Catholic Health World - October 1, 2020

Executive changes 7 Rapid access for lung cancer treatment 8 PERIODICAL RATE PUBLICATION

OCTOBER 1, 2020 VOLUME 36, NUMBER 10

How and when to resume visitation safely: Long-term care facilities weigh benefits, risks With abundance Eldercare facility of caution, care staff guard against communities move the consequences toward welcoming of isolation visitors back

By JULIE MINDA

Sr. Anthony Veilleux, O CARM, has seen firsthand the ill effects that visitation restrictions imposed in response to the COVID-19 pandemic have had on some nursing home residents.

She directs mission integration for St. Patrick’s Residence in Naperville, Illinois, a long-term care community that is part of The Carmelite System. Since its doors were locked in mid-March to almost everyone except residents and staff to help stem the spread of the infection, the community Continued on 4

Bill Greenblatt/UPI

By LISA EISENHAUER

Kay Pickett, left, uses the “Arms Of Love,” a COVID-safe plexiglass booth, to safely hug and kiss her mother, Sue Croan, at Garden Place Columbia Senior Living in Columbia, Illinois. Because of restrictions in place since early in the pandemic, many residents of eldercare communities went months without in-person visits.

When the Centers for Medicare and Medicaid Services advised March 13 that all long-term care facilities strictly limit visitation and communal activities, few could have foreseen that the restrictions would stretch into late summer and beyond.

Residents in eldercare facilities across the U.S. have spent months living lives that are much more isolated and constricted than they were pre-pandemic. And, while facilities in states and localities that have eased restrictions have been resuming visits and communal activities on a limited basis, visitation remains very limited even in Continued on 5

Community benefit departments shift gears to respond to hard times

By JULIE MINDA

Pandemic-related shutdowns have dealt a powerful blow to the U.S. workforce.

Unemployment hit its highest point since the Great Depression.

Several ministry community benefit leaders say they began seeing an immediate toll from the economic downturn in March and April with long lines at food banks. The certainty of community spread and asymptomatic transmission underscored longstanding issues of housing insecurity and overcrowding.

“We have been watching society’s safety net unravel, and it is disturbing and alarming, and the numbers are unprecedented,” when it comes to unemployment counts and similar measures of community impact, says Michael Miller, system vice president of mission and ethics for St. Louis-based SSM Health. He says SSM

Chris Outlaw, a mental health technician with SSM Health, reviews patient registration information at SSM Health Behavioral Health Urgent Care in suburban St. Louis.

SSM Health, SSM Health and its community partners started the monthly “Mobile Market” in Mount Vernon, Illinois, Providence St. Joseph to distribute boxes of produce and dairy to people who are experiencing food insecurity during the COVID-related economic downturn. The University of Illinois Extension, the United Way of South Central among vanguard Illinois and the U.S. Department of Agriculture partner in the effort. offering behavioral Palliative Care Academy teaches clinicians empathetic communication health urgent care Continued on 6

By KATHLEEN NELSON

Framework for goals of care conversations

Like many of his colleagues, Dr. Syd Hindley cares for a growing number of patients with advanced chronic illness. An emergency room physician at CHI Franciscan’s St. Anthony Hospital in Gig Harbor, Washington, Hindley has no working relationship with these patients, who arrive suffering debilitating symptoms and a decreasing quality of life. Some have reached a point where curative treatments offer little to no chance for improvement; some have difficulty managing the symptoms of a serious chronic illness. In both cases, palliative care treatments could provide relief and support.

Even so, broaching the topic of palliative care can lead to a critical and intimate conversation about prognosis and life goals, a conversation where respect and empathy are paramount.

“Too often, we have to make a deep connection on the spur of the moment and have a Continued on 2

Centers provide ready access to care, referrals

By JULIE MINDA

Collaborative Decisions Balanced Medical Recommendation Patient Story

Medical Story Relationship

Tammy Newman Bhang and Dr. Juan C. Iregui: “Creating a climate for healing: A visual model for goals of care discussion,” Journal of Palliative Medicine, 2013, 16:718. Reprinted with permission.

A simplified schematic of The House Model illustrates a patient-centered approach to conversations about palliative care and advanced care planning for end-stage disease.

Nearly 60 percent of U.S. adults with a mental illness have not received treatment for their conditions. And nearly a quarter of adults with mental illness reported that they have been unable to receive the treatment they sought. This is according to a 2020 report on mental health care access from the nonprofit Mental Health America.

The organization’s analysis said the cost of services and the lack of availability of appropriate services were barriers to access.

Facilities within SSM Health and Providence St. Joseph Health are among a small number of U.S. health care providers Continued on 3

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CATHOLIC HEALTH WORLD October 1, 2020

Palliative Care Academy

When care conversations matter most, listen first, talk later

From page 1

difficult conversation with very little background,” he said. “It isn’t easy to get from, ‘Hey, I just met you and now I’m recommending that we can either do something that could make you feel worse or focus on easing your symptoms rather than seeking a cure.’ They don’t teach those skills in med school or residency.”

Hindley helped fill the gap in his trainHindley ing by attending CHI Franciscan’s Palliative Care Academy, a two-day training program that blends the palliative skillset of supportive care and symptom management with ethics and communication.

Dr. Juan Iregui, a hospice and palliative care specialist at St. Joseph Medical Center in Tacoma, Washington, and a member of the CHI Franciscan system’s ethics committee, leads sections of the training. “We tend to see ethics at 30,000 feet, Iregui as something theoretical, but it really belongs bedside,” he said. “This training brings our ethics back to Earth.”

The basics of difficult conversations The journal Heart Failure Reviews reported in 2017 that there was just one palliative medicine specialist for every 1,200 people living with a serious or lifethreatening illness — versus one cardiologist for every 71 people experiencing a heart attack. With so few specialists in palliative medicine, clinicians in other disciplines need a broader understanding of the scope and benefits of palliative medicine. Participants in the Palliative Care Academy learn simple and practical techniques to offer supportive care in the form of symptom and pain management as a complement to, or replacement for, curative treatments.

They discuss ethics and the fundamentals of specific treatments, such as artificial nutrition, hydration and management of pain and breathlessness. The training supplements this clinical information with sessions on patient communication that deal with breaking bad news and matching medical treatments to the preferences of the patient and family.

“We’re really not trying to teach people palliative care. We want to get in front of primary care doctors, nurses, social workers, really everyone on the team to improve basic communication skills,” said Dr. Mimi Pattison, regional medical director for CHI Franciscan Hospice and Palliative Care and chief facilitator of the Palliative Care Academy. “It’s so amazing how everyone can take these basic skills and apply them the next day.”

Hindley signed up for the training after seeing the improvements in quality of life that palliative care provided to his grandparents at the ends of their lives. He also regularly treats patients in the ER with terminal, serious or chronic conditions and wanted to learn more about treatment options for managing symptoms and pain.

