Catholic Health World - February 1, 2022

Executive changes 7 Retired RNs pitch in 8 PERIODICAL RATE PUBLICATION

FEBRUARY 1, 2022

VOLUME 38, NUMBER 2

COVID omicron variant slams Catholic health care ministries in waves

By LISA EISENHAUER

In Baton Rouge, Louisiana, Our Lady of the Lake Regional Medical Center was experiencing a record surge of COVID-19 cases as the omicron variant of the coronavirus took hold in mid-January.

Dr. Catherine O’Neal, an infectious disease specialist and the hospital’s chief medical officer, said the hospital was admitting 30-40 patients a day for COVID care. “We’ve O’Neal never admitted that many COVID-positive patients before,” O’Neal said.

Even with that pace, the hospital wasn’t keeping up with demand. The medical center, one of the largest hospital in the state and in the Franciscan Missionaries of Our Lady Health System, was not accepting transfers of COVID patients in need of specialty care, as it normally would as a regional hub. It was running at capacity

Nurse Abby Raye, left, and respiratory therapist Melissa Shaha don protective gear as they prepare to enter the rooms of patients with COVID-19 in the intensive care unit at HSHS St. Mary’s Hospital Medical Center in Green Bay, Wisconsin. The Hospital Sisters Health System has seen record numbers of inpatients with the virus during the omicron surge.

caring for those who presented at its own emergency rooms and clinics.

In the Pacific Northwest, the PeaceHealth system was bracing for what was to come. Dr. Doug Koekkoek, chief physician Koekkoek executive for the Vancouver, Washington-based system, said projections showed the region was two or three weeks away from a peak in the latest surge.

“The models suggest that probably hospital volumes will be about 30% higher than we had with the delta peak,” Koekkoek said.

The system set records for COVID hospitalizations during that surge in late summer.

In Cleveland, the staff at St. Vincent Charity Medical Center was catching its breath. The hospital and others across the city saw a spike in COVID patients in December that appeared to peak around Christmas. The governor sent in National Guard troops to help.

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We Are Called: Assessing progress at the one-year mark

By BRIAN REARDON

Helen Graves, a resident of St. Ignatius Nursing & Rehab Center in Philadelphia, visits with her family virtually in a scene from “Our COVID Journey,” a documentary the facility made to share the challenges its workers have faced during the pandemic.

A child hams it up as men get haircuts at JP Hair Design in Madison, Wisconsin. The barbershop is the site of the Men's Health & Education Center, which opened in 2016 with funding from SSM Health. Black men in the community have shorter life spans and higher rates of diabetes and other chronic conditions. The center offers health screenings and health education materials to an underserved population in a trusted setting.

In February 2021, members of CHA came together to publicly commit to confront racism by achieving health equity.

Leaders of the Catholic health ministry pledged to be actively anti-racist, lead through accountability, develop authentic community engagement built on trust and demonstrate measurable impact of this work in the communities Catholic health care is called to serve.

The We Are Called pledge they signed recognizes that the Catholic health ministry — the largest sector of nonprofit health care in the U.S. — can and must do more to eradicate systemic racism and more forcefully address the profound effects racism has on the health and well-being of individuals and communities.

Philadelphia nursing home captures COVID’s impact Ministry providers continue push to expand palliative care access Lack of resources remains in documentary pressing problem

Continued on 3

By LISA EISENHAUER

By JULIE MINDA

Susan McCrary, president and chief executive of St. Ignatius Nursing & Rehab Center in Philadelphia, recounts the day in spring 2020 when she “kind of lost it,” breaking into tears as the body of a resident was being wheeled away. The resident was one of several on the same floor to die of COVID-19 within days of each other early in the pandemic.

Karin D. Purcell, St. Ignatius’ director of development, recalls her frenPurcell zied search for personal protective equipment for the staff and the cloak-and-dagger tactics involved in picking up a donation of masks so as not to call

Even though the availability of palliative care services has been increasing steadily in the U.S. over the past two decades, significant gaps remain. It can be especially difficult for people in rural areas and people who are not hospital patients to access such care. And there are some minority groups that use palliative care at a much lower rate than white people do.

Much remains to be done to meet the full promise of palliative care, program administrators in the ministry said.

As they work to offer palliative care services including pain and symptom management to more patients and in more venues, they do so knowing demand won’t

Continued on 8

Continued on 4

Dr. Donald McDonah visits a hospice patient at St. Joseph Hospital in Nashua, New Hampshire. The patient died several months later at home. McDonah is the physician member of the palliative care program at the hospital. He says the hospital is looking at how best to expand palliative care services to more people in need.

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CATHOLIC HEALTH WORLD February 1, 2022

Divisive political climate freezes out common good, speakers say Matthew Dowd is worried about democracy in America. A political strategist, he has worked for candidates from both parties including two Texans: former President George W. Bush and the late Sen. Lloyd Bentsen. Dowd maintains that the political system the nation has championed across the globe is at risk at home.

It has been undermined, he said, by gerrymandering, allowing limitless donations to political campaigns and other practices that have given rise to leaders more interested in maintaining their own power and that of a narrow constituency than in doing what’s best for the majority.

“If you don’t have an ability to get to the common good you no longer have an ability to have a democracy and I think that’s the point in time we are at here in America today,” said Dowd, one of four panelists who took part in an online discussion on Dec. 7 titled “Whatever happened to the common good? Divided by COVID-19, torn apart by politics, fractured by faith.”

The discussion was sponsored by the Initiative on Catholic Social Thought and Public Life at Georgetown University and moderated by John Carr, co-director of the initiative.

Carr paraphrased an address that Pope Francis had given days earlier in Athens in which the pontiff said the world is witnessing a retreat from and skepticism about democracy.

The pope, Carr said, went on to urge: “The remedy is good politics, for politics is and ought to be in practice a good thing: the art of the common good, so that the good can be truly shared and particular attention, I would even say a priority, should be given to the weaker parts of society.”

U.S. Rep. Marcy Kaptur, D-Ohio, the longest serving woman in the history of the House, shared her own concerns that American democracy is fraying as candidates from the political extremes find the means to seize and keep power.

“Both parties are making it almost impossible for a more moderate set of members to be elected,” Kaptur said.

