Health Progress - Spring 2023

THINKING STRATEGICALLY

SPRING 2023

THINKING STRATEGICALLY

FEATURE

42 TARGETING OBESITY: LOUISIANA PARTNERS HARNESS THE LATEST SCIENCE FOR WEIGHT LOSS

Robin Roenker

DEPARTMENTS

2 EDITOR’S NOTE

BETSY TAYLOR

48 COMMUNITY BENEFIT

How Health Care Can Respond to End National Hunger

INDU SPUGNARDI

52 HEALTH EQUITY

A Call To Seek and Tell the ‘True Truth’ of Injustice

KATHY CURRAN, JD

55 FORMATION

Ministry Formation Has Come a Long Way, but Is It Enough?

DIARMUID ROONEY, MSPsych, MTS, DSocAdmin

58 MISSION

How Catholic Health Care Can Light the Way Toward Well-Being

JILL FISK, MATM

60 AGING

‘Caring for Caregivers’ Model Addresses Needs of Those Looking After Others

ELLEN L. CARBONELL, MSW, LCSW

64 ETHICS

What Can We Learn From Casuistry?

NATHANIEL BLANTON HIBNER, PhD

66 THINKING GLOBALLY

Spirit of Women Religious Provides Guiding Compass

BRUCE COMPTON

29 POPE FRANCIS — FINDING GOD IN DAILY LIFE

68 PRAYER SERVICE

Illustrations by Alice Mollon

Ihave a soft spot in my heart for small-town cookbooks, especially if it’s from a community I lived in or covered as a news reporter, because I personally know some of the contributors. I love if the recipes have notes, little asides from whoever submitted them about where in town to procure an ingredient, or even a memory tied to when they first tried the recipe and who shared it with them.

I also like local cookbooks because unlike the classic weighty tomes — like the Joy of Cooking, or the glossy celebrity chef bestsellers (yes, Ina Garten’s recipes really do hold up) — you can tell a lot of the recipes are submitted by busy home cooks. The recipes usually don’t have a million ingredients; they’re not afraid to include some Campbell’s Soup in that casserole recipe; and the instructions tend to be clear and to the point. If you need to get dinner on the table, these recipes show you how to make that happen. The home chefs know. They’re giving you their “tried and trues” because they need to get dinner on the table, too.

Essentially, those cookbooks are strategydriven, right? What’s the need? A meal. How are you going to achieve it? Well, here’s the recipe.

I won’t pretend health care strategy is as straightforward, but I might argue that a little bit of a small-town cookbook approach went into this issue of Health Progress. What specifically is the need? What information is needed to plan, and how are you going to execute it? The issue includes a detailed article about U.S. demographics, projections and some health care forecasting questions to consider based on that data. It includes a thoughtful article by a senior executive outlining the method he uses to make strategic decisions, and he clearly explains the process in

hopes it may be of use to others. Just like those community cookbooks, he even credits the original mentor who helped him learn leadership strategy along the way.

There are also several articles that examine some current issues related to staffing, workflow and patient care, and how health care organizations are taking new approaches for short-term fixes and for improved systems over time. If those local cookbooks are fun because they give you a glimpse into what your neighbors are doing, consider Health Progress an insider’s view into what your neighbors are doing on a national scale.

And we approach authors and ask for articles on topics with just that in mind. We are only as good as our contributors, and we value the insight that you bring. At its best, Health Progress provides a way for those in health care to learn from one another, though I hope my folksy analogy doesn’t mask my respect for the complexities of health care strategy and the publication’s goal of presenting those complexities in a useful and understandable format.

But you can consider me the equivalent of your small-town cookbook author. If you have an idea for an article we should be including, a thought on a colleague who may make an excellent contributor (and won’t they thank you for the nod?) or want CHA to connect you with an author for more information on something they describe, we’re here to help. After all, that dinner isn’t going to cook itself.

BETSY TAYLOR

®

VICE

PRESIDENT,

COMMUNICATIONS AND MARKETING

BRIAN P. REARDON EDITOR

BETSY TAYLOR btaylor@chausa.org

MANAGING EDITOR

CHARLOTTE KELLEY ckelley@chausa.org

GRAPHIC DESIGNER NORMA

KLINGSICK

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OPINIONS expressed by authors published in Health Progress do not necessarily reflect those of CHA. CHA assumes no responsibility for opinions or statements expressed by contributors to Health Progress.

2022 AWARDS FOR 2021 COVERAGE

Catholic Press Awards: Magazine of the Year — Professional and Special Interest Magazine, Second Place; Best Special Issue, Second Place; Best Layout of Article/Column, Second and Third Place; Best Color Cover, Honorable Mention; Best Guest Column/Commentary, First Place; Best Regular Column — General Commentary, Second Place; Best Regular Column — Pandemic, Second Place; Best Coverage — Pandemic, Second Place; Best Essay, First and Third Place, Honorable Mention; Best Feature Article, First Place and Honorable Mention; Best Reporting on a Special Age Group, Second Place; Best Writing Analysis, Third Place; Best Writing — In-Depth, Third Place.

EDITORIAL ADVISORY COUNCIL

Trevor Bonat, MA, MS, chief mission integration officer, Ascension Saint Agnes, Baltimore

Sr. Rosemary Donley, SC, PhD, APRN-BC, professor of nursing, Duquesne University, Pittsburgh

Fr. Joseph J. Driscoll, DMin, director of ministry formation and organizational spirituality, Redeemer Health, Meadowbrook, Pennsylvania

Tracy Neary, regional vice president, mission integration, St. Vincent Healthcare, Billings, Montana

Gabriela Robles, MBA, MAHCM, vice president, community partnerships, Providence St. Joseph Health, Irvine, California

Jennifer Stanley, MD, physician formation leader and regional medical director, Ascension St. Vincent, North Vernon, Indiana

Rachelle Reyes Wenger, MPA, system vice president, public policy and advocacy engagement, CommonSpirit Health, Los Angeles

Nathan Ziegler, PhD, system vice president, diversity, leadership and performance excellence, CommonSpirit Health, Chicago

CHA EDITORIAL CONTRIBUTORS

ADVOCACY AND PUBLIC POLICY: Lisa Smith, MPA

COMMUNITY BENEFIT: Julie Trocchio, BSN, MS

CONTINUUM OF CARE AND AGING SERVICES: Julie Trocchio, BSN, MS

ETHICS: Nathaniel Blanton Hibner, PhD; Brian Kane, PhD

FINANCE: Loren Chandler, CPA, MBA, FACHE

GLOBAL OUTREACH: Bruce Compton

LEGAL: Catherine A. Hurley, JD

MINISTRY FORMATION: Diarmuid Rooney, MSPsych, MTS, DSocAdmin

MISSION INTEGRATION: Dennis Gonzales, PhD

THEOLOGY AND SPONSORSHIP: Fr. Charles Bouchard, OP, STD

CORRECTION

Produced in USA. Health Progress ISSN 0882-1577. Spring 2023 (Vol. 104, No. 2).

Copyright © by The Catholic Health Association of the United States. Published quarterly by The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797. Periodicals postage paid at St. Louis, MO, and additional mailing offices. Subscription prices per year: CHA members, free; nonmembers, $29 (domestic and foreign); single copies, $10.

POSTMASTER: Send address changes to Health Progress, The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797.

Follow CHA: chausa.org/social

The print version of “The Evolution of Sponsorship Models: A Progress Report” article, which appeared in the Winter 2023 issue of Health Progress, omitted a sponsor of Catholic Health in Buffalo, New York. The sponsors are the Diocese of Buffalo and the Franciscan Sisters of St. Joseph. The online version of the article was corrected in January 2023.

Reflective Decision-Making for Our Times

ERIK WEXLER President and Chief Operating Officer, Providence St. Joseph Health

Health system leaders make difficult and complicated decisions every day. The process may seem routine, but rushed decisions can be shortsighted, and poor decisions can have long-term implications affecting caregivers and services to the community. Today, when transformation is imperative, reflecting on how we arrive at truly sound decisions is crucial.

Here is one example of how good intentions can initially go off track. In the 1990s, I was a hospital CEO with an overtaxed emergency department that couldn’t accommodate all the patients arriving in ambulances. As a result, ambulances were lined up outside the hospital, waiting to deliver patients.

This caused widespread concern. Emergency Medical Services (EMS) personnel were rightly frustrated, tired of waiting to drop off patients and needing to return to the field and handle incoming emergency calls. The emergency department staff could not work fast enough to assist incoming patients. The community did not feel secure with a line of ambulances biding their time in front of a hospital, unable to respond if a health emergency impacted the lives of their families, friends and neighbors.

We needed to solve this problem as soon as possible, so I called the emergency department team together to help find solutions. I said to

them, “You are the experts. Please work together and come back with your ideas in 30 days.” As the chief executive, I was comfortable with that directive. After all, I’d asked those who best understood the problem to find a solution.

When the group of experts came back to my office, they had charts and documents that proposed what they said would be the best possible answer to the situation. As I reviewed the presentation, it was clear to me that the solution needed to be stronger to make a real impact. I’d seen this situation before — solutions that were set up to satisfy a CEO who people believed to be more concerned with cost than actual outcomes. I asked, “Do you think this is going to make a difference?” The group sat in silence until someone finally said, “It’s the best we can do. Given the

Today, when transformation is imperative, reflecting on how we arrive at truly sound decisions is crucial.

circumstances and our time and budget constraints, we can’t offer anything better.” I looked around the room and saw intelligent and dedicated people who wanted to make the best possible decision for patients and the community. They appreciated the opportunity to collaborate, but I believed they had put on blinders.

WHY DID THIS HAPPEN?

The group thought they were dealing with leadership that wouldn’t tolerate decisions involving some risk and resource expenditure. A reset on that expectation was needed. I asked the group to try again, giving them a new perspective. “Let’s say you have $1 million on the table, all the resources you need, 30 more days, and the full confidence of your leadership to solve the problem. I want you to show me you have used all the creative solutions possible and are giving me the best decision we can make,” I said. With that guidance, the group reassembled, and they came back with a new plan. It was thoughtful with tactics that we were all eager to implement.

Within weeks of launching the plan, the line of ambulances was gone, patients were getting the treatment they needed, staff functioned more efficiently, and the community was reassured. The total cost of the initiative was $600,000, which was quickly recouped through serving more patients in need who previously were redirected to other faroff hospitals. The group demonstrated that when leadership supports collaboration and encourages thoughtful decision-making — even if it includes a bit of risk — sound solutions are possible.

MANAGING DECISION-MAKING AT SYSTEM AND REGIONAL LEVELS

As president and chief operating officer for Providence’s seven-state health system, I always seek to improve our strategic decision-making process. With my team, I lead a vast portfolio of vital, highquality and affordable health services that require constant deliberations to keep processes streamlined and deliver care to support a wide range of communities.

But my role involves more than keeping operations moving at an even pace. As the pandemic ebbs, I am helping my team to return their focus on the transformational strategies we began planning before the world changed with COVID-19. Our health system is emerging from the “allhands-on-deck” approach to the pandemic,

where everyone needed to focus on the immediate needs, to making more long-term decisions for this decade and beyond.

This is not to say we should overlook all we learned from the past three years. In fact, our experience dealing with the short-term challenges of COVID helps us make better decisions for long-term sustainability, especially for Providence, which encountered exceedingly intense challenges early in the pandemic. We came out of COVID far more aware of how to develop technologies that virtually connect with people, vaccinate populations quickly and push for health equity in our communities. The lessons learned — and data we gathered — are all critical for our long-term, transformational strategies.

As a former regional leader, I understand the nuances of making decisions that balance the health system’s goals with regional and community needs. Before assuming the COO title, I was president of operations and strategy for our southern footprint but served as a regional executive for many years. Additionally, I was chief executive for another health system’s northeast region, covering Massachusetts, Pennsylvania and Illinois. These regional roles provided me with an appreciation for how system decisions impact the community level. “One-size-fits-all” policies are rarely the right approach, and collaboration is essential. One must understand the geography and communities they serve, as well as the cultural differences that make our communities so special for those who live there.

At Providence, our diversity of regions across the West Coast and Pacific Northwest is particularly pronounced. Providence covers rural areas such as Kodiak, Alaska, along with many of the nation’s largest urban populations, such as Los Angeles. It is impossible to move all these entities to transformation without well-reasoned and inclusive decision-making.

I am proud of how Providence comes together to make sound and equitable decisions, especially given our size and scale. One example of the benefit of scale was setting up regional specialty pharmacies in 2005. When our Providence Portland region did this successfully, the health system saw merit in instituting similar pharmacies throughout all regions. However, we wanted to make it something other than an all-or-nothing mandate. Instead, we organized those responsible for pharmacies across the regions to come together with

clinicians, pharmacists, financial officers and other stakeholders. Thanks to sound decisionmaking where all entities were heard, the result was specialty pharmacies that will work for each area. The bonus was that, in coming together, they improved upon the best practices achieved by the Portland region prototype.

A FIVE-POINT DECISION-MAKING STRATEGY

Granted, the decision-making process was not always as straightforward for me as it is today. In the early years of my career, I admit to leaping into action with insufficient data. It took the mentorship of a hospital CEO and nursing executive to guide me toward a more disciplined approach.

I am forever grateful that Lucille Janatka, one of my early CEO mentors who I worked with at MidState Medical Center in Meriden, Connecticut, had tremendous confidence in me. Although I was not very experienced, she saw potential and tapped me as chief operating officer of the hospital, but with the proviso that I learn from her.

Lucille had some of the greatest skills in thinking strategically and in formulating goals and tactics that I had ever seen at that point in my career. I learned and watched from her. What I found was that the more time we spent reflecting on and refining the decision-making process, the more equipped our team was to go out and accomplish our goals. We used a five-point plan for decisionmaking that continues to have relevance for me today:

1. Clarify the problem you are trying to solve. Gather the data you need to understand the situation. This does not mean becoming overly burdened by data, but by the information necessary to understand the problem, its root causes and its impact on the organization. Many leaders love to skip to the solution, thinking this gets the problem behind them faster. However, if you don’t have clarity on the true nature of the problem, the solution will probably not be the right one.

2. Know what part of the problem you are trying to resolve. Problems can be massive, especially in today’s health care environment. We would all like to resolve every aspect of the staffing shortage, health equity, climate change and the rising cost of care. However, most CEOs are dealing with more specific aspects of these concerns and, therefore, must focus on the part that

will impact their community and organization the greatest. Although this may sound like common sense, it is often surprising how many leaders don’t focus on the specific problem in front of them.

3. Get buy-in. All too often, leaders identify a significant problem, jump to tactics to resolve the issue, and don’t take the time to involve stakeholders who can add insight and need to be engaged in implementing performance improvement. Using the insight of internal and external experts will take a little extra time, but it will pay dividends in the unity needed to put the right plan together and then execute on what is agreed to.

4. Build a solid tactical plan. Here’s where the real challenge starts. Some leaders don’t enjoy “the weeds” of tactical planning, but this is just as important as strategy. It’s essential to build a plan that gets from problem to solution in the best possible way. There will probably be risks and costs, and good leaders must tolerate these elements if the plan is strong enough to get results.

5. Measure. Good leaders keep asking for measurement every step of the way and deliberate whether or not adjustments are necessary. Never let ego get in the way of making necessary alterations in a plan. Measurement allows us to celebrate success or explore what needs to improve to meet the goal. Absent measurement, one never knows whether they have met expectations.

THE PROCESS WORKS

I regularly put this five-point methodology to the test at Providence. A recent example involved difficult decisions around organizational structure. The problem involved resources. As the pandemic crisis ebbed, Providence faced financial challenges and large-scale operational challenges. In this case, the desired metrics were clear: reduce cost structure to keep the organization viable to retain bedside caregivers so that access to patient care could remain robust.

Our tactical plan was difficult but necessary. The organization needed a leaner and nimbler administrative team to reduce the cost structure, which meant consolidating from seven geographic regions to three. It was the most logical path for what we needed to do: reduce costs at the administrative and leadership levels to have more

resources for the front lines and empower local decision-making to continue meeting the unique needs of each community Providence serves.

Today, Providence is well on its way to achieving desired cost reductions while maintaining essential staff. Losses have stemmed, and the postpandemic caregiver workforce is progressing toward healing and rebuilding. Our plan also recognized that impacted individuals needed support. It included vital mental health and other well-being programs for caregiver retention and assistance for executives now stretching themselves geographically and taking increased responsibilities.

And there were other dividends. The organization discovered it could make decisions more fluidly when pared to three divisions. Did everything work perfectly? It rarely does. We needed to make adjustments midstream, and some elements did not go exactly as we had hoped. But we accepted that we needed to readjust and stay focused. Ultimately, we chose the right path.

LOOKING TOWARD FUTURE TRANSFORMATION

Today’s challenging decisions are merely a hint of what is to come as health care resets its transformational goals. These are not only monetary deci-

QUESTIONS FOR DISCUSSION

sions but strategic considerations that will guide the changes that health systems want to achieve in the coming years, which is providing excellent care and serving our amazing diverse communities. Among these considerations are the decisions we must make around value-based care that necessitate greater alignment with communities and physicians, investments in digital innovations that reach more segments of the population, innovative solutions that reduce health disparities and changes to internal culture to ensure caregiver well-being.

This work demands sound decision-making by executives, leadership throughout the organization and external partners who will all be co-architects of the desired future. We must sharpen our decision-making capabilities, spend time reflecting, give our leaders the room to make decisions and mistakes and be cognizant of the proven principles. This is how we achieve a healthier future and can continue to serve our mission.

ERIK WEXLER is president and chief operating officer for Renton, Washington-based Providence St. Joseph Health and lives in downtown Seattle.

As President and COO at Providence St. Joseph Health, Erik Wexler needs to make complex decisions that can impact care and people’s day-to-day lives. He outlines a decision-making strategy that ties into examining and defining problems closely, understanding what part of an issue a person or team is trying to address, getting support from others, planning a response and measuring effectiveness.

1. Do you use a similar approach when you need to plan strategy? What are some techniques you use if a strategy isn’t clear? Do you gather better data, bring more people into the discussion, troubleshoot barriers or even manage the pace of change?

2. What kind of foundational principles are significant when beginning to plan and implement strategy? Do you have a “north star” of mission and/or goals that helps you focus on what needs to be done?

3. How do you ensure that the concepts of human dignity, the common good and our call to serve the most vulnerable in our communities are at the center of strategic decisions for the ministry? Is your mission leader involved in the process and a member of the team? Do you consider the needs of the community as well as financial realities?

4. Wexler talks about co-architects within an organization and its external partners. Do you think of yourself as a co-architect in your role? Is there more your leaders could do to make you feel vital to implementing strategy?

Workflow Improvements To Reduce Burnout

ERIN ARCHER, RN Contributor to Health Progress

Physician burnout appears to be at an all-time high. Consider that a 2021 survey of physicians disclosed that 63% had at least one symptom of burnout, up from 38% in 2020. Levels of professional satisfaction have fallen, while levels of emotional exhaustion, depression and depersonalization (for instance, cynicism) have risen.1

Some of these changes may be related to ongoing pandemic stresses upon the health care workforce, including periodic COVID-19 surges, the politicization of vaccines, increases in verbal and physical assaults on health workers, and being required to deviate from standard practices or normal areas of expertise. But given that almost 44% had symptoms of burnout before COVID, it is likely that the pandemic merely exacerbated factors already in place.

In “Physician Burnout: The Root of the Problem and the Path to Solutions,” NEJM Catalyst reported that the No. 1 source of burnout for physicians was the “increased clerical burden” that has been imposed by electronic health records (EHRs). The second cause was continual expectations and demands to be more productive. Overall, they noted that 80% of burnout is attributable to “workflow issues.” While this report — which helped draw attention to the issue — was issued more than five years ago, the problem persists. Just recently, Drs. Anthony DiGiorgio and Praveen Mummaneni of the University of California San Francisco discussed their findings in MedPageToday. Residents at their facility spent 20 hours per on-call shift logged in to the EHR, with nine of those hours interacting directly with the EHR instead of with patients.2

As health care organizations continue to look for ways to reduce physician burnout, finding approaches that can help to improve EHR usabil-

ity and efficiency across all clinical care team members can help offer support and promote well-being for strained physicians.

ADDRESSING WORKFLOW AND CLERICAL BURDEN

In 2022, the U.S. Surgeon General released “Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory of Building a Thriving Health Workforce.”3 It discusses the causes and impacts of health worker burnout, calling for a whole-of-society approach to address it, saying that we must immediately:

1. Protect the health, safety and well-being of all health workers.

2. Eliminate punitive policies for seeking mental health and substance use care.

3. Reduce administrative and other workplace burdens to help health workers make time for what matters.

4. Transform organizational cultures to prioritize health worker well-being and show all health workers that they are valued.

5. Recognize social connection and community as a core value of the health care system.

6. Invest in public health and the public health workforce.

The advisory recommends lessening administrative and documentation burdens, “… ensuring health information technology that is humancentered, interoperable, and equitable, and aligning payment models to recognize the value of a

conversation, not just of a procedure.” The advisory includes pleas to both insurers and tech companies on this account, noting that providers currently spend two hours on clerical duties for every one hour of patient care.

In their work on burnout, the National Academy of Medicine also cites the importance of addressing workflow and clerical burden, explaining that providers need to have systems that operate reliably and efficiently to do their best, undistracted work. The National Academy of Medicine notes that many physicians spend “nearly an hour

posed to make health care workflow easier and more seamless has instead complicated the lives of many health workers.

Although EHRs have offered some benefits, their design has emphasized billing and administrative needs over clinical decision-making and care delivery, often imposing outdated paperbased workflows onto a digital environment capable of doing things differently. Because of this, most clinicians spend one half to two-thirds of their workday on the EHR and other clerical tasks, often at the expense of spending time with patients.5

per day manually entering orders, another hour processing through a series of drop-down boxes for prescription renewal, nearly 90 minutes per day on inbox work, and hours per week on prior authorization requirements. All of this time could be reduced by re-engineering workflows and empowering teamwork, allowing physicians to spend more time with their patients and engaging in ‘deep work,’”4 the substantive aspects of a person’s job that require mental focus and benefit from a lack of distractions.

