Health Progress - Spring 2021

JOURNAL OF THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES

HEALTH PROGRESS SPRING 2021

Caring for the Caregivers

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WE ARE CALLED

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s we pass the one-year mark of the COVID-19 pandemic, we have an opportunity to reflect on the many moments of grace and hope we’ve witnessed across our country and indeed the world. We remember the health providers who made their own personal protective equipment (PPE) so that they could continue to treat those in their care. We recognize the many moments of hope when a patient, whose first prognosis was so dire, took a first step toward recovery.

There are so many examples from hospitals, long-term care facilities and residential communities that remind us of our belief that “every person is a treasure, every life a sacred gift, every human being a unity of body, mind and spirit” is flourishing in Catholic health care.

This is also a moment to reflect on the ways our nation’s social and economic fabric has been tested and strained over the last year. We have recognized our ability to stand together to confront the COVID-19 crisis while stark political divisions pulled us apart.

We’ve witnessed our health sysSR. MARY tems stretched to their limits as HADDAD, RSM the financial pressures of the pandemic challenged our ability to serve those most in need.

The past year also brought to the forefront the stark realities of racial discrimination and health inequality that were laid bare by police violence and systemic racism. These challenges remind us that what we have done is not enough. Justice cries out for us to do more to ensure that all people are treated with dignity.

Sadly, the challenges of systemic racism in our communities are not new. However, COVID-19 proved that we as a nation and as a health ministry must do more. This moment calls for deep reflection and a reckoning with the ongoing failure to address racism in our society. It demands that we break the cycles of good intentions and half measures, and to make real efforts to reverse systemic racism and health inequity in our country.

In response to this crisis, the Catholic Health Association’s Board of Trustees has issued a call for a concerted and unified effort by the Catholic health ministry to improve health equity in our health systems and communities. The call is rooted in our respect for every person’s dignity and our mission to bring Christ’s healing touch to all those in need.

This ministry-wide call has already been answered by the nation’s largest Catholic health systems that together care for almost four million patients annually. Their outpouring of support testifies to the deep commitment by Catholic health leaders across the country to increase efforts to address root causes of disparities and promote a more just health system for everyone.

The first step in our collective efforts to address health inequity is to focus on the devastating impacts that COVID-19 has had on communities of color.

Engaging communities of color and community leaders enables us to identify ongoing disparities in access to COVID-19 treatment, testing and vaccines and begin confronting the dire state of health disparities in our communities.

Addressing today’s needs is only a beginning. In order to make real and lasting change, we must also ensure that our own houses are in order by enacting change at all levels within our organizations. We must build stronger partnerships with communities of color, listening carefully and engaging with them to participate in inclusive health care systems that truly respond to everyone’s needs. Equally important, we must leverage the influential voice and experience of the Catholic health ministry to advocate for the elimination of health disparities and systemic racism in our society.

Over the coming months and years, CHA will continue to work with the Catholic health ministry to broaden participation in this vital initiative and continue to strengthen our collective efforts to create meaningful change. We will endeavor to do all that we can to eliminate health inequity and create a just health system in our country.

We Are Called: Confronting Racism by Achieving Health Equity addresses the health and racial inequities of our time and dedicates us to advancing the common good. We have a centuries-long tradition to guide us on this journey, and we are uniquely positioned to help lead this contemporary mandate for justice. The Catholic health ministry was begun by religious sisters who came to this country almost 300 years ago, and we continue the mission of health and healing. We do this by ensuring a just health system where everyone matters and no one is left out.

We encourage all members and supporters of this effort to join with us and learn how you can also be part of this incredible community of people working together to promote the health and well-being of all.

Learn more, sign up and stay involved at www. wearecalled.org.