He got so much more.

“Juan and Mimi give you this foundation for how to frame questions and approach the conversations and address these concerns,” Hindley said.

Listen first Iregui and Pattison base the communications training on what they call The House Model, built on a foundation of asking and listening, rather than telling: asking for permission to hold a conversation, listening to the patient’s history and goals and asking for permission to make a balanced recommendation based on what is important to the patient and what the physician knows about his or her medical condition.

Participants cite this “ask before you tell”

T

Dr. Mimi Pattison, regional medical director for CHI Franciscan Hospice and Palliative Care and chief facilitator of the Palliative Care Academy, leads a pre-COVID training session. She says the connection that many clinicians make between palliative care, hospice and dying keeps them from recommending palliative care to patients who could benefit.

approach as the most transformative piece of the two-day training.

“The interesting thing about the process is that it’s very collaborative,” Hindley said.

“You ask a lot of questions, but there are also specific points where you ask for permission to offer a medical recommendation. So, you don’t really leave the patients on their own. You collect the information then give them an informed recommendation based on what they tell you.”

In addition to training as many clinicians as possible, Pattison hopes to move participants away from thinking of palliative care as giving up on a patient, or solely as hospice, which provides palliative care and emotional support to patients with end-stage terminal illness. She wants palliative treatments integrated into a care continuum.

Anytime, anywhere “In the course, we talk about how palliative care is for anyone, anytime, anywhere, any diagnosis,” she said. “Most people who need palliative care aren’t dying. And people are shocked when they hear that because it’s so linked to hospice. We really work to uncouple that connection between palliative care, hospice and dying.”

Hindley noted that he uses the skills from the academy more than once a week, not just in conversations with terminal or gravely ill patients but in helping on less critical decisions of care.

“There’s nowhere near enough discussion of palliative care,” Hindley said. “Every

patient in (intensive care) should have a palliative care consult to discuss goals of care and improve their comfort. It should be done for every patient with a cancer diagnosis, to talk about the process of care.

It should be a standard part of a care plan.”

The program has been offered once a month since 2015 and has trained more than 800 clinicians across disciplines: obstetricians, oncologists, hospitalists, psychiatrists, cardiothoracic surgeons. Most of the participants are employed by or affiliated with Catholic Health Initiatives facilities in the Pacific Northwest. Some program participants have come from other health systems and from the region’s community health service providers. The training is so popular that sessions are booked a year in advance.

COVID-19: Challenge and opportunity As with every aspect of health care, the outbreak of COVID-19 has presented challenges and opportunities for the academy. Sessions were capped at 13 participants before the pandemic and have been reduced to six because of the need to social distance. But working with CommonSpirit Health, CHI’s parent ministry, Pattison and Dr. Christine Cofer of the Palliative Care Academy have developed a virtual version of the course that meets for three days in three-hour sessions. After finishing the first online session in July, they offered a second session in August.

They plan to refine the presentation and

he Palliative Care Academy teaches communication techniques based on The House Model, developed by Tammy Newman Bhang, the academy’s former director, and Dr. Juan Iregui, palliative care specialist at St. Joseph Medical Center in Tacoma, Washington. The hallmark: Ask before telling. Following are the model’s five elements and some of the guiding questions for physicians: Foundation. After creating a quiet, safe space, ask for permission to begin the conversation through a question such as: “We want to provide the best care possible from your perspective. Can we talk about that?”

Patient story. The key is to gather emotional and cognitive data by asking such questions as: “Can you tell me, in your own words, what have you heard about your condition?”

“Where do you get your strength and support?”

“What is your body telling you?”

Medical story. Only after listening, ask to share medical information. Iregui and Bhang suggest delivering the news in a headline, for example: “I’m worried that what we are hoping for may not happen,” then letting the patient break the silence.

As a follow-up, “Given your medical situation, what is most important to you?”

Recommendation. After repeating their concerns and priorities, ask permission to offer a treatment that aligns with their goals, then ask: “What do you think about this as a plan?”

Collaborative decision making. The goal is to ensure the quality of the collaboration, rather than judge the quality of the decision. Physicians should summarize and affirm the patient’s decision and perhaps offer next steps, such as a time-limited trial of a treatment with a specific goal, then ask: “To make sure I have done a good job communicating, can you share with me what we talked about?”

are encouraged at the possibilities.

“I was surprised how effective it was,” Iregui said after the July presentation. “A lot of the activities are the same. It can’t totally replace the in-person sessions but may turn out to be more effective in delivering the training to a broader audience.”

Upcoming Events from The Catholic Health Association Sponsor Formation Program for Catholic Health Care Webinar – Session Three Oct. 8 – 9 (Invitation only)

Eldercare Webinar: Delirium in LTC — COVID Implications Oct. 13 | 1 – 2 p.m. ET

Sponsorship: Sustaining the Ministry Webinar Series Series 1 Session 3: Models of Sponsorship

Community Benefit 101 Virtual Meeting

Formation Leader Community Networking Call

Oct. 22 | 2:30 – 3:30 p.m. ET

Oct. 14 | 2 – 3:30 p.m. ET

Oct. 27–29 |2 – 5 p.m. ET

Networking Call for Facility Ethicists

Oct. 15 | 1 – 2 p.m. ET

A Passionate Voice for Compassionate Care® chausa.org/calendar

October 1, 2020 CATHOLIC HEALTH WORLD

Behavioral urgent care From page 1

aiming to address such problems by offering immediate access to treatment for acute mental health issues, and referrals to community providers for longer-term mental health care.

SSM Health Behavioral Health Urgent Care opened at the end of August on the campus of SSM Health DePaul Hospital – St. Louis. Providence Behavioral Health Urgent Care – Everett opened about a year ago on the campus of Providence Regional Medical Center Everett in Everett, Washington.

“We are working with community partners to provide a wellness path for ongoing care, we’re helping clients avoid a mental health crisis and we’re helping them avoid going to the emergency department for mental health conditions,” said Michelle Schafer, SSM Health regional vice president of behavioral health. “We’re Schafer also meant to be a model that can be replicated elsewhere.”

The urgent care approach “solves for a lot of gaps. The dream is to create a behavioral health continuum” of care, said Laura Knapp, director Knapp of behavioral health for Providence’s northwest region.

Care now Both the SSM Health and the Providence behavioral health urgent care centers allow walk-ins, including right from the emergency department of the adjacent hospitals, as well as scheduled appointments. In many cases, patients can access services virtually, a draw for those who are taking pains to avoid public places during the pandemic.

Typical conditions seen in both centers include substance use disorders, depression, mood disturbances, anxiety, stress, grief reactions and psychosis.

The SSM Health center’s staff includes a nurse, a master’s prepared clinical therapist, a nurse practitioner, a nurse manager and a community health worker. A psychiatrist is the center’s medical director.