Granted, some of the workflow issues are larger than any given office or hospital system, representing fractured practices, charting and reimbursement models. Still, the literature shows that there may be evidence-based ways available to health care practitioners to improve workflow, decrease the menial tasks in physician workloads and hopefully bring back more meaningful “deep work” in the process.

Much of this workflow improvement research has focused on use of EHRs and physicians’ clerical burden, on team-based care models, on changes to reimbursement models and on the use of artificial intelligence tools.

EHRs AND OTHER CLERICAL BURDENS

One of the main reasons routinely cited for physician burnout is the current clerical burden, specifically, charting in the EHR. A tool that was sup-

Even with so much office time on the EHR, many physicians have to extend their day beyond office hours just to complete their documentation. In 2019, the U.S. Centers for Disease Control and Prevention found that 91% of office-based physicians routinely spent time outside office hours documenting clinical care. About a quarter were spending an extra two to four hours per day performing these tasks, and about 9% were spending an additional four hours per day documenting their care.6 This extra clerical work performed outside of work hours is sometimes referred to as “pajama time” and contributes significantly to burnout. Those with more than three hours per day of after-hours work were shown to have 13 times the odds of burnout compared with those who spent less than 30 minutes on it per day.7

IMPROVEMENT OF THE EHR ITSELF

The Surgeon General’s advisory on burnout includes a section called “What Health Care Technology Companies Can Do,” arguing that tech companies have a part to play in health worker well-being. From the time systems are designed, they suggest that developers of these electronic records examine factors that may contribute to information overload, clinical complex-

Improvements

include reducing the records’ pop-up messages, minimizing mouse clicks needed to complete a task, and curating health data in such a way as to better visualize a patient’s information. The report also recommends that systems be designed at the outset for interoperability to optimize communication from disparate sources such as care teams, laboratories and public health.8

ity and interruptions.

can

In 2019, the U.S. Centers for Disease Control and Prevention found that 91% of office-based physicians routinely spent time outside office hours documenting clinical care.

On an institutional level, staff can be encouraged to engage in multidisciplinary improvement “sprints” with EHRs, where clinician “pain points” are determined and more appropriate workflows are created.9 This can include creating procedures for routine medication refills, prior authorizations and other time-consuming clerical duties that can be delegated to nonphysician staff.

Staff at all levels can take a lesson from an EHR initiative launched by Hawaii Pacific Health in Honolulu, Hawaii, called “Getting Rid of Stupid Stuff,” where all system physicians and nurses were encouraged to nominate aspects of the EHR that they thought were “poorly designed, unnecessary, or just plain stupid.” More than three-fourths of the nominations were from nurses, mostly regarding eliminating documentation not required by regulations or internal policies, and more than half

RESOURCES

BURNOUT

AND WELL-BEING

National Academy of Medicine

Resource Compendium for Health Care Worker Well-Being: Contains nearly 100 resources from across health care, arranged in six subject areas: 1) advancing organizational commitment, 2) strengthening leadership behaviors, 3) conducting a workplace assessment, 4) examining policies and practices, 5) enhancing workplace efficiency and 6) cultivating a culture of connection and support.

https://nam.edu/compendiumof-key-resources-for-improvingclinician-well-being/

American College of Physicians

Practice Resources: Physician

Well-Being and Professional Fulfillment

https://www.acponline.org/practiceresources/physician-well-being-andprofessional-fulfillment

U.S. Surgeon General

Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on

of the suggestions wound up being implemented.10 (The “Getting Rid of Stupid Stuff” initiative is now available as a training through the American Medical Association. See resource box below.)

TRAINING ON THE EHR

Some improvements of the EHR interface for providers can happen through appropriate training. Protected time for “at-the-elbow” EHR training — where someone works directly with providers to train and answer questions — is key to provider satisfaction and efficiency. Such education can happen upon hire, upon implementation of changes and at regular intervals thereafter. Surveys have shown that providers who received poor EHR training were three-and-a-half times more likely to report that their EHR did not “enable them to deliver high-quality care.”11

Building a Thriving Health Workforce, 2022: Figure 4 on page 30 in the report below includes many helpful related resources.

https://www.hhs.gov/surgeongeneral/ priorities/health-worker-burnout/ index.html

American Association of Critical-Care Nurses Healthy Work Environments

https://www.aacn.org/nursingexcellence/healthy-workenvironments

988 Suicide and Crisis Lifeline https://988lifeline.org/ (or call “988” on your phone)

EHRs AND ADMINISTRATIVE TASKS

National Academy of Medicine (NAM) Checklist for Health Care Leadership on Health IT and Clinician Burnout https://nam.edu/systems-approachesto-improve-patient-care-bysupporting-clinician-well-being/ checklist-for-health-care-leadership-

on-health-it-and-clinician-burnout/

The Office of the National Coordinator for Health Information Technology Health IT Playbook

https://www.healthit.gov/playbook/

American Medical Association

EHR Inbox Management: Tame Your EHR Inbox

https://edhub.ama-assn.org/ steps-forward/module/2798925

American Medical Association

Getting Rid of Stupid Stuff (GROSS): Reduce the Unnecessary Daily Burdens for Clinicians

https://edhub.ama-assn.org/stepsforward/module/2757858

PAYMENT/REIMBURSEMENT

American Academy of Family Physicians

Direct Primary Care Toolkit

https://www.aafp.org/familyphysician/practice-and-career/ delivery-payment-models/directprimary-care/toolkit.html

INBOX MANAGEMENT

Many EHR systems push notifications to physicians by default, unnecessarily increasing their cognitive burden. Secure messages received from electronic record systems have become a significant source of burnout. Researchers have found that providers with more than 300 messages per week have six times the odds of burnout compared with those with less than 150 messages per week. It is worth noting that the average family physician has approximately 100 inbox messages per day.12

The American Medical Association has a step-by-step training to help manage inbox messages generated by the EHR. (See resource box on page 12.) The training recommends that the information technology department be engaged at the outset to determine which kind of messages should never enter the physician inbox in the first place, and what IT can do to remedy a variety of issues that physicians encounter with EHR inboxes as currently designed. Similarly, the training offers guidance on how various “buckets” of messages can be created and how those buckets can be delegated to various other nonphysician team members.13

SCRIBES AND LANGUAGE SOFTWARE

In a 2018 study of the use of scribes in primary care, researchers found that scribes significantly decreased administrative burden, leading to significantly less after-hours charting. It found 85% of the providers in the study were able to spend 75% of the visit interacting with the patient (as opposed to 13% without scribes), and only 25% of the visit interacting with the EHR. It found 94% of the PCPs reported greater job satisfaction with scribes, and 89% reported that they had improved clinical interactions with patients when they used scribes. The majority of patients (61%) also reported that the use of a medical scribe had a positive impact upon their visit.14

Speech recognition programs (like Dragon) are also commonly used to dictate into the record and have been in use for about three decades. A 2016-2017 survey showed that 77% of physicians felt speech recognition systems helped to improve their efficiency. Natural language processing is a similar artificial intelligence tool that is sometimes used to extract information from free text that can be used for billing. There are emerging technologies referred to as “digital scribes” that

combine speech recognition, language processing and other tools, technologies that range from artificial intelligence otoscopes to algorithms that aid in the detection of cancerous lesions. Some of these artificial intelligence tools are built in to current EHRs, and some exist as “add-on apps.”15

Some people have hopes that extensive artificial intelligence development might help to take immense pressure off physicians in the future. Currently, researchers note that the technology cannot be relied upon to truly understand language or to perform diagnostic functions, but some are hopeful that artificial intelligence may someday aid physicians enough to restore what can seem like the currently fractured doctorpatient relationship.16

IMPROVED ORDERING

Order bundles can be helpful to ensure that evidence-based interventions that belong together can be ordered together. When auditing for efficacy, an “all-or-none” model is used to assess compliance, but this is made easier by bundling them together in the record in the first place.17 Although EHRs commonly have bundles for admissions, discharges or common procedures, bundles can be developed for any multi-order process routinely performed by a team.

AVOIDING THE EHR ALTOGETHER

One way of avoiding the stress and clerical burden that EHRs impose is to avoid them altogether. Not all providers use an EHR, especially office-based physicians.18 And some providers who have had EHRs have ditched them in favor of a return to paper charting.19

TELEHEALTH

There’s no question that the pandemic hastened the use of telehealth appointments, so much so that it has been the recent focus of a separate Health Progress article.20

When COVID hit, reimbursement and provider willingness to engage in telemedicine skyrocketed. 21 In the intervening three years, telemedicine has become incorporated into the workflow of many practices, allowing patients to be seen easily and relatively conveniently for both patients and providers. Because some follow-up appointments may not require a physical examination, those patients can often be seen sooner, even rapidly scheduling an appointment

through a waiting list if the previously scheduled patient is a no-show.

TEAM-BASED CARE

In an article published in STAT in December 2022, Audrey Provenzano, MD, a practicing primary care physician and Harvard Medical School instructor, argues primary care is fundamentally broken and that the problems have only been exacerbated by the COVID pandemic. She argues that physicians simply can’t do it all, and that attempting to do so leads to disproportionately high rates of depression and suicide. The gap between what patients need and how primary care is resourced is simply too wide, she says. In order to be sustainable, primary care particularly must move to a team-based model and physicians must learn to set limits on their time. Physicians shouldn’t be expected to do it all, she argues, but they must also accept their own limitations.22

When a team is involved in the care of a patient, some clinical documentation can be performed by nonphysician staff, and this approach also seems to have high rates of provider and patient satisfaction.23

ity. All team members should be included in the process of developing workflows and standards of behavior in how to treat each other. Results of the exploratory process should never be used to punish people, and all results should be shared with the team. Everyone should be allowed to participate in brainstorming ideas about how to improve the culture, and a written compact on how staff should treat each other should be developed.25

Research on interprofessional team collaboration found that major barriers included a lack of time and training, a lack of clear roles, fears relating to professional identity and poor communication. Facilitating factors for team-building included tools to improve communication, colocation enabling face-to-face communication and the recognition of others’ skills and contributions.26

CHANGES TO PAYMENT MODELS

Although not an option open to all practices, some practices have found that changing their billing and payment model has helped their burnout and workflow. Both the National Academies of Science, Engineering, and Medicine and the Surgeon General’s advisory argue that the fee-for-service model is not working, especially for primary care.

For health care teams to work well, the provider must be able to delegate confidently. The provider must have a highly functional team where everyone operates at the top of their skill set and licensure.24 This allows for clerical work to be delegated to administrative personnel, while medical assistants can perform tasks within their scope, and LPNs, RNs, NPs, PAs and social workers can do similarly. Clerical and clinical tasks can be assigned and triaged to the appropriate personnel, only making its way to a physician or nurse practitioner/physician assistant if truly needed due to clinical scope or licensure.

Before intervening with a clinical team, it is important to assess the team’s current functional-

As Shirlene Obuobi, MD, noted in her recent heartbreaking editorial in The Washington Post , “There’s a clear disconnect between what most patients value in health care and what hospital systems and insurance companies want. The American medical system rewards procedures, imaging, tests, and other diagnostics that generate revenue and have high reimbursement rates. … Because they don’t generate revenue from procedures, non-procedural specialists are pressured to increase their patient volume and are often given appointment slots as short as 10 minutes.”27

To avoid these broken reimbursement models, some providers have gone to alternative reimbursement models like Direct Primary Care (DPC) or to concierge medicine. Both models gained popularity in the 2000s as a reaction against rising operational costs, increased administrative burden and cuts in reimbursement. By restructuring their practices and reimbursement, many physicians found that they could earn more

For health care teams to work well, the provider must be able to delegate confidently. The provider must have a highly functional team where everyone operates at the top of their skill set and licensure.

money while cutting their patient panel from approximately 2,000 down to 500 or 600. Some people are worried that these models further diminish the number of primary care providers available in a time of increasing shortage. Alternatively, some people argue that these models might keep some providers in practice who might otherwise burn out and quit medicine.28

Direct Primary Care

The Direct Primary Care model charges patients a monthly, quarterly or annual retainer fee that covers all or most of primary care clinical and laboratory services, consultative services, care coordination and care management. Fees are paid exclusively by patients and sometimes patients’ employers, with no billing to insurance companies or government programs.

Direct Primary Care practices sometimes recommend that participants have a high-deductible plan in event of emergencies. Direct Primary Care is not synonymous with concierge medicine, which sometimes bills insurance or government programs. Instead, it tries to avoid the fee-for-service third-party payer model entirely.29

Concierge Medicine

Concierge medicine allows for more access to physicians and comes at a cost of $200 per month on average. Unlike Direct Primary Care, concierge care can be primary care or cover a wide gamut of specialties. This cost is in addition to insurance, as concierge medical practices also bill insurance. Currently, approximately one in five of the United States’ wealthiest 1% pays extra fees for direct access to their doctor. While providing more one-on-one care may prevent burnout, one concern is that such an approach clearly isn’t available to those who can’t afford it.30

NATIONWIDE ADMINISTRATIVE IMPROVEMENTS NEEDED

If implemented nationwide, there are administrative improvements that could potentially help with workflow and save significant amounts of money. Much like grocery stores have gone to universal product codes (a.k.a. “barcodes”) rather than having their own, standardizing certain industry-wide practices could lead to efficiency of time and money.

Researchers argue that having a centralized claims clearinghouse and allowing insurers and

THINKING STRATEGICALLY

providers to share computer systems could save $55 billion a year. Standardizing the information that insurers require could save another $35 billion per year and greatly reduces the backand-forth and stress of the authorization process on providers and on patients.31

In a 2020 survey, 85% of physicians described the burden associated with prior authorization as “high” or “extremely high,” and 34% reported that the prior authorization process had led to a serious adverse event for a patient in their care. When the Office of the Inspector General looked at the issue in 2018, it found a high rate of inappropriate prior authorizations. It is estimated that transitioning to all-electronic prior authorization systems could save $417 million annually. A fully electronic prior authorization system would also save health workers up to 12 minutes per transaction, a time burden that quickly adds up.32

By addressing workflows, health care systems can make a dent in health care worker burnout.

ERIN ARCHER is a freelance health care writer and nurse in Tucson, Arizona. She has written for Everyday Health, Institut Pasteur and Medscape Medical News

NOTES

1. Tait D. Shanafelt et al., “Changes in Burnout and Satisfaction with Work-Life Integration in Physicians during the First 2 Years of the COVID-19 Pandemic,” Mayo Clinic Proceedings 97, no. 12 (December 2022): 2248-2258.

2. “Physician Burnout: The Root of the Problem and the Path to Solutions,” NEJM Catalyst, June 2017, https:// contentmanager.med.uvm.edu/docs/physician_ burnout_the_root_of_the_problem_and_the_path_ to_solutions/faculty-affairs-documents/ physician_burnout_the_root_of_the_problem_ and_the_path_to_solutions.pdf?sfvrsn=2; Anthony DiGiorgio and Praveen Mummaneneni, “Death by 10,000 Clicks: The Electronic Health Record,” MedPage Today, January 21, 2023, https://www.medpagetoday.com/ opinion/second-opinions/102722.

3. “Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce,” Office of the U.S. Surgeon General, 2022, https:// www.hhs.gov/surgeongeneral/priorities/health-workerburnout/index.html.

4. Christine A. Sinsky et al., “Organizational EvidenceBased and Promising Practices for Improving Clinician Well-Being,” NAM Perspectives (November 2020): https://doi.org/10.31478/202011a.

5. Tina Shah et al., “Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action,” NAM Perspectives (August 2020): https://doi.org/10.31478/202008a.

6. “QuickStats: Distribution of Hours per Day That Office-Based Primary Care and Specialist Care Physicians Spent outside Normal Office Hours Documenting Clinical Care in Their Medical Record System — United States, 2019,” Morbidity and Mortality Weekly Report 70, no. 50 (December 17, 2021): 1752, https://doi.org/10.15585/mmwr. mm7050a4.

7. Sinsky et al., “Organizational Evidence-Based and Promising Practices.”

8. “U.S. Surgeon General’s Advisory.”

9. Shah et al., “Electronic Health Record Optimization.”

10. Shah et al., “Electronic Health.”

11. Shah et al., “Electronic Health.”

12. Sinsky et al., “Organizational Evidence-Based and Promising Practices.”

13. “EHR Inbox Management: Tame Your EHR Inbox,” American Medical Association, November 17, 2022, https://edhub.ama-assn.org/steps-forward/ module/2798925.

14. Pranita Mishra, Jacqueline Kiang, and Richard Grant, “Association of Medical Scribes in Primary Care with Physician Workflow and Patient Experience,” JAMA Internal Medicine 178, no. 11 (November 2018): 1467-1472.

15. Shah et al., “Electronic Health.”

16. Julian Acosta et al., “Multimodal Biomedical AI,” Nature Medicine 28 (September 2022): 1773–1784, https://doi.org/10.1038/s41591-022-01981-2.

17. “10 IHI Innovations to Improve Health and Health Care,” Institute for Healthcare Improvement, 2017, https://www.ihi.org/resources/Pages/Publications/ 10-IHI-Innovations-to-Improve-Health-and-HealthCare.aspx.

18. “QuickStats: Management of Patient Health Information Functions among Office-Based Physicians with and without a Certified Electronic Health Record (EHR) System — National Electronic Health Records Survey, United States, 2018,” Morbidity and Mortality Weekly Report 69, no. 38 (September 2020): 1381, http://dx. doi.org/10.15585/mmwr.mm6938a8.

19. Joanne Finnegan, “Why One Practice Ditched EHR in Favor of Paper Records,” Fierce Healthcare, August 14, 2017, https://www.fiercehealthcare.com/practices/ unhappy-ehr-one-practice-ditched-it-and-went-back-topaper-records.

20. Robin Roenker, “Your Care Provider Can See You Now: Pandemic Prompts New Approaches in Telehealth,” Health Progress 103, no. 2 (Spring 2022): 19-22, https://www.chausa.org/publications/health-progress/ archives/issues/spring-2022/your-care-provider-cansee-you-now-pandemic-prompts-new-approaches-intelehealth.

21. “QuickStats: Percentage of Office-Based Physicians Using Telemedicine Technology, by Specialty — United States, 2019 and 2021,” Morbidity and Mortality Weekly Report 71, no. 49 (2022): 1565, http://dx.doi. org/10.15585/mmwr.mm7149a6.

22. Audrey Provenzano, “Primary Care Physicians Try to Give Their All—Until They Can’t. It’s Time to Flip the Archetype to Teamwork,” STAT, December 13, 2022, https://www.statnews.com/2022/12/13/ flip-primary-care-archetype-to-teamwork/.

23. Shah et al., “Electronic Health.”

24. The National Academies of Sciences, Engineering, and Medicine, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care (Washington, DC: The National Academies Press, 2021).

25. Sara Berg, “Addressing Physician Burnout Starts with a Healthy Team Culture,” American Medical Association, September 12, 2018.

26. Cloe Rawlinson et al., “An Overview of Reviews on Interprofessional Collaboration in Primary Care: Barriers and Facilitators,” International Journal of Integrated Care 21, no. 2 (2021): 32, https://doi.org/10.5334/ijic.5589.

27. Shirlene Obuobi, “Why It Seems Like Your Doctor Doesn’t Care about You,” The Washington Post, November 17, 2022.

28. Michelle Konstantinovsky, “Many Doctors Are Switching to Concierge Medicine, Exacerbating Physician Shortages,” Scientific American, October 19, 2021, https://www.scientificamerican.com/article/ many-doctors-are-switching-to-concierge-medicineexacerbating-physician-shortages/.

29. “The Direct Primary Care Model: How it Works,” American Academy of Family Physicians, https:// www.aafp.org/family-physician/practice-and-career/ delivery-payment-models/direct-primary-care.html.

30. Konstantinovsky, “Many Doctors Are Switching to Concierge Medicine.”

31. David Cutler and Nikhil Sahni, “How to Save a Quarter-Trillion Dollars in Health-Care Spending Every Year,” The Washington Post, November 11, 2021, https:// www.washingtonpost.com/outlook/2021/11/11/ health-care-costs-administrative-spending/.

32. “U.S. Surgeon General’s Advisory.”

Demography Is Destiny: Planning Care for a Changing Population

MARIAN C. JENNINGS, MBA President of M. Jennings Consulting

It’s Spring 2040, and the U.S. population has grown by 41 million people since 2020 to over 373 million, fueled primarily by migration and longevity. 1,2 The nation is more ethnically and racially diverse than ever. Until 2030, the average annual increase in U.S. population growth remained at historical levels, but has declined throughout the last decade.3 The national median age has increased from 38.5 years in 2020 to 41.5 years in 2040, which sounds small until you realize that this represents nearly 22 million more persons ages 75 years or older now than then.4 The youngest baby boomers are now 76 years old, Gen Xers are 60 to 75 years old, Millennials are 44 to 59 years old, and the oldest Gen Zers are in their forties.

A health care 2040 leadership team — a diverse group composed primarily of Millennials and Gen Zers — is grateful that their counterparts in the early 2020s did not suffer from strategic myopia, despite being so focused on unprecedented ministry challenges brought on by the times, including the pandemic, workforce shortages, financial pressures and market disruptions. Regardless of the hardships that they faced at the time, they still had the foresight to consider the longer-term implications of changing U.S. demographics.

As health care leadership strategizes to address the needs of our nation’s population, consideration of our changing demographics should play a substantial part in planning for what care will be needed and how it should be provided for future generations.

DEMOGRAPHY IS DESTINY

The quotation “demography is destiny” often is attributed to 19th-century French philosopher Auguste Comte. While perhaps in some ways sim-

plistic or overstated, there is no question that the makeup of the population’s size, age, race, ethnicity and gender — commonly referred to as demographics — impacts its health needs. Anticipating our communities’ future health needs, as well as the implications for the Catholic health care ministry’s continued relevance and mission fulfillment, require us to understand three interrelated demographic national trends:

Slowing U.S. population growth.