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FEATURES

CARING FOR THE CAREGIVERS

50 THE COVID CONUNDRUM SALLY J. ALTMAN, MPH 58 CLOSING THE LOOP WITH MINISTRY ASSESSMENTS BILL BRINKMANN 63 HOW TO STRENGTHEN CATHOLIC IDENTITY IN A DIVERSE WORKFORCE CHAD RAITH, PhD 69 COMMITMENT TO QUALITY AND SAFETY IS PART OF CATHOLIC HEALTH CARE’S MISSION JON POPOWICH and GORDON SELF, DMin

DEPARTMENTS 2 EDITOR’S NOTE MARY ANN STEINER 74 HEALTH EQUITY How to Advance Equity with Diverse Governance DARREN M. HENSON, PhD, STL 78 MISSION CHA Offers Resources on Care Provider Well-Being DENNIS GONZALES, PhD and CARRIE MEYER McGRATH, MDiv, MS 80 ETHICS Christmas, Ashes, Chrism and Choices BRIAN M. KANE, PhD

Illustrations by Cap Pannell 4 CANARIES DON’T BELONG IN COAL MINES Heather Schmidt, DO, Nicole Dewitt, MA, and Tom Bushlack, PhD 10 FINDING THE PANDEMIC’S HIDDEN HEROES Fr. Joseph J. Driscoll, DMin 14 WELL-LIVED MISSION INCLUDES MORE THAN PATIENT CARE Steve Tappe, MTS 18 SPACES FOR THE SOUL OF CARE Kathy Okland, RN, MPH, EDAC and Adeleh Nejati, AIA, PhD, EDAC 23 A MODERN-DAY PARABLE FOR THE PANDEMIC Michael Rozier, SJ, PhD, with introduction by Bruce Compton 26 CAREGIVING DURING CHALLENGING TIMES Ellie M. Hanson, MPH, LMSW 31 LONG-TERM CARE HOMES BRAVELY RESPOND TO COVID Sr. M. Peter Lillian Di Maria, O.Carm. and Shane Cooney

83 COMMUNITY BENEFIT To Reduce Disparities, Be Mindful of History and Reform Systems MICHELLE HINTON, MBA 85 THINKING GLOBALLY The Guiding Principles BRUCE COMPTON Prudence GEORGIA WINSON, MS, LCPC 88 AGE FRIENDLY We Owe Long-Term Care Workers a Debt of Gratitude and Our Support DOUGLAS R. EKEREN, MHA

30 POPE FRANCIS

36 JEANNE’S HANDS Lisa Picker

92 PRAYER SERVICE

40 HEALTH DISPARITIES AND PEOPLE WITH DISABILITIES Joan F. Peters, JD, MPH 48 REFLECTION: “I SEE YOU” Jim Smith

IN YOUR NEXT ISSUE

THE PANDEMIC AND FAMILIES

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EDITOR’S NOTE

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arely had Jesus called Peter and Andrew and the brothers Zebedee to leave their fishing nets behind when they gathered for a first meeting of apostles at the home of Peter.

The least important person in that household — the old mother-in-law — ordinarily would have served the men some refreshment, but, as Peter explained to Jesus, she was ailing with a fever. Jesus healed her and she immediately got up to serve them. The evangelist Mark, who recounts this event, is known for his abbreviated versions of the gospel stories, but this is particularly terse even for him. Two sentences, no dialogue, done.

The writer Joan Didion described her state of mind after losing her husband in a book she titled The Year of Magical Thinking. I would name the 12 months we’ve just lived through “The Year of Living Mutely.” Beyond my lapses on Zoom (“Mary Ann, MARY ANN you’re on mute!” or worse, “Mary STEINER Ann, mute yourself!”), I have felt, and often wanted to be, muted. I experience this in family and friends too. As much as we miss each other, some of us are hard-pressed to put words to what we’re feeling, thinking or praying. I keep handing things up wordlessly, wondering if maybe later I will find the words.

The caregivers who are tending the sick, the dying, the families and each other during the pandemic often have been profoundly muted. Professionally, they adhere to all the protocols and PPE that make communication with patients and families so difficult; and there’s so little time to rest and talk things over with colleagues. It has been even harder for them personally: what to tell the people who love you about the disease that could take you down; how many deaths you witnessed this week; how it feels to have your job on the line when you’ve already given so much; how close you are to cracking. Some of us were so moved by the nurse who explained this in a New York Times story, I thought you might want to see the video too: https://www.nytimes.com/video/ opinion/100000007578176/covid-icu-nursesarizona.html.