She believes other parts of American society are growing fragmented and uncivil along with the political sector. She mentioned families breaking up, corporations turning their backs on workers and media focusing on violence and conflict.

Kaptur said that many Catholic churches in struggling neighborhoods have been shuttered and the supportive services they once provided discontinued.

“We have to think as Catholics how we connect back to the most needy, even if they’re not Catholics. It doesn’t matter.

They’re people,” she added.

Kaptur called on Georgetown and other Catholic universities to work with institutions affiliated with other faiths to develop messaging and outreach campaigns around unifying themes, such as ending violence and promoting better parenting.

Vincent Rougeau, a scholar on law and Catholic social teaching and the first lay president of College of the Holy Cross in Worcester, Massachusetts, stressed that the common good is a foundational social tenet for Catholics. These days, he said, it is clashing with beliefs by some Americans that their individual rights should not be compromised except in extreme cases.

In the Catholic tradition, Rougeau said, rights come with responsibilities. “Just because you have a right to do something doesn’t mean that it’s unfettered, or gives you license to push as far as you possibly can,” he said.

He believes that even many Catholics aren’t comfortable with Pope Francis’ appeals to keep in mind what’s best for all of humanity when making decisions. The pontiff, Rougeau said, is challenging American Catholics “to be self-critical about the society in which we live and whether or not it is truly reflective of the kinds of values our

faith embraces.”

Rougeau exhorted Catholics to “go to discomfort” by seeking out places to pray and work on common issues with people whose faith traditions and life experiences are different.

“Spend time in communities that you know little about,” he urged. “That can be a great political action plan.”

Tricia Bruce, a sociologist and author whose books include Parish and Place: Making Room for Diversity in the American Catholic Church, discussed her research that has shown Americans’ views on divi-

Dowd

Carr

Kaptur

sive issues such as abortion are much more nuanced than the political debates around them are.

Debating those issues without acknowledging their nuances and complexities,

Associated Press/Carlos Baltas

By LISA EISENHAUER

Pope Francis attends a meeting with members of the religious community at the Cathedral of Saint Dionysius in Athens in December. In an address on the same day, the pontiff warned that the “easy answers” of populism and authoritarianism are threats to democracy and called for renewed dedication to promoting the common good.

Rougeau

Bruce

she said, makes it more challenging for the nation to achieve collective goals and serve the common good.

Despite his deep concerns about the state of the American political system, Dowd isn’t giving up on it. He announced a run as a Democrat for lieutenant governor of Texas but bowed out the same day as the Georgetown discussion, citing the diverse field that had emerged. He released a statement that noted: “I do not want to be the one who stands in the way of the greater diversity we need in politics.”

Dowd’s advice to voters is to choose candidates with integrity and with reverence for the common good, regardless of political party.

He encouraged Catholics to follow the example of Mother Teresa by serving their communities in some way. “Find your own Kolkata,” he urged.

A recording of this discussion is available at catholicsocialthought.georgetown.edu. leisenhauer@chausa.org

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February 1, 2022 CATHOLIC HEALTH WORLD

We Are Called pledge

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Whitney Curtis/© Catholic Health World

Focus on the community Building just and right relationships with From page 1 the communities that Catholic health care serves requires not only listening, but also CHA members who’ve joined the We acting to address the specific needs of comAre Called initiative agree to take action to munities of color. In Milwaukee, Ascension achieve COVID-19 health equity; examine opened an obstetrics emergency departtheir own organizations, including how ment in response to the disproportionately they provide clinical care and recruit staffs high rates of maternal and infant morbidthat mirror the makeup of their communiity and mortality, particularly among Black ties; build and strengthen trust with comwomen. munities of color; and Through its Maternal Health Social Sysadvocate for policies that tems Initiative, Ascension also is addressing end health disparities and the many social barriers that at-risk women systemic racism. encounter in attempting to access prenatal “The We Are Called J. C. Dawkins, an outreach coordinator at the Men's Health & Education Center, talks with a man who and perinatal care. pledge is very much like a visited the facility that is housed inside JP Hair Design in Madison, Wisconsin. The barbershop caters to a In other underserved communities, pattern that guides us as largely African American customer base. The health and education center, funded by SSM Health, offers CHA members continue to make capiwe weave together a stron- easy access to health screenings and information. tal investments to extend access to care.

Sr. Mary ger and more just health Mercy invested $2.8 million to construct care tapestry,” said Sr. Mary Haddad, RSM, how they build their boards and leadership ers from CHRISTUS Health and Providence and equip a 5,500-square-foot clinic in CHA’s president and chief executive offi- teams.

St. Joseph Health Ferguson, Missouri. cer. “Whether it’s responding to the pan“Making sure that system, regional or shared some of the It’s part of a neighbordemic, finding ways to better address the hospital boards are inclusive and reflect strategies and tactics hood redevelopment social determinants of health, or working to the communities we serve is important to they’ve employed that clusters the Boys reduce our carbon footprint, health equity ensure that different voices, perspectives when selecting and and Girls Club, Urban is the thread that connects our collective and life experiences are heard when deci- recruiting board memLeague and Salvation work.” sions are made,” said Dennis Gonzales, co- bers to ensure greater Army. Together, the In the year since the pledge was leader of the We Are Called initiative. He is diversity. organizations are proannounced, CHA members have launched CHA’s senior director of mission innovation CommonSpirit viding health care, job new initiatives and shared best practices and integration. The pledge also requires Health and Moreplacement, children’s related to long-standing programs aimed health care providers to work directly with house School of Mediprogramming, and at advancing health equity and improving communities of color to strengthen trust cine have joined in a other services near the care outcomes for members of underserved and to listen and respond to what the com- 10-year partnership site where civil unrest minority populations. CHA’s webpage munities identify as their priorities. to promote diversity over the police killchausa.org/we-are-called, includes videos, During a CHA webinar in June, Odette among clinical staff ing in 2014 of teenager prayers and stories about how members Bolano, president and chief executive of around the country Michael Brown proare tackling the complex challenges before Saint Alphonsus Health System in Boise, and build an education pelled the Black Lives them.