An increasing population of those over 65 years of age.

Greater ethnic and racial diversity of our population.

SLOWING U.S. POPULATION GROWTH: THE 2030 TURNING POINT

The U.S. Census Bureau projects a slowing rate of U.S. population growth, with a turning point in 2030 when net international migration is expected to overtake natural increases (the excess of births minus deaths) as the driver of U.S. population

Projected Change in U.S. Population by Age: 2020-2040

(numbers in thousands)

growth.5 This change reflects a combination of relatively small growth in the number of women of childbearing age (females aged 15-44), declining fertility rates (births per 1,000 women of childbearing age), and an increase in the number of deaths among baby boomers in older adulthood.6

Assuming that today’s migration levels continue, between now and 2030, the nation’s population is expected to grow by approximately 2.3 million people per year. However, this rate is projected to fall to an average of 1.8 million per year between 2030 and 2040.7 These figures are what the Census Bureau refers to as its “main series” projections and, unless otherwise noted, have been used throughout this article. Were the U.S. to have zero immigration, our 2040 population is projected to be essentially the same size as in 2020, older (median age 43.3 years) and at that point declining slowly annually.8

without immigration, the U.S. population will shrink. Of course, no population growth takes place uniformly across the country and a variety of factors come into play with population shifts, so we expect that regions that attract and retain immigrants may see stable or growing populations, with other areas experiencing population declines.

65 AND OLDER: POPULATION GROWTH

Because of large gains during the late 20th century, longevity is the new normal. The Census Bureau anticipates that by 2034 (and continuing into 2040), adults aged 65 and older are projected to outnumber those under age 18 for the first time in U.S. history (see Figure 1 above).10 Some call this the “silver tsunami.” Others see it as merely the first wave of elderly, to be followed in 2060 by a second wave of older adults, made up of Millennials who currently outnumber baby boomers. Regardless, the baby boom “bubble” has caused economic and societal changes at every stage, and their demographic impact will continue to be dramatic through 2040 and beyond.

Using these Census Bureau “main series” projections, the expected 2040 annual total population change of 1.7 million comprises only 600,000 from natural increases (births minus deaths) with the remaining 1.1 million accruing through net international migration.9

Projecting net migration is extremely challenging since it is impacted by economic and political factors, but the key takeaway is clear:

Clearly, the definition of elderly as those “65 and older” is outmoded, more appropriate in 1935 when Social Security was established than today. We know that health status and the demand for health care services — and the types of those services wanted or needed — varies dramatically for those aged 65 to 74 years versus those aged 75 to 84 years, who again are markedly different from those 85 years or older.

The Census Bureau’s projections for 2040

FIGURE 1

CHANGE 2020-2040

Source: 2017 US Census Bureau, 2017 National Population Projections, Main Series

The Census Bureau anticipates that by 2034 ... adults aged 65 and older are projected to outnumber those under age 18 for the first time in U.S. history. Some call this the “silver tsunami.”

Total all ages

Total 65 or older

65 to 74 years

75 to 85 years

85 to 94 years

95 years or older

anticipate that growth of those over 65 will account for more than 60% of the period’s total population growth since 2020 (see Figures 1 and 2 on pages 18 and 19), with this cohort increasing by nearly 25 million persons (or more than 40%).11 The vast majority of this older population’s growth will occur among those reaching 75 years or older who, on their own, will account for more than half of total population growth.12 In other words, the baby boom bubble will continue to travel through time.

The incidence and prevalence of chronic illness or age-related conditions such as dementia, especially among older adults, will generate an increase in demand for new models of health care. What will be needed will be more innovative virtual and home-based models that deliver not only essential acute care services, but supportive services to meet peoples’ changing social, emotional, housing and other needs as they age.

Those 18 to 64 years of age, historically described as “those of working age,” are projected to increase from 2020 to 2040 by only 6% (as shown in Figure 1 on page 18). This will exacerbate the current competition for scarce workforce talent, especially when recruiting those 20 to 40 years of age, as well as a movement to recruit and retain staff over 65 years of age. Retiring at 65 may

look less attractive when individuals have another 25 years or more to live, and many may look for new opportunities to redeploy their skills.

Postponing retirement will be essential not only to ensure an adequate workforce to support growth across all economic sectors, but also to address the political and economic challenges created by an increasing “old-age dependency ratio” (see Figure 3 on page 20). This ratio is a measure of the potential burden on the working-age population, computed by comparing the number of individuals who are 65 and older to the number of those of traditional working age.13 The 2040 ratio of 37 means that there will be a projected 37 people aged 65 and older (eligible for Medicare and, shortly thereafter, full Social Security) for every 100 working-age adults.

Finally, it is projected that the number of children will increase by only 4% during this period (refer to Figure 1 on page 18) and will be likely to occur primarily in areas attracting immigrants.

POPULATION’S GREATER ETHNIC AND RACIAL DIVERSITY

In addition to projected changes in population growth and aging, the U.S. is projected to become a much more racially and ethnically pluralistic country. The only group projected to shrink over

FIGURE 2

Projected Change in U.S. Population by Age: 2020 - 2040 (numbers in thousands)

Source: Projected 5-Year Age Groups and Sex Composition Series for the United States, U.S. Census Bureau, Population Division: Washington, DC. Revised release date September 2018.

the coming decades is the non-Hispanic white population, expected to decrease by approximately 10 million between 2020 and 2040. Despite this decline, non-Hispanic whites are projected to remain the single largest racial and ethnic group; it is only in 2045 that they will no longer be projected to make up the majority of the U.S. population.14

The country’s racial and ethnic diversity is most visible among children under age 18. A slight majority of those under 18 today already are of racial and ethnic minority groups other than non-Hispanic white, with this group making up an estimated 57% of those under 18 by 2040. An even greater percentage of births that year are projected to be babies who are Asian, Black, Hispanic, two or more races, or other groups (includes babies who are American Indian and Alaska Native, Native Hawaiian and other Pacific Islander). The greatest projected absolute population increases for children are for those who are ethnically Hispanic and/or racially two or more races.15

We continue to be a nation of immigrants, with 44 million residents in 2020 — or more than one in seven — being foreign-born.16 If past trends continue, the Census Bureau projects more than 60 million foreign-born residents by 2040. The share of foreign-born people living in the U.S. population hit a historic low in 1970 at only 4.7%. Since then, both the number and share of those who are foreign-born have grown steadily; and it is projected that by 2028, the share of foreign-born will exceed the nation’s historic high since 1850 of 14.8%. By 2040, it is projected that one in six residents will be foreign born.17

Over the past decade, more than 75% of those who are foreign-born have been of working age and generally more likely to hold full-time jobs than their native peers.

FOCUS ON 2040 DEMOGRAPHICS FOR FUTURE STRATEGIES

So, what do these demographic trends for a slower growing, aging and more racially and ethnically diverse future mean to us strategically? While every community will experience its own demographic changes, there are several overarching implications for care delivery, ensuring the needed future talent and workforce, and advocacy.

Care Delivery: We need to design new delivery models built upon the needs and wants of an

Old-Age Dependency Ratios for the Population: 1940 to Projected 2040

aging, consumer-oriented population.

Stop thinking that “those over 65” are a monolithic group. Instead, understand the unique needs of different cohorts of older consumers, and design approaches that focus on sustaining their health and well-being as they age, rather than on primarily diagnosing and treating their illnesses, too often on an episodic basic.

Recognize that more than 75% of those 50 and older want to stay in their home and community as they age.18 Revolutionize your approaches to “care in the home” with a more intentional focus on enhancing your patients’ emotional and spiritual well-being and reducing social isolation.

Leverage emerging technologies, including remote patient monitoring, to better and more cost-effectively serve your patients or residents in their preferred settings.

Start using artificial intelligence to develop personalized care plans that can provide more precision treatments for chronic diseases of the

FIGURE 3

Source: U.S. Census Bureau, 2017 National Population Projections, 1940-2012 Population Estimates.

elderly, such as diabetes and heart disease.

We also need to accelerate and sustain our efforts to reduce health inequities and disparities, especially as our population becomes so much more ethnically and racially diverse. To do this, we must:

Recognize that moving the health equities needle will require “collective impact,” collaborative networks of community members, health care organizations, academic institutions and the business community committed to advancing health equity and addressing the social determinants of health.

Simultaneously become a more culturally competent organization by creating more welcoming and inclusive health care settings through tailoring care delivery models to meet the diverse social, cultural and linguistic needs of those we serve.

Future Workforce: Today’s children under 18 are 2040’s younger workforce. There will be tremendous competition from all industry sectors for this relatively small talent pool. We must: Start now to cultivate relationships with schools, houses of worship and community organizations to expose this diverse group to opportunities in health care.

Redesign both our work and our work environments to attract members of the highly diverse and technology savvy members of Gen Z and Generation Alpha (those born after 2013).

For our future workforce of all ages, we must: Shift the focus of our human resources efforts from “diversity” to “inclusion,” expanding on our notions of cultural competency to also include meeting the diverse social, cultural and linguistic needs of our staff.

Offer new tools and approaches for “lifelong learning” both to retain staff and to attract new staff members.

Reimagine roles for those nearing traditional retirement age.

Advocacy: Immigration has been and will continue to be the lifeblood for our overall economy. Without immigration, our population will shrink. Continued advocacy on this issue may seem Sisyphean, but it has never been more essential.

Additionally, given the “old-age dependency

ratios” (see Figure 3 on page 20) there will be a tremendous need to advocate for fair and adequate public payments against the headwinds of a substantially aging population with relatively fewer workers to financially support the Medicare and Medicaid programs.

CONCLUSION

Some of the projected demographic shifts are a continuation of the American experiment, where waves of those born elsewhere seek expanded opportunities in a new homeland. However, our upcoming demographic turning points will be unique and challenging as we seek to create a vibrant, more racially and ethnically pluralistic country while simultaneously attending to the needs of an aging population. Demography may not determine destiny, but it certainly has its hand on the tiller.

MARIAN C. JENNINGS is president of M. Jennings Consulting, Inc., in Malvern, Pennsylvania. She recently served on the Editorial Advisory Council for Health Progress.

NOTES

1. “U.S. and World Population Clock,” U.S. Census Bureau, https://www.census.gov/popclock/.

2. Jonathan Vespa, Lauren Medina, and David M. Armstrong, “Demographic Turning Points for the United States: Population Projections for 2020 to 2060,” U.S. Census Bureau, February 2020, https://www.census. gov/content/dam/Census/library/publications/2020/ demo/p25-1144.pdf.

3. Vespa, Medina, and Armstrong, “Demographic Turning Points for the United States.”

4. “Census Bureau Releases 2020 Demographic Analysis Estimates,” U.S. Census Bureau, December 15, 2020, https://www.census.gov/newsroom/pressreleases/2020/2020-demographic-analysis-estimates. html; “Projected 5-Year Age Groups and Sex Composition Series for the United States,” U.S. Census Bureau, https://www2.census.gov/programs-surveys/popproj/ tables/2017/2017-summary-tables/np2017-t3.xlsx.

5. Vespa, Medina, and Armstrong, “Demographic Turning Points for the United States.”

6. Vespa, Medina, and Armstrong, “Demographic Turning Points.”

7. Vespa, Medina, and Armstrong, “Demographic Turning Points.”

8. Sandra Johnson, “A Changing Nation: Population Projections Under Alternative Immigration Scenarios,”

U.S. Census Bureau, February 2020, https:// www.census.gov/content/dam/Census/ library/publications/2020/demo/p25-1146. pdf.

9. Vespa, Medina, and Armstrong, “Demographic Turning Points.”

10. Lauren Medina, Shannon Sabo, and Jonathan Vespa, “Living Longer: Historical and Projected Life Expectancy in the United States, 1960 to 2060,” U.S. Census Bureau, February 2020, https://www.census.gov/ content/dam/Census/library/ publications/2020/demo/p25-1145.pdf.

11. Vespa, Medina, and Armstrong, “Demographic Turning Points.”

12. “Projected 5-Year Age Groups and Sex Composition Series,” U.S. Census Bureau.

13. Vespa, Medina, and Armstrong, “Demographic Turning Points.”

14. Vespa, Medina, and Armstrong, “Demographic Turning Points.”

15. Vespa, Medina, and Armstrong, “Demographic Turning Points.”

16. “Citizenship and Immigration Statuses of the U.S. Foreign-Born Population,” Congressional Research Service, July 18, 2022, https://sgp.fas.org/crs/homesec/ IF11806.pdf.

17. Vespa, Medina, and Armstrong, “Demographic Turning Points.”

18. “AARP Survey Shows 8 in 10 Older Adults Want to Age in Their Homes, While the Number and Needs of Households Headed by Older Adults Grow Dramatically,” AARP, November 18, 2021, https://press.aarp.org/ 2021-11-18-AARP-Survey-Shows-8-in10-Older-Adults-Want-to-Age-in-TheirHomes-While-Number-and-Needs-ofHouseholds-Headed-Older-Adults-GrowDramatically.

CHA Vice President, Sponsorship and Mission Services

The Catholic Health Association seeks candidates for the position of Vice President, Sponsorship and Mission Services.

The Catholic health ministry is the largest group of nonprofit health care providers in the nation. It is comprised of more than 600 hospitals and 1,600 long-term care and other health facilities. To ensure vital sponsorship and a vibrant future for the Catholic health ministry, CHA advocates with Congress, the administration, federal agencies and influential policy organizations to ensure that the nation’s health systems provide quality and affordable care across the continuum of health care delivery.

CHA’s Vice President of Sponsorship and Mission Services plays a leadership role within the organization. The position reports directly to CHA’s President and Chief Executive Officer, and the Vice President is a member of the President’s Advisory Council and senior management. This executive will be responsible for providing leadership and strategic vision in the design, development, implementation, evaluation and coordination of programs and services that advance CHA members’ Catholic identity and promote a vision and understanding of the Catholic health ministry as an essential ministry of the church.

The Vice President will be responsible for the coordination of the association’s member services involving mission integration, theology and ethics, ministry formation and sponsorship. This executive will ensure CHA services in these areas enhance member value and align with CHA’s strategic plan. Duties include serving as a CHA spokesperson on sponsorship and mission issues in conjunction with President and Chief Executive Officer and maintaining effective relationships with CHA members and leaders in other national organizations. Travel is required.

CHA seeks candidates who are practicing Catholics with a minimum of 12 years’ experience in a Roman Catholic ministry. The successful candidate will have broad knowledge of religious and lay sponsorship models and Catholic moral and social traditions and a working knowledge of health care and health system management. Candidates should have a minimum of 5 years’ experience in management, including supervision of staff.

This position requires a master’s degree or PhD in Roman Catholic theology or equivalent work experience.

Interested parties should direct resumes to:

Cara Brouder

Sr. Director, Human Resources

Catholic Health Association

Further inquiries: 314-253-3498

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

For consideration, please email your resume to HR@chausa.org.

A Passionate Voice for Compassionate Care®

Creative Solutions to Quell the Staffing Crunch

KELLY BILODEAU Contributor to Health Progress

Health care staffing shortages were brewing well before the COVID-19 pandemic hit. Three years before the pandemic began, concern was already rising about a wave of impending retirements. More than half of all nurses were age 50 and older, and nearly a third were 60 and older, according to the American Hospital Association.1 COVID dealt a sudden blow that accelerated the crisis.

“COVID was a huge driver for the present shortage, and for a lot of different reasons: the stress that nurses endured, watching immense suffering before the vaccine, lots of deaths, fear for their own health, fear for their families’ [health],” says Mary Ellen Glasgow, PhD, dean of the School of Nursing and vice provost for research at Duquesne University in Pittsburgh, Pennsylvania. But the pandemic didn’t just affect nurses. Industrywide, as many as one in five health care workers have left their positions since 2020, according to a report by Definitive Healthcare.2 “Frankly, a lot of our nurses and techs and doctors decided that they just weren’t able to do the job anymore,” says Greg Till, executive vice president and chief people officer for Providence, an organization with 120,000 caregivers across five Western states.

Like millions across the U.S. since the beginning of the pandemic, health care workers quit jobs and abandoned long-term careers, joining a mass exodus now referred to by many as “The Great Resignation.” Many people retired early or

pursued entirely new roles and opportunities. Hospitals were forced to rely heavily on temporary nurses — who commanded compensation as high as $240 an hour — in addition to other contract workers, such as respiratory therapists. This drove up labor costs, which jumped by as much as 19% per patient between 2019 and 2021.3

Today, hospitals are still struggling with historic staffing shortfalls and the recognition that there is no easy answer — or end — in sight.

“The overall labor market seems to be depleted at levels that I have not seen in my lifetime,” says Damond Boatwright, president and CEO of Hospital Sisters Health System (HSHS), an organization with locations across Illinois and Wisconsin. Baby boomers are retiring at a record pace, labor force participation is at a record low and birth

Industrywide, as many as one in five health care workers have left their positions since 2020, according to a report by Definitive Healthcare.

rates are decreasing, he explains. Based on these factors, it’s likely that a plentiful workforce won’t become a reality, at least for the early part of this century, he says.

Some specialties and parts of the country may feel shortages more acutely than others. “If current trends hold, 29 states will not be able to fill the demand for nursing talent, coming up almost 100,000 nurses short in the next five years,” states a 2021 report by Mercer.4 “The largest projected shortages of nursing talent will be in Pennsylvania, North Carolina, Colorado, Illinois and Massachusetts.”

Overall, there’s a new recognition among many health care leaders that the old staffing model no longer works. To survive, health care organizations are rethinking old ways and changing everything from how they recruit people, to training requirements, compensation packages and even how the typical workday looks for those delivering care.

“What we really need to focus on as an industry is more transformational ways to change the work of health care, so that we can do it with less people,” Till says.

GIVE STAFF REASONS TO STAY

The priority for many organizations is to keep the people they have and avoid any more losses. Surveys show that the mass exodus from health care may not be over. Forty-seven percent of U.S. health care workers in one recent survey say that they have an eye on the door and may exit the field by 2025, according to a report by Elsevier Health.5

In hopes of enticing people to stay, health care leaders are increasing pay, adding educational incentives and building career ladders to help people achieve upward mobility without leaving the organization. They’re also improving job flexibility, allowing virtual and hybrid work options for some positions, and abandoning the traditional 12-hour shift in favor of schedules that give people more ability to balance their work and personal lives.

PROMOTING BALANCE AND CHOICE

“I like to say that flexibility is the new engagement capital,” Till says. “Everyone wants more flexibility, including clinicians.” To this end, Providence is implementing, four-, six- and eight-hour schedules.

At South Dakota-based Avera Health, the system has created an internal training and staffing organization aimed not only at filling jobs, but improving retention. Avera Education & Staffing

Solutions, which launched its internal travel RN program in November 2021, places both temporary workers and traveling nurses. During the pandemic, Avera was leaning heavily on travel positions, something they knew wasn’t sustainable long-term, says Kimberly Enebo, vice president of Talent and Rewards at Avera. An internal traveling RN program was not only a less expensive alternative, but it also provided benefits to employees, she says. The program gives staff members a lot of room to move, says Ryan Donovan, vice president of Business Development at Avera Health. “Maybe they’re going to school and they can’t work full time. We have temp staff options for them so they can work flexible hours,” he says. There are work options not only for nurses, but for CNAs and LPNs as well. And those who are interested can take a traveling nurse position. “Now they can do all of that while staying an Avera employee,” Donovan says.

Other organizations are also providing more flexibility through virtual and hybrid work options. Providence, for example, is using virtual nursing to help free up nurses at the bedside, by handling tasks such as going over discharge instructions with patients, reviewing medications or helping to fill out paperwork or answer questions. “Where we’ve been able to pilot [the program], it’s extended the careers of some nurses who can’t spend 12 hours on the floor,” notes Till.

Organizations also encourage older nurses to stay engaged in the workforce by hiring them for advisory positions to support more junior nursing staff on busy hospital units, says Glasgow. Turnover rates for entry-level nurses can be high in some organizations. Many nurses now entering the workforce lack some clinical experience due to changes made to training programs during COVID. “They’re coming here with less clinical experience in an environment where the acuity is through the roof,” Glasgow explains. Without the right support, many are getting overwhelmed and leaving within the first year. Investing in nurse advisers can help solve both the retirement and the turnover problem. “We have to be really creative in how we are utilizing the brain trust of nursing,” she says.

BUILDING SKILLS, INSPIRING LOYALTY

Organizations are also expanding opportunities for career growth in hopes of keeping staff members happy. “I want people — when we have them in our organization — to feel like they can reach

their God-given true and full potential,” Boatwright says. “And I want them to feel like they’ve got a number of different career opportunities just here in the organization. You can move up and move around, but you don’t have to move out.” Like other organizations, HSHS offers career levels and clinical ladder programs. “We also offer learning opportunities to emerging and current leaders,” he says. These are in addition to scholarships, tuition discounts, tuition reimbursement and student loan repayment programs, Boatwright says.

In addition to job flexibility and support, organizations also recognize the need to address the emotional and physical health needs of staff members. The pandemic took a harsh toll, and many people are now struggling with symptoms such as fatigue, depression and anxiety, Boatwright says. HSHS is using a 24-hour-a-day, seven-day-a-week employee assistance program that provides confidential counseling assessments and referral services for staff members at no charge. Providence has a similar program. “We implemented a program last year where almost every one of our caregivers has access to mental health resources immediately. We pay for them to meet with a counselor if they want, up to 26 times a year,” Till says. The organization has also trained internal staff members to recognize signs of distress in their coworkers. “We’ve gotten really good at helping folks through some of the most difficult mental challenges that they might be having as well,” Till says. Ultimately, health care organizations can offer the right salary and job description, but if workers don’t feel supported and valued, it’s not uncommon for them to explore other opportunities for a better fit or in hopes of a more fulfilling career.6

GET CREATIVE WHEN SEARCHING FOR CANDIDATES

In addition to a focus on staff retention, organizations are refining strategies to attract new workers to the profession by revamping job benefits, streamlining education and training requirements, and dipping their buckets into historically overlooked talent pools.

