierra Nevada Memorial Hospital’s café.

community and habitat loss due to natural disasters — floods, wildfires — that may even cause forced mass migration.

“Sadly,” she continues, “those who are most vulnerable to such health impacts are typically people with the fewest resources to combat it — the elderly, low-income communities and communities of color, and people with chronic illnesses.”

Rapid response The Nurses Climate Challenge was launched in May 2018 with the goal of preparing Nurse Climate Champions to educate 5,000 nurses and other health professionals within a year with online resources that help them in planning and hosting educational sessions about climate change.

That goal, says Demorest, was reached in nine months. Today there are Nurse Climate Champions helping to educate others across 26 countries and 49 states. Primarily a U.S.-based initiative, it is now working with the Canadian Association of Nurses for the Environment and Health Care Without

A big tent “One of the strengths of the Nurses Climate Challenge is that it explains the science briefly and simply, in 15-minute, easily digestible segments. It is solution based, using clear examples to help people conStraight talk Demorest knew that Gallup polls consisnect the dots between climate change and the problems it causes,” she says. tently rank registered nurses as the nation’s Schenk is using the challenge as a basis most trusted professionals. With nearly for presentations at St. Patrick Hospital; she 4 million RNs in the U.S., they also make up estimates that by the end of 2019, the largest component of 75% of the nurses there had already the health care workforce. been involved in environmental So why not employ them education. A 2020 goal has been in improving public health to educate personnel in other hosby addressing environmental concerns? pital departments, such as houseThe problem, Demorkeeping, supplies and pharmacy, as well. est learned, was a gap in Schenk also uses the program nurses’ knowledge about with nursing students at both the intersection of cliWashington State University and mate and health. To tackle Montana State University. “For the that, Health Care Without most part, they do not need to be Harm and the Alliance of convinced that climate change is Nurses for Healthy Envian issue; in fact, it is weighing heavronments joined together with Demorest to produce Erin Berquist, left, and her brother, Mark Berquist, enfold their grandmother ily on them,” she says. “They’ve content that drew upon Carrie Berquist. The elder Berquist inspires her granddaughter’s environmentalalready experienced wildfires, bad the best science available ism by living simply and in harmony with nature on her California ranch. smoke days, snow melts, droughts, — research findings from increases in Lyme disease and the National Climate Assessment, the Cen- Harm in Europe to expand the program. It is poor air quality. Agricultural life is changters for Disease Control and Prevention, the also involved in a campaign geared toward ing in the northern Rockies. They are lookAmerican Public Health Association, the nursing schools; 18 of them are now in part- ing to learn ways to cope with a changing World Health Organization and the Inter- nership with the Nurses Climate Challenge, environment.”

In addition to programs like the Nurses using its online content to educate students governmental Panel on Climate Change.

Climate Challenge, Schenk says Catholic Then that research was packaged and before they begin their nursing practice.

And the original goal of registering those health care is a leader in this work. “Our presented in a way that would engage nurses to act regionally to mitigate environmental 5,000 nurses to become climate champi- leaders understand our circumstances. We hazards in health care workplaces and, ulti- ons? It’s now been increased to reach 50,000 all hope to be true to our Catholic teachings on caring for creation,” she says. health professionals by 2022. mately, to improve patient outcomes.

Sandra Boyd

“Green Team,” the hospital’s sustainability team, which works to study its flow of trash and recycling, and how to best use its purchasing power to reduce greenhouse gas emissions.

“As soon as I began my nursing career, I began noticing how much waste a hospital produces,” she recalls. “While we are trying to heal bodies, we are simultaneously destroying the planet.”

With the encouragement and collaboration of like-minded colleagues in the CommonSpirit Health system — including Sr. Mary Ellen Leciejewski, OP, system vice president for environmental sustainability, and Laura Seeman, director of mission integration and community health for Sierra Nevada Memorial — Berquist felt she was having some impact at the hospital.

Beyond her focus on trash management, she was able to bring together her volunteer work at Sierra Harvest, a nonprofit that connects Nevada County families to fresh, seasonal food, to the hospital, which is seeking grant support for a pilot program of prescribing local organic produce for patients with diabetes and heart disease.

At the same time, Berquist was also trying to recruit co-workers through social media to get them involved in environmental causes. Sadly, she realized she was “more passionate than most” in attacking the problems associated with climate change.

Sandra Boyd

From page 1

Among them is Beth Schenk, executive director of environmental stewardship for Providence St. Joseph Health and adjunct research professor at Washington State University College of Nursing in Spokane.

Schenk says her trajectory in environmental activism began many years ago, when she was a critical care nurse at Providence St. Patrick Hospital in Missoula, Montana.

She recognized there were Schenk opportunities to improve waste management in health care.

She began studying recycling in the 1990s and eventually earned a Ph.D. in nursing, studying environmental impacts in health care. Today she leads a systemwide commitment to reduce operational pollution while addressing environmental justice and climate resilience in the communities Providence serves, as well as a team to make her health care system carbon negative by 2030.

Schenk also has been instrumental in working with Demorest, Health Care Without Harm, the Alliance of Nurses for Healthy Environments and Practice Greenhealth to shape the Nurses Climate Challenge.

Nurses from Sierra Nevada Memorial Hospital, staff from Sierra Harvest and crew from Mountain Bounty Farms gather during a tour of Mountain Bounty Farms in 2019. Erin Berquist, a Nurse Climate Champion who volunteers with Sierra Harvest, wears a plaid shirt. Sierra Harvest works to build local markets for farmers and it connected buyers for the hospital’s café with Mountain Bounty Farms.