Just as Peter’s mother-in-law got up to serve the new apostles after Jesus healed her from her illness, we know many caregivers serve their patients, residents or loved ones with brief recoveries from their own illnesses, traumatic events, exhaustion and anxieties. We don’t know the

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mother-in-law’s motive or her expectation, only that she did it. Just as we don’t know as much as we should about the caregivers who are there for us in emergency departments, eldercare facilities, urgent care clinics, intensive care units, mental health crisis centers, and in the home care the people who love them give frail elderly, severely disabled or people with dementia. We do know they are there when we need them.

This issue of Health Progress explores how to take better care of the caregivers who fulfill the mission of Catholic health care. We have tried to unmute the conversations that need to take place about overly stressful working conditions and relief for caregivers in terms of regular breaks, respite spaces and channels to express frustrations and requests for help. There are important suggestions about self-care, but also a recognition that self-care only works when it is supported with strategic institutional commitment. In the pages that follow there are wonderful examples of how some of our members are doing exactly this: moving beyond recognition and gratitude to system-wide strategies to hear, respond and put firmly in place best practices for caring for their caregivers.

At this point in the Editor’s Note, I usually thank the authors who have provided the articles that raise important topics and expand our understanding. While I do that most gratefully here, let me also thank the many authors I’ve worked with over the years: so generous and insightful and courageous when offering honest critiques to the ministry they love and represent. I will be retiring from CHA at the end of April, so this is my last opportunity to write these things to you. Let me just tell you this: I have loved preparing these issues of Health Progress for the people of Catholic health care, and I have treasured your companionship along the way. Godspeed, I will miss you.

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VICE PRESIDENT, COMMUNICATIONS AND MARKETING BRIAN P. REARDON EDITOR MARY ANN STEINER masteiner@chausa.org MANAGING EDITOR BETSY TAYLOR btaylor@chausa.org GRAPHIC DESIGNER LES STOCK

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

2019 AWARDS Catholic Press Association: Magazine of the Year, First Place; Editor of the Year, First Place; Best Special Issue, Third Place and Honorable Mention; Best Regular Column, Second Place; Best Essay, First, Second and Third Place; Best Feature Article, Third Place and Honorable Mention; Best Reporting on Social Justice Issues, Third Place; Best Writing Analysis, First Place; Best Coverage of Immigration, Second Place; Best Coverage of Disasters, Second Place.

Association Media & Publications EXCEL: Best Special Issue, Bronze Produced in USA. Health Progress ISSN 0882-1577. Spring 2021 (Vol. 102, No. 2).

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

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Editor, Health Progress CHA seeks an editor for Health Progress.

As the principal architect of the content and quality of CHA’s journal, the editor is a thought leader in the Catholic health ministry. CHA advances the Catholic health ministry of the United States in caring for people and communities. Composed of more than 600 hospitals, 1,600 long-term care, and other health facilities in all 50 states, the Catholic health ministry is the largest group of nonprofit health care providers in the nation.

The editor sets editorial philosophy and strategy in collaboration with the association’s leaders, identifying current trends and related topics and soliciting the best experts from relevant fields to author material for publication. The editor is the public voice of the magazine and may make presentations to member and external audiences regarding issues and developments in the ministry and health care sector. The editor manages the journal staff; sets standards; writes and edits as needed; selects and directs the work of artists/illustrators and creates and monitors editorial calendars, production schedules, procedures, etc. Additional accountabilities include ensuring integration of CHA’s mission, goals, strategies and policies in HP editorial efforts, and contributing as needed on other communications projects of the association. Some travel may be required.

Minimum qualifications: Seven+ years in journal editing or publishing.

Three to five years in Catholic publishing or Catholic health ministry, yielding knowledge of Catholic teaching, tradition.

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Bachelor’s degree or equivalent work experience in English, communications, journalism or related field. Graduate-level work in Catholic theology and history an asset.

