Ethics as wise advice 2 Executive changes 7 PERIODICAL RATE PUBLICATION
MAY 1, 2021 VOLUME 37, NUMBER 7
Ethics frame how Catholic systems make care decisions for unrepresented patients By LISA EISENHAUER
In her early days as a medical ethicist just over 15 years ago, Leslie Kuhnel remembers getting one or two requests per year for consultations regarding patients who lacked decision-making capacity and had no known surrogate to speak on their behalf about their care. These days, Kuhnel says, there are two or three ongoing consultations underway at any given time regarding what Kuhnel are known as unrepresented or unbefriended patients receiving care in the hospitals she serves across CHI Health, where she is vice president of ethics and theology. CHI Health is CommonSpirit Health’s regional system operating in Nebraska and Southwest Iowa. There is apparently no tracking done
nationwide for unrepresented patients. But ethics professionals say facilitating the creation or approval of care plans for incapacitated patients with no identified surrogates or advance medical directives makes up a large and growing portion of their workload.
Establishing a care plan for an incapacitated patient who doesn’t have a designated surrogate can pose ethical challenges for health care providers.
Disconnected from family Nick Kockler is vice president for system ethics services at Providence St. Joseph Health. He says about 20% of the clinical ethical consult requests Kockler at Providence’s Center for Health Care Ethics in Portland, Oregon, in the first quarter of 2021 involved unrepresented patients. He adds that experts forecast that this patient population will increase across the nation because of the Continued on 4
Hugs, hand-holding: Long-term care opens up to more intimate visits By JULIE MINDA
Patricia Addarith Magaña Lozano, director of nursing schools for CHRISTUS MUGUERZA-UDEM, is among the several dozen people who have taken part in the system’s leadership development program for women.
In CHRISTUS MUGUERZA leadership program, women gain skills, confidence to advance Course is increasing gender diversity in management ranks
While most residents of Benedictine Living Community | Garrison, North Dakota, had been troubled by the visitation lockdowns that were necessary to prevent viral spread during the pandemic, a particular resident had an especially difficult time with the isolation. Scott Foss, the eldercare facility’s executive director, says, “When open visitation returned, she was able to actually see her family, including her Tennessee family, in-person on her birthday! You could sense her smile from a mile away and her laugher that we haven’t heard for so long returned. It was like sweet music!” With vaccination rates very high among residents of eldercare facilities nationwide and with COVID infection rates low in numerous communities, public health agency guidelines are allowing facility doors to open wider to visitors and, for the vaccinated, the protective plexiglass barriers no longer need separate them from visitors.
“The joy and life that have been injected back into our residents is such a blessing!” says Foss. “Families are so grateful they get to see their loved ones again; there are many tears of joy!”
A long year The Centers for Medicare and Medicaid Services issued a memorandum in March 2020 recommending that, to prevent viral spread, long-term care facilities restrict all visitors and nonessential staff from entrance, with few exceptions. Long-term care facilities across the U.S. adapted to the initial lockdown on visitation by connecting residents with their loved ones via videoconferencing, phone calls and window visits. They erected plexiglass and other nonporous barriers when protocols allowed for indoor visitation without contact.
Ethel Hauf, 93, is eager to resume playing for chapel services at Benedictine Living Community | Garrison in North Dakota. She’s played piano all her life.
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Indigenous people have fared far worse in pandemic than Caucasians Ministry providers support efforts to reduce COVID’s impact on American Indians
By JULIE MINDA
About five years ago, executives at the CHRISTUS MUGUERZA system in Mexico saw that women were underrepresented in the leadership ranks of the system and its facilities and that when management opportunities did open up, very few women applied. To better understand that reticence, the system conducted focus groups among female employees. The most respondents — about 50% — said they did not seek out promotions because of self-doubt about their skills. They did not feel entitled to claim a place in a management cadre dominated by men let alone aspire to executive leadership.
Melodies Now, in many facilities, protocols are allowing for vaccinated residents to hug
By JULIE MINDA
St. Vincent Healthcare staff place flags in the front lawn of the Billings, Montana, hospital to commemorate the lives of patients who died from COVID-19 while hospitalized at the facility.
American Indians have suffered far worse health outcomes and experienced much higher mortality rates from COVID than Caucasians. The Indian Health Service and tribal governments have led the work to mitigate the impacts of the coronavirus upon American Indians, including with an effort to vaccinate against COVID. Ministry facilities have helped to address the needs of American Indians amid the pandemic. Leroy “J.R.” LaPlante, director of the American Indian LaPlante Health Initiative, says “the most Continued on 6