Idaho, stressed the importance of diversity pipeline that creates a Matter movement. at the board level to propel change. “We bigger pool of minorIn Lafayette, LouiPutting our house in order feel comfortable having people that are ity doctors. A $100 mil- Fr. Tom Haley blesses the Mercy Clinic siana, where many A foundational element of the pledge like us around us and we have to get com- lion investment from Primary Care – Ferguson facility at the residents are Black and is for members to evaluate their own com- fortable with being uncomfortable about CommonSpirit will dedication ceremony in August. The clinic is lack adequate access to mitment to diversity, equity and inclusion having different voices at that table that allow Morehouse, a part of a neighborhood redevelopment in a care, Franciscan Miswithin their organizations. Signatories may make us think differently … that may historically Black insti- section of the suburban St. Louis community sionaries of Our Lady commit to achieving diversity and inclu- make us reconsider a strategy that we think tution, to ensure that that was scarred by protests in 2014.

Health System operates sivity including through how they recruit, is so great,” she said.

300 additional physianother of the many hire, retain and promote employees and During a CHA webinar last month, lead- cians from Black and other minority groups acute care clinics in the Catholic ministry complete medical residencies each year. As that treat patients without insurance. part of the effort, Morehouse will open five In Cleveland, the Sisters of Charity Founnew regional medical school campuses, dation has held listening sessions among expand its medical school enrollment and residents in a predominantly Black neighincrease the number of medical students borhood where it plans to develop a health recruited from rural and other underserved campus anchored by St. Vincent Charity communities.

Medical Center.

The partnership goes further in addressAnd Renton, Washington-based ing health inequity by supporting research Providence St. Joseph Health is investing into diseases that disproportionately $50 million over the next five years as part of impact minorities. an effort to leverage and refine population health strategies to reduce health dispariCOVID-19 ties and achieve health equity. The system Throughout the pandemic, CHA and will use de-identified patient data to zero its members have recognized the need in and bring resources to bear on specific to ensure the equitable distribution and health disparities in communities it serves.

Practice manager Sophia Easterling, left, speaks with a walk-in patient as medical assistant Chasity availability of personal protective equipParker works in the reception area at Mercy Clinic Primary Care – Ferguson. The clinic was opened by ment, COVID-19 tests, vaccines and drug Advocacy Mercy, which is based in a nearby St. Louis suburb, as part of a commitment to help Ferguson after therapies.

The We Are Called pledge builds on CHA protesters took to the streets in 2014 to demand racial justice. The protests were prompted by the fatal When COVID vaccines first became members’ long-standing commitment to police shooting of Michael Brown. widely available in early 2021, Dr. Regi- social justice by rallying ministry opposinald Eadie, president and chief executive tion to government policies that perpetuate of Trinity Health of New England, met with economic and social inequality, and suprepresentatives of communities of color port for policies that improve the delivery and faith leaders to listen to their concerns of culturally competent care. During the about the vaccines and establish a founda- past year, CHA’s advocacy priorities have tion of respect and trust. included reducing racial and ethnic health Catholic Health World (ISSN 8756-4068) is published Vice President “I am making sure that they know every- disparities in maternal care, expanding Communications semi­monthly, except monthly in January, April, July thing about the vaccine, so there are no Medicaid coverage for 2.2 million Ameriand Marketing and October and copyrighted © by the Catholic Health Brian P. Reardon secrets,” Eadie explained during a CHA cans, increasing access to federal assistance Association of the United States. POSTMASTER: Address podcast. programs for legally present immigrants all subscription orders, inquiries, address changes, etc., to Editor Judith VandeWater Eadie’s outreach efforts are just one and providing additional support for access CHA Service Center, 4455 Woodson Road, St. Louis, MO jvandewater@chausa.org 63134-3797; phone: 800-230-7823; email: servicecenter@ example of CHA members making the extra to affordable housing for low-income 314-253-3410 chausa.org. Periodicals postage rate is paid at St. Louis and effort to reach diverse and often marginal- families. additional mailing offices. Annual subscription rates: CHA Associate Editor ized groups of people to encourage vaccine Kathy Curran, co-leader of the We Are Julie Minda members free, others $29 and foreign $29. understanding and acceptance.

Called initiative and CHA’s senior direcjminda@chausa.org Opinions, quotes and views appearing in Catholic 314-253-3412 Avera Health is working through leaders tor of public policy, said the commitment Health World do not necessarily reflect those of CHA and of immigrant communities in South Dakota to health equity and social justice is core do not represent an endorsement by CHA. Acceptance of Associate Editor Lisa Eisenhauer to gain the trust of people without legal to CHA’s advocacy work: “As we advocate advertising for publication does not constitute approval or leisenhauer@chausa.org endorse­ment by the publication or CHA. All advertising is immigration status who fear that getting a for policies that will increase access to 314-253-3437 subject to review before acceptance. vaccine would invite the scrutiny of immi- health care and improve health outcomes, Advertising gration authorities. SCL Health and Avera we need to be vigilant in ensuring that the ads@chausa.org Health both have supported the work of changes we seek are equitable and just 314-253-3477 tribal leaders and the Indian Health Service for all, especially those who have historiGraphic Design in inoculating Native Americans, a popu- cally been marginalized due to preexisting Les Stock lation that has endured terrible loss in the biases and structural racism.” pandemic. breardon@chausa.org © Catholic Health Association of the United States, Feb. 1, 2022

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CATHOLIC HEALTH WORLD February 1, 2022

Palliative care From page 1

automatically follow supply because too many people in the public and in the health care profession don’t know what palliative care is. To move the needle on palliative care, proponents see a need to educate not only patients, but also in many cases doctors, other clinicians and health executives.

Increasing reach Efforts are underway to add palliative care to the tool kit of general practitioners and specialists in other fields. Ascension is among systems integrating palliative care into cardiac and cancer care management pathways to ensure patients have timely access to supportive care.

Others are trying to increase the reach of palliative care by educating consumers so they’ll know to ask for the services when they or a family member could benefit.

The Caring for the Whole Person Initiative funded by CHA and two Catholic health systems in California is a national pilot to promote the uptake of palliative care in part through parish-based education.

The Archdiocese of Boston, which successfully fought against assisted suicide legislation in Massachusetts, is taking palliative care education into parishes, high schools and grade schools.