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CARING FOR THE CAREGIVERS

Canaries Don’t Belong in Coal Mines Taking Cues from Creation to Rethink Well-Being at Work

HEATHER SCHMIDT, DO, NICOLE DEWITT, MA, AND TOM BUSHLACK, PhD

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he phrase “canary in the coal mine” is used to describe an early warning signal for danger. The canary played an important role in both American and British mining history.

Coalminers took caged canaries into the mines with them to monitor for toxic gases.

When the canary showed signs of distress, miners took this as a signal to promptly leave the mine to avoid asphyxiation. While the practice was discontinued in 1986, the phrase is often used in health care when it comes to well-being and professional burnout. It leads us to ask the following questions: Do we toughen up the canaries to make them more resilient to the toxic environment? Or do we fix the coal mine to decrease the risk of harm to humans and canaries? In other words, is employee well-being a problem of individual resiliency, or is it a problem with organizational culture or with the health care industry as a whole? Or is it some combination of all three?

CANARIES DON’T BELONG IN COAL MINES

Professional burnout was first described nearly 50 years ago and is characterized by emotional exhaustion, a sense of reduced personal and professional accomplishment and feelings of cynicism and detachment from the job. Professional burnout in health care is far from a new phenomenon. The prevalence of burnout among health care workers is alarming and has been described by many as a national epidemic, impacting between 40% to 50% of doctors, nurses and other clinicians. Beyond their personal well-being, studies have shown that burnout negatively affects patient care, results in increased turnover, and is projected to exacerbate physician and nurse shortages.1 The canaries are no longer singing and yet, as an industry, we have not sufficiently heeded the warning signals of impending danger.

Risk factors for mental health concerns worsen

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during times of acute crisis or in response to prolonged stress. The COVID-19 pandemic presents challenges on both fronts. In a recent survey by the Kaiser Family Foundation, 51% of Americans thought the coronavirus pandemic negatively impacted their mental health, including 25% who felt the impact was major.2 The critical nature of the situation cannot be overstated. And yet, there is a bright spot. We are seeing a growing number of discussions about the importance of mental health in the workplace.3 As part of that discussion, we have an opportunity to rethink well-being at work.

Let’s move beyond the “canary in the coal mine” metaphor. Canaries don’t belong in coal mines. We find a better metaphor in Jesus’ discussion about how God cares for the birds of the air in the Sermon on the Mount and suggest we take these cues from creation in how we can rethink well-being at work.

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FINDING OUR WAY OUT OF THE COAL MINE

40,000 employees across four states; and we We imagine a future where our north star is not wanted to attend not only to the short-term crisis, just the absence of burnout, but the presence of but also prepare to care for employees who suffer well-being and flourishing. SSM Health estab- from more long-term stress and trauma.

As the crisis grew, we identified the need to lished an aspirational goal in 2017 to “be nationally recognized as the ministry where people address the psychological needs of our workforce. can reach their greatest potential and fulfill their We acted quickly to mobilize a Healthy Work and calling to serve others.” For people to reach their Wellness Steering Committee, which was a mulgreatest potential, the workplace must be an envi- tidisciplinary group with members from nursronment designed to promote health and well- ing and medical staff, human resources, mission, being. Finding our way out of the coal mine will wellness and various other support departments.

The steering team led the effort to identify the take time and concentrated effort.

In 2019, guided by the belief that our employees’ areas of greatest social, emotional and spiritual well-being matters, the SSM Health senior leader- needs and determine what our organization could ship team directed the development of a world-class wellness program. From Like health care workers its inception, the program was developed to avoid revisiting all the ways the everywhere, our employees were canaries (that is, our health care workvery worried about their safety, ers) have been told they just need to “toughen up.” Rather, the goal is to build and the topic of personal protective an innovative, system-wide effort that aligns with our mission and values and equipment (PPE) became part of is guided by evidence-based intervenevery conversation. tions and industry best standards. Our goal is ambitious — to make wellness the lens through which we approach all our work do to meet those needs in order to promote better as a ministry. In order to accomplish this goal, we health and well-being. The steering team leaned collaborated with the Harvard Lifespan Research on clinical, mission and human resources leaderFoundation to develop a best-in-class wellness ship for weekly pulse checks with staff to underprogram grounded in the science of healthy rela- stand workforce needs.