Before committing to a floor plan, SSM Health set up this full-scale cardboard model of its behavioral health urgent care center in a church banquet hall. Potential patients and mental health clinicians were among those giving input about the layout.

The center also has access to other psychiatrists and clinicians on staff at SSM Health DePaul Hospital.

The Providence center’s staff comprises a medical director who is a psychiatrist, two psychiatric nurse practitioners, a clinical social worker trained and licensed in behavioral health, a substance abuse expert, a peer counselor and a receptionist.

When a new patient arrives at the SSM Health urgent care facility, a nurse does a first assessment to assure any pressing medical needs are addressed, then the therapist conducts a mental health history and assessment to understand the person’s needs. That therapist also can initiate basic therapy for acute symptoms of mental illness.

The nurse practitioners can prescribe psychiatric medications. The team members will then refer the client to SSM Health sites or partner community organizations that can provide long-term mental health care and social services. Those providers have commited to schedule appointments within three days.

When a patient arrives at the Providence behavioral health urgent care clinic, it’s the peer counselor who performs a triage interview using a screening tool. The patient provides some medical history and describes the reason they are seeking care.

The peer counselor presents the reason for the client’s visit to the multidisciplinary

team. That team decides who will see the patient first. The patient may see multiple team members during the visit.

The patient can get immediate therapy for the acute symptoms, a prescription for psychiatric medications and assistance with accessing social services.

In both behavioral urgent care centers, staff locate a community mental health provider that would meet the longer-term needs of the patient and schedule any appointments to ensure a smooth handoff with that next organization.

SSM Health’s Schafer and Providence’s Knapp said the main role of their respective facilities is stabilizing patients until that handoff occurs and helping them find the resources they need in the community.

They said community partnerships are essential to the success of this approach.

Strength in partnership Schafer said the SSM Health center is the result of two-plus years of planning.

The effort began after the St. Louis Regional Health Commission convened a group of mental health care providers including SSM Health as well as representatives of law enforcement, the judicial system and other groups with a stake in community mental health to study the problem of unmet mental health care needs regionally.

In St. Louis over the last decade, there has been an increase of more than 40 percent in people visiting emergency rooms seeking treatment for mental health issues.

That is according to the St. Louis Regional Mental Health Data Report. Schafer said people often seek mental health care in emergency departments because they cannot find the services they need in the community or they are unable to get an appointment quickly.

SSM Health developed the concept for the urgent care center drawing on learnings from the commission’s work, insights from partners on the commission and other research. Schafer noted that the con-

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cept is so new that the planning team had very few examples to study — she’s aware of fewer than a dozen behavioral health urgent care centers in the U.S. Schafer said the urgent care center is a collaborative effort of SSM Health and other mental health provider organizations in the region. SSM Health is the region’s largest provider of mental health care, with a continuum of services, including 400 inpatient psychiatric beds spread out across several campuses in the greater St. Louis area.

Knapp said that the Western Washington region has many innovative facilities operated by Providence and other community partners. These sites are dedicated to assisting people with mental health and related needs. Partner facilities include a county run diversion center that is a shortterm shelter for homeless individuals with substance abuse or other behavioral health issues, community mental health centers and a crisis triage and stabilization center.

Despite the fact that these services are available in the area, multiple assessments in Everett have shown that there was not enough capacity to meet all acute mental health needs. Knapp noted that because many people cannot get the help they need when they need it, they often turn to the emergency room. The Providence Regional Medical emergency center sees 1,200 people per month who have behavioral health needs as their primary or secondary diagnosis.

A mental health committee that Providence Everett medical center assembled determined that a behavioral health urgent care was the best approach to address the community needs.

Providence has a behavioral health urgent care in Missoula, Montana, as well.

Piece of the puzzle Dr. Arpan Waghray, co-chair of the Providence St. Joseph Health Behavioral Medicine Clinical Practice Group and the medical director for Well Being Trust, said Providence is developing “a comprehensive approach to improve mental health and substance use care across all our EDs with an upstream focus. We are looking at behavioral health urgent care and bridge clinics as part of a larger solution based on specific regional needs and assessments.”

Waghray said Providence is considering converting its adult clinics in its Portland, Oregon, service area into behavioral health urgent care centers.

Knapp said the Everett center’s services are especially essential now as shutdowns related to the pandemic are isolating people and in many cases increasing their economic instability, and these pressures can increase people’s risk of mental illness.

“With the risk factors COVID created, we’re not surprised to see what the data (based on the center’s medical records) is showing — substance abuse is up, stress is up, anxiety is up, depression is up.

“We are trying to create a seamless system of care to help,” she said.

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CATHOLIC HEALTH WORLD October 1, 2020

Welcoming back visitors From page 1

has assisted residents with remote visits through phone calls and smartphone apps such as FaceTime and Skype.

Nevertheless, the lockdown has left many residents feeling disconnected and isolated, Sr. Veilleux says.

“Those with dementia especially find it hard to understand why they’re seeing their family on a screen and they can’t Sr. Veilleux touch them,” she says. “We had to actually stop a visit with a resident with dementia because she just kept saying to her daughter, ‘I want you here. I need to hug you.’ And she began to develop severe behaviors.”

Pat Tursi, chief executive at Elizabeth Seton Children’s, has seen similar anguish among residents of its long-term care facility for children with profound disabilities in Yonkers, New York, and relatives who have been barred from being near Tursi them for months. She was so determined to ease the New York state restrictions on nursing home visits that she made her case to a joint state legislative panel in August. “f you had to look into the faces of our beloved children every day wiping away tears because they miss their parents, are unable to communicate through technology and further can’t understand why their families are not coming to see them, you would stop at nothing to change this policy,” she said during her testimony.

On Sept. 9, the state eased the visitation restrictions on pediatric skilled nursing facilities. Under the new guidance, Elizabeth Seton Children’s Center will be able to open up to in-person visits for residents.

Eager to ‘do the right thing’ Across the nation, facilities like St. Patrick’s and Elizabeth Seton Children’s Center are grappling with restrictions on in-person visits that since early in the pandemic have been limited mostly to compassionate cases, such as when residents are dying. The restrictions were put in place as it became clear that congregate living centers such as nursing homes were especially vulnerable to outbreaks of the contagion. About 40% of the deaths from the virus have been linked to nursing homes or other adult long-term care facilities, according to a database maintained by The New York Times.

Jason, a resident of Elizabeth Seton Children’s Center in Yonkers, New York, visits with his mother, Mindy Leiter, through a fence this spring. The center for children with complex medical conditions has followed strict restrictions on visitation during the pandemic. Outdoor, distanced visits were among the few options for parents to see their children until recently.

The pressure on care facilities by residents, relatives and their advocates to ease visitation rules is nevertheless intense. At Elizabeth Seton Children’s Center, Tursi is proud that none of its 169 medically fragile residents has contracted coronavirus.

She maintains that the rigid precautions including temperature checks, symptom screening and masking that her facility has in place to keep out the virus will make safe reunions with loved ones possible.