Instead of coming up short after mining the usual sources for workers, recruiters are turning

to new areas to find potential candidates. To tap into these markets, leaders need to engage with the community and serve on local boards, suggests Heather Brenden, a senior director of human resources at Intermountain Health’s Montana and western Colorado regions. Intermountain is headquartered in Salt Lake City. They’ve also got to forge ties not only with colleges and universities, but high schools. This enables health care organizations to introduce themselves to younger people and encourage them to consider health care as an option, she says.

Health care groups also are actively recruiting from other industries, and enlisting staff members to find recruits. “We’ve invested in a colleague referral program,” Boatwright says. “I pay them to recruit.” Staff members are paid bonuses when their referral is hired. The bonus amount varies

based on the position filled. “In 2022, 21% of overall hires came from our Refer a Friend Colleague Referral Program,” says Boatwright. “Staff members have become some of the best recruiters that we have.”

ILLUMINATE A PATH TO SUCCESS

While offering competitive salaries has become a necessity, it’s a recruitment strategy that has its limits. “The cost of that is not sustainable given that revenues are falling short to make up for it,” Boatwright says. With this in mind, organizations are using novel incentives to help draw in potential candidates. “It used to be just a sign-on bonus. Right now, we’re trying to be more creative,” Brenden says. “What works for you? What do you need? Would it be a housing stipend or would it be something different?”

Many organizations are offering tuition assistance and other types of compensation for education. At Intermountain, they’ve made the program even more flexible. “[Our] program can also be shared with qualified family members. So, if a

“It used to be just a sign-on bonus. Right now, we’re trying to be more creative. What works for you? What do you need? Would it be a housing stipend or would it be something different?”

— HEATHER BRENDEN

Fr. Callistus Chukwudi Onumah blesses the hands of St. John’s College of Nursing December 2022 graduates. As Hospital Sisters Health System takes a variety of approaches to recruit and retain health care professionals, HSHS St. John’s Hospital planned to employ several of the recent graduates. The college and St. John’s have a partnership to familiarize students with hospital staff and procedures as part of their education.

caregiver doesn’t use their educational support benefit, they can share it with a family member,” Brenden says.

Another incentive that distinguishes one organization from another is the potential they offer for career advancement. For people coming into entry-level positions, charting a defined career pathway that will allow them to advance and build their skills quickly helps to make these jobs more appealing than other entry-level jobs with comparable pay, Brenden says. “When people see a pathway to where they can go from what they perceive as an entry-level position up to a position that is not entry level, they realize they could build a career. Creating those pathways and giving them a solid plan to get there is huge,” Brenden says. “You see the light go on, and then they’re not just plugging in and coming in for that shift. They’re coming in to help build themselves.”

RETHINKING TRAINING STRATEGIES

To get people into the workforce as quickly as

possible, schools and hospitals are also collaborating to streamline education and training programs, focusing on prioritizing the most crucial elements. They’re also looking to remove some of the unnecessary barriers that may make it harder for certain students, particularly those from less affluent backgrounds, to enroll.

“We are test optional here at Malloy. We don’t require college aptitude tests, such as the SAT or ACT, for admission to the nursing program,” says Marcia Gardner, dean of the Barbara H. Hagan School of Nursing & Health Sciences at Molloy University in Rockville Centre, New York. This eliminates one barrier for students who may not be able to afford test preparation courses due to cost.

Some health care organizations are considering moving away from hardline degree and tenure requirements. “Something that we’re really looking at is redesigning all of our job descriptions, capabilities and requirements in order to lower the barriers to entry to health care professions,” Till says.

Photo courtesy of Hospital Sisters Health System

The vision is to create a skills and capabilitybased model that allows people to build quickly and advance from a solid foundation. Instead of going back to school for four or six years to get a degree, people would instead get more tailored training in the skills they need to effectively do the job, Till says. This type of skills-based approach will make it easier to attract new candidates from more underprivileged settings and access talent starting at the high school level.

Nursing programs are willing to adapt to the needs of an ever-changing industry, Gardner says. “We’re trying to have a new vision as to how to make sure that nurses are educated for the needs of now, and also the needs of an unknown future,” she says. This may mean shifting to a competency and outcomes focus, instead of a process focus.

USE TECHNOLOGY WISELY

However, even if retention and recruitment strategies are successful, health care organizations may still come up short of the staff numbers they need. “No matter how much we spend, it’s not going to solve the macrolevel demographic issues that we have,” Till says. So, organizations are also looking to technology to help increase efficiency. Providence is using data to predict patient flow to optimize scheduling and give nurses more flexibility, Till notes. They’re also aiming to digitize more processes to cut the administrative burden on staff members.

“We’re doing things like predictive hiring, opening roles before they’re technically available, to limit vacancy time,” he says. Technology can spot patterns, identifying where demand might surge so that the organization can be prepared. “All those things are aimed at really helping us today with our workforce challenges,” Till says.

Technology is also helping to speed recruitment, Boatwright says. Some HSHS interviews, introductions and career fairs are offered virtually to allow people to drop in quickly without taking a full day off from work. It’s crucial to streamline the hiring process and to make offers quickly to stay ahead of the competition. At Avera, they gave hiring power directly to nursing leaders to accelerate the process. “The first person who’s out there with that applicant to get them interviewed and an offer made is probably the winner, so we needed to be able to speed that up,” says Enebo.

LOOKING AHEAD

It’s been more than three years since the start of the pandemic, and as organizations look to the future, there is hope that health care operations are starting to stabilize.

“In 2023, there’s probably not going to be a whole lot of wind at our back in health care,” Till says. “But we’ll have less wind in our face.” And there’s hope that the changes being made now will make a difference going forward.

As Till explains, “What I’m most excited about is, I think, that while the supply-and-demand challenges are not going to get easier on their own, that many of our solutions are going to help curb the challenges, and they’re also going to bring the joy back in practice for our clinicians.”

KELLY BILODEAU is a freelance writer who specializes in health care and the pharmaceutical industry. She is the former executive editor of Harvard Women’s Health Watch. Her work has also appeared in The Washington Post, Boston magazine and numerous health care publications.

NOTES

1. Stacey Hughes to Frank Pallone, Cathy McMorris Rodgers, Diana DeGette, and H. Morgan Griffith, American Hospital Association, Washington, D.C., March 1, 2022, https://www.aha.org/lettercomment/2022-03-01-ahaprovides-information-congress-re-challenges-facingamericas-health.

2. Ethan Popowitz, “Addressing the Healthcare Staffing Shortage,” Definitive Healthcare, October 2022, https:// www.definitivehc.com/sites/default/files/resources/ pdfs/Addressing-the-healthcare-staffing-shortage.pdf.

3. “National Hospital Flash Report,” Kaufman Hall, January 2022, https://www.kaufmanhall.com/sites/ default/files/2022-01/National-Hospital-Flash-Report_ Jan2022.pdf.

4. Tanner Bateman et al., “U.S. Healthcare Labor Market,” Mercer, 2021, https://www.mercer.us/content/ dam/mercer/assets/content-images/north-america/ united-states/us-healthcare-news/us-2021-healthcarelabor-market-whitepaper.pdf.

5. “Clinician of the Future: Report 2022,” Elsevier Health, March 2022, https://www.elsevier.com/__data/assets/ pdf_file/0004/1242490/Clinician-of-the-future-reportonline.pdf.

6. Victor Lipman, “66% of Employees Would Quit If They Feel Unappreciated,” Forbes, April 15, 2017, https:// www.forbes.com/sites/victorlipman/2017/04/15/66of-employees-would-quit-if-they-feel-unappreciated/ ?sh=604551706897.

How Can Systems Better Support Catholic Chaplaincy?

DAVID LEWELLEN Contributor to Health Progress

When groups of health care chaplains get together, Connolly Huddleston stands out. Very often, she’s the only millennial in the room. She loves the work, but “I get a lot of attention,” due to her youth, she says. “I think there’s a little pressure on me, too. People say, ‘You know how to help us,’ and I don’t know how to begin.”

Her own path to chaplaincy began as an undergraduate, when she felt a call to minister to people in need, and an influential professor told her that spiritual care in health care settings was an option for a lay Catholic woman.

After she graduated in 2014, she soon enrolled in a master’s program in pastoral studies and counseling. Then it was on to clinical pastoral education — the specialized postgraduate training required for certified chaplains. She earned her certification from the National Association of Catholic Chaplains in 2020, and today she is a chaplain with Ascension in Michigan.

In a field that is struggling to replenish its ranks, Huddleston is a rare first-career chaplain. She does have some thoughts about how the field could encourage more students to begin a path toward chaplaincy, but her own education was “definitely a financial strain,” she says. “I’m thankful I didn’t have a lot of loans to pay back.” Potential chaplains, she says, face “the moving piece and the money piece” as obstacles.

For most Catholic health care systems, hiring qualified chaplains who are Catholic is a challenge that has been growing for at least a decade. Mission directors say that one factor may be the lingering belief that it’s a job for sisters and priests. But just as Catholic laity stepped up in the 1980s and ’90s to take on roles previously reserved for priests, in the current moment many systems are looking to ensure they have qualified chaplains to fill the vacancies.

Chaplains play a vital role as members of clinical teams. Far beyond praying with the sick, they listen to fears and uncertainties, talk about advance care directives, run meetings with family members, and provide a spiritual presence to staff. They pride themselves on ministering to patients and families of any faith. According to

For most Catholic health care systems, hiring qualified chaplains who are Catholic is a challenge that has been growing for at least a decade.

a recent survey of U.S. adults, half of those surveyed who have ever interacted with a chaplain did so in a health care or hospice setting. 1 But many hospitals want at least one Catholic on staff, and beyond the public-facing ministry, many mission leadership roles at Catholic facilities are reserved for Catholics.

Adding to the concerns, many Catholic staff chaplains who provide direct patient care are aging, and even more are retiring in the next five to six years.2 That leaves spiritual care departments searching for ways to attract qualified new chaplains who are attuned to the needs of Catholic health care.

OPENING CHANNELS TO NEW CHAPLAINS

“We can’t fulfill our Catholic health care mission without spiritual care,” says Jill Fisk, director of mission services for CHA, but finding a pipeline of willing and able Catholic chaplains who want to move up to management is a problem. “We want to create more nimble opportunities for folks to begin,” she says. “But how do we offer those initial opportunities, and how do we extend them out?”

“There are incredible positions open in Catholic health care,” says Erica Cohen Moore, executive director of the NACC. The ERDs require directors of pastoral care to be either a Catholic or someone who has been approved by the local bishop. There are also diocesan policies related to the appointment of non-Catholics to pastoral care staff in these settings.

Pastoral care is related to, but not the same as, sacramental care. In Catholic health care, pastoral care is obligated to offer sacramental care. Volunteers can and do deliver the Eucharist, but staff priest chaplains are becoming quite rare, and many hospitals contract with parish priests to provide sacrament coverage. “It’s a problem if someone is dying at 2 a.m. and they want the Sacrament of (Anointing of) the Sick,” says LaVera Crawley, vice president of pastoral and spiritual care at CommonSpirit Health in San Francisco — but the rest of the time, it can be managed.

Chaplains are “often seen as doing nothing but praying at the bedside,” Crawley says, but they do much more, and the work they do is nuanced and complex. She is working to develop a chaplaincy leadership track at CommonSpirit for those who are interested. “Hospitals need evidence-based guidelines,” she says. “Is what we do effective, or is it just nice? Volunteers can offer Communion or say prayers. That’s not what professional chaplains do. They diagnose spiritual distress and come up with treatments.”

Theoretically, it may be possible to change the Ethical and Religious Directives to allow nonCatholics to fill top mission roles, but at this time, CHA is focused on building partnerships to address the chaplaincy shortage in Catholic health care settings. Working with the National Association of Catholic Chaplains (NACC) and senior leaders in spiritual care within member systems, CHA is committed to elevate chaplains as a critical part of the clinical team in wholepatient care. In this regard, CHA mission leaders say supporting chaplaincy salaries as commensurate with other highly qualified clinical coworkers is essential. “We’re trying to give the bishops the assurance that we’re doing what we can,” Fisk says.

Ascension Michigan allows chaplains to fill specialist roles, creating “a career ladder so we don’t lose people who are ready to grow,” explains Beverly Beltramo, director of spiritual care. Chaplains who feel a particular affinity for behavioral health, women’s health or palliative care can create a role for themselves where they “serve as mentor or coach or the expert in this area of ministry.”

“How do we create a pipeline to ministry, and are there other ways of looking at chaplaincy?” Cohen Moore asks. “The Catholic laity don’t understand what a chaplain is. But there’s a market for it. It’s a very viable profession.”

She repeated the decades-old lament among Catholic professionals that not many young people are coming into ministry fields. “I’ve always

Chaplains are “often seen as doing nothing but praying at the bedside,” LaVera Crawley says, but they do much more, and the work they do is nuanced and complex.

been on the young end of ministry,” says Cohen Moore, who is 47, “but now we’re in crisis mode.”

Geography is a factor, too. Beltramo said that areas with clinical pastoral education centers have an easier time hiring than areas where a newly qualified chaplain would have to relocate.

The NACC has been losing members for 20 years, while its cognate nondenominational organization, the Association of Professional Chaplains (APC), has remained basically flat. One plausible reason, Beltramo says, is that as sisters have retired, laity have not taken their place. “It’s a tension we continue to carry, to maintain our professionalism,” Cohen Moore says. “But we have to welcome people who are at the starting line, who need an entry point.”

For that reason, the NACC is re-emphasizing its designation of “certified associate chaplain,” which requires a bachelor’s degree and two units of clinical pastoral education (CPE), in an attempt to make the profession more accessible. In the second half of 2023, it hopes to unveil a curriculum that could be used at the parish level to train volunteers, which could also serve as credit for people who continue toward professional chaplaincy.

“There’s a definition of a nurse or a doctor or a lawyer,” Cohen Moore points out. “That’s not true in chaplaincy. People see a gaping hole of need and they create programs, but it could be six weeks and you become a chaplain.” Certification by the NACC (or by the Association of Professional Chaplains) requires a master’s degree and four units of CPE — which represents another year of work. Most Catholic hospitals require their chaplain hires to meet those credentials or to be well on their way.

But those requirements, which built up over the years in an attempt to professionalize the field, are now often cited as one reason why it’s hard to fill jobs. “It takes a lot of work to become a certified chaplain,” says Antonina Olszewski, vice president of spiritual care for Ascension, and the extensive requirements make it hard to recruit across the full range of ethnic and socioeconomic backgrounds. “There are some barriers of our own making,” she says.

THINKING STRATEGICALLY

Many organizations now offer training, but most Catholic health care systems accept credits from only a handful. Olszewski favors the current standards, but “we also need to ask if other agencies have arisen because we make the process too onerous,” she says. “That’s probably the most contentious area right now. Much as we might not want to address it, it’s not going away.”

OBSTACLES TO GROWTH

One of the new groups that has sprung up for spiritual care providers is the Spiritual Care Association, which requires only two units of CPE and no in-person interview for certification. “We’re very evidence-driven,” says George Handzo, the association’s director of credentialing and certification. “There are plenty of people out there who would be good chaplains who

are not getting certified.” His group’s process is faster and cheaper, but has not become as popular as organizers hoped. “Part of it is the politics,” Handzo says. If a hospital runs a clinical pastoral education program, “people are very invested in the sanctity of four units of CPE. They need residencies, and hospitals need students.”

The Chaplaincy Innovation Lab, an independent center for the study and support of chaplaincy, has its own reservations about the process. “The evidence on what yields a good chaplain is questionable,” says founder and director Wendy Cadge, “and any change threatens the status quo.” If Catholic universities started twoyear programs that ended with certifications and opportunities for job placements, “they would fill those seats,” she says. “But we don’t know if there is interest.” Instead, she said the training process can be a “byzantine” system that involves

“It takes a lot of work to become a certified chaplain,” says Antonina Olszewski, vice president of spiritual care for Ascension, and the extensive requirements make it hard to recruit across the full range of ethnic and socioeconomic backgrounds.

jumping through hoops and the need for some to take out loans. Some Protestant divinity schools, she says, are creating programs that are “professionally oriented to get you in and out” with the necessary credentials to be a health care chaplain.

“We know lots of individuals and institutions are making an effort,” says Chaplaincy Innovation Lab Program Director Michael Skaggs, but time and money have become significant barriers, particularly to historically underrepresented groups. “We could collaborate more to support these groups and provide better information for them. Until those things are true, it can be an uphill battle for them to enter the profession.”

Many systems do offer some flexibility. Fr. Lawrence Chellaian, senior vice president of mission integration for CHRISTUS Health, says that his system hires some “people who are excellent at what they do, but they couldn’t get board certification. For example, one woman in our system is one of the best of the best, but she doesn’t have her master’s degree. Her family situation wouldn’t permit it.” Also, he says, at CHRISTUS facilities in South Texas, where Latino residents make up a majority of the population, 3 he will allow the hire of a noncertified bilingual chaplain.

laincy. We’re not talking about it in the parish setting. Deacons are an untapped resource.” There has been general agreement for several years that chaplaincy should be better promoted, but Chellaian says that he has not seen follow-through.

Aside from lack of information and unwillingness to move for a job, Chellaian says that compensation is “a major concern. You need a master’s degree, CPE, certification renewed every five years — and you look at other disciplines like nursing, with similar qualifications, and they’re getting a much higher salary.” A 2018 study commissioned by the NACC and the APC found that the national median salary for a chaplain just below the rank of manager was $59,000.4

But Chellaian, in his upper management position, cannot unilaterally raise his chaplains’ pay. “We can’t make significant changes, because we’re competing with other health care systems,” he says. “We can only make some insignificant changes.”

NO EASY SOLUTIONS

“The chaplaincy needs to look like the Church and the people we serve,” says Beltramo, the Ascension Michigan director. But even though time and money are obstacles, she does not want to reduce the requirements. “We worked hard as a profession” to get to the current levels, she says. “We need to say, ‘This is the standard.’ But how do we think out of the box to make a pathway?”

Can he find Catholic chaplains? “That’s a big no,” he says. “It’s a big challenge.” At one time in an earlier role with CHRISTUS, he wanted a qualified Catholic chaplain on staff, kept the position open for 18 months, and “did not get one single applicant.” For management positions that require a Catholic, “it’s very challenging, especially in the rural areas.”

Also, he says, “we are not promoting chap -

Three years ago, she made an attempt. Under Beltramo’s leadership, Ascension set up an informal system to recruit prospective chaplains and find funding for their initial training, with the possibility of paid work along the way. Patrick Baker, a labor attorney and graduate student in pastoral studies, was a member of that cohort. He took his first unit of training online and did his field work with housebound members of his home parish. For his later units, he worked in Ascension facilities throughout Southeast Michigan.

He was fortunate to find an organization that paid for his first unit and to receive a stipend for learning on the job afterward. But he points out that many potential chaplains may not have that

“The financial barrier to making this a career is an extra-high barrier. Until you compensate students for their outlay, you cannot attract a concentration of the laity. It’s just one here and there.”

— PATRICK BAKER

option and that chaplaincy does not pay as well as most other professions that require years of education.

A very attractive job offer from his first career recently took Baker to northern California, just before he finished his formal chaplaincy education. Most of his fellow students, he says, were relying on their spouse to pay the bills.

“The financial barrier to making this a career is an extra-high barrier,” he says. “Until you compensate students for their outlay, you cannot attract a concentration of the laity. It’s just one here and there.”

He would like to get back into chaplaincy in his new location. But he still has children to put through college, and “I haven’t felt called to the state of poverty.”

DAVID LEWELLEN is a freelance writer in Glendale, Wisconsin, and editor of Vision, the newsletter of the National Association of Catholic Chaplains.

THINKING STRATEGICALLY

NOTES

1. “Survey of Demand for Chaplaincy,” Chaplaincy Innovation Lab, 2022, https://chaplaincyinnovation.org/ wp-content/uploads/2022/09/Survey-of-Demand-forChaplaincy-among-US-Adults-Chaplaincy-InnovationLab-2022.pdf.

2. Brian Smith et. al, “Mission and Leadership–Spiritual Care Survey Reveals Challenges for Ministry,” Health Progress 100, no. 5 (October 2019): 59-63, https://www.chausa.org/publications/health-progress/ article/september-october-2019/mission-andleadership---spiritual-care-survey-reveals-challengesfor-ministry.

3. “The South Texas Region: 2020 Regional Report,” Texas Comptroller of Public Accounts, https:// comptroller.texas.gov/economy/economic-data/ regions/2020/south.php.

4. “2018 Chaplain Compensation Custom Survey Report,” National Association of Catholic Chaplains, January 2018, https://www.nacc.org/docs/ resources/2018%20Chaplain%20Compensation%20 Custom%20Survey%20Report.pdf.

G’DAY TO THE USA

THINKING STRATEGICALLY

Moving Care Home

LISA MUSGRAVE, RN, BSN, MHA Ascension Senior Vice President of Post-Acute and At-Home Services

If you have chronic health care needs, perhaps due to diabetes or high blood pressure, you may often find yourself frustrated by the incredibly complex health care system. You may be a working member of the “sandwich generation,” caring for both children at home and elderly parents with increasing health care needs of their own. Managing the health care services needed by you and your loved ones likely includes visits to multiple locations, often telling your stories repeatedly. Your goal: get the care you need and get home.

At times, navigating health care may feel like a full-time job: trying to get appointments, selecting the right providers, arranging transportation, communicating between providers, and getting answers to your questions. What if the health care you need could just come to you?

As part of Ascension’s strategic planning process, health system leaders noted several swings supporting a shift to care in the home. Some of the key factors include:

More than 10,000 people are becoming eligible for Medicare every day, and by 2030, every baby boomer will be 65 or older.1, 2

More than half of Americans have one or more chronic condition.3

A growing number of people expressed in a recent national survey the desire to “age in place” or live in their own homes independently for as long as possible.4

There is an increasing desire for more affordable concierge-style medicine, specifically care in the home.5

In response to these increasing factors and shifting demands, Ascension Post-Acute recognized a need to simplify the path to care by bringing multiple levels of it to the patient where they live, providing a satisfying alternative to multifacility care through one integrated program.