To gain further insight, we administered the tionships. Working with the Harvard Study of Adult Development (the 80-year-long multigen- AMA “Coping with COVID-19 for Caregivers” surerational study led by Dr. Robert Waldinger), we vey to staff at some hospitals in our system. Based conducted a needs assessment and developed a on staff feedback, the multidisciplinary wellness comprehensive plan. However, the emergence of steering committee worked with leaders in menthe coronavirus pandemic challenged us to rap- tal health, pastoral care and mission to develop interventions focusing on social, emotional and idly reconsider our approach.

When SSM Health’s Incident Command Cen- spiritual support. Interventions included increasters were staffed to respond to COVID-19, focus ing Employee Assistance Program awareness, was primarily related to safety and security. Like leader rounding and encouraging participation health care workers everywhere, our employees in SSM Health’s internal peer support program were very worried about their safety, and the topic known as Care for Caregivers. Additionally, a of personal protective equipment (PPE) became spiritual support hotline was set up, along with part of every conversation. We also needed to recorded webinars led by a trained mental health attend to the needs of those with a high poten- expert. A wellness care package was developed tial for exposure to the virus, such as families and and released monthly to highlight resources, prosupport staff. We wanted our support to be com- grams and health observances that were available prehensive, which led us to focus on financial, to all employees.

We also partnered with the Schwartz Cenemotional and professional safety. We needed fast, innovative action to support a staff of about ter for Compassionate Healthcare and quickly

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trained over 20 facilitators to hold virtual ing work schedule. We are now partnering with Schwartz Rounds. These rounds create a safe Volunteers of America to adapt their veterans’ environment in which health care professionals Resilience Strength Time program, and we are connect virtually with one another and discuss incorporating this model into our graduate nurse challenging experiences, offer and receive sup- residency curriculum. By introducing well-being port and decrease their sense of isolation. Unlike habits early in our nurses’ career development, other forms of rounding that focus on clinical or and by encouraging them to build intentional, ethical analyses of cases, Schwartz Rounds invite supportive relationships with colleagues, we are caregivers to discuss the social and emotional infusing support that will also sustain a long-term dimensions of providing care, to encourage mind- culture shift toward healthy work relationships, ful self-care and to practice compassionate care self-care and resiliency.

We have created a pilot program with the Harfor each other as colleagues and for our patients.

As one example, Kathy Geib, a nurse informati- vard Lifespan Research Foundation in order to cist who also volunteers as a wellness champion train “wellness champions” across our system. within the organization, said the Schwartz Rounds The next phase of this program involves trainelicit honest conversations on specific topics for ing wellness champions to spread word-of-mouth care providers during the pandemic. “It has given awareness of wellness resources, to build a supme an outlet for voicing my struggles, and to lis- port infrastructure to help share resources, and to ten to others’ struggles. The information is helpful advocate a holistic well-being mindset among all for me to better understand that I am not alone, staff. Our marketing team also has worked with and that there are clinically proven ways to help employees identified as having expertise in varimanage my feelings, and ultimately help with my ous facets of wellness to create a series of videos promoting “Peace in the Pandemic.” And misoverall well-being.”

We offered additional support by partnering sion leaders created podcasts during our annual with experts from the Harvard Lifespan Research Mission and Heritage Week. Podcast episodes Foundation to develop a series of mini-webinars focused on integrating spiritual practices, wellfor leaders on how to respond to and deal with common emotions like anxiety, anger, We are committed to shifting our grief, fear and guilt. We kept interventions health care system’s culture to short and practical, with plenty of time for conversation and questions, to ensure one that is supportive, aware and employees felt heard, appreciated and supported by their leaders and colleagues. inclusive.

“Lavender carts,” stocked with snacks, beverages and inspirational resources, were ness and connection to purpose. These media taken to inpatient COVID units to show apprecia- have been extremely well-received by our coltion and support for those unable to access other leagues and among members of the communities we serve. resources due to work schedule.