The Centers for Medicare and Medicaid Services, which issued the strict visitation guidance in March, put out reopening recommendations in May for state and local health officials to consider when easing the visitor lockout. The recommendations suggest a phased approach to reopening based on several factors, including the absence of COVID among residents and staff, the prevalence of the infection in the service area, and whether the facility has adequate staffing. CMS said states could require all facilities to go through each phase together, conduct the phased reopening by region, or allow nursing homes to reopen on an individual basis as they meet state criteria.

Urging immediate relief CMS isn’t requiring that the restrictions be loosened. Its most recent missive on the topic, which came out in June in the form of answers to frequently asked questions, says only that visits “should be” allowed for “compassionate care situations.” In an earlier memo, CMS said visits could be allowed when a resident’s “health status has sharply declined.”

Robyn Grant, director of public policy and advocacy for the National Consumer Voice for Quality Long-Term Care, says the CMS recommendations “basically didn’t

change anything in terms of what was currently happening on the ground regarding visitation.”

“We think that the restrictions at this point really need to be eased,” Grant says. “There’s a Grant subset of residents that are really suffering and have experienced significant decline in terms of physical well-being but also emotionally and psychosocially, and those individuals need immediate help.”

Grant says this should be possible if facilities enforce precautions like symptom screening, temperature checks, masking and hand sanitizing.

Layers of guidance, rules LeadingAge, the association of nonprofit providers of aging services including nursing homes, says states are cautiously moving to embrace the CMS recommendations.

By the end of August, 41 of them had used CMS’s recommendations to craft guidelines of their own for how care providers can let visits resume. A few states’ guidelines practically mirror what CMS suggested. Others have drafted sets with different criteria, such as how low community COVID case rates must be before easing visitor restrictions. Within states, some counties have issued their own requirements.

Some care providers say the array of exacting requirements can be dizzying. Jeri Reinhardt is vice president of clinical Reinhardt services and performance excellence for Benedictine, which has care

School bell joyfully reunites wistful parents with their medically fragile children Leader of center for frail children advocated to bring parental visitation back

W

hile she waited for the state to ease its visitation restrictions and for Elizabeth Seton Children’s Center to surmount all the hurdles to reopening, Pat Tursi found a loophole that answered the prayers of some relatives of the residents of the home for children with complex medical needs in Yonkers, New York.

The center includes a special education school for its residents that is attached to, but yet separate from, the part of the facility with the residents’ living areas. This summer, Gov. Andrew Cuomo specifically eased restrictions on schools to let those that provide special education reopen.

Coincidentally, at those schools parents are required to be part of the Individualized Education Program that the schools craft for each student.

“We slowly started calling parents and having them come in for two-hour visits,” says Tursi, Elizabeth Seton Children’s chief executive.

Vanessa Nunez, a therapeutic recreation specialist, works with Lianna at the school Elizabeth Seton Children’s operates at its center for medically fragile children in Yonkers, New York.

Over the four-week summer session, that parent involvement meant 33 families were reunited for the first time in months and

Tursi says the process will continue in the fall session.

“The reactions when they came back together, it was so overwhelming,” she says. “I did get to witness a few of them, and I was in tears.”

Those visits are just one of the ways Tursi pushed back against New York’s rigid visitation restrictions, which were eased on Sept. 9.

She and one of the parents of the home’s 169 residents testified before state lawmakers about how wrenching the months-long separation was for the children and their families. She also urged state health officials to reclassify the facility from nursing home to children’s specialty hospital, which under state regulations never had to halt visits from parents and guardians.

In addition, Tursi recounted the heartbreak she’s witnessed because of the separation to the media, including The Wall Street Journal. Among her stories is how four parents were so determined to stay near their children that they moved into the facility. The last of those parents moved out after about three months, when she faced losing her job.

— LISA EISENHAUER

communities in several Midwestern states.

“We know in our hearts that our residents need to see their families so we try to do whatever we can to make that possible,” she says.

Reinhardt says Benedictine communities in Minnesota have been happy to invite “essential caregivers” back after the state became one of the earliest to allow close family members or companions of longterm care residents to resume visits. The communities follow the state’s guidelines for when and where the visits can occur, health screenings, and precautions such as masking. The state limits the number of visits that can take place simultaneously within a facility.

Reinhardt says Benedictine also would welcome a more standard set of guidelines on visitation across the nation. “One thing that would help is if there was just one voice that was telling us what to do.”

Complicated decision Dee Pekruhn, director of life plan communities services and policy for LeadingAge, says the organization supports giv– ing states and counties Pekruhn flexibility to develop their own reopening policies and leaving the final decision on whether to pursue reopening to care providers.

Pekruhn says whether or not to open up is a complicated decision that administrators agonize over. They have to weigh how severe the COVID threat is within their facilities and in the communities where they are located and whether they have the resources to keep it at bay. “Many of our members talk about this all the time because of course they want to reunite families, but they also want to first and foremost keep their residents safe and protect them from the spread of COVID-19,” she says.

To safely loosen restrictions, LeadingAge says facilities need resources. This includes personal protective equipment like masks and gloves and access to rapid testing. Many either don’t have access to those resources or lack the money to pay for them. To that end, the group is urging Congress to approve more support for aging services providers, including $100 billion in funding.

Pekruhn says some facilities have found that to accommodate visits — including escorting visitors and residents to specially designated spaces, disinfecting those spaces, overseeing the proper use of protective garb and monitoring social distancing — takes the equivalent of about four fulltime employees every week.

Ascension Living is among the systems that have created a new category of employee whose primary role is to facilitate visits.

“We hired hospitality companions in most of our communities to grow the amount of connectivity with families,” says Danny Stricker, Ascension Living’s president. “We understand the significance of these visits and will do what we can to offer these services.”

‘It’s for the residents’ At St. Patrick’s Home in Bronx, New York, Administrator Sr. Diane Mack, O CARM, says her team is hoping to meet the rigid state restrictions that would allow socially distanced outdoor visits with patients. The facility, also part of The Carmelite System, had reached the third and final phase of the process in early September. To complete that phase requires no positive tests for the virus among residents or staff for 28 days.

Sr. Mack was jubilant that after months of residents and their loved ones seeing each other only through windows or video screens, in-person visits between them might be only days away.

“We thank God every day and say our prayers every night to maintain this,” she says of the negative test results. “It’s not for us. It’s for the residents. It’s always for the residents.”

October 1, 2020 CATHOLIC HEALTH WORLD

Easing isolation

into months, loneliness and depression began to set in. “They have had enough,” Bonavita-Rhodes says.

From page 1

those sites. Eldercare experts from around the Catholic health ministry say their facilities have been concerned about the impact of the isolation on their residents and have been diligent in seeking ways to ease that isolation.