TRANSITION TO HOME-BASED CARE

When the COVID-19 pandemic emerged, the mandate to safely increase access to care in the home became even more clear. People expressed a desire to avoid facility-based care when possible, preferring the convenience of receiving care in their own home. New technologies, programs and capabilities for providing care in the home were initially shown to be cost-effective and the quality greater than or equal to facility-based care.6 For example, remote patient monitoring,

once a helpful tool but intermittent and cumbersome, can now be enhanced through algorithms and analytics that support clinical insights and facilitate early intervention by medical providers. This option became a lifeline for sending patients home for care during the pandemic when hospital capacity was limited. COVID-positive patients could be discharged home from the emergency room by arranging for remote monitoring of

Ascension Post-Acute recognized a need to simplify the path to care by bringing multiple levels of it to the patient where they live, providing a satisfying alternative to multifacility care through one integrated program.

Medicare Enrollment Projections

Enrollment in Medicare is expected to grow exponentially through 2030 when the last of the baby boomers turn 65.

their oxygen status and other vital signs. Providers were alerted to any significant changes early enough for prompt intervention without requiring hospitalization, reserving beds for the sickest patients.

Virtual care is another area that catapulted forward during the pandemic. Virtual care — or telemedicine — services can be leveraged in the home to provide primary and specialty care, home health, and outpatient mental and behavioral health visits. Other models that emerged or expanded rapidly during the pandemic included home dialysis, skilled nursing facility care at home, urgent/emergent care at home and hospital at home. Hospital-at-home programs that have been in existence in England, Australia, Israel and Canada for years have had limited growth in the U.S., mostly due to limited reimbursement, but they grew significantly during the pandemic because of facility capacity constraints and a waiver from the Centers for Medicare and Medicaid Services providing a path to Medicare reimbursement.7

In a desire to meet the evolving demand, Ascension Post-Acute, while always committed to ensuring that patients receive care in the most appropriate setting, made an at-home strategy one of its top imperatives. Ascension became a founding member of Moving Health Home, an alliance of stakeholders working together to advance home-based care policy at the state and federal level to enable the home to be a more prominent clinical site of care.8 Ascension believes we can shift up to a quarter of the care that in the past was provided in traditional health care facilities to the home setting, creating value for consumers, payers and providers alike.

CONSUMER BENEFIT

The American Journal of Accountable Care finds that at-home care models increased patient satisfaction, improved functional recovery, improved outcomes, decreased admissions and readmissions, reduced preventable adverse health events and lowered family member stress.9 As noted earlier, a national consumer survey — released in

Source: MedPAC July 2022 Data Book: Health Care Spending in the Medicare Program

2021 by Moving Health Home and conducted by Morning Consult — clearly illustrated a desire for and comfort with receiving care in the home: 88% of adults were satisfied with the clinical care services they received in the home, and 85% of people who had an experience with care in the home responded that they would recommend it to family and friends.10 For the consumer, being home means remaining in their familiar space with their family and pets, eating food they like, and sleeping better without noise and disruption. It also promotes trust and communication as services are delivered on the patient’s home turf where they have more control.

Through at-home care, health care professionals get an intimate look at the day-to-day lives of people they are caring for: meeting their pets, grandchildren and neighbors; seeing all the

associated infections and adverse health events, promote patient compliance, increase coding accuracy and improve overall member satisfaction.11 Some payers may hesitate to provide coverage, concerned that demand for services will increase with the convenience of care, but just recently, as 2022 ended, a very good sign in the battle for expanded care in the home occurred. The House and Senate passed the Hospital Inpatient Services Modernization Act, which extended the Acute Hospital Care at Home waiver under Medicare for two more years, signaling their support for high-acuity home-based care models.12

Health System Benefits

things that bring joy into someone’s life; and most importantly, seeing their priorities. Seeing people at home also gives glimpses into real risks: pills that have been dropped on the floor and remain unseen and untaken, or never picked up from the pharmacy at all; a home full of handwoven rugs just waiting to be tripped on; and the day-to-day stressors that impact health, including limited food, unpaid bills, strained relationships with friends and family, and even loneliness. While the health system may not be able to solve all those issues, providing health care in the home allows us to really emphasize the “care” piece of what we do and to address some of these social determinants of health that we may not ever become aware of until we have a glimpse into the home setting.

AT-HOME CARE BENEFITS

Payer Benefits

Payers, including commercial payers, Medicare Advantage and traditional Medicare, may see significant benefits from a shift to at-home care. The lower-cost setting may also reduce facility-

For health systems, a shift toward care in the home allows them to free up capacity in their facilities that may be constrained for beds or, more likely, staff, and move lower-acuity care to the home. As well, systems may be able to approach payers under value-based arrangements using care navigation to guide patients to the right level of care and using higher-acuity, lower-cost care at home as appropriate. Systems like Ascension, with a full continuum of services available, are optimally positioned to deliver new models of care in the home through high-quality preferred provider networks in conjunction with at-home assets like Ascension At Home’s health and infusion services, remote monitoring through Current Health’s Care-at-Home platform and Ascension At Home’s advisory services.

Staff/Provider Benefits

Moving care to the home may be one solution to health care provider burnout. The one-to-one provider-to-patient ratio when working in the home provides time to assess, teach and care-manage. This can be highly satisfying to staff who were considering leaving health care or needing a change. In-home care providers must be highly skilled, highly independent and highly resourceful. In a sense, they are moving into more of the ministry’s work in communities when they leave the facility and go into people’s homes. Some patients live in comfort with many resources and others alone in poverty. Comprehending the home environment can help health care professionals better understand their patients and their health. For

For the consumer, being home means remaining in their familiar space with their family and pets, eating food they like, and sleeping better without noise and disruption.

example, they may have insight into why a patient with heart failure living on canned foods from a food pantry is unable to stay out of the emergency room for more than a few weeks at a time, and how to help them adapt to improve their health status simply by giving their canned food a rinse before cooking. It is highly rewarding work.

OUR AT-HOME STRATEGY

Ascension is planning to bring a variety of home services to our patients. The vision for these future services includes a network of options to best suit each person’s needs. For someone relatively healthy, but experiencing an illness, this could be an urgent care visit in their home. For a person with a chronic condition, like heart failure, it may start with an urgent care visit in the home, but it may include a continuing path of care. This may involve a hospital stay at home with IV medications and advanced imaging of their heart, followed by a transition to skilled nursing facility care at home with therapy to help the person regain strength and nursing to help with medication management. Then, finally, the path culminates with a care management program that involves remote patient monitoring and virtual nursing support to avoid future returns to the hospital and ensure the person is living a life that includes the things that matter most to them.

Components of these care choices exist in many systems, but they often stand alone and siloed. Our team seeks to build new offerings in the home and harmonize the experience across our diverse portfolio of services, solving the most frustrating friction points by leveraging nonhealth care best practices and bringing more services directly to the consumer. For example, in February 2023, Ascension At Home, in partnership with Compassus, launched SNF (Skilled Nursing Facility) at Home in Austin, Texas. This integrated program offers a combination of home health rehab, skilled nursing and personal care, and as-needed remote monitoring, meal/nutritional support, durable medical equipment and medications.

Anyone who has had to navigate themselves or their loved one through the health care system knows it can be a difficult task, filled with unknown terminology and high emotions, often at a time when you or your loved one isn’t feel-

ing their best. We are leveraging our Ascension digital offerings to connect people to health care professionals who will provide customized care

planning and review at-home service availability, simplifying the next steps and providing seamless navigation through options. In the future, we plan to increase and add new technology to match in-home care programs available to meet patient goals and support them with caregiver communication and scheduling services.

COVID fundamentally shifted the health system’s vision for both the type and acuity of care that can be provided in the home, and many in the health care industry are recognizing this transition. Ascension is committed to creating a continuum of care-at-home programs through which our communities can benefit from high-quality, accessible care. The aging population, the increasing number of chronic conditions, the desire to age in place and increased consumer focus are all pointing us to the home. We look forward to partnering with our patients to help them reach their health goals. There’s no better place than home to do it.

LISA MUSGRAVE is Ascension’s senior vice president of Post-Acute and At-Home Services, and provides senior management to: Ascension Living, a senior living organization; Ascension At Home, a home health division managed in partnership with Compassus; Program of AllInclusive Care for the Elderly (PACE) services; and Ascension’s inpatient rehabilitation.

NOTES

1. “Aging,” U.S. Department of Health & Human Services, April 27, 2022, https://www.hhs.gov/aging/index.html.

2. Andrew Meola, “The Aging U.S. Population is Creating Many Problems — Especially Regarding Elderly Healthcare Issues,” Insider Intelligence, January 1,

COVID fundamentally shifted the health system’s vision for both the type and acuity of care that can be provided in the home, and many in the health care industry are recognizing this transition.

2023, https://www.insiderintelligence.com/insights/ aging-population-healthcare/.

3. “About Chronic Diseases,” Centers for Disease Control and Prevention, July 21, 2022, https://www.cdc.gov/ chronicdisease/about/.

4. “Americans Want Home to Be at the Center of Their Health,” Moving Health Home, December 2, 2021, https://movinghealthhome.org/national-survey/.

5. “United States Concierge Medicine Markets Report 2021-2028: Entry of Concierge Medicine Specialists Driving Growth,” Cision PR Newswire, February 2, 2022, https://www.prnewswire.com/news-releases/ united-states-concierge-medicine-markets-report2021-2028-entry-of-concierge-medicine-specialistsdriving-growth-301473633.html.

6. Christine Ritchie and Bruce Leff, “Home-Based Care Reimagined: A Full-Fledged Health Care Delivery Ecosystem Without Walls,” Health Affairs 41, no. 5 (May 2022): 689–695, https://doi.org/10.1377/hlthaff.2021.01011.

7. “CMS Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge,” Centers for Medicare & Medicaid Services, November 25, 2020, https://www.cms.gov/newsroom/press-releases/ cms-announces-comprehensive-strategy-enhance-

QUESTIONS FOR DISCUSSION

THINKING STRATEGICALLY

hospital-capacity-amid-covid-19-surge.

8. Moving Health Home, https://movinghealthhome. org/.

9. James Howard et al., “Improved Cost and Utilization among Medicare Beneficiaries Dispositioned from the ED to Receive Home Health Care Compared with Inpatient Hospitalization,” The American Journal of Accountable Care 7, no. 1 (March 2019): 10-16.

10. “Americans Want Home to Be at the Center,” Moving Health Home.

11. Howard et al., “Improved Cost and Utilization”; “Pamela M. Saenger et al., “Cost of Home Hospitalization Versus Inpatient Hospitalization Inclusive of a 30-Day Post-Acute Period,” Journal of the American Geriatrics Society 70, no. 5 (May 2022): 1374-83, https:// doi.org/10.1111/jgs.17706; Kevin D. Frick et al., “Substitutive Hospital at Home for Older Persons: Effects on Costs,” American Journal of Managed Care 15, no. 1 (January 2009): 49-56.

12. Anuja Vaidya, “Spending Bill to Extend Telehealth, Hospital-at-Home Waivers for 2 Years,” mHealthIntelligence, December 20, 2022, https://mhealthintelligence. com/news/spending-bill-to-extend-telehealth-hospitalat-home-waivers-by-2-years.

The work of Ascension and partners to increase health-at-home programs provides a number of ways people can receive care outside of hospital, clinic or doctor office settings.

1. What is your health care ministry doing to increase care in home settings? The evolving approaches will require an increased use of technology and one-to-one relationships in personal settings. What sort of workplace, personal and ethical issues might arise for care providers and those they serve? Does your ministry have systems in place to consider and address these changes?

2. Increased health at home is viewed as important at a time when more than half of those in the U.S. have one or more chronic conditions. What are some of the most cost-effective, patient-centered and value-driven ways to respond to or reduce chronic conditions? What changes in a person’s environment might make the biggest difference overall? How do you encourage those changes?

3. The article’s author Lisa Musgrave, Ascension’s senior vice president of Post-Acute and At-Home Services, notes that hospital-at-home programs have existed for years in countries like England, Australia, Israel and Canada. Do you read or talk to colleagues internationally to learn from them? What mechanisms might exist in your workplace to assist with this?

TARGETING OBESITY: Louisiana Partners Harness the Latest Science for Weight Loss

ROBIN ROENKER Contributor to Health Progress

At 35, Steven Harris feels he has a new lease on life. The Gonzales, Louisiana, native dropped from 520 pounds in 2021 to his current weight of 180 pounds, following a duodenal switch surgery — a bariatric procedure that modifies both the stomach and small intestine — overseen by Philip Schauer, MD, director of Metamor, a metabolic institute in Baton Rouge.

“Dr. Schauer saved my life,” says Harris, who now is fit enough to work as a lab analyst in a factory, where he averages 15,000 steps a day. Before the surgery, even walking was difficult for Harris, whose high body weight had also caused him to be diagnosed with prediabetes, hypertension and obstructive sleep apnea.

Today, Harris has none of those health issues. “I’m living on top of my world,” he says. After his transformative weight loss, Harris is looking forward to tackling bucket-list items his previous size had made impossible, including riding on his first-ever roller coaster this spring.

Harris is just one success story among many at Metamor, a new metabolic institute on the campus of Pennington Biomedical Research Center (PBRC) at Louisiana State University. The new clinical facility takes an integrated approach to weight management, drawing on evidence-based research and personalized medicine to help patients move toward improved health.

FORGING NEW PARTNERSHIPS

Launched in 2020, Metamor represents an innovative partnership between Pennington and Our Lady of the Lake Regional Medical Center, a member of the Franciscan Missionaries of Our Lady Health System. It receives additional funding support from the Office of the Governor of Louisiana, Louisiana Economic Development, LSU Health New Orleans and the Pennington Biomedical Research Foundation.

The new facility hopes to provide muchneeded weight management services at a time when an estimated 41.9% of U.S. adults and 19.7% of American children are currently struggling with obesity.1 Currently, 19 states have adult obesity rates over 35%; a decade ago, none did, according to Trust for America’s Health.2 Significantly, Americans living in the South — and, in particular, in rural areas of the South — are more likely to be obese than those living in urban or northern population centers.3

Metamor was launched in Louisiana, in part,

to help improve access to weight management services precisely where they are needed most: in the Southern U.S. 4 “Metamor represents a very unique collaboration between Pennington, which is a LSU facility, and the state of Louisiana,” explains Schauer, who was recruited from his former position at Cleveland Clinic to direct the institute. “And Our Lady of the Lake Regional Medical Center — one of the largest hospitals in Louisiana, practically across the street — was brought in as a partner as well, because prior to this, Pennington had been a research entity and didn’t treat patients. They had clinical trials involving patients, but Pennington had never previously provided health care.”

With these partnerships in place, the research center’s campus is, for the first time, offering multidisciplinary weight loss services — including bariatric surgery, drug therapies and lifestyle interventions — to patients. Scientists on the campus already had an international reputation for their findings related to diabetes and metabolic function, and Schauer is an innovator in these fields, known for his research and bariatric surgery advances.5

Schauer’s team completely renovated a preexisting Pennington Biomedical Research Center building to establish Metamor’s state-of-theart obesity treatment center, which was unveiled in March 2022. The new facility has specially designed waiting room seating, exam rooms, exam tables and bathrooms able to comfortably accommodate patients who weigh up to 900 pounds. The center also incorporates an array of specialist services, from surgeons and obesity medicine specialists to nutritionists, dietitians and behavioral health experts — all under one roof.

“We realized we had a unique opportunity to build a clinic specifically to meet the needs of people who struggle with their weight,” says Schauer. “We developed the center with a goal that a person who’s struggling with their weight can come here, and we’ll help them figure out the best treatment strategies for their particular case — whether it’s medication, diet, surgery or all of the above.”

Schauer believes the office of Louisiana Gov. John Bel Edwards was motivated to push for the institute’s expanded patient treatment model, partly due to Louisiana’s routine placement near the top of annual lists of American states most impacted by severe obesity.

“Obesity is a national problem — but it’s also a

Louisiana problem,” Schauer says. “So, I think the governor’s reasoning was that Louisiana needed to put more effort in this area in order to turn a negative into a positive.”

ADVANCES IN WEIGHT MANAGEMENT SCIENCE

Significantly, many of the current standards of care in weight loss treatment being offered at Metamor — and other similar clinics across the country — have been informed by groundbreaking research done at PBRC over the past 35 years. Opened in 1988, Pennington has long been viewed as “one of the top research institutes in the country devoted to obesity, nutrition and chronic illness,” says Schauer.

For example, PBRC-related research helped spur the development of the low-salt, rich-in-

Steven Harris at 180 pounds in early 2023 after his duodenal switch surgery in May 2022 at the Metamor metabolic institute in Baton Rouge. “I’m living on top of my world,” he says as a result of his transformative weight loss. Harris weighed 520 pounds in 2021 prior to his surgery.

Photos courtesy of Steven Harris

vegetables Dietary Approaches to Stop Hypertension (DASH) diet, which is routinely prescribed as a first-line treatment for high blood pressure management.6

Similarly, PBRC was a site of the National Institutes of Health-funded Look AHEAD Trial, which helped establish best practices for weight-loss lifestyle interventions that combine exercise and dietary management.7

“I think we have been involved in the clinical trials for all FDA-approved obesity drugs, as well as most of the FDA-approved diabetes management drugs,” adds Eric Ravussin, PhD, PBRC’s associate executive director for clinical science and director of PBRC’s NIH-funded Nutrition Obesity Research Center.8

While Pennington will still be heavily involved in basic and clinical science work, the new evolution to include weight-management treatment means it’s now easier than ever for PBRC physicians and researchers to directly translate the latest scientific discoveries into improvement and advances in patient clinical care.

Ravussin is particularly excited about the move toward precision medicine in weight management. With this new approach, patients’ individual genomic biomarkers could be used to identify the specific types of medications and precise kinds of exercise or dietary changes likely to be most effective on their personal pathway to weight loss.

“Ten years ago, weight loss science was a onesize-fits-all approach, and we know now that is not correct,” he says. Ravussin’s current work also includes a directory role in the NIH-supported Molecular Transducers of Physical Activity Consortium, dubbed MoTrPAC, aimed at studying the body’s response to physical activity on a cellular level.9

Through this work, it may be possible eventually to identify individuals who can more effectively manage their hypertension or prediabetes through endurance activities versus resistance activities, and vice versa, for example.

For his part, Schauer is energized by advances in both surgical and pharmacological options for patients seeking to lose large amounts of weight.

He points, for instance, to the recent addition of a new classification of FDA-approved drugs called incretins, which simulate the production

of hormones involved in digestion, help regulate insulin and decrease appetite.10, 11

“One drug approved last year, Wegovy (a semaglutide injection),12 is delivering a lot more weight loss than drugs had before. We’re talking about weight loss around 15% of total body weight, which is really quite significant,” Schauer says, adding he expects to see other new drugs entering the market that are far more effective than obesity management drugs of the past.

Surgery for weight loss, too, is advancing, with new endoscopic procedures — such as the endoscopic sleeve gastroplasty, or ESG — able to replicate the long-term weight loss success of some traditional bariatric surgeries, but with a significantly shorter recovery time.

“I think there’s a whole line of other fully endoscopic weight loss management approaches that will be receiving FDA approval in the coming years,” he says.

ADDRESSING THE YOUTH OBESITY EPIDEMIC

In January, the American Academy of Pediatrics issued its first comprehensive guidelines for treating children and adolescents with obesity. The guidelines make clear the group’s findings that obesity treatment for youth — including an increasing number of pharmacologic and surgical interventions now FDA-approved for children and adolescents — is “safe and effective.”13

The move is one example of the health profession’s growing acknowledgement that obesity is, in fact, a medical disease that should be addressed medically, says Katie Queen, MD, a pediatrician at Our Lady of the Lake Children’s Health who is board certified in both pediatrics and obesity medicine.

In October 2021, Queen helped launch a multidisciplinary pediatric obesity specialty clinic at Our Lady of the Lake in Baton Rouge. The practice includes two pediatricians, two dieticians and a social worker who can help patients practice mindful eating or combat disordered eating

“Ten years ago, weight loss science was a one-size-fits-all approach, and we know now that is not correct.”

— ERIC RAVUSSIN

practices like binge eating, among other services.

To qualify for the clinic’s care, patients must be at least two years old and have a BMI above 30 or that falls in the 95th percentile or above for their age. Many of Queen’s patients, significantly, screen highly on intake questionnaires surrounding issues of food insecurity as well as transportation and housing insecurity. For these patients, Queen’s team works to make connections with food banks and other social and mental health supports to ease emotional distress that may be contributing to the child’s weight gain.

“We are seeing some of the sickest, most severe pediatric obesity cases from across the state,” Queen says. “And what’s different about our clinic is that we don’t just do lifestyle treatment — meaning teaching them about healthy eating, nutrition and physical activity. We offer all aspects of treatment, which includes lifestyle modifications plus anti-obesity medications and surgery, when appropriate.”

Given her clinic’s proximity to Pennington, Queen can refer pediatric patients in need of bariatric surgery seamlessly to Schauer and his surgical team at Metamor.

“When a young patient comes in, we’re not just saying, ‘OK, we’re going to teach you how to eat healthier and be active.’ Instead, we’re really looking at their condition medically, and thinking about how best to match the severity of their obesity and their health complications with treatments that are available,” she says.

Queen points to one recent success story: a 12-year-old girl who had gained significant weight following use of psychiatric medications to address schizoaffective disorder. With Queen’s prescription of liraglutide, an anti-obesity medi-

cation that’s FDA-approved for ages 12 and up, the patient was able to lose 15% of her body weight in just six months — far more than she likely would have been able to lose with diet and exercise modifications alone.

In addition to developing her own pediatric specialty clinic, Queen has also been working to share pediatric weight management best practices with other pediatricians and clinics across Louisiana, many of them within the Franciscan Missionaries of Our Lady Health System.