We are committed to shifting our health care system’s culture to one that is supportive, aware RETHINKING WELL-BEING AT WORK Over time we have shifted from an “all hands-on and inclusive. This has meant intentionally develdeck” approach to focusing resources on those oping an interdisciplinary network, and working interventions identified as the most effective directly with leaders in our Mission Integration and that have the greatest impact. For example, and Diversity and Inclusion departments. We have we found higher levels of engagement by offer- adopted a philosophy of wellness that is holistic ing unit-based Schwartz Rounds, as compared and personalized: one that is both grounded in our to the system-wide, drop-in, virtual model of spiritual traditions as a Catholic health care sysSchwartz Rounds with which we began. These tem, informed by the Franciscan charism of our unit-based Schwartz Rounds are integrated into a foundresses, and inclusive of people of all backdepartment’s scheduled meeting time, making it grounds. We know that a sense of belonging and easier to incorporate them into employees’ exist- inclusion is critical to ensure that all employees

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feel supported and believe they can thrive in our there is only one canary, working in an inherently organization. To do this we also need to shift the toxic coal mine. Our Catholic heritage insists that conventional thinking that wellness is only for human persons are radically social creatures. Our those in certain roles or of certain socioeconomic vision of the common good is not a simple model statuses or certain races, or that all wellness inter- of lone individuals influenced by their environventions will work equally well for persons from ments. Rather, the Catholic tradition offers a view diverse cultural backgrounds.4 We are challenged of human flourishing that recognizes how we are to create resources that will appeal to a diverse embedded in dense networks of complex, overworkforce from many cultural and religious back- lapping and interdependent relationships that in grounds. Healthy work and wellness is for all turn are embedded in the broader systems and environments in which we work, live and play. employees and all those we serve.

This theological vision is also congruent with One of our goals for 2021 is to reduce the stigmas that prevent health care professionals from the most significant finding of the Harvard Study seeking help — letting them know “It’s OK not to of Adult Development. Grounded in more than be OK.” The mission statement for SSM Health 80 years of research, the single greatest prediccalls us to “reveal the healing presence of God,” tor of long-term happiness and resilience is and we embody this by building a culture of healthy relationships, encouragAs a system, we are also able to ing being truly present to each other by practicing reflective and active listening, collect anonymous, aggregate promoting mental health awareness and data that will enable us to better integrating spirituality as an essential dimension of wellness interventions. understand our employees’ We are also leveraging the Well-being Index, developed by the Mayo Clinic, challenges and provide support which is a self-assessment tool with custhat is focused on areas of tomized resources. The tool is available for all employees, and they are encourgreatest need. aged to return and take the assessment at least once each quarter. Each participant receives immediate feedback and results that the individual’s perception of support through encourage self-awareness and suggest actions and healthy, quality relationships. Our goal, therefore, interventions to improve health and well-being. is to develop a network of inter-connected and As a system, we are also able to collect anony- engaged employees who feel supported by colmous, aggregate data that will enable us to bet- leagues and leadership, and where systemic supter understand our employees’ challenges and port is delivered quickly, easily and in real-time as provide support that is focused on areas of great- employees’ needs rise. est need. Results of the Well-being Index will be In the Sermon on the Mount, Jesus comforts monitored and shared with leaders and employ- his followers’ anxieties by inviting them to “Look ees over time to make sure our interventions are at the birds of the air; they neither sow nor reap effective. nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they?” (Matthew 6:26). Jesus reminds us that God TAKING CUES FROM CREATION Our first intuition as we set out to build a best-in- provides for all “the birds of the air” — indeed, class wellness program was informed by a belief for all of creation — and for each and every prethat our employees will thrive when we can sup- cious human person. We owe it to our employees port canaries while they are in the coal mine. This to build the most comprehensive and supportive basic intuition about focusing on both individu- wellness program that we can. Indeed, our goal is als and the work environment remains true, but to make wellness the lens through which we do all we have also seen the limits of the canary-in- our work as a ministry. If we can accomplish this the-coal-mine metaphor. In the classic scenario, goal, then we will have moved well beyond the