Debbie Scionti is mission and values director for D’Youville Life and Wellness Community in Lowell, Massachusetts, which is sponsored by the Carmelite Sisters for the Aged and Infirm. She says the restrictions had resulted in residents living almost as shut-ins, and she had worried the lack of stimulation and human contact was negatively impacting some residents’ cognition and their desire to thrive.

But, Scionti notes, on June 12 D’Youville resumed some spatially distanced dining and communal activities, and it opened up visitation on a very limited basis — visits are done outdoors with staff present to ensure social distancing is maintained. And, in mid-September, the facility was awaiting health department guidelines on how to move the visits indoors when cold temperatures arrive.

Scionti says that even the limited inperson contact with loved ones has helped to lift spirits and made the residents feel more connected to their families. And she says the increased social activity generally has helped residents and staff to feel “like our normal selves.”

Still distant While some facilities have slowly resumed some level of in-person visitation, others are not yet ready. For instance, while Florida Gov. Ron DeSantis issued an executive order Sept. 1 easing restrictions on in-person visitation in longterm care sites. Catholic Health Services of Lauderdale Lakes expected to resume face-to-face visits the week of Sept. 20.

Bon Secours St. Petersburg Health System planned to resume face-to-face visits on Sept. 21.

Representatives of those systems say while workarounds like drive-thru visits and window visits have been enabling

Long-term care facilities have been organizing engaging events to help residents remain connected to their loved ones in the midst of the pandemic. Here, residents await a car parade this summer at St. Andre Health Care in Biddeford, Maine, part of Covenant Health.

Dean Suffrins, a resident at Benedictine Living Community Winona in Minnesota, plays a game devised by recreation staff to keep residents entertained and stave off boredom, loneliness and isolation.

residents to see family members live, the residents still were longing for closer contact with family and friends.

Fr. Edmund Aku is pastoral care direc-

tor at St. Anne’s Nursing Center & Residence of Miami, part of Catholic Health Services. He says that many frail elders are in long-term care settings because of decreased mental ability, limited mobility and diminished independence. “These factors minimize their ability to cope with sudden changes that last for a protracted time, like they are now experiencing.”

Kip F. Corriveau, director of mission at Bon Secours St. Petersburg Health System in Florida, agrees that nursing home residents with dementia and other cognitive impairments are especially vulnerable to the impacts of pandemic-related restrictions. This is because many of them rely on the comfort of familiar settings and familiar people, and they need the social cues of familiar voices and facial expressions. With residents and staff wearing masks, facial expressions are obscured and voices are muted, he says.

Restrictive visitation and socialization policies “have had a tremendous mental effect on our residents,” says Jamie Bonavita-Rhodes, administrator of Catholic Health Services’ St. Joseph Residence of Lauderdale Lakes, an assisted living community.

The residents understand that the restrictions are for their protection, since frail elderly are the most vulnerable population with regards to this virus. But when weeks of family separation turned

National Academies sees opportunity for providers to address isolation St. Jude Medical has programs in place to reduce isolation among senior adults

I

n February, the National Academies of Sciences, Engineering and Medicine issued a report detailing how social isolation can harm older adults and recommending approaches for reducing loneliness.

The report, “Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System,” says social isolation and loneliness can put seniors at higher risk of dementia, depression, heart disease and early death.

The authors say that older adults have a higher probability of experiencing social isolation and loneliness than people in other age groups, because they are more likely to live alone, to have survived the death of loved ones, to have chronic illness or to have sensory impairments — and all of these are predisposing factors for social isolation and loneliness.

A National Academies committee developed the report, with support from the AARP Foundation. A press release announcing the report says the health care system “remains an underused partner in preventing, identifying and intervening for social isolation and loneliness among adults over age 50.”

The study recommends that clinical care providers conduct assessments to identify at-risk individuals, include social isolation measures in electronic health records and connect patients with social

5

or community programs that can address isolation and loneliness. The report mentions that technology used to enable home monitoring of patients can in fact be a contributing factor in isolating them.

The report calls for more research on social isolation and more action at the community level to stem it.

One ministry member taking on the issue of isolation among senior adults is St. Jude Medical Center in Fullerton, California, part of Providence St. Joseph Health. Karyl Dupée is clinical supervisor of senior services and community care navigation for the medical center.

She says research shows that loneliness among senior adults is linked to increased fall risk, increased use of emergency centers and urgent care centers, anxiety and depression, dementia and suicide among older adults. Senior adults who are lonely can forget to take needed medications. They also are at increased risk of being the victim of elder abuse and scams, she says.

Among the programs Dupée has developed at St. Jude to reduce isolation among seniors is a visitation program called “Caring Neighbors.” Volunteers who pass a background screening pay social visits to senior adults and assist with basic needs, such as carrying laundry up the stairs, or with errands.

That program is on temporary hold amid the pandemic. But St. Jude created another program in its place. The “Cheer-A-Senior” program has screened and trained volunteers who place weekly phone calls to senior adults to check in and chat. The volunteer team also can do grocery runs and medication pickups and can help the clients to

Mark Pennington, a volunteer with the “Cheer-ASenior” program, visits with program client Peggy Coked after bringing groceries to her home.

St. Jude Medical Center of Fullerton, California, created the Cheer-A-Senior program to reduce isolation among seniors in Orange County, California, amid the pandemic. St. Jude is part of Providence St. Joseph Health.

access community resources they may need, like support groups. Upwards of 70 volunteers — including St. Jude staff, college interns and graduate students — serve more than 400 senior adults.

As part of the program, the volunteers also administer a depression and anxiety survey every quarter. Anecdotal evidence and these assessment results among clients show that elders can be at increased risk of loneliness amid the pandemic, says Dupée.

— JULIE MINDA

Stimulation Long-term care facilities, including those represented here, have tried to bridge the gap created by the restrictions.

They have increased their use of videoconferencing to allow for virtual visits with loved ones. They’ve ensured access to Masses through closed circuit television and other mediums. And, they’ve modified recreational therapies and other activities, including by using social distancing in group rooms or employing technology that allows individuals to participate in their private rooms.

However, says Bonavita-Rhodes, “all the technology in the world cannot make up for a physical touch from a loved one.

“It is the little things we always took for granted — we are now realizing how truly important a hug from a loved one is, or a chat with a neighbor that you can sit next to, and even just getting a haircut to make one feel good about themselves,” she says.

Many eldercare staff around the ministry are seeing their role in a broader way than before, says Scionti of D’Youville.

“We’ve always considered ourselves a family, but that has taken on a whole new context now that we are the only family” that residents can see in-person on a regular basis. Staff are making more time for personal interactions with residents; making extra efforts to take residents outside, which can have a restorative effect; and engaging residents in conversation about favorite topics.

Assessment At Bon Secours St. Petersburg facilities, says Corriveau, all team members monitor residents’ social, emotional, mental and spiritual well-being on an ongoing basis. At daily meetings, those team members discuss which residents need support most and what type of support would be warranted.