In this pursuit, she has worked closely with Amanda Staiano, PhD, director of the pediatric obesity health behavior lab at PBRC, whose research has included studies on the effectiveness of exergames — video games that encourage kids to get up and moving.

Staiano’s findings illustrate that these interventions, when implemented correctly, can successfully help kids lose weight and improve their blood pressure and other weight-related health concerns.

“The kids that we’ve worked with really seem to enjoy that relationship with their [online] coach, as well as having these resources that they can do at home or with their family,” Staiano says.

She’s currently at work to expand the intervention to an easy-to-use app and to share it with other pediatric patients, including kids dealing with ADHD. She notes that, compared to 15 years ago, exergames have become much more involved and immersive as technology has improved.

Building on their mutual expertise and research findings, Staiano and Queen have trained about 40 pediatricians, nurse practitioners and family medicine doctors throughout South Louisiana. During these workshops, they’ve offered insights into

“When a young patient comes in, we’re not just saying, ‘OK, we’re going to teach you how to eat healthier and be active.’ Instead, we’re really looking at their condition medically, and thinking about how best to match the severity of their obesity and their health complications with treatments that are available.”

— KATIE QUEEN, MD

scientifically proven weight loss interventions as well as practical tips for how best to engage families in conversations about weight management.

Because obesity medicine is a relatively new board specialty, “most of these providers did not get this type of training in medical school or graduate school,” Staiano says.

Staiano hopes her partnership with Queen can help pediatricians and nurses begin to routinely and directly “talk about children’s weight with their family [during office visits], just like they would about blood pressure or labs.”

CONCLUSION

As the partnership between Metamor and Our Lady of the Lake grows, weight management researchers and clinicians at both facilities hope their combined efforts will help curb the growing tide of obesity across Louisiana and the South.

“It is pretty clear now that obesity is one of the most important public health problems in our nation — if not the most important,” Schauer says. “To address the issue, we really need to be devoting as much energy as possible into finding solutions both on the clinical care side and the research side, and that’s exactly what we’re trying to do here.”

ROBIN ROENKER is a freelance writer based in Lexington, Kentucky. She has more than 15 years of experience reporting on health and wellness, higher education and business trends.

NOTES

1. “State of Obesity 2022: Better Policies for a Healthier America,” Trust for America’s Health, https:// www.tfah.org/report-details/state-of-obesity-2022/; “Childhood Obesity Facts,” Centers for Disease Control and Prevention, https://www.cdc.gov/obesity/data/ childhood.html.

2. “Nation’s Obesity Epidemic Is Growing: 19 States Have Adult Obesity Rates above 35 Percent, Up from 16 States Last Year,” Trust for America’s Health, https:// www.tfah.org/article/nations-obesity-epidemic-isgrowing-xx-states-have-adult-obesity-rates-above35-percent-up-from-xx-states-last-year/.

3. “U.S. Obesity Rates Reach Historic Highs – Racial, Ethnic, Gender and Geographic Disparities Continue to Persist,” Trust for America’s Health, https://www.tfah.

org/report-details/stateofobesity2019/; Elizabeth A. Lundeen et al., “Obesity Prevalence Among Adults Living in Metropolitan and Nonmetropolitan Counties — United States, 2016,” Morbidity and Mortality Weekly Report 67, no. 23 (June 2018): 653-658, http://dx.doi.org/10.15585/ mmwr.mm6723a1.

4. “Adult Obesity Prevalence Maps,” Centers for Disease Control and Prevention, September 27, 2022, https:// www.cdc.gov/obesity/data/prevalence-maps.html.

5. “Big Deal: Dr. Philip Schauer Is Putting Pennington on the Global Map,” Baton Rouge Area Foundation, February 17, 2021, https://www.braf.org/stories/2021/2/17/ big-deal-penningtons-philip-schauer-is-puttingpennington-on-the-global-map.

6. “The DASH Diet,” Pennington Biomedical Research Center, https://docsdash.pbrc.edu/dash-diet/; “DASH Diet: Healthy Eating to Lower Your Blood Pressure,” Mayo Clinic, https://www.mayoclinic.org/healthylifestyle/nutrition-and-healthy-eating/in-depth/ dash-diet/art-20048456.

7. Xavier Pi-Sunyer, “The Look AHEAD Trial: A Review and Discussion of Its Outcomes,” Current Nutrition Reports 3, no. 4 (December 2014): 387-391, https://doi.org/10.1007/s13668-014-0099-x.

8. “Nutrition Obesity Research Centers,” National Institute of Diabetes and Digestive and Kidney Diseases, https://www.niddk.nih.gov/ research-funding/researchprograms/nutrition-obesity-research-centers.

9. Molecular Transducers of Physical Activity Consortium (MoTrPAC), https://www.motrpac.org/.

10. Hope Chang, “What Are Incretins and How Do They Affect Weight Loss, Blood Sugar, and Type 2 Diabetes?,” Good RX Health, June 28, 2021, https://www.goodrx. com/conditions/diabetes-type-2/what-are-incretins.

11. Gina Kolata, “New Drugs Could Help Treat Obesity. Could They End the Stigma, Too?,” The New York Times, May 11, 2021, https://www.nytimes.com/2021/05/11/ health/obesity-drugs.html.

12. “Weight Loss With Wegovy,” Wegovy, https://www.wegovy.com/about-wegovy/weight-losswith-wegovy.html.

13. “American Academy of Pediatrics Issues Its First Comprehensive Guideline on Evaluating, Treating Children and Adolescents With Obesity,” American Academy of Pediatrics, January 9, 2023, https://www.aap.org/ en/news-room/news-releases/aap/2022/americanacademy-of-pediatrics-issues-its-first-comprehensiveguideline-on-evaluating-treating-children-andadolescents-with-obesity/.

HOW HEALTH CARE CAN RESPOND TO END NATIONAL HUNGER

Last year in late September, the Biden-Harris Administration convened the White House Conference on Hunger, Nutrition and Health, more than 50 years after the first White House conference on this issue. 1 The administration announced its ambitious goal to end hunger and increase healthy eating and physical activity by 2030. In a memo announcing the goal and supporting national strategy, the White House wrote, “The consequences of food insecurity and diet-related diseases are significant, far reaching, and disproportionately impact historically underserved communities.”2 The memo goes on to note that “food insecurity and diet-related diseases are largely preventable, if we prioritize the health of the nation.”3

In his statement introducing the national strategy, President Joe Biden notes that while the plan builds upon the federal government’s existing work to address hunger and diet-related diseases, it also depends heavily on a “whole-ofgovernment and whole-of-America approach” to achieve success. This call to end hunger can provide health care organizations with a valuable opportunity to review their organization-wide approach to address food insecurity and diet-related diseases in their patient and employee populations and in the broader communities they serve.

As existing and new efforts are considered, it is important to ensure that groups most impacted by food insecurity are included in these discussions. Are their needs and voices heard and reflected in the ways this issue is addressed?

FOOD INSECURITY AND HEALTH IN THE U.S.

According to the U.S. Department of Agriculture’s (USDA) most recent report on food security in the U.S., 10% of American households (13.5 million households) were food insecure in 2021.4

However, there are significant disparities in food insecurity in the U.S. based on race/ethnicity, income and household composition:5

Almost 20% of Black households were food insecure at some point in 2021, as were 16% of Hispanic households when compared to 7% of white households.

In 2021, 32% of households with incomes below the federal poverty line were food insecure.

In 2021, households with children had a food insecurity rate of 12.5%, while households without children had a rate of 9%. Those with a female head of household, children and no spouse had a 24% food insecurity rate.

Food insecurity can have profound impacts on health and well-being. A 2017 study from the USDA found that in working-age adults, lower food security was associated with higher probability of 10 of the most common, costly and preventable chronic conditions.6 Some of these conditions — such as heart disease, cancer, stroke and diabetes — are among the leading causes of death in the U.S.7

In young children, research shows food insecurity increases rates of hospitalizations, poor health, iron deficiency, developmental risk and behavioral problems. In school-age children, research finds similar poor outcomes in health, behavioral functioning and academic performance. For both adults and children, the stresses of food insecurity can lead to increased risk of anxiety, depression and mental health issues.8

NATIONAL STRATEGY ON HUNGER, NUTRITION AND HEALTH

In the White House’s national plan to end hunger and increase healthy eating and physical activity by 2030, the strategy lays out five pillars of work that the administration will pursue with a “call to action for a whole-of-society response” for each pillar.9

1. Improving food access and affordability, including advancing policies that bolster family economic security; helping more people experiencing food insecurity to benefit from federal assistance programs; and investing in community and economic development to increase access to food.

2. Integrating nutrition and health, including leveraging Medicare and Medicaid, and tasking federal agencies such as CMS and the CDC to provide greater access to nutrition services to better prevent, manage and treat diet-related diseases; incentivizing health care organizations to screen for food insecurity and connect people to the services they need; and strengthening and diversifying the nutrition workforce.

3. Empowering all consumers to make and have access to healthy choices, including providing consumers with updated and more accessible food labeling; creating healthier food environments and a healthier food supply so the healthier choice is the easier choice; and supporting robust and tailored nutrition education.

4. Supporting physical activity for all, including building environments that promote physical activity and supporting robust and tailored physical activity education and promotion.

5. Enhancing nutrition and food security research, including bolstering funding to improve metrics, data collection and research to inform nutrition and food security policy, particularly on issues of equity and access; and implementing a vision for advancing nutrition science.

HOW HEALTH CARE CAN RESPOND

Health care organizations have a vital role to play in this work and have been called out by the administration as key partners. As health care organizations consider how to respond, a review of all the ways the organization addresses food and nutrition security can be a useful first step.10 This review could include a cross section of departments, including clinical care, food services, community benefit, population health, advocacy and philanthropy. Using the federal actions and supporting calls to action for each pillar, organizations can evaluate existing efforts for possible changes as well as identify new approaches or partnerships to undertake.

Possible actions include:

Screening patients for food insecurity, con-

necting patients to nutrition assistance services and ensuring services are available. The federal government is encouraging screening/referrals for a range of health-related social needs since addressing these risk factors is seen as a key step to improving care and lowering health care costs. As this practice grows, it will be important for health care organizations to work with community partners to ensure there is community capacity to meet referral needs. The Partnership to Align Social Care: A National Learning & Action Network is one group working on this issue and includes health care organizations such as CommonSpirit Health, Kaiser Permanente and Rush University Medical Center.11

Incorporating nutrition education and healthy food access into patient care plans and serving healthy foods in your facilities.

Providing assistance to patients and community members to enroll in government food assistance programs for which they are eligible. For some groups, tailored outreach and education may be needed to encourage enrollment. For example, three out of five older adults who qualify for the Supplemental Nutrition Assistance Program (SNAP) pass up this valuable benefit because of misconceptions, such as SNAP being only for families with children or that applying for SNAP assistance will take food benefits away from others who need it.12

Ensuring community health needs assessments and implementation strategies look at food security and access to healthy, safe and affordable foods important to health. Organizations should consider bolstering existing community efforts to address food insecurity, such as food pantries, school meal programs and local food policy councils.

Advocating for policies that address food insecurity, with particular attention to policy solutions that attend to the needs of populations that are disproportionately impacted. As temporary pandemic response measures — such as expanding free school lunch and nutrition programs used by millions of low-income Americans — are ended, it is important to understand what new policies need to be put in place to ensure impacted groups still have access to the food they need. Advocacy on food security should be part of broader advocacy and coalition efforts that help low-income Americans achieve economic security.

Review the $8 billion in new commitments as part of the White House’s call to action to address hunger, nutrition and health to see what investments might be leveraged, supported or replicated by your organization or community and business partners.13 These commitments were announced at the White House conference to show ways various sectors of society can help achieve the administration’s goal.

Attend regional “Come to the Table” summits being held around the country to celebrate and showcase what the health care sector is already doing to integrate nutrition and health. These meetings are being sponsored by The Root

FOOD, NUTRITION AND HEALTH RESOURCES

CHA RESOURCES

Food and Water Health Progress March-April

2019 edition:

“Hunger Is a Health Issue,” by Francine Blinten, MS, MBA, CCN, CNS

https://www.chausa.org/publications/ health-progress/archives/issues/marchapril-2019/hunger-is-a-health-issue

“Healthy Eating for Healthy Communities”

by Susan Bridle-Fitzpatrick, PhD

https://www.chausa.org/publications/healthprogress/archives/issues/march-april-2019/ healthy-eating-for-healthy-communities

CHA Issue Briefs

Social Determinants of Health

https://www.chausa.org/advocacy/policy-briefs/ social-determinants-of-health

Health Equity

https://www.chausa.org/advocacy/policy-briefs/ health-equity

OTHER RESOURCES

Delivering Community Benefit: Healthy Food Playbook

https://foodcommunitybenefit.noharm.org/

Cause Coalition, a membership organization committed to ending the root causes of health inequities, and ProMedica, a nonprofit health care organization serving communities in Ohio and Michigan. The USDA is supporting these meetings as part of their commitment to the national strategy to end hunger.

A CALL TO RESPOND FOR THE COMMON GOOD

As we respond as a ministry to help end hunger in America, we must not lose sight of the human costs of food insecurity and remember it is an issue of protecting life, human dignity and the common good. Parents who cannot feed their children

“HAN (Health Anchor Network) Members Creating Food Systems Level Change”

https://healthcareanchor.network/2021/02/hanmembers-creating-food-systems-level-change/ Health Affairs: “As They Take on Food Insecurity, Community-Based Health Care Organizations Have Found Four Strategies That Work”

https://www.healthaffairs.org/do/10.1377/ forefront.20210616.615098

Root Cause Coalition

https://www.rootcausecoalition.org/

American Hospital Association’s “Social Determinants of Health Series: Food Insecurity and the Role of Hospitals”

https://www.aha.org/ahahret-guides/201706-21-social-determinants-health-series-foodinsecurity-and-role-hospitals

SIREN (Social Interventions Research & Evaluation Network)

https://sirenetwork.ucsf.edu/

NPR: “The Hidden Faces of Hunger in America”

https://www.npr.org/2022/10/02/1125571699/ hunger-poverty-us-dc-food-pantry

“Come to the Table” Sign-up Form for Summit Information and Invitations

https://lp.constantcontactpages.com/su/ XZg7O77/cometotableregionalsummit

often skip meals to ensure their children can eat. Hunger and the stress of not meeting the basic needs of their families causes anxiety and depression, which can then affect parents’ health and ability to work. Children who go to school hungry and see their parents’ struggles can also suffer from anxiety and depression, which often results in behavioral and academic issues.

In a recent opinion piece in The Washington Post that illustrates how food insecurity impacts families, a mother struggling to feed her family describes her feelings of hopelessness: “If you don’t have food, you don’t have anything. Hunger is one of the most crippling, unfortunate and devastating feelings in the world. When they’re cutting benefits, they’re also cutting families. We’re going to feel it — mentally, emotionally, financially.”14

INDU SPUGNARDI is director, advocacy and resource development, for the Catholic Health Association, Washington, D.C.

NOTES

1. “White House Conference on Hunger, Nutrition and Health,” Office of Disease Prevention and Health Promotion, https://health. gov/our-work/nutrition-physical-activity/ white-house-conference-hunger-nutrition-and-health.

2. “Executive Summary: Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health,” The White House, September 27, 2022, https:// www.whitehouse.gov/briefing-room/statementsreleases/2022/09/27/executive-summary-biden-harrisadministration-national-strategy-on-hunger-nutritionand-health/.

3. “Executive Summary,” The White House.

4. “Food Security in the U.S.: Key Statistics & Graphics,” USDA: Economic Research Service, October 17, 2022, https://www.ers.usda.gov/topics/foodnutrition-assistance/food-security-in-the-u-s/ key-statistics-graphics/.

5. “Food Security and Nutrition Assistance,” USDA Economic Research Service, October 18, 2022, https://www.ers.usda.gov/data-products/ag-and-foodstatistics-charting-the-essentials/food-security-andnutrition-assistance/; Alisha Coleman-Jensen et al., “Household Food Security in the United States in 2021,”

USDA Economic Research Service, September 2022, https://www.ers.usda.gov/webdocs/ publications/104656/err-309.pdf?v=5832.6.

6. Christian A. Gregory and Alisha Coleman-Jensen, “Food Insecurity, Chronic Disease, and Health Among Working-Age Adults,” USDA Economic Research Service, July 2017, https://www.ers.usda.gov/webdocs/ publications/84467/err-235_summary.pdf?v=0.

7. “Leading Causes of Death,” Centers for Disease Control and Prevention, September 6, 2022, https://www. cdc.gov/nchs/fastats/leading-causes-of-death.htm.

8. “The Link Between Food Insecurity and Mental Health,” Psychology Today, November 10, 2020, https://www.psychologytoday.com/us/ blog/evidence-based-living/202011/the-linkbetween-food-insecurity-and-mental-health.

9. “Biden-Harris Administration National Strategy on Hunger, Nutrition and Health,” The White House, September 2022, https://www.whitehouse.gov/wpcontent/uploads/2022/09/White-House-NationalStrategy-on-Hunger-Nutrition-and-Health-FINAL.pdf.

10. “What Is Nutrition Security?,” Economic Research Service, https://www.usda.gov/nutrition-security.

11. “Partnership to Align Social Care — A National Learning & Action Network,” https://www. partnership2asc.org/.

12. “Seniors & SNAP: 5 Myths Busted,” National Council on Aging, April 4, 2022, https://www.ncoa.org/article/ seniors-snap-5-myths-busted.

13. “FACT SHEET: The Biden-Harris Administration Announces More than $8 Billion in New Commitments as Part of Call to Action for White House Conference on Hunger, Nutrition and Health,” The White House, September 28, 2022, https://www.whitehouse.gov/ briefing-room/statements-releases/2022/09/28/ fact-sheet-the-biden-harris-administration-announcesmore-than-8-billion-in-new-commitments-as-part-ofcall-to-action-for-white-house-conference-on-hungernutrition-and-health/.

14. Theresa Vargas, “D.C. Could Offer Free Meals to All Students. Every City Should.,” The Washington Post, January 28, 2023, https://www.washingtonpost.com/ dc-md-va/2023/01/28/free-school-lunch-dc-nation/.

A CALL TO SEEK AND TELL THE ‘TRUE TRUTH’ OF INJUSTICE

KATHY CURRAN, JD

Servant of God Sr. Thea Bowman spoke to the National Conference of Catholic Bishops at their June 1989 meeting, less than a year before her death from breast cancer. From her wheelchair, Sr. Thea preached, sang, exhorted and teased the gathering of bishops. The first Black woman to speak at the bishops’ annual meeting, she began by asking, “What does it mean to be Black in the Church and in society?” She then broke into song with: “Sometimes I feel like a motherless child.”1

An acclaimed evangelizer, teacher, writer and singer, Sr. Thea generously taught young people about the fulfillment and glories of being Christian, and along with the joy of the Gospel, she shared her rich cultural heritage and spirituality to audiences throughout the nation. Through her work, she was able to promote cultural awareness and racial reconciliation.

Sr. Thea was from Canton, Mississippi. Raised as a Protestant, she converted to Catholicism in grade school with her parents’ permission. In high school, she was called to religious life and, overcoming her parents’ initial reluctance, she headed to Wisconsin to join the congregation of sisters who had educated her, the Franciscan Sisters of Perpetual Adoration, where she was the only Black sister in the order. After taking her first vows, she returned home in 1961 to teach in her parish school and went on to earn a doctorate in English language and literature from Catholic University of America in Washington, D.C. She was a college professor and English department chair at Viterbo College in La Crosse, Wisconsin, and co-founded the Institute for Black Catholic Studies at Xavier University of Louisiana in New Orleans. When her elderly parents needed care, she returned to Mississippi and was invited by the bishop of Jackson to establish a diocesan office of intercultural awareness.

Throughout those years, she traveled across the country evangelizing and advocating for interracial understanding and greater appreciation of Black Catholics within the Church. One of her messages was to embrace the “true truth”: the truth of the Gospel, the truth of who we each are

in our deepest being, and the truth of racism in our Church and society. “I’ll tell you the truth,” she would often say, “only if you can stand to hear the ‘true truth’!”2

Sr. Thea’s life and words call us to our shared responsibility as Americans to learn, listen and acknowledge the racial injustices of our past and present, and to take the time to seek out and understand the personal testimonies of those who have experienced these wrongdoings firsthand. We must face these realities to truly address the effects of racism in our nation and in our communities.

SEEKING AND HEARING THE TRUTH

I recently had the opportunity to travel to Mississippi for the first time to visit Canton with the Missionary Servants of the Most Holy Trinity, an order of priests and brothers with several mission parishes in the area, including Holy Child Jesus Church, Sr. Thea’s home parish. It was the Missionary Servants who first invited the Wisconsin Franciscan sisters to open a school for Black children in the 1940s, and the Missionary Servants still serve the parish and several others in the area.

The visit was moving for several reasons, including our visit to the home where Sr. Thea grew up and later died. But what touched me most were moments that brought me — a white woman from the Northeast — closer to the “true truth” of racism and discrimination.

We heard from the priests and the parishioners who welcomed us and told us stories about the Jim Crow laws that enforced racial segregation through the mid-1960s, and their lingering

legacy. When Sr. Thea came back to Canton in the early 1960s to teach at Holy Child Jesus Catholic School, laws forbidding Blacks and whites to cohabitate were still on the books, which meant Sr. Thea could not live in the convent with the other sisters, who were white. So, a small trailer was obtained and parked just a few inches from the convent, allowing Sr. Thea to pass through the adjacent doors into the convent for meals and community with her sisters; however, to observe the letter of the law, she had to sleep in the trailer.

In the mid-1960s, Holy Child Jesus parish needed a new church, but local officials refused to give a permit. So, one Sunday, parishioners walked over to attend Mass at the white Catholic church. In short order, the permit was issued, but with conditions: the new church had to be set far back on the property and could not face the street, just to show who was in control.