Dr. Donald McDonah is the physician member of the palliative care program at St. Joseph Hospital in Nashua, New Hampshire, part of Covenant Health. McDonah and his staff are explorMcDonah ing how best to promote palliative care in the hospital’s catchment area, and particularly in communities that

CHA palliative care resources For CHA resources on palliative care, visit chausa.org/palliative/palliative-care.

To hear a CHA podcast on palliative care featuring Dr. Glen Komatsu and Denise Hess visit chausa.org/newsroom/ podcast. Komatsu is regional chief medical officer of Hospice & Palliative Care for Providence St. Joseph Health, Southern California, and Hess is CHA’s director of supportive care.

have little access to — or knowledge of — palliative care. “We don’t do well when we go in and try to tell people what we think they need. We need to listen” and then respond to what they say, he said.

Gaps remain A 2019 report, “America’s Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals,” says while palliative care services have expanded greatly over the last two decades, “access is determined not by patient need but by where a patient lives or the type of hospital (factors such as hospital size or tax status) to which they are admitted.” Only 17% of rural hospitals with 50 or more beds had a palliative care team when the report was published.

Dr. Francine Arneson is a palliative medicine physician with Avera Arneson Medical Group and medical director of the palliative care program for Avera McKennan Hospital & University Health Center in Sioux Falls, South Dakota. She said the palliative care fee and reimbursement structure can make it difficult to secure the financial and human resources needed to expand access.

Avera Health, the regional health sys-

tem parent of Avera McKennan, built one of the nation’s most comprehensive telehealth services to bring specialty care including palliative care to rural communities and small towns across South Dakota and adjacent pockets of Minnesota, Iowa, Nebraska and North Dakota.

But unequal access remains a big issue. Charlene Berke, a project director for a grant-funded palliative care program at Avera Sacred Heart Hospital in Yankton, South Dakota, explained that few residents of Native American Berke communities and reservations in Avera’s service area have heard of palliative care and many likely couldn’t access the services if they wanted to.

Native Americans can be difficult to reach with services because many live in remote areas that are not wired with the technology needed for telemedicine access, said Arneson.

Berke said even in areas where palliative care is available, health care professionals may conflate palliative care with hospice. St. Joseph’s McDonah added that large swaths of the public don’t know what palliative care is — “no one knows how to spell it or say it” — or they confuse it with hospice and believe it’s only for the dying.

McDonah noted that in Nashua palliative care was until recently available only in the hospital and mainly to inpatients.

Last month the hospital opened an outpatient palliative care program on campus, offering in-person and telehealth appointments.

Most palliative care services in the U.S. are hospital-based and that has presented its own obstacles, said McDonah.

The uninsured and poor patients may be reluctant to seek hospital-based palliative services out of concerns over cost,

although some may qualify for incomebased discounts or free care. Additionally, he said, those who are poor, including people who are homeless, may not have transportation to get to an appointment.

Cathi Ruiz, a hospice and hospital chaplain at Adventist Health Sonora, is a volunteer in the Caring for the Whole Person Initiative. She said in her rural California community in the foothills of the Sierra Nevada, few of the Hispanic residents know about palliative care services — though information is reaching Ruiz some of the most vulnerable individuals as the church- and CHAsponsored initiative equips parishes to provide volunteer support to parishioners who are seriously ill or dying.

Ruiz teaches the volunteers at St. Patrick Church in Sonora, California, to explain the potential benefits of palliative and hospice care and how to access the services to infirmed patients they visit. She said of the Caring for the Whole Person Initiative: “It’s about building trust, not making assumptions, not being judgmental, not giving opinions. It’s about doing all this, and directing people to resources.”

Palliative care service administrators’ concerns over inequitable access are borne out in a survey of research literature published in the Dec. 8, 2020, American Journal of Hospice and Palliative Medicine. The authors of “Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature,” wrote that “available data points to significant barriers to palliative and end-of-life care among minority adults. … There are also geographic disparities in access to palliative care in (the) United States, suggesting

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CHA convenes palliative care council, assists ministry in creating care standards

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n the year since the Supportive Care Coalition became part of CHA, the association has learned through surveys and other contact with members that a top priority when it comes to palliative care is to standardize and expand services.

Shortly after it brought the coalition into its fold, CHA invited 31 former members of the Supportive Care Coalition board and 33 additional hospice and palliative care leaders from Catholic health care systems across the U.S. to identify their priorities around palliative care. Just over 80% of the 26 respondents said a top priority is reducing clinical variation in Catholic-sponsored palliative care programs. This includes having program development tools, electronic health record dashboards and outcome measures to align palliative care programs with the Joint Commission and the National Consensus Project for Quality Palliative Care’s “Clinical Practice Guidelines for Quality Palliative Care,” now in its fourth edition.

Respondents also said it is a high priority for Catholic-sponsored palliative care programs to expand such services beyond the acute care setting. This includes using telehealth to reach rural and other underserved communities. Payment reform and advocating for legislation and policy to advance palliative care workforce development and foster innovative care models were among the respondents’ priorities.

CHA invited 12 palliative care and hospice leaders from around the ministry to address these priorities as members of its newly formed Palliative Care Advisory Council. That council met for the first time in December.

Many of the council members had been on the board of the Supportive Care Coalition. The coalition was founded

CHA has developed these and other resources for use by palliative care teams across the ministry.

in 1994 to counter state-level efforts to legalize assisted suicide by improving the care and reducing the suffering of seriously chronically ill and dying patients. At the time it joined CHA, it had 14 members, including 11 Catholic health systems, two long-term care providers and the Archdiocese of Boston.

Denise Hess, CHA director of supportive Hess care, was executive director of the Supportive Care Coalition when it merged into CHA in January 2021. She is the CHA staff lead of the Palliative Care

Advisory Council.

She said the initial focus of the council will be to assist CHA members in participating in the efforts of the Palliative Care Quality Collaborative by contributing to a national palliative care registry that tracks adherence to the guidelines established by the Joint Commission and the National Consensus Project for Quality Palliative Care.

According to Hess, without the involvement of the CHA advisory council, many Catholic palliative care providers may not learn about the existence of the registry, nor its potential to advance palliative care quality. CHA has hosted sessions where

representatives of the nonprofit Palliative Care Quality Collaborative teach participants to document, track and report on their palliative care programs, the composition of their palliative care teams, the way they market services and other aspects of the palliative care services they offer. Palliative care consultations, chronic pain management and home palliative care visits are among the services being tracked.