Sondra Norder is president and chief executive of St. Paul Elder Services of Kaukauna, Wisconsin. The Franciscan Sisters of Christian Charity Sponsored Ministries facility resumed visitation in late June but has since had to discontinue visitation amid a COVID outbreak. Visitation had not yet resumed as Catholic Health World went to press in mid-September.

Norder says all her staff is trained to be “expert noticers” when it comes to residents’ emotional well-being. If frontline staff detect worrying behavior or symptoms among residents, including lack of appetite, tearfulness and disinterest in activities they once loved, those staff can discuss the issues with a multidisciplinary team.

The team might modify care plans, such as by increasing the residents’ social interaction, implementing medication therapy as warranted or initiating talk therapy. The facility has access to outside geriatric psychiatrists who can assist.

Norder says St. Paul focuses on providing trauma-informed therapies, since much of what the residents are experiencing is traumatic. Such therapies involve understanding, acknowledging and verbally addressing the source of trauma — which in this case is the isolation.

Norder says, “We can’t prevent all heartache. But it’s our mission to do the right thing” for the residents, including trying to protect their well-being.

Scionti of D’Youville says the chaplain and social work teams have had a crucial role to play in the important work of addressing the psychosocial fallout of isolation. “We’re paying attention to those most in need.”

Visit chausa.org/chworld for more details on government regulations and guidance on visitation in long-term care. jminda@chausa.org

6

CATHOLIC HEALTH WORLD October 1, 2020

Community benefit

They worked at a shuttered Baton Rouge hospital that the health system and partner health facilities stood up in a week’s time.

Barrett says now that the original testing site is closed, the collaborative is operating a drive-thru testing center and the COVID Recovery Resources Program at a former bank branch. The clinic offers referral to primary and specialist care to address lingering effects of COVID-19.

Barrett says health education events and outreach that are part of the community benefit landscape now are largely done by videoconference, but community benefit staff is brainstorming how to ensure people without technological connections don’t get left behind. As the number of new positive cases of coronavirus has been falling, the community benefit staff at Franciscan Missionaries of Our Lady facilities has been slowly restarting some of the in-person patient education classes and events, putting in place contagion prevention measures including social distancing.

From page 1

Health has been working with its community partners amid the pandemic to help ensure that families in need have access to food, shelter and other basics.

Partner support The community benefit leaders who spoke to Catholic Health World say much of their systems’ work to address acute economic disparities is grounded in partnerships with numerous community organizations. These include public health agencies and nonprofit providers of food, housing, transportation and other aid.

Shortly after the pandemic shut down much of the U.S. economy, community benefit leaders say, their departments got in touch with their local partners to assess how they’d been impacted and to determine what was needed in terms of the ministry systems’ funding to keep those organizations viable in the near term.

Miller says in March SSM Health community benefit staff sent partner organizations a brief survey on their immediate needs. The responses helped community benefit staff understand what was happening in the neighMiller borhoods, so they could adjust in a way that supported the partners doing frontline work and respond with urgency to the needs of the underserved.

In many cases, SSM Health allowed the community organizations to temporarily halt grant-funded programming and to instead use SSM Health funding for COVID responses, such as for converting walk-in food pantries to drive-thrus.

At the Irving, Texas-based CHRISTUS Health system, Chara Abrams is director of mission integration and community benefit and Marcos Pesquera is system vice president of health equity, diversity and inclusion. Abrams Abrams says at the onset of the pandemic CHRISTUS Health also reached out to its community partners to determine how best to help them. Pesquera says CHRISTUS Health gave broad leeway to the partners, enabling them Pesquera to use funds in ways that were outside of contractually established parameters of their relationships.

For instance, community benefit staff in the system’s Santa Fe, New Mexico, and San Antonio regions offered their partner organizations the leeway to divert preexisting grant funds to pressing needs, such as the purchase of personal protective equipment or technology assistance to transition to virtually provided services.

Jesse Cirolia, manager of community health at CHRISTUS St. Vincent, says the health system formed a funding alliance including CHRISTUS St. Vincent, Anchorum St. Vincent and the Santa Fe Community Foundation to reduce duplicative funding processes. Nonprofit organizations dedicated to addressing the social determinants of health were able to apply for funds from all three funding organizations under the umbrella alliance organization, using one simple form, and receive the support they needed to continue providing essential services. Nonprofits have played a critical role in helping to provide necessary supports throughout the COVID-19 pandemic, Cirolia says, adding that simplifying the funding process and working with organizations to build capacity is strengthening the safety net programs in northern New Mexico communities.

Nimble staff Ministry sites

also

reconfigured

Jalee Helmuth, a nurse with the Mount Carmel Health System’s street medicine program, brings lunch and medical supplies to a homeless encampment in Columbus, Ohio. The outreach allowed homeless individuals to follow stay-at-home orders issued by the governor earlier this year to combat coronavirus contagion. The street medicine program is part of Mount Carmel’s community benefit work.

their own staff activity, resources and approaches to respond to emerging community needs.

Adjustments at CHRISTUS Health included expanding the outreach of case managers and community health workers with its Equity of Care initiative. Prior to the pandemic, those case managers had contacted patients with hypertension to help them with care follow-up and with addressing socioeconomic needs. After the pandemic began, the case managers did similar intervention with uninsured COVID patients quarantined and isolated at home.

Abrams says CHRISTUS Health’s community benefit department is making sure that COVID information disseminated to the public is accessible in multiple languages and that interpreters are available to patients.

Jaime Dircksen, vice president of Community Dircksen Health and Well-Being at Livonia, Michigan-based Trinity Health, says because of COVID precautions, front-

line community health workers who were used to making in-person visits to community members in need instead contacted them by telephone.

Nearly all of Trinity Health’s ministries established social care hubs during COVID, staffing them in part with reassigned community health workers. Callers get referred to Trinity Health or partner organizations that can address their socioeconomic needs. Most Trinity Health ministries also have COVID nurse triage lines, and about one-third of those nurse lines have a direct connection to the social care help lines.

Dircksen says the nurse triage lines and social care hubs are particularly valuable to the many people who are newly unemployed in Trinity Health markets.

Coletta Barrett is vice president of mission for Our Lady of the Lake Regional Medical Center, part of Baton Rouge, Louisiana-based Franciscan Missionaries of Our Lady Health System. She says that system redeployed its community health workers — including many who work in its school-based health center program — to administer COVID tests.

Advocacy efforts At a system level, many of the community benefit departments in the ministry are exploring how they can better integrate their goals with advocacy work throughout their systems. Miller of SSM Health says the pandemic has underscored the importance of safe housing and streets, access to preventative health care, good nutrition, good education and job opportunities. The working poor have suffered disproportionately from the virus and its economic fallout.

Miller says SSM Health’s community benefit staff is increasing its attention to the local and national policy decisions that can impact population health status.