Well, one might say, that all happened a long time ago, but the effects of Jim Crow still linger. We heard the story of a new pastor who arrived in the late ’90s/early 2000s at the Missionary Servants parish in nearby Camden. He noticed that only half of a cemetery was mowed and wellmaintained. Upon inquiry, he was told that the man who did the mowing only tended to the white side of the cemetery. Although the fence that once

plants in Mississippi, affecting at least 100 families in the largely Guatemalan parish.4 The parish provided hot meals, services and counseling for traumatized children missing one or both parents following the raids.

I grew up in an integrated town in Connecticut in the 1970s, attended diverse universities where I had friends of all backgrounds, and for the past 10 years have been staff lead for CHA’s health equity work. Even so, I thought of segregation as an evil from the past, and I had never heard someone I know personally speak about life under Jim Crow and its lingering effects today. Shame on me, perhaps. But as I spoke to people and listened to their life stories in Mississippi, it was like a previously unnoticed fog was lifted and my perception of injustice sharpened.

FACING OUR NATION’S TRUTH

divided the white and Black sections of the cemetery was now gone, the discriminatory attitude was not. The pastor put a quick stop to this.

We also visited other Missionary Servants parishes touched by injustice. Holy Rosary Indian Mission, located in a town called Philadelphia, serves members of the Choctaw nation, descendants of those who remained on their ancestral land when the U.S. government moved the tribe to a reservation in Oklahoma.3 Another, St. Anne Catholic Church in Carthage, became command central for immigration lawyers and social workers in 2019 following U.S. Immigration and Customs Enforcement raids on chicken processing

I believe white people of goodwill, who have no personal frame of reference for the reality of the injustices committed against our sisters and brothers, would be moved if they heard stories like these. Their eyes must be opened by hearing the “true truth” of the historical realities of racism and the lived experiences of those affected by it. As “educated” as many white people may think they are, the white experience in the United States by its nature means they do not have a full understanding of the experiences of people of color in our country. Maybe I am being naïve — there are certainly people who are racists or just do not want to hear about it — but people cannot know what they have no knowledge about, and we have an obligation to tell them. It is crucial, for a start, that we teach about race massacres that occurred in Tulsa, Oklahoma; Rosewood, Florida; and too many other places,5 as well as the day-to-day indignities suffered by victims of racism.

CHA’s introductory video for the We Are Called initiative6 talked about racial restriction covenants in housing and redlining. I had younger acquaintances tell me they were shocked, as they had never heard of this type of racial discrimination. Well, I was shocked that this could be new to anyone; but people cannot know what they do not know.

We must face our country’s past and present.

The social and cultural effects of over 300 years of racist laws and practices did not magically disappear when the Civil Rights Act of 1964 was enacted.

We must acknowledge that, as author David French has written, “Systems and structures designed by racists for racist reasons are often maintained by nonracists for nonracist reasons.”7 That’s what it means to recognize the existence of systemic racism. The social and cultural effects of over 300 years of racist laws and practices did not magically disappear when the Civil Rights Act of 1964 was enacted. We have to do the hard work of intentionally looking for and eradicating the effects of racism in our nation and in our communities — looking for the places where the fence may have come down, yet the practices and attitudes have not changed.

GETTING OUR OWN HOUSES IN ORDER

Given how polarized our country is today, I fear some reading this are thinking, “You just want white folks to feel guilty.” I felt many things while I was in Mississippi — sorrow, shock and disbelief, but not guilt. Rather than “white guilt,” I felt red hot anger at the betrayal of the values we say we hold as Americans and the injustices committed in the name of and with the support of our institutions. Almost 60 years after Rev. Martin Luther King Jr.’s “I Have a Dream Speech,” we still have work to do to fully honor what King called the promissory note of our founding: “... a promise that all men — yes, Black men as well as white men — would be guaranteed the unalienable rights of life, liberty and the pursuit of happiness.”

If we truly believe the values espoused in the Declaration of Independence and U.S. Constitution, then as Americans we have the collective and individual responsibility to accept Sr. Thea’s challenge — to have the courage to hear the “true truth” and to do something about it. One of the pillars of the We Are Called pledge is to get our own houses in order. Take the time to learn about your local community, town or state’s racial history.8 Read about the forced marches of American Indians to reservations, the race massacres and the lynchings. And don’t “just learn the facts,” for as important as those are, reading people’s personal testimonies is how we can begin to authentically embrace the truth.9

Only if we face and acknowledge injustice — past and present — can we do something about it. This is our shared responsibility as Americans.

Maybe it sounds overwhelming, maybe you do not see how taking the first steps of learning and listening can matter. Take heart, and listen again to Sr. Thea: “I think one difference between me and some other people is that I’m content to do my little bit. Sometimes people think they have to do big things in order to make change. But, if each one of us would light the candle, we’d have a tremendous light.”10

KATHY CURRAN is senior director, public policy, for the Catholic Health Association, Washington, D.C.

NOTES

1. “Sr. Thea’s Address to U.S. Bishops,” YouTube, June 1989, https://www.youtube.com/ watch?v=uOV0nQkjuoA.

2. Friar Noel Danielewicz OFM Conv., “Thea Bowman & Bede Abram: A Reflection,” Franciscan Voice, February 4, 2021, https://franciscanvoice.org/ thea-bowman-bede-abram/.

3. “History,” Holy Rosary Indian Mission, https:// holyrosaryindianmission.com/history.

4. Carmen Sesin, “#NBCLatino20: The Rev. Odel Medina — A Community’s Solace,” NBC News, September 16, 2019, https://www.nbcnews.com/news/ latino/latino20-rev-odel-medina-community-s-solacen1050441.

5. Gillian Brockell, “Tulsa Isn’t the Only Race Massacre You Were Never Taught in School. Here Are Others,” The Washington Post, June 1, 2021.

6. “We Are Called,” Catholic Health Association, https:// www.chausa.org/cha-we-are-called.

7. David French, “The NFL Has a ‘Good Ol’ Boy’ Problem,” The Atlantic, February 3, 2022, https://newsletters.theatlantic.com/thethird-rail/61fc2e3b6c908600204d373a/ nfl-brian-flores-discrimination/.

8. M. Therese Lysaught and Sheri Bartlett Browne, “Looking Backward to Move Forward: Writing Your System’s Racial Autobiography,” Health Progress 103, no. 2 (Spring 2022): 43-50.

9. “Remembering Jim Crow: Read Stories,” American Public Media, http://americanradioworks.publicradio. org/features/remembering/read.html.

10. “1987 Special Report: ‘Sister Thea Bowman,’” YouTube, April 5, 2021, https://www.youtube.com/ watch?v=g3xuC0XkG48.

FORMATION

MINISTRY FORMATION HAS COME A LONG WAY, BUT IS IT ENOUGH?

“There is indeed a ‘tipping point’ in the kind of leaders who serve to continue a ministry, or send it off in another direction never intended by its founders. As the work of leadership formation continues to develop within the health care ministry, the 16th century wisdom of St. Ignatius Loyola may speak to us in fresh ways today. Let our future work be less about checklists and more about the compass.” 1

— BRIAN YANOFCHICK

So much has happened in the world of formation over the last two decades. Multiple systems have formation as a priority in their strategic plans, and many have senior leader formation programs. But is it enough? When exploring this question, one area that does not require any analysis or investigation to determine its importance is the undeniable need for formation leaders. Aside from determining who are the formators of the Catholic health care ministry now, what about those in the years ahead? And more importantly, how are they being trained not only for today, but into the future?

A CALL FOR CONTINUING FORMATION

More than 20 years ago, I was invited to coordinate prayers and reflections for a two-day gathering of sponsors and senior executives of California Catholic health care systems and hospitals, in addition to the state’s Catholic bishops meeting. The agenda was clear: How would the healing ministry of Jesus, as expressed in Catholic health care, continue now and into the future? Bill Cox, president and CEO of the Alliance of Catholic Health Care and organizer of the event for Catholic health care leaders, noted: “Thoughtful critics have questioned whether the institutional Catholic health ministry can remain alive, vibrant and formative, given the context in which health care is delivered today. … The critics’ most worrisome concern, however, is that Catholic health care may be ill-equipped to effectively address largely external challenges because the culture of Catholic health care itself is becoming dysfunctional. That culture, which is anchored in the healing mission

of Jesus, is Catholic health care’s raison d’être — its meaning and purpose. Without it, Catholic hospitals cannot continue to be efficacious church ministries, much less sustain their identities in a rapidly changing external environment.”2 Cox’s answer to these critics was and remains the necessity for ministry formation at all levels of the organization, from frontline workers to the sponsor.

DIARMUID ROONEY

A core competency of the sponsor body is ministry formation, namely to “ensure, oversee and assess formation activities throughout the ministry, starting with the sponsor body itself” and for leaders’ and associates’ participation in “appropriate formation programs that strengthen them spiritually for the ministry of health care.”3 The Code of Canon Law — which references formation in multiple instances — states: “lay persons who devote themselves permanently or temporarily to some special service of the Church are

Formation has to be “continuing,” which implies that growth in the Christian life, or for any state in life, is a matter of ongoing development.

obliged to acquire the appropriate formation required to fulfill their function properly and to carry it out conscientiously, zealously, and diligently.”4 Formation has to be “continuing,” which implies that growth in the Christian life, or for any state in life, is a matter of ongoing development.

Formation has even been called out in CHA’s recent national 2022 Mission Leader Survey as the foremost core competency that mission leaders most seek to improve. Ministry formation is also on the majority of system-level strategic priorities, yet operationalizing this is stymied by the scarcity of qualified mission and formation leaders to do the work.

FORMATION FOR FORMATION LEADERS

CHA has recognized the growing need for innovative approaches in ministry formation for some time. To creatively lead formation into the future and establish a community of practice, this fall, CHA will launch its 24-month Formation for Formation Leaders program. This comprehensive training, which will run through the fall of 2025, will provide participants with an opportunity to learn and engage in rigorous academic and experiential practices in an immersive, supportive and community-learning environment. The program will use a hybrid methodology and includes four in-person and nine virtual sessions.5

Formation for Formation Leaders provides professional development through:

Theological Grounding

Understanding Christian anthropology as foundational to Catholic health care.

Illuminating theological connections to vocation, tradition, Catholic social teaching, ethics, spirituality and discernment.

Accessing theology as a resource for the formation process.

Psycho-Spiritual Development

Cultivating spiritual practices for strengthening contemplative presence.

Using the Enneagram [a classification system that helps differentiate personality/ego from one’s essence/self] for deepening self-awareness.

Developing strategies for ongoing personal formation.

Design, Facilitation and Presentation

Enhancing design and facilitation skills. Utilizing media and virtual modalities of formation.

Managing self, group, time and content.

FORMATION’S EVOLVING FUTURE

Formation as a modern discipline in Catholic health care is in its relative infancy, which brings up two issues: fragility and potentiality. At CHA, we tend to lean into potentiality and see the possibility of formation becoming a discipline in its own right. But that takes more than a vision — it takes time and multiple talents. For this to happen, we also need to move out of silos and into a united community of practice, where difference and diversity are respected and encouraged, and sharing of resources and generation of ideas and strategies are a given.

There have been discussions about a new charism emerging in Catholic health care, which can directly serve the ministry of the Church. Formation is at the heart of this possibility and has to be invested in and given the attention it requires. Bringing together a cohort of present and future formation leaders is where the gifts and talents and potentiality get infused with grace, and all manner and means of things become possible.

But most importantly, as we all know, this is an extraordinary ministry — and it is spilling over with gifts and sacred meaning that is begging for greater distribution, in addition to meeting a desperate need in the human condition and in our communities. This is what it means to continue the healing ministry of Jesus, and to honor those that went before us, who so selflessly initiated us into this vocational work.

DIARMUID ROONEY, MSPsych, MTS, DSocAdmin, is senior director, ministry formation, at the Catholic Health Association, St. Louis.

Bringing together a cohort of present and future formation leaders is where the gifts and talents and potentiality get infused with grace, and all manner and means of things become possible.

NOTES

1. Brian Yanofchick, “Leadership Formation: Choosing Between the Compass and the Checklist,” Health Progress 89, no. 1 (January/February 2008): 8-9, https://www. chausa.org/publications/health-progress/ archives/issues/january-february-2008/ mission-and-leadership---leadershipformation-choosing-between-thecompass-and-the-checklist.

2. William J. Fox, “Nurturing the Ministry’s Soul,” Health Progress 85, no. 5 (September/October 2004): 38-43, https://www. chausa.org/publications/health-progress/ archives/issues/september-october-2004/ nurturing-the-ministry’s-soul.

This presentation was first delivered in October 2002 at a talk to the sponsors and senior executives of California Catholic health care systems and hospitals and the state’s Catholic bishops meeting in Palo Alto, California. It is worth noting that the

Ministry Leadership Center (known today as MLC) was created out of this meeting, which would go on to produce a three-year formation program that more than 1,000 executives completed over a 10-year period.

3. “Guide for Sponsors in Catholic Health Care,” Catholic Health Association, 2021, https://www.chausa.org/docs/defaultsource/sponsorship/cha-sponsorship-guide. pdf?sfvrsn=fac9cff2_5.

4. Code of Canon Law, c. 231, 1, in The Code of Canon Law: Latin-English Edition (Washington, DC: Canon Law Society of America, 1983).

5. “Formation for Formation Leaders,” Catholic Health Association, 2022, https://www.chausa.org/docs/defaultsource/formation-resources/ final-formation-for-formationleaders-brochure-2022-24. pdf?sfvrsn=34adc6f2_6.

Upcoming Events from The Catholic Health Association

Global Health Networking Zoom Call

May 3 | 1 – 2:30 p.m. ET

Mission in Long-Term Care Networking Zoom Call (Members Only)

June 7 | 1 – 2 p.m. ET

Assembly 2023 (Virtual)

June 12 – 13

Diversity & Disparities Networking Zoom Call

For further details on CHA’s Formation for Formation Leaders program, including how to apply and participation requirements, email Formation@chausa.org.

June 29 | 1 – 2 p.m. ET

Faith Community Nurse Networking Zoom Call

July 25 | 1 – 2 p.m. ET

Mission in Long-Term Care Networking Zoom Call (Members Only)

Sept. 6 | 1 – 2 p.m. ET

chausa.org/calendar

HOW CATHOLIC HEALTH CARE CAN LIGHT THE WAY TOWARD WELL-BEING

At the start of this year, CHA introduced ReNew Year, an approach to well-being aimed at reinspiring meaning and reestablishing healthy rhythms for those serving the health care ministry.

ReNew Year developed after CHA members took part in a survey about well-being last fall and some common themes emerged. Survey participants reported varying definitions of well-being, ranging from “body/ mind/spirit integration” and “work/life balance” to a definition within the work context only. Results indicated the desire for a common definition across Catholic health care, and one that would recog nize communality as es sential. Holistic and eq uitable care for all was another clear finding.

To this end, CHA’s Well-Being Task Force, comprised of leading experts from member systems who have been convening since early in the pandemic, concluded we must return health care team members to the joy of vocation and purpose, reinvigorating God’s healing ministry of Jesus through our shared mission, vision and values. The task force recommended CHA support well-being efforts as indicated by survey findings: propose a vision of well-being as a Catholic health ministry, host webinars that highlight best practices and enhance well-being spiritual care resources.1

In our distinctive identity as a Catholic health ministry, we have an opportunity to firmly commit to well-being as central to who we are, not just as a means to reduce burnout among team members, as important as that is in itself.

Representing approximately 700,000 associates, CHA is uniquely positioned to shine a light on the fundamental importance of “attending to the whole person” to promote or sustain wellbeing for all.

The Christian anthropology — what we profess about love and the human person in relationship to God — informs our shared identity and shapes our core commitments related to wellbeing. How might we draw from this anthropology as we continue to develop our approach and models for well-being? As one survey respondent urged: “How do we create an organization that people want to work for and would not leave for anything, and that patients seek out over others? What does that look like? ... How do we create a culture of excellence … that in and of itself draws the best of the best in staff and causes patients to seek us out? How do we draw God’s love and compassion in to guide us daily in the creation of such an organization?”

CHA’s ReNew Year approach was designed with these key points in mind. Our call was to redesign well-being resources for leaders — simply and immediately. The revised framework offers leaders a daily rhythmic approach to reinspire purpose and meaning with their teams and to connect with God, themselves and one another.

A MODEL FOR SELF-CARE

As CHA’s well-being offerings were developed, we closely examined other well-regarded pro-

JILL FISK

grams that promoted whole-person health. One excellent approach is found in the U.S. Department of Veteran Affairs Circle of Health model.2 At the center of the model is the individual, and one’s practice of mindful awareness supports key areas of self-care: moving the body; surroundings; personal development; food and drink; recharge; family, friends and coworkers; spirit and soul; and power of the mind.

ReNew Year took some inspiration from the self-care aspects of the Veteran Affairs’ model but places them within a weekly rhythm for employees. Each day is aligned around a theme with focus questions and an assortment of corresponding prayers, reflections, audio or video meditations, articles or homilies for leaders and their teams to reinspire and engage in purposeful work. The week consists of Mission Monday, Time to Think Tuesday, Wonder Wednesday, Thankful Thursday, Refocus Friday and Worthy Weekend for Saturday and Sunday.

A MINISTRY ROOTED IN LOVE

One of CHA’s recent Health Calls podcasts unveiled ReNew Year’s approach to well-being. Deeper than mindful awareness, the podcast highlighted how well-being is a realization of God’s love that informs our call to serve.3 As a ministry of compassionate care rooted in love, we receive love in order to extend it. This is the differentiator from other models of well-being. It informs our beliefs, thoughts and actions. Love is what compelled our founders to be the hands and feet of God in a ministry of healing. And, prayer is what keeps us centered in love — to God and to one another — and it returns us to our relationship with love itself. Any response to organizational well-being in Catholic health care must begin in this way.

Second, a model of well-being in Catholic health care must wholly return people to one another. To be whole and healthy, we must be in community with each other. And in this, one’s own well-being manifests in direct proportion to another’s. Is it truly possible to be “well” if an-

other’s well-being is not being fulfilled? We were created to love, live and move through our relationships with others. We are called by love and formed by it through being loved, both by God and by others. Well-being, then, is far more than self-care: it is an essential component of the human experience. The ministry has continued in this way from the very beginning.

A CONTINUING ROAD TO WELL-BEING

To thrive in the future and in the current health care environment — where workers are in high demand, have a variety of employer options and have the flexibility to choose — how might we improve current models of well-being that promote whole-person care and human flourishing? How might Catholic health care raise a collective voice as a national health care leader to define wellbeing distinctly through the lens of our Catholic identity? How might returning to the most basic human elements of connection and relationship improve employees’ joy and meaning in their work, and, ultimately, restore patients’ wellbeing?4 If we choose the right path, the ministry and our teams can only continue to shine.

JILL FISK, MATM, is director, mission services, for the Catholic Health Association, St. Louis.

NOTES

1. “ReNew Year,” Catholic Health Association, https://www.chausa.org/well-being/renew-year.

2. “Circle of Health Overview,” U.S. Department of Veterans Affairs, https://www.va.gov/WHOLEHEALTH/ circle-of-health/index.asp.

3. Diarmuid Rooney and Jill Fisk, “A Fresh Approach to Well-Being in Health Care,” Health Calls, Catholic Health Association, January 24, 2023, https://catholic-health-usa-podcast.simplecast.com/ episodes/a-fresh-approach-to-well-being-in-health-care.

4. Brian P. Smith, “Mission: Back to the Basics,” Health Progress 103, no. 2 (Spring 2022): 62-64, https://www.chausa.org/publications/ health-progress/archives/issues/spring-2022/ mission-back-to-the-basics.

‘CARING FOR CAREGIVERS’ MODEL ADDRESSES NEEDS OF THOSE LOOKING AFTER OTHERS

ELLEN L. CARBONELL, MSW, LCSW

Imagine being offered a job that will require you to be on call 24/7 every day of the year, with no time off for holidays or illness. You will probably need to cut back on hours at your current job or leave it to take on this new role, which means financial worries, including reduced retirement assets in your future. The new job has no salary attached. In fact, you will be responsible for paying for some aspects yourself. The work is stressful, your physical and mental health may suffer, and you may even be more prone than others to developing serious chronic health conditions as a result. The job can be fulfilling in many ways, but you naturally have reservations. However, because there may be no one else to take this role on, you feel you have no choice but to accept it.

Welcome to the world of the family caregiver.

Because the United States lacks a comprehensive plan for long-term care for older adults, family caregivers continue to be the assumptive long-term care providers for the nation’s aging population. Although many family caregivers find meaning in this role and take it on willingly, they often experience related physical, emotional and/or financial costs. However, thanks to a new initiative started by Rush University Medical Center in Chicago, resources are now becoming available to patients and their caregivers to help improve their well-being.

LANDSCAPE OF THE FAMILY CAREGIVER

Family caregivers in the U.S. are providing approximately 24 hours of complex care per week, with 58% engaging in medical and nursing tasks.1 Seven out of 10 of these caregivers also experience the practical and emotional burden of managing pain for the person they are looking after.2 This care is provided to the best of the caregivers’ abilities, but few have received ongoing training and support from medical professionals. Less than a

third (29%) of family caregivers say that a member of the care recipient’s health care team has asked them about the support they need to provide care, and only 13% say a health care provider asked what they needed to care for themselves.3 This clearly demonstrates the need for more to be

done to provide assistance to meet those needs.

Clinically significant signs of depressive disorders are present in 40%-70% of family caregivers of older adults, with a quarter to a half of them meeting the criteria for major depression.4 Caregivers are frequently strapped for time and energy, so neglect their own care needs, and 40% report experiencing two or more chronic diseases.5 These issues are affecting millions of caregivers throughout the U.S., resulting in serious consequences for them as well as the older adults for whom they provide care.

Clinically significant signs of depressive disorders are present in 40%-70% of family caregivers of older adults, with about a quarter to a half of them meeting the criteria for major depression.