Members of the Palliative Care Quality Collaborative can use its pooled data and metrics to benchmark how they are doing against other providers and then to build up their services where there are gaps. CHA’s endorsement of the Palliative Care Quality Collaborative’s work already has resulted in more Catholic health systems joining that effort and entering their information into the registry, according to Hess.

She said that being part of this standardization work and using benchmarks can help palliative care administrators to illustrate to their systems’ executives where their respective organizations may be falling short. The comparison may help those palliative care leaders to gain support to increase the resources their systems dedicate to holistic care and symptom management for the chronically ill and dying.

Hess said research has shown that bolstering palliative care services can boost patient and clinician satisfaction, improve health care outcomes and reduce hospital readmissions, among other benefits.

Hess said once the council helps CHA members to make headway on care standardization, the council will focus on other palliative care priorities that CHA members have identified, such as the need for service expansion and for increased advocacy efforts.

—JULIE MINDA

February 1, 2022 CATHOLIC HEALTH WORLD

The Center to Advance Palliative Care and the National Palliative Care Research Center in 2019 published a report card on how states rate when it comes to access to palliative care. This map from the report shows what percentage of hospitals in each state have a palliative care program. The report is titled “America’s Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals.”

that access to such care is worse among more racially diverse, poorer, and more politically conservative states.”

The authors said the literature specifies race and culture as the main barriers preventing non-Hispanic Black patients

from receiving effective hospice and palliative care. “An important challenge is to develop an understanding of how race/ ethnicity, cultural values, and preferences of non-Hispanic Black patients and their families lead to disparities in palliative

and end-of-life care,” they conclude.

Making the case Arneson in South Dakota, McDonah in New Hampshire and Kyle Terry, who directs the hospice program at Saint Fran-

cis Health System of Tulsa, Oklahoma, are among the providers across the U.S. documenting palliative care’s effectiveness in care improvement and cost avoidance to support the case for service expansion.

For now, the service expansion they are implementing is incremental. McDonah said St. Joseph plans to use a mobile unit to offer palliative care education and services in underserved Nashua neighborhoods where there are concentrations of people who are poor, uninsured and unhoused.

Avera has two grants that pay for outreach education on palliative care. Berke said the first program builds awareness of the hospital’s palliative care offerings among rural health care providers, students studying for health careers, community members and patients. A separate five-year grant supports the sharing of culturally relevant information on and access to palliative care on Cheyenne River, Pine Ridge and Rosebud Sioux Native American reservations.

Under the latter grant, Avera is talking with cancer patients, caregivers, tribal leaders, healers and health care providers to learn their perspectives. It plans to use that information to develop a palliative care educational program and tool kit for health care providers serving the tribes. Avera also is providing a health care liaison for palliative care patients living on the reservations as well as for their families. jminda@chausa.org

ABCs of palliative care

From page 1

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oth palliative care and hospice care focus on symptom relief, quality of life and family involvement in serious illness. Such care is holistic, collaborative and usually delivered by a team of specially trained providers, according to CHA. While palliative care is for any person suffering from a serious chronic illness, hospice is for terminally ill patients who are not expected to live longer than six months.

The National Consensus Project for Quality Palliative Care outlined a national standard of care for palliative care programs and services in its “Clinical Practice Guidelines for Quality Palliative Care.” However, in practice, the guidelines are followed unevenly, and there is wide variation in programs, according to Denise Hess, CHA’s director of supportive care.

While it is common for a large hospital’s palliative care team to include doctors and nurses, social workers, nutritionists, and chaplains, some palliative care practices are much smaller.

Many are led by registered nurses or advance practice nurses.

Palliative and hospice services aim to manage pain and other symptoms, address the patient’s emotional health, coordinate care and improve communication between providers and patients, and align care and decision-making with the individual patient’s goals.

Catholic programs generally include a spiritual care component.

Palliative care improves care quality and lowers the cost of health care delivery for chronically or terminally ill patients, according to the Center to Advance Palliative Care and the National Palliative Care Research Center. “America’s Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals” was published jointly by the centers in 2019. It says 72% of U.S. hospitals with 50 or more beds had a palliative care team. That was up from just 7% in 2001.

—JULIE MINDA

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CATHOLIC HEALTH WORLD February 1, 2022

Omicron From page 1

Janice Murphy, who moved from president and chief executive of St. Vincent to the same role for its parent Sisters of Charity Health System on Jan. 1, was hopeful that the worst of the surge had passed. “Even though we’ve had challenges with Murphy our staffing, we’ve been able to manage it internally and so we did not require the National Guard,” she said.

More cases, less severity As omicron moved in waves across the nation, the Department of Health and Human Services reported that total hospitalizations for COVID were hitting records.

On Jan. 12, a new high was set at 151,211.

The Centers for Disease Control and Prevention reported that on Jan. 10 the sevenday average for COVID admissions was at 20,269, up about 30% from a week before.

Children involved in the 4-H program bring animals to visit Ruth Carlson at her window at Mission Court, an assisted living facility that is part of the Benedictine Living Community – Ada in Minnesota. While COVID-19 was rapidly spreading at nursing homes across the country because of the highly contagious omicron variant, Benedictine as a system had seen relatively few new cases among residents through mid-January.

Executives at Catholic health care ministries reported that the characteristics of the omicron spread did seem to be following trends seen in places like Cleveland where it hit early. They said more patients

Hospital uses algorithm to staunch inequity in COVID treatment T

he scarcity of some treatments for COVID-19 patients means that doctors have to make tough decisions.

For example, in the first week of January, Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, got an allotment to treat about 30 patients with a monoclonal antibody medication that has been shown to be effective against the omicron variant. The next week, the hospital was expecting about 60 doses, still far from the need in a region where hundreds of patients were hospitalized with the virus.

“It’s not adequate for the number of people we’re diagnosing and the number who would benefit,” said Dr. Catherine O’Neal, the hospital’s chief medical officer.

O’Neal said that having precious medications in such limited supply creates the potential for inequity and favoritism. “Unless you try to be just as random as possible in who you treat, you’re going to end up treating the people who know about the supply first or who know somebody who knows about the supply,” she said. “It’s caused quite a difficult decision matrix for our physicians to have to follow.”