Including through work with CHA, they are looking at how to affect structural, systemic change nationally in a way that can have a positive impact on the health and well-being of poor and vulnerable populations. Dircksen says Trinity Health too has increased its focus on the intersection of community benefit and community advocacy work since the pandemic began.

“Local policies are super important,” and so Trinity Health is looking at how to expand its political activism for policies that benefit the underserved.

The community benefit leaders say their systems’ commitment to appropriately addressing community needs will not waver. They acknowledge that COVIDrelated economic pressures on health care systems may mean the work gets done despite resource and staff constraints.

“All of our work has been affected by COVID,” says CHRISTUS Health’s Pesquera, “but we will continue in that work.” jminda@chausa.org

Community health workers ask visitors health status questions and take their temperatures before “badging” them at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana. The photo was taken in March. The governor issued a mandatory mask order in July.

October August 1, 2020 CATHOLIC HEALTH WORLD

7

KEEPING UP PRESIDENT/CEO Brandon Harvath to president and chief operating officer, Saint Francis Healthcare, part of Trinity Health Mid-Atlantic.

NEW WEBINAR SERIES

ADMINISTRATIVE CHANGES

Introducing

Sponsorship: Sustaining the Ministry

This two-part series will examine the roles and responsibilities of sponsors, address evolving issues in juridic person sponsorship models and provide insights about cultivating effective working relationships with church leaders, executives and boards.

A new webinar series for sponsors, CEOs, senior executives, mission leaders, bishops and board members

SERIES 1 Fundamentals of Sponsorship Six webinar sessions Aug. 12, 2020 – Feb. 10, 2021 Second Wednesday of the month 2 – 3:30 p.m. ET SERIES 2 Advanced Issues in Sponsorship Six webinar sessions March 10 – Aug. 11, 2021 Second Wednesday of the month 2 – 3:30 p.m. ET

REGISTER TODAY! View the curriculum at CHAUSA.ORG/SPONSORWEBINARS

A. Verona Dorch to executive vice president and chief legal officer of Providence

EXECUTIVE REFERRAL Spiritual Care and Community Life Coordinators, Collaborative Governance — Two Missouri congregations of women religious (the Sisters of the Most Precious Blood of O’Fallon and the Franciscan Sisters of Mary of Bridgeton) are seeking two individuals to work collaboratively to develop and implement a comprehensive pastoral care plan for each congregation’s respective members.

This collaboration would involve coordinating elements of ongoing spiritual care, planning opportunities for spiritual and personal enrichment, and providing resources and facilitating the members’ living out their mission.

The ideal candidates will have a degree or certification in theology, adult education, spirituality, and/or gerontology or a related field. Creative problem solving and an understanding of the aging process would be helpful, and prior experience working with the elderly is required. Being a current or former member of an institute of women religious and/or having worked in close capacity with women religious is preferred. Both positions are full time.

Please e-mail resumé and letter of interest to ahewitt@fsmonline.org or mail to Allison Hewitt, Executive Director, Collaborative Governance, 3221 McKelvey Road, Suite 107, Bridgeton, MO 63044.

in Renton, Washington.

James M. Garvey to executive vice president and chief operating officer of Catholic Health in Buffalo, New York.

Covenant Health of Tewksbury, Massachusetts, and some of its facilities have made these changes: Michelle Marshall to vice president of strategy, marketing and innovation; Jake Redden to vice president of quality improvement and safety; Dr. Deepak R. Vatti to chief of emergency medicine for St. Joseph Hospital of Nashua, New Hampshire; and Patricia A. Scherle to vice president of patient care services and chief nursing officer for St. Mary’s Health System of Lewiston, Maine.

Brett Kinman to administrator of CHRISTUS St. Michael Hospital – Atlanta in Atlanta, Texas. He has been interim administrator since May 1. Kinman continues as administrator of CHRISTUS Good Shepherd Medical Center – Marshall in Marshall, Texas.

Organizations within Trinity Health of Livonia, Michigan, have made these changes: Dr. Genevieve “Jen” Lankowicz to chief clinical officer of Saint Joseph Health System of Mishawaka, Indiana. Jason Schultz to vice president of strategy and business development for Saint Joseph Health System.

Trish Sanders to chief nursing officer and vice president for St. Mary’s Healthcare of Amsterdam, New York.

ANNIVERSARY The Siena Campus of Dignity Health – St. Rose Dominican in Las Vegas, 20 years.

OBITUARY Richard Haughian died June 28. He worked at the Catholic Health Association of Canada for 24 years ending in 2004 — 11 of those years as executive director.

Community Benefit 101 is Going Virtual in 2020!

VIRTUAL

Community Benefit 101: The Nuts and Bolts of Planning and Reporting Community Benefit OCT. 27 – 29 Each day from 2 to 5 p.m. ET

Spread the word about wearing masks to slow the spread of COVID-19 by ordering a #LoveThyNeighbor mask.

CHA invites everyone to use its free resources at chausa.org/masks

to promote mask wearing and protect the health of all. chausa.org/masks

CHA is transforming its highly regarded CB 101: The Nuts and Bolts of Planning and Reporting Community Benefit program into a virtual conference that will provide new community benefit professionals with the foundational knowledge and tools needed to run effective community benefit programs.

What you will learn: Through video presentations, live chat and commentary provided by community benefit leaders, online opportunities to connect and more — CHA will provide the basics of community benefit, access to practical tools and resources, as well as timely public policy updates.

Who should attend: While it is designed for new community benefit professionals, the new virtual format now makes this meeting accessible to a wider audience, including:

vv Staff in mission, finance/tax,

population health, strategic planning, diversity and inclusion, communications, government relations, and compliance who want to learn about the important relationship between their work and community benefit/ community health.

vv Veteran community benefit staff

who want a refresher course to update them on current practices, inspire future activities and connect with others in nonprofit health care doing this work.

WE HOPE TO SEE YOU THERE! LEARN MORE AT CHAUSA.ORG/COMMUNITYBENEFIT101

8

CATHOLIC HEALTH WORLD October 1, 2020

St. Joseph’s/Candler lung cancer program cuts time from diagnosis to treatment

By NANCY FOWLER

A

ny cancer diagnosis may come as a shock but a lung cancer diagnosis can be particularly shattering. Statistically, it’s more deadly than any other cancer, with more than half of patients dying within a year of diagnosis, according to the American Lung Association.

A year-and-a-half-old program in Savannah, Georgia, is helping patients better process the fear and other emotions around a lung cancer diagnosis while expediting access to treatment intended to cure, or, if that is not possible, to improve the quality of life and likelihood of longer term survival for its patients. The Lung Cancer Rapid Access Team at the Nancy N. and J.C. Lewis Cancer & Research Pavilion is operated by the Savannah-based St. Joseph’s/ Candler Health System.

Patients are referred to the program by a physician after a suspicious finding during a primary care exam, or on a lab test or X-ray, and often before a conclusive diagnosis has been rendered. Appointments are usually set within a week. In the space of an afternoon, patients hear from a team of physicians.