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debate between “tougher canaries” vs. “healthier coal mines.” Instead, just as God provides for the birds of the air in the natural environment where they are created to thrive, so too we are working to infuse our health care system with all the elements that will enable our employees to thrive in their “natural” environment. Our employees choose to work in the field of health care because they experienced a calling to care for patients and communities. Creating a best-in-class wellness program is not simply a matter of setting goals and measuring key performance indicators. As in all Catholic health care organizations, the healing ministry of Jesus lives through people. When our employees feel they are supported, just as God provides for the birds of the air, then they will be empowered to live their vocation and thrive as human beings doing God’s work.

HEATHER SCHMIDT is a family medicine physician in Fond du Lac, Wisconsin, and serves as the system medical director for Healthy Work and Well-being for SSM Health. NICOLE DEWITT serves as the system manager for Healthy Work and Well-being in Madison, Wisconsin. TOM

BUSHLACK serves as regional director of mission integration in St. Louis.

NOTES 1. Thomas P. Reith, “Burnout in United States Healthcare Professionals: A Narrative Review,” Cureus 10, no. 4 (December 4, 2018): https://dx.doi. org/10.7759%2Fcureus.3681.

2. Lunna Lopes et al., “KFF Health Tracking Poll – December 2020: COVID-19 and Biden’s Health Care Agenda,” Kaiser Family Foundation, December 18, 2020, https://www.kff.org/coronavirus-covid-19/report/ kff-health-tracking-poll-december-2020/.

3. Jeffrey Pfeffer and Leann Williams, “Mental Health in the Workplace: The Coming Revolution,” McKinsey & Company (December 8, 2020): https://www.mckinsey. com/industries/healthcare-systems-and-services/ourinsights/mental-health-in-the-workplace-the-comingrevolution#.

4. For a related resource, see the National Wellness Institute website, Multicultural Wellness Wheel, https://nationalwellness.org/resources/ multicultural-competency-in-wellness/.

QUESTIONS FOR DISCUSSION Heather Schmidt, DO, Nicole Dewitt, MA, and Tom Bushlack, PhD, are associates for SSM Health, a health care system that has taken a very proactive stance in caring for their caregivers who continue to give so much to people affected and threatened by the pandemic.

1. What do you think about the “canary in the coal mine” metaphor in relation to the people on the front lines in your health system? The authors also make a distinction between resilience (tougher canaries) and well-being (healthier coal mines). In terms of caregiver well-being, is this an either/or, a both/and, or a something else proposition?

2. Your ministry must have learned a lot since their initial response to the pandemic. Talk about what positive changes have been put in place as well as what areas still need attention in terms of how caregivers are at risk for infection, exhaustion or mental health problems.

3. The authors put a lot of emphasis on encouraging and enabling well-being in the workplace. How confident are you that your ministry will continue to put resources and staff to that priority? What do you think individuals can do to support the momentum? What do you think senior leadership needs to do to make it an ongoing priority?

4. Toward the end of the article, the authors point to 80 years of research by the Harvard Study of Adult Development that shows the number one predictor of long-term happiness and resilience is the individual’s perception of support through healthy, quality, interconnected relationships with colleagues and leaders. What does your system currently do to help caregivers feel safe, supported, connected and listened to so their concerns are quickly addressed? What are additional ways you can help caregivers flourish and thrive?

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The Pandemic’s Hidden Heroes FR. JOSEPH J. DRISCOLL, DMin

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very day, every night, pictures of doctors and nurses in personal protective equipment, interviews with alarmed emergency department physicians, and heart-breaking stories from weary ICU nurses are featured in the media.

And then when it seems we just can’t take any more, the pictures of patients wheelchaired down hallways lined with the same heroic caregivers applauding a needed good-ending story.

And these doctors and nurses are our heroes, always have been, and always will be.

But something is missing; no, some ones are missing.

The other heroes at the back, in the left and right corners, behind closed doors, even in the basement. All fighting the same pandemic with skill sets just as indispensable and protocols just as integral to the healing process. Environmental services, maintenance, transport, food services, laundry, registration and security.