To rectify that, and ensure the doses go to patients with the most to gain from the treatment, Our Lady of the Lake counsels doctors to use an algorithm that factors in a patient’s age, preexisting conditions, immune system suppression and other characteristics. For those deemed at high risk of poor COVID outcomes, the doctors are urged to use whatever medications are on hand and appropriate.

O’Neal said Our Lady of the Lake hopes the algorithm gets doctors past any compulsion to hold back scarce medications for fear that an even more vulnerable patient will need them. “You start to play more mind games with yourself, and it becomes inequitable,” she said.

— LISA EISENHAUER

were falling ill with the virus than ever, but a lower percentage needed intensive care.

O’Neal said that at Our Lady of the Lake about 10% of COVID patients had been mechanically ventilated during the delta surge. Only about 5% of hospitalized patients with the omicron variant have been on ventilators. In addition, stays in this surge have been shorter, typically three or four days rather than the three or four weeks during the delta surge.

Unvaccinated at higher risk Something that’s unchanged from delta, the hospital executives said, is that the patients getting the worst cases of COVID are those who have not been vaccinated.

When the Hospital Sisters Health System, which has hospitals in Illinois and Wisconsin, hit a record for COVID inpatients on Jan. 8, executives called a press conference to mark the “unfortunate milestone.”

Of the system’s 303 COVID inpatients, 76% were unvaccinated; of the 64 in intensive care units, 80% were unvaccinated.

Koekkoek said PeaceHealth’s statistics would be similar. “This is still an epidemic of the unvaccinated, as far as who’s in the hospital,” he said.

Dr. Michael Elliott, chief medical officer at Avera McKennan Hospital & University Health Center in Sioux Falls, South Dakota, part of Avera Health, said in Elliott mid-January his system appeared to be in the early days of an omicron-fueled surge. He called the variant’s spread “a little bit mind-boggling.”

Based on the rates of community spread and positive tests, the system, which spans South Dakota and reaches into pockets of neighboring northern plains states, was anticipating a spike in demand for COVID hospitalization in late January. But Elliott said there was little his hub hospital or Avera Health could do to make room for a surge of patients. He said Avera Health hospitals already were at capacity for inpatients based on available staffing.

At Avera McKennan, he said, “there are many days when we have more people on the waiting list to come into the hospital than we have planned discharges.”

Worker shortage worsens As in the general population, omicron has sidelined many health care staffers. At Avera Health, hundreds of workers were out on sick leave because of the virus in mid-January. At Our Lady of the Lake, O’Neal said 130-140 Ronda Morrison leaves HSHS St. John’s Hospital in Springfield, Illinois, “bedside team memafter being hospitalized there with complications from COVID-19. Morrison bers” were out with recorded a video crediting the hospital for saving her life and urging others COVID every day. She to get vaccinated against the virus. She had not been vaccinated at the said the medical centime she was hospitalized. The health system says most of the record ter, which is licensed number of patients it has been caring for during the omicron surge have for 800 beds, was been unvaccinated. unable to staff 60-70 of them because of lack of staff.

The COVID cases among staff were exacerbating the ongoing critical shortage of workers across the medical sector, the hospital executives said. The shortage is forcing extraordinary steps, including hiring unprecedented numbers of temporary workers from staffing agencies, delaying or limiting nonurgent surgeries and refusing transfers from hospitals that lack the specialists needed for severe COVID cases.

O’Neal said in mid-January her hospital had a request in for assistance from the military, which had sent in reinforcements over the summer. Back then, Louisiana was experiencing a COVID spike from delta that was worse than in most other parts of the nation. She was uncertain about whether the hospital would get help again because omicron and the staffing shortage have created a widespread need “and now everybody’s sort of clamoring for that same pot of people.”

Meanwhile, the executives said that their diminished staffs are wrung out by the demands of the pandemic. Early on, Elliott noted, Avera cut back on services and patients were reluctant to come in for some procedures. That allowed the system to shift workers in outpatient facilities into hospital care.

“We’re now almost three years into this and everybody’s extremely tired,” he said.

“We’re crazy busy in the clinics and the acute care settings so we don’t have folks that we can float from those areas to the A graphic posted on social media by the Hospital Sisters Health System shares the breakdown between vaccinated and unvaccinated patients who are hospitalhospitals.” ized for COVID-19. The system set new records for the number of hospitalized patients with the virus in January as the omicron variant spread.

If there’s a bright side to the latest

February 1, 2022 CATHOLIC HEALTH WORLD

COVID surge, the hospital executives said it might be that their staffs are now so familiar with the virus that they have learned how to check its spread in their facilities and how to best care for patients.

Murphy credited the sharing of information and cooperation within the health care sector for rapid advances in COVID care.

“I would say now our clinical teams are really experts at the protocols, the medication, the way that we manage these patients, the way that we work to keep them off of ventilators,” she said.

KEEPING UP

Alderfer

St. Vincent Charity Medical Center, part of the the Sisters of Charity Health System, joined several other providers in a plea to the public issued in this full-page ad in The Plain Dealer newspaper in mid-December.

Sisters of Charity and several other health systems bought a full-page ad in The Plain Dealer, a Cleveland newspaper, in midDecember with a simple plea: Help. The ad urged people to get vaccinated and

follow standard COVID precautions. “We need you to care as much as we do,” it said. leisenhauer@chausa.org

Benedictine stays vigilant as COVID spikes elsewhere in long-term care settings

A

report released in mid-January by the American Health Care Association and the National Center for Assisted Living pointed to an alarming spike in new COVID-19 cases at nursing homes.

On Dec. 19, the report said, there were 4,361 COVID cases among nursing home residents and 5,919 among staff. On Jan. 9, cases among residents had jumped to 32,061 and among staff to 57,243.

The report urged that public health officials prioritize long-term care facilities for testing and treatment and provide workforce support as the facilities struggled to find staff.

Jerry Carley, president and chief executive of Minneapolis-based Carley Benedictine, said the system was seeing an uptick in COVID cases in early to mid-January at its 35 senior living communities in the Midwest as the omicron variant spread but nothing like what the report showed on a national scale.