The goal is to have all testing done before the initial appointment, so the lung cancer specialists can evaluate test results and devise a treatment plan. Occasionally though, out-of-town patients who live in areas where the diagnostic test battery is unavailable may undergo a lung function test, scans and/or biopsy on the same day they meet with the program’s clinicians. Patients who are candidates for surgery can be scheduled for an operation the following week.

The process can condense into a 14-day period an ordeal that might otherwise take up to six weeks — enough time for the disease to become more advanced, according to thoracic surgeon Dr. Marc Bailey. Hastening treatment for aggressive cancers is good for the patient, the community and

Dr. Marc Bailey, left, and Dr. Doug Mullins discuss a treatment plan with patient Rudd Long. Bailey and Mullins were leaders in creating St. Joseph’s/Candler Health System’s Lung Cancer Rapid Access Team.

St. Joseph’s/Candler, Bailey said.

“It’s good for the health system because it brings in more early stage, treatable cancers and curable cancers,” BaiBailey ley said. “So it’s a good thing for all involved.”

‘Wait one second’ Normally, before patients arrive for their initial in-person appointment, a pulmonologist, radiation oncologist, cardiothoracic surgeon and medical oncologist discuss and evaluate their case. The initial appointment can be overwhelming for patients who may feel bombarded by medical terminology or a less than ideal prognosis.

“The nurse navigator will sometimes literally put her hand up and say, ‘Wait one second — what they’re saying is this and that,’ and she completely translates it,” Bailey said. “This also can be grounding for us, as physicians, too.”

Dana Coleman has been the

program’s nurse navigator since its launch in February 2019.

She’s guided approximately 100 patients through treatment thus far. Her job begins before patients arrive for their first visit. She lets people know what to expect and advises them to bring a Coleman family member or friend to help process the flood of information. Coleman makes sure her patients understand normal lung function so they can better comprehend their test results and she explains the different types of treatment that may be proposed, be it surgery, radiation, chemotherapy or palliative care, or a combination of any or all of the therapies.

“We truly take an interest in the patient, listen to their fears, their anxieties, and answer questions that they may have,” Coleman said.

Coleman also may refer patients to a hospital social worker, chaplain or nutritionist.

She remains a resource for them

FEAST OF ST. FRANCIS | Oct. 4

See more prayer resources at chausa.org/ environment/feast-of-st-francis

On the Feast of St. Francis, let us be mindful of protecting our natural resources.

Lord, grant that all who have positions of responsibility in economic, political and social life, and all men and women of goodwill, will be “protectors” of creation, protectors of God’s plan inscribed in nature, protectors of one another and of the environment.

Whenever we fail to care for our brothers and sisters in creation, the way is opened to destruction, and hearts are hardened. Soften our hearts, Lord, so that we may care for each other and creation as you have ordained. Amen.

— just a phone call away.

Coleman said many patients with new lung cancer diagnoses may have quit smoking as long as 20 years ago. (Smoking — whether current or past — contributes to 80 percent of lung cancer deaths in women and 90 percent in men.)

“They may kind of blame themselves,” Coleman said of the program’s patients. She helps patients work through that and focus on what will give them the best quality of life. Early diagnoses set the stage for the best care outcomes.

Coleman hopes the outreach of the program and its hospital system to physicians in outlying areas will encourage newly diagnosed patients and those with suspicious medical test findings to seek immediate care at St. Joseph’s/Candler.

“Our overall goal is to get these patients diagnosed before they’re Stage 3 or 4,” Coleman said.

Outreach to African Americans Most of the program’s patients live in Savannah. But up to 30% travel from surrounding areas, including South Carolina’s Lowcountry, a stretch between Savannah and Charleston that is home to a large retirement population. Eighty-six percent of those living with lung cancer are 60 and over.

Most of the clinic’s patients are white. The hospital continues to reach out to primary care physicians with predominantly African-American patients, and offer screenings and education in majority African-American spaces, Coleman said.

Serving this population is particularly important given that the age-adjusted lung cancer rate for Black men is approximately 30% higher than for white men, despite their lower overall exposure to cigarette smoke. For Black women, the incidence is the same as that of white women even though Black women smoke fewer cigarettes, according to research cited by the American Lung Association.

Just do it Bailey and pulmonologist Dr. Doug Mullins led the creation of the Lung Cancer Rapid Access Team. No one is turned away from the program for a lack of health

insurance or inability to pay, Coleman said, calling the policy part of the health system’s mission. The program gets some of its referrals from free clinics for the uninsured operated through the health system’s mission services department, headed by Sr. Margaret Beatty, RSM. Sr. Pat Baber, RSM, directs two of the clinics making referrals, St. Mary’s Health Center and the Good Samaritan Clinic at St. Joseph’s/Candler.

“It’s not just something we say to make us look as if we take care of our community,” Coleman said. “We do take care of our community.”

Mullins, Coleman, Bailey and other clinicians fold their Lung Cancer Rapid Access Team hours into their regular workload. The program sees patients on Monday and Tuesday afternoons.

At the outset, the team decided to move forward with the program in an agile way, fixing issues as they arose rather than anticipating every potential hiccup.

“We just said, ‘We’re going to figure this out,’” Bailey said. “If we’d waited until every single thing was perfect, it would never have gotten started.”

One thing they could have never imagined: The COVID-19 pandemic. The program shut down for two months but resumed in June. The pandemic became an incentive for looking further into transitioning some of the initial visits to telehealth, especially for patients from outside Savannah.

As the medical staff looks to the future of the program, Bailey believes it will continue to grow as an important resource for patients. Coleman says the program hopes to add another pulmonologist and medical oncologist and become a center of excellence mainstay in the St. Joseph’s/ Candler cancer service line.

From fear to optimism The Lung Cancer Rapid Access Team definitely has been a good thing for Geri Sharp of the Savannah area. Sharp, 71, was diagnosed in March 2019 with limited stage small cell lung cancer, a stage that usually involves the fastgrowing cancer being confined to one lung. According to the American Cancer Society, only one in three patients with small cell lung cancer are diagnosed at this earlier stage when a cure may be possible for some people.

Sharp went to urgent care for a bad cough and got referred to the program. She arrived at her intake appointment frightened and discouraged.

“I walked in and saw all these doctors there and I thought, ‘This isn’t good,’’’ Sharp said. “I was afraid they’d say it couldn’t be treated.”

But she learned her lung cancer was treatable. Over three months, Sharp underwent four rounds of chemotherapy and 40 radiation treatments. She’s now in remission.

Recently, doctors found a spot on one lung, and as Catholic Health World went to press, she was awaiting results of a PET scan.

“I am very optimistic that, if the cancer has come back, they can take care of it,” Sharp said. “I feel very thankful to have the doctors I have there; they’re very caring and very, very thorough.”