Despite these dramatic findings and the crucial role of caregivers in providing long-term care, health care providers have typically not attended to these needs. Health systems are uniquely positioned to address their needs, given the care recipient’s reliance on caregivers for help with making and keeping appointments. Because of this accessibility and thanks to funding from RRF Foundation for Aging, Rush University Medical Center embarked on an effort in 2019 designed to have a two-pronged effect: to change the ways the health system identifies and addresses the needs of family caregivers of older adults, and to provide education and support them to improve their and their care recipients’ well-being.

ADDRESSING CAREGIVER NEEDS WITHIN HEALTH SYSTEMS

Intervention begins with identification. The CARE Act, enacted in 44 states and territories, stipulates that caregivers of older adults need to be identified and entered into the medical record upon admission to the hospital. 6 Rush University Medical Center has expanded this expectation and has established it as a best practice in both its inpatient and outpatient settings. Although most medical record systems do not make it easy to enter this information, Rush has created a work-around to allow this change, explicitly listing the relationship and care provision role with the recipient, and for it to appear on the storyboard in the older adult’s medical record so it can be easily viewed by anyone opening their chart. In addition, multiple caregivers who handle different tasks can be noted, with those tasks delineated in the record. The entry may be made or edited by anyone with appropriate access to the record.

Rush also actively encourages providers to view the caregiver and the care recipient as a dyad to be included in discussions about care planning and provision. Caregivers have historically not been included in these discussions, which has led to misunderstandings about what will be done and how. Age-Friendly Health Systems support the use of four evidence-based elements of care for all older adults, known as the “4Ms” (What Matters, Medication, Mentation and Mobility) including a focus on what matters to both the older adult and the caregiver as key components. Rush’s approach adds what matters to the caregiver as a key component of addressing the needs of the dyad.

LISTENING AND PLANNING TO PROVIDE SUPPORT

The “Caring for Caregivers” model begins with a referral to the program by anyone inside or outside of the health system, and caregivers may also self-refer to take part. An appointment is set up for the caregiver to meet with a social worker or other mental health professional to get acquainted and to assess caregiver needs with a set of evidencebased tools. By the end of this meeting, a customized intervention plan is established together.

If the caregiver is experiencing physical difficulties or a lack of confidence related to care tasks, skill-building meetings with physical therapists, occupational therapists, nurses, dieticians, pharmacists or social workers are available to assess concerns and address identified needs. Planning meetings may also be initiated to include the caregiver and the care recipient in working with the health care team on current and future care plans.

In addition, up to five sessions may be held with family-therapy trained mental health professionals — referred to as “Planning for What Matters” sessions — to assist the care recipient and/ or the caregiver alone with expanding the care team, communicating effectively with each other and the health care team, exploring what is valued most by both parties and mapping out ways to support each other currently and in the future. Care plans for what is needed now and for what will be anticipated with disease progression are included, and extended family and friends who can support the dyad may be brought in to discuss their participation in the plan as well.

OUTCOMES

Program engagement begins with the mental health professional and the caregiver completing a set of evidence-based tools, including the shortened version of the Burden Scale for Family Caregivers7; the Patient Health Questionnaire-9 to assess depression8; and the General Anxiety Disorder-7 to assess anxiety.9 Once the caregiver has completed the recommended interventions, follow-up assessments occur at one, three and six months post-intervention. Initial results using paired sample t-tests [a statistical test that is used to compare the means of two groups] indicate statistically significant reductions in all three measures at one and three months, and significant reductions in self-reporting of burden at six months. (See Figure 1 on page 62.)

Additionally, outcomes have been explored to see if caregivers’ participation in the program is

associated with changes for care recipients in the number of hospital admissions, length of hospital stays and emergency department visits when comparing these six months prior to and six months after caregiver participation using paired sample t-tests. When looking only at changes in Rush care recipients’ hospital use, preliminary results indicate statistically significant reductions in all three measures with more clinically significant changes seen when the pool is limited to care recipients who had any inpatient or emergency department visits (see Figure 2 on page 63). These types of findings are of particular interest to health system administrators due to associated financial penalties for instances of high rates.

EXPANDING THE CARING FOR CAREGIVERS MODEL

Beginning in 2020, thanks to a grant from The John A. Hartford Foundation, Rush University Medical Center began working with the Institute for Healthcare Improvement to prepare expansion of the Caring for Caregivers model throughout the country as part of the Age-Friendly Health System movement, an initiative started by the foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and CHA. Six pilot sites began testing the model within their health systems to determine the facilitators and barriers to implementation, and the data collected is being explored to make needed updates to the model and related materials.

A three-year continuation grant from The John A. Hartford Foundation — which began in October 2022 — is allowing this work to move forward. The importance of including caregivers in age-friendly care is being promoted by the Institute for Healthcare Improvement through their marketing and communication efforts, and ways to include caregivers in the care provision of older adults is being discussed in their Action Communities, which include individuals from participating Age-Friendly Health Systems and offer information and facilitate discussion among members.

Rush University Medical Center will offer opportunities for health systems to establish Caring for Caregiver model programs at their sites and will assist with tailoring the model’s interventions to the needs of interested systems and their patient/caregiver populations. Presentations at conferences, workshops and trainings, learning communities offering information and peer support, and meetings with individual health systems will be held to help health care systems learn about the

Measured results indicate a reduction in caregiver burden, depression and anxiety among those initially assessed who took part in the Caring for Caregivers program.

Figure 1: Caregiver Outcomes

model, assess for readiness to integrate the model into existing programs and services, garner active support from leadership, promote the program and gather and assess outcomes to adjust the intervention as needed.

The Caring for Caregivers model is being offered to sites free of charge nationwide, and recruitment for the program has begun. For more information and implementation at your site, please contact Diane Mariani, Program Manager, at Diane_Mariani@ rush.edu.

ELLEN L. CARBONELL is an assistant professor for the Department of Social Work in the College of Health Sciences at Rush University in Chicago. She is also a social work consultant for caregiver programs in the Department of Social Work and Community Health at Rush University Medical Center.

NOTES

1. “2020 Report: Caregiving in the U.S.,” AARP and National Alliance for Caregiving, May 2020, https://www.aarp.org/content/dam/aarp/ppi/2020/05/ full-report-caregiving-in-the-united-states.doi.10.264192Fppi.00103.001.pdf.

2. Susan C. Reinhard et al., “Home Alone Revisited: Family Caregivers Providing Complex Care,” Home Alone Alliance, April 2019, https://www.aarp.org/content/ dam/aarp/ppi/2019/04/home-alone-revisited-familycaregivers-providing-complex-care.pdf.

3. “Caregiving in the U.S.,” AARP and National Alliance for Caregiving.

4. “Caregiver Statistics: Health, Technology, and Caregiving Resources,” Family Caregiver Alliance, https:// www.caregiver.org/resource/caregiver-statisticshealth-technology-and-caregiving-resources/.

5. “Caregiving for Family and Friends — A Public Health Issue,” Centers for Disease Control and Prevention, 2018, https://www.cdc.gov/aging/agingdata/docs/ caregiver-brief-508.pdf.

6. “Supporting Family Caregivers Providing Complex Care,” AARP, https://www.aarp.org/ppi/initiatives/ supporting-family-caregivers-providing-complex-care/.

7. Elmar Graessel et al., “Subjective Caregiver Burden: Validity of the 10-Item Short Version of the Burden Scale for Family Caregivers BSFC-s,” BMC Geriatrics 14, no. 23 (February 2014): 1471-2318, https:// doi.org/10.1186/1471-2318-14-23.

8. Kurt Kroenke and Robert Spitzer, “The PHQ-9: A New Depression Diagnostic and Severity Measure,”

2: Care Recipient Outcomes

Psychiatric Annals 32, no. 9 (September 2002): 509-515, https://doi.org/10.3928/0048-5713-20020901-06.

9. Robert Spitzer et al., “A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7,” Archives of Internal Medicine 166, no. 10 (May 2006): 1092-1097, https://doi.org/10.1001/archinte.166.10.1092.

WHAT CAN WE LEARN FROM CASUISTRY?

Recently, I came across an article in Commonweal by Cathleen Kaveny called “A Defense of Casuistry.” The article outlines the ways in which casuistry, as an ethical approach, can be used well or poorly.

Kaveny highlights the ways that casuistry can be a proper and more robust moral discernment tool. She argues that “casuistry is the practice of discernment about what to do in particular situations. It is not the practice of an armchair intellectual. Doing it correctly requires both prudential judgement, love of others, and a fair amount of self-knowledge.”1

Casuistry brings together all aspects of the moral act: the object, the circumstances and the intentions. It recognizes St. Thomas Aquinas’ insight that “people … find themselves in situations where there is no perfectly acceptable path forward for them.” Therefore, we must navigate multiple “goodish” ends, and try to find the most “acceptable” path.

In health care, we, too, must choose between the poor form of casuistry and the more robust version when making ethical decisions. We can look at the Ethical and Religious Directives as an example. The casuistry which Kaveny opposes would use the ERDs as a rule book, categorizing actions as a sin or not. It would not care that a given situation may not provide a perfect end, clean of all vice or evil. We can fall into this trap of considering “human acts in very abstract and schematic forms,” especially when using moral tools like double effect or the principle of cooperation.

Such a focus on these devices tricks us into thinking that if only we follow the rule of the law, we will we achieve the spirit as well. However, without incorporating spirit and meaning when arriving to a decision during difficult situations, we leave out our trust in God to respond creatively with compassion and understanding. As Pope

Francis notes, God’s grace works in our lives by giving us “the courage to do good, to care for one another in love and to be of service to the community” in which we live and work.2

REDEEMING CASUISTRY

Casuistry comes to our tradition by way of the moral manuals starting in the 13th century. These books were provided to priests as a taxonomy of sins to serve as a guide for administering the proper penance during confessions. They literally categorized actions under different degrees of sins and gave recommended penitential acts. As Kaveny writes, “They were focused on what not to do on pain of mortal or venial sin, not what to do in order to grow virtue.”3 This tradition of examining particular acts and diagnosing their level of sin continues in the poor form of moral casuistry today.

Kaveny provides four ways in which casuistry can be redeemed. I believe that her recommendations can also be used to counter the often judgmental use of the ERDs in the health ministry. First, we must remind ourselves that there is an actor behind the act — people who have goals, fears, relations, limitations and even bad luck. When discerning a course of action, we must consider the fullness of the people involved unless we fall back into a casuistry abstractly focused on acts.

Second, Kaveny quotes Francis as saying “time is greater than space.” The understanding here is that we should situate the action of the person into their life. We are all on a journey. Hopefully, that path will lead us to reunion with God, but some will be further along than others. Like the first recommendation, we need to bring into account more than the individual decision of the person but rather see that act as a series of acts.

NATHANIEL BLANTON HIBNER

By doing so, we rid ourselves of the temptation to define a person by one decision. We instead desire to accompany and guide them through a part of their life that, as a patient in our facilities, can sometimes include fear and distress.

Third, Kaveny wants to remind us of the famous quote by Aquinas, which states that “although there is necessity in the general principles, the more we descend to matters of detail, the more frequently we encounter defects.” What Aquinas and Kaveny are hinting at here is the messiness of real-world discernment. The case studies, articles, books and webinars which provide us the opportunity to try and navigate complex decisions can only go so far. It is not until we are in the room, beside a patient, among the family and caregivers, that we finally see the difficulty of an abstract and cold moral framework. It is in this moment that our prudential wisdom comes forth to hopefully guide us toward an acceptable end, even if it cannot be the perfect one.

Finally, Kaveny reminds us all that the Church’s moral tradition comes to us through Jesus Christ. She wishes to repeat the message of Francis that God “does not abandon us, even when we try to abandon him.” God instead accompanies us through all of our decisions, “patiently, gently, trying to turn us around without breaking us.” Our approach to ethics must do the same. We, too, should not abandon those who are in arduous situations or who make decisions difficult to fit within a rigid ethical framework. Instead, we can be a loving support, be present to the chal-

lenges of our patients, and guide them through to the end.

FAITH ROOTED IN JESUS’ MINISTRY

The Ethical and Religious Directives are an excellent resource for the ministry to stay true to the moral vision of true healing. However, like casuistry, people can use the tool as a list of laws, devoid of any spirit or meaning. Let us take the lessons given by Kaveny and Francis to reimagine the way moral discernment is provided in the ministry. Let us remember that in all of this intellectual thinking, we are here to care for people as Jesus cares for us all.

NATHANIEL BLANTON HIBNER, PhD, is senior director, ethics, for the Catholic Health Association, St. Louis.

NOTES

1. Cathleen Kaveny, “A Defense of Casuistry: Casuistry Doesn’t Have to Be Rigid,” Commonweal, January 24, 2023, https://www.commonwealmagazine.org/ casuistry-pope-francis-morality-theology-thomismkaveny.

2. Pope Francis, “XIV Ordinary General Assembly: The Vocation and Mission of the Family in the Church and Contemporary World,” The Holy See, 2014, https://www.vatican.va/roman_curia/synod/ documents/rc_synod_doc_20141209_lineamenta-xivassembly_en.html.

3. Kaveny, “A Defense of Casuistry.”

THINKING GLOBALLY SPIRIT OF WOMEN RELIGIOUS PROVIDES GUIDING COMPASS

The women religious founders of our ministries were faith-filled, bold and courageous in their endeavors. Their stories and charisms are the very foundation of who we are as a Catholic health ministry and integral to our current decision-making. In the foreword of A Call to Care: The Women Who Built Catholic Healthcare in America, Margaret Susan Thompson, a professor of history at Syracuse University, describes the tenacity of the Ursuline sisters, who founded an early Catholic hospital in the United States:

“They adjusted to unforeseen changes in plans and made themselves useful in whatever ways that they could. In their desire to make themselves useful, they made themselves indispensable. When, within a few years of their arrival, an interfering cleric threatened the Ursulines’ autonomy, Mother [Marie] Tranchepain declared that she would relocate her congregation to the West Indies unless the sisters were allowed to follow their rule without interference. The protests of both seculars and other clerics were unanimous on the women’s behalf; no one could imagine New Orleans without the sisters’ ministry.” 1

Today, Catholic health care is the largest group of nonprofit health providers in the nation, caring for one in seven patients.2 It is difficult to imagine where we would be without the women religious who built Catholic health care in the United States. As we face current challenges, what can we learn from the stories of our founding orders of women religious? How are we amplifying their charisms and stories as we set strategic priorities and make critical decisions, and how are we ensuring the ongoing influence of our work beyond just our communities?

As a ministry of the Church, we must consider the impact that our domestic decisions make on our global communities, and to carefully consider our engagement with low- and middle-income countries through the lens of Catholic social teaching.

STRATEGIES FOR FUTURE GLOBAL HEALTH PARTNERSHIPS

Without strategic plans in hand or the formal processes of today, the founders of the Catholic health ministry adjusted to the signs of the times and pivoted to respond to emerging needs while remain-

ing steadfast in continuing the healing ministry of Jesus with particular attention to those who were poor and vulnerable.

As leaders carrying forth the healing ministry of Jesus and the work of the sisters, the core commitments from the Shared Statement of Identity for the Catholic Health Ministry offer a guiding compass for our path. These commitments call on us to promote and defend human dignity; attend to the whole person; care for poor and vulnerable persons; promote the common good; act on behalf of justice; steward resources; and serve as a ministry of the Church.

Do we understand the commitments in their fullness as a ministry of the global Church, or do we see them pertaining only to what is in front of us? How do they inform our actions and decisions?

In times of difficulty, it is easy to look inward and focus on the problems at our doorstep. The COVID-19 pandemic was a stark reminder that we really are all in this together and that global health is domestic health. As we address issues related to health equity, workforce and climate change at home, and engage globally in disaster response or mission-trip planning, it is essential to consider that each of our actions has the potential to advance or diminish human dignity and the common good.

BRUCE COMPTON

Part of the Catholic social tradition that we can turn to in our discernment and decision-making is the “see-judge-act” method of analysis. As our founding congregations have long done, this relates to seeing social problems and opportunities; judging what is happening in light of Catholic social teaching; acting to advance human dignity and the common good; and promoting justice and improving outcomes for those served.

As noted in the last issue of Health Progress, CHA worked with Accenture Development Partnerships, a social impact business, to further reveal the close alignment between global and domestic health challenges and trends since the start of the pandemic.3

To advance opportunities associated with the Accenture report, CHA’s Global Health Advisory Council has established goals with a particular focus on health equity for all and future conditions affecting global health matters, including workforce, decolonization of global health and climate change.

The council is committed to identifying and sharing best practices and strategies for future global health partnerships through strategic collaborations, CHA member work groups and communities of practice. (A community of practice is a group that shares common concerns and interests and collaborates to fulfill individual or group goals.) The pandemic, the war in Ukraine, the devastating February earthquakes in Syria and Turkey and other crises have magnified many needs and opportunities to consider when evaluating how we should respond in ways that advance social justice, human dignity and the common good. To assist with future collaborations with global health partners, CHA provides recommendations and resources related to new best practices around global mission work and disaster response.

Planning Mission Trips

With the return to prepandemic normalcy, some in the ministry may again be planning mission trips to low- and middle-income countries. CHA has developed several video case studies on global health and medical surplus recovery topics. The video series is designed to prompt meaningful conversation and illuminate some feedback from CHA’s research on surplus recovery and shortterm medical mission trips. They shed an ethical light on practices and some of the mentality behind the desire to serve and do good for others.

(The video case studies can be found under the “Resources” tab at chausa.org/globalhealth.)

Responding in Times of Disaster

As disasters arise, CHA invites members to consider the best-practice-based recommendation of sending cash instead of supplies and working directly with a trusted partner organization serving in the impacted area. While well-intentioned, unsolicited in-kind donations from health systems’ surplus equipment and supplies often slow supply chains, costing money to store and taking valuable time from aid workers to process.4 Cash donations can be used for precisely what is needed, preventing waste and helping to provide a much-needed stimulus to local economies during times of crisis.

RENEWING OUR GLOBAL RELATIONSHIPS

As the ministry continues to respond to the changing landscape of the global health sector, it is imperative that as we shape our priorities and strategies in our communities, we integrate new models of global health care, acknowledging that the issues we face domestically are deeply interconnected to those experienced globally. As reflected in the Shared Statement of Identity for the Catholic Health Ministry, we are continually aiming to transform “hurt into hope,” for “all persons and communities.”

BRUCE COMPTON is senior director, global health, for the Catholic Health Association, St. Louis. If you wish to join CHA’s related networking calls or a workgroup related to emerging trends in global health, please contact him at bcompton@chausa.org.

NOTES

1. Suzy Farren, A Call to Care: The Women Who Built Catholic Healthcare in America (St. Louis: Catholic Health Association, 1996).

2. “U.S. Catholic Health Care,” Catholic Health Association, 2022, https://www.chausa.org/docs/defaultsource/default-document-library/the-strategic-profile. pdf.

3. “View from 2022: A Look at the Changing Global Health Landscape and Future of Partnerships,” Catholic Health Association, June 2022, https://www.chausa. org/docs/default-source/international-outreach/chaacn-global-health-partnership-trends.pdf.

4. Rachelle Barina and Erica Smith, “Relief Efforts for Ukraine: What to Weigh When Asked for Donations,” Health Progress 103, no. 3 (Summer 2022): 56-58.

A Prayer for Renewal

KARLA KEPPEL, MA, MA MISSION PROJECT COORDINATOR, THE CATHOLIC HEALTH ASSOCIATION, ST. LOUIS

INTRODUCTION

As a Catholic health ministry, we are called to be leaders in well-being — to embody it as individuals, to promote it among our colleagues and patients, and to advocate for it in our communities. CHA’s ongoing ReNew Year campaign offers an invitation to abundant living, which we hope can be integrated across services, departments and facilities. Indeed, we consider it an invaluable strategy for holistic care and vocational living, especially as we continue to face burnout and staffing issues.

As you prepare to pray, consider: What does an invitation to holistic and rhythmic living mean for you in your current lived experience? How can you continue to deepen your practice, despite what can feel like the “tyranny of the urgent?”1

Let us pray.

READING

A reading from the Book of Ecclesiastes. (Ecc. 1:3-10)

“What profit have we from all the toil which we toil at under the sun? One generation departs and another generation comes, but the world forever stays.

“The sun rises and the sun sets; then it presses on to the place where it rises. Shifting south, then north, back and forth shifts the wind, constantly shifting its course. All rivers flow to the sea, yet never does the sea become full. To the place where they flow, the rivers continue to flow. All things are wearisome, too wearisome

for words. The eye is not satisfied by seeing nor has the ear enough of hearing.

What has been, that will be; what has been done, that will be done. Nothing is new under the sun! Even the thing of which we say, ‘See, this is new!’ has already existed in the ages that preceded us.”

The Word of the Lord.

REFLECTION

At its core, ReNew Year is an invitation to and reclamation of rhythmic living. It is a call to simplify and deepen our connection to God, one another, the world and our work. By dedicating time and space each week to mission, thoughtfulness, wonder, gratitude, focus and to being intentional about how we spend our weekends, we claim for ourselves what is important to us. Committing to it week after week, we develop a practice of mindful awareness wherein, hopefully, what we claim as important continues to deepen within us — it becomes engrained in our core. Our Scripture reading is a valuable reminder that, even

as it feels like things are constantly changing, “nothing is new under the sun.” While perhaps this invitation to intentional living is nothing new, renewal emerges out of the depths of continued reflection.

As you approach this call for renewal, take a breath. Pause. Consider what might need to be shed to make room for a deeper connection to God, one another, the world and our work.

Now, consider for yourself what wisdom these ancient words might offer you in your ministry and vocation. How are you called to be renewed in this season?

CLOSING PRAYER

God of yesterday, today and tomorrow:

Grant that our repetition might bring resurrection and a renewed faith of Your work in the world.

May we experience the refreshment that only Your love can bring, that it might bring a deeper connection with You and one another.

In Your Holy Name we pray. Amen.

NOTE

1. Diarmuid Rooney, “Formation — A Spiritual Antidote to the Tyranny of the Urgent,” Health Progress 99, no. 3 (May/June 2018): 92-95.

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