Among Benedictine’s 4,000 residents in its independent living, assisted living and skilled nursing units, Carley said there were 30 positive COVID cases; among its 4,000 staff, about 160 were off because of the virus.

The numbers were far from the peak for the system, which happened in fall 2020 before vaccines were available. At that time, 150-160 residents of its con-

Brooks

PRESIDENTS AND CEOS

Scarce medication One factor that could enhance that treatment but that is out of their control, the health care executives said, is a larger supply of some medications, especially the one monoclonal antibody therapy that has proven effective against omicron.

Elliott said systemwide Avera Health was getting 30-40 doses per week of that onedose-per-patient therapy when it could use hundreds. “It hardly scratches the surface,” he said.

The executives said the antiviral pills made by Pfizer that got approval for emergency use from the Food and Drug Administration in December for mild-tomoderate cases of COVID were in equally short supply.

Dr. Marc Shelton, senior vice president and chief clinical officer for HSHS, noted that the allocation for central Illinois was about 200 pill packs per week. “That can be awesome for the 200 people that need it and get it but we’re seeing thousands of people get this disease Shelton right now so that’s a drop in the bucket,” he said.

Public appeals go on Across the country, health systems and clinicians continue to urge the public to get vaccinated, wear masks, wash their hands and practice social distancing. HSHS posts regular updates on its social media channels about the rates of unvaccinated patients in its COVID units.

7

A group of masked residents of the Benedictine Living Community-Ada in Minnesota venture out for a bus tour of Christmas lights. The community has eased up on some restrictions that were in force early in the pandemic but continues to follow masking and other safety protocols to prevent the spread of COVID-19.

tinuum of care facilities were testing positive on any given day. Carley credited a high vaccination rate and continued adherence to masking and other COVID protocols for preventing subsequent outbreaks.

Benedictine is keeping a close watch on how omicron progresses through its continuum of care communities, he said. If need be, the system will implement additional safety precautions to lower the infection risk for all its residents.

Carley said of the lockdown that eldercare communities endured early in the pandemic: “It was horrible,” adding, “It is our hope we don’t return to that level of restrictions due to this latest surge.” The

system had eagerly reopened its doors to residents’ loved ones as soon as it got the go-ahead from public officials.

Even with visitors back in and the virus mostly kept out, Carley said Benedictine is not yet back to pre-COVID operations. For one thing, its census in skilled nursing facilities is down about 10%, largely because of a lack of staff.

In Minnesota, the staff shortage has been so severe that it has backed up the pipeline for hospital discharges to skilled nursing facilities. Late last year, 75% of nursing homes in the state were restricting admissions and 25% had complete bans.

To address the shortage of skilled nursing beds, Minnesota started a “hospital decompression initiative” with four facilities, three of them part of Benedictine. The state is providing National Guard troops and agency workers and the nursing homes are providing space for patients who are rehabbing from hip surgery and other medical conditions other than COVID. Carley said the initiative has helped hospitals move hundreds of patients to nursing homes, opening up needed inpatient beds for COVID and other patients. The initiative was set to end on Dec. 31 but was extended through February. He expected another extension, as Benedictine and other skilled nursing and long-term care providers continued to recruit staff.

— LISA EISENHAUER

Jen Alderfer to president of the SCL Health Montana Region and of St. Vincent Healthcare of Billings, Montana.

Molseed She was president of Good Samaritan Medical Center in Lafayette, Colorado, and system transformation officer for SCL Health.

Jake Brooks to president of SSM Health’s St. Joseph Hospitals in St. Charles and Wentzville, both in Missouri. He was vice president of operations for SSM’s St. Charles and Wentzville ministries since July 2020.

Brooks succeeds Dr. Doug Barton, who had been interim president in addition to his role as chief medical officer.

Richard “Dick” Molseed to interim regional president and chief executive of Avera St. Luke’s Hospital in Aberdeen, South Dakota, and chief executive of Avera St. Mary’s Hospital in Pierre, South Dakota, effective Feb. 21. He replaces Todd Forkel, who recently announced plans to leave Avera Health to become chief executive of Altru Health System of Grand Forks, North Dakota. Molseed had retired from Avera Health in June 2020. Following his retirement, he returned to fill an interim chief information officer role at Avera Health.

Upcoming Events from The Catholic Health Association Global Health Networking Zoom Call Feb. 2 | Noon ET

Foundations of Catholic Health Care Leadership 2022: An Online Course for Formation and Development

Feb. 3 – March 24 | 1 – 3:30 p.m. ET

Global Health: A Conversation with Sponsors Feb. 8 | Noon ET

Diversity & Disparities Networking Zoom Call Feb. 25 | 1 – 2 p.m. ET

In-Person Meeting: Ecclesiology and Spiritual Renewal Program for Health Care Leaders Invitation Only May 1 – 6

chausa.org/calendar

8

CATHOLIC HEALTH WORLD February 1, 2022

140. That number was below 100 at the end of the year, a drop that Sr. Talone and Purcell say is due to the pandemic, with many potential residents worried about exposure to the virus and isolation from loved ones as well as many more people working from home and able to care for elderly family members, and due to staffing constraints.

Full-time staff now number about 140; before COVID that figure was about 250.

Purcell notes that the movie also doesn’t convey the entire scope of the pressure that St. Ignatius staff has been under over the last two years, not all of it from COVID. She points out that in summer 2020 buildings just blocks from the nursing home burned as racial justice protests turned violent. The facility was at times locked down because of the unrest.

Nursing home documentary From page 1

attention to the source of the scarce supplies. “I remember driving back here,” she says. “It was like having gold in the car.”

Steve Annable, nutrition manager, relates the frustration of having to work remotely so he wouldn’t risk exposing others, especially the Annable facility’s frail residents, when he had COVID-like symptoms but no access to a test for the virus. “It’s more than just a job,” he explains. “We are their family.”

Those reflections are among many captured in “Our COVID Journey,” a 15-minute documentary that St. Ignatius produced and released in late December.

The video was the idea of Sr. Patricia Talone, RSM, who chairs the board of the nursing home. Sr. Talone retired from CHA Sr. Talone in 2016 as the association’s vice president of mission services. St. Ignatius has been in operation in West Philadelphia since 1952, when a parish priest founded it to care for the neighborhood’s low-income elderly.

The voices on the ground Today, the majority of St. Ignatius’ residents rely dually on Medicare and Medicaid. Most are African Americans from the surrounding working-class neighborhood.

When the pandemic started, many of St. Ignatius’ patients, like the frail elders in nursing homes everywhere, were especially vulnerable. Protocols for containing the virus weren’t established and protective gear was elusive. The Kaiser Family Foundation reports that staff and residents at

Plexiglass separates resident Ruth Wilson and her daughter Rashera Wilson as they visit in the solarium at St. Ignatius Nursing & Rehab Center in Philadelphia. The photo is part of the film “Our COVID Journey” that was produced by the facility to capture the experience of staff during the pandemic.

long-term care facilities accounted for 31% of all COVID deaths in the nation through June 30, 2021.

Once St. Ignatius closed its doors to everyone except staff and residents, Sr. Talone couldn’t visit, but she stayed in close touch with staff who told her about the challenges they faced in trying to keep the virus at bay and the isolated residents healthy and happy.

“I felt for historic reasons and archival reasons we needed to capture the voices of people on the ground,” she says.

St. Ignatius hired RiseArt Media, a video company the facility had worked with in the past, for the documentary. The first interviews with staff began as the pandemic appeared to be waning in summer 2020.

That might have been the end of taping, had the virus not continued its march. The videographer returned to St. Ignatius in August 2021, as COVID variants continued to cre-

ate surges, to add a more updated segment to the film.

“It took us a really, really long time to finish and part of that was because each time we began moving on it COVID itself changed and morphed and it was like, OK, how do we capture this?” Sr. Talone says.

Pandemic and protests She credits Purcell for moving the project forward by connecting the videographer and the staff. Purcell hopes the film conveys the compassion she witnessed from workers who set aside their own fears to care for St. Ignatius’ residents. “It was unbelievably heroic to me,” she says.

Even with all the emotional and gutwrenching interviews the video packs in, it doesn’t capture all that the pandemic wrought at St. Ignatius. For example, the facility is licensed for 176 beds and in preCOVID days normally had a census of about

‘Forever changed’ St. Ignatius has to date had 67 cases of COVID among residents and lost 22 residents to the virus. The last death was in May 2020. St. Ignatius reported no new cases of the virus among residents from March 2021 until early this year, when it had seven new cases.

“I feel that we have put things in place very rapidly for patient safety that can now be a model for the future,” Sr. Talone says. “I don’t think we’re over the hump yet, but at least we sort of know how to handle it.”

Purcell is hopeful that the pandemic’s darkest days are past, too, although as 2021 was winding down more of her friends and acquaintances were battling COVID than at any time since the start.

In the latter part of the film, Scot Weirich, St. Ignatius’ director of human resources, expresses guarded optimism.

“I think we have a long way to go,” Weirich says. “I think we’ll be forever changed, but we’re getting back to normalcy, whatever the new normalcy might be.”

“Our COVID Journey” can be viewed on YouTube at youtu.be/62poomN-5M0. leisenhauer@chausa.org

Mercy Health – Clermont Hospital welcomes retired nurses back as volunteers

By DALE SINGER

Ruth Bailey retired after 38 years as a nurse, and she missed her days on the hospital floor, dealing with patients.

Mercy Health – Clermont Hospital in Batavia, Ohio, saw a need for its staff nurses to have more support, particularly for those chores that help a hospital run smoothly but don’t necessarily call for the specialized training that nursing requires.

Enter the Retired RN Nightingale Program, an effort that was conceived before the pandemic began but brought very welcome relief to a COVID19-weary nursing staff.

“I don’t think COVID changed the program all that much,” said Tracy Taylor, director of volunteer services at Clermont Hospital and Mercy Taylor Health–Anderson Hospital in Cincinnati. Both hospitals are part of Bon Secours Mercy Health. What has changed, she added, is how fatigued the nursing staff can become with the constant demands that the pandemic has brought.

Bailey said her time as a nurse gave her the ideal background to relieve the fulltime staff from the needs that patients have that may not require highly specialized skills.

“I’m excited to be able to give the staff the support they need,” she noted. “If a patient needs their water refilled, a staff nurse doesn’t have to stop to do that. We can do that.”

Added Ann Owens, another member of the volunteer corps: “I’ve given a couple of baths, sat with a patient, made rounds to say hello as soon as I get there. If someone wants someone to do something like just

Ruth Bailey, a volunteer in the Retired RN Nightingale Program at Mercy Health-Clermont Hospital in Batavia, Ohio, is only too happy to relieve floor nurses by taking on routine tasks. Retired nurse volunteers feed patients, restock supplies and run errands to lighten the load on nurses.

check on a patient, I can do that.”

Taylor said the volunteer program was adapted from a similar effort she heard about at another Midwestern hospital.

Volunteers do not have to have active nursing licenses to participate. They can help with a number of tasks that enrich patient care yet may have to take a lower

priority during hectic times.

The volunteers work four-hour shifts between the hours of 8 a.m. and 4 p.m.

Slots are available seven days a week.

Mercy Health – Cincinnati provides orientation and on-site training for those who are interested.

A volunteer nurse might feed a patient, assist with discharge phone calls, update whiteboards, visit with patients and families, restock supplies or run errands for a nursing unit.

“We do anything that would make anyone’s job easier or that would make the patients’ life a little easier,” Owens said.

She left nursing in 1999 to join a law firm that specializes in defense work for hospitals — a job that she says could be just as stressful as working on a hospital floor. After she retired from the firm, she gravitated toward the volunteer nursing program.

“I thought that would be a good way to go back to something that I enjoyed, hospital work,” Owens said. “Plus, I liked the idea of Mercy Clermont being a smaller hospital.”

Both Bailey and Owens said that nurses on the floor appreciate their assistance.

“The first thing is to always listen,” Bailey said. “I try to determine exactly what the need is — if it’s something I can take care of, or something I need to reach out to the nursing staff to take care of. If I’m unsure, I don’t hesitate to ask questions.”

Taylor said Mercy Health is using a variety of techniques to attract more volunteer nurses, including encouraging current nursing staff to distribute flyers promoting the Retired RN Nightingale Program.

“A lot of nurses come from a family that had other nurses as well,” she said, “so we thought that would be a good avenue to pursue.”