The technology not only in respirators, surgical instruments and pharmaceuticals, but sterilization, safety, security and information services.

The compassion and commitment not only from those leading and speaking from the center, but the compassion and commitment from those working quietly and diligently from the back and on the sides.

THE DIRECTION OF JESUS’ EYES

Why is it so important that as a ministry we look in the back, to the right and left corners, to those not in the front and center? Because Jesus did.

His eyes were always searching for the good people, who labor and are burdened and yet are hidden from plain view (Matthew 11:28).

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His eyes looking from the Pharisee up front, center stage and public in his prayer, to the tax collector in the back of the Temple, barely whispering, who stood off at a distance and would not even raise his eyes to heaven (Luke 18:9-17).

Jesus saw his goodness and brought him and his humility out of the shadows.

Another time, his eyes looking as he sat opposite the Temple treasury, Jesus saw rich people putting in large amounts in front of everyone while way to the side a poor widow shyly dropped two little copper coins all she had, her whole livelihood (Mark 12:41-44).

Jesus saw her goodness and called his disciples over to see genuine generosity hidden in the corner.

His eyes looking up a tree spotting Zacchaeus, a hated tax collector, determined not to let his small stature deprive him a view of this Jesus.

“Come down quickly,” Jesus demanded, adding, “for today I must stay at your house.”

Jesus saw his goodness and was equally determined to raise this man’s moral stature above the muttering, he has gone to stay at the house of a sinner (Luke 19:1-10).

Jesus too had a so-called hidden life until he emerged out of the waters of the Jordan River at his baptism with visibility: the heavens being torn open and the Spirit, like a dove, descending upon him, and a voice: You are my Beloved Son (Mark 1:9-11).

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This Jesus no longer hidden unseen, no longer silent unheard. His eyes searching for those in the back, behind the porticos of the Temple; his eyes turning to the edge of the seashore and looking to the sides of the road — seeing goodness and speaking God’s glory.

THE DIRECTION OF THE MINISTRY’S EYES

ward to coming in and seeing them get bigger and bigger. “Those parents were so joyous,” she says.

She admits that the pandemic was frightening at first, and even with all the reassurances and safety protocols she felt unsure. “And then one day I thought, ‘I’m making a difference’ and then I was not afraid. I’m going to keep that place clean and safe for those babies.”

Ron has spent 47 years in food services cooking meals for residents and patients in various settings. “You know we say here that we ‘care, comfort and heal’ — yeah, that’s our saying. Not sure how I do it.”

He pauses and thinks a moment. “Well, maybe it’s like when I cook myself a good meal, filling my belly and afterward, I feel comfort. Yeah, maybe that’s how I do it.”

He is laughing, pleased with himself. Well, truth be known, yes, a belly laugh, at his own onthe-spot reflection on the mission.

The challenges of the pandemic affect his area in many ways. The masks and a lot of the little things that make work a little harder. “The work force is down, but you pick it up a notch. I try to help my fellow workers where I can.”

Fear of the virus? “No,” Ron declares assuredly,

Why is it so important that as a ministry we point out those working in the back, laboring in the right and left corners, unseen among the seen in the center? Put simply, in doing so we live Jesus’ ministry of making visible the once invisible, making heard the previously unheard.

In the frame of Catholic Social Teaching, human dignity is measured with visibility and voice.

Johnnie Mae is starting her 51st year in the laundry at a skilled nursing facility down in the basement. She puffs with pride as she recounts hearing the elderly woman with dementia announce day after day the coming of “that laundry girl.” Johnnie Mae beams, “I turn around and it makes me feel good. It is beautiful to be recognized.”

Worried about the pandemic? “No,” she says, “at my age I can catch it, but I wear my mask and a shield. And besides I’m not afraid.

God is looking after me. I’ve come “And then one day I thought, ‘I’m this far, he ain’t gonna leave me.” making a difference’ and then I was Jim, in his 36th year in maintenance at the hospital, speaks of not afraid. I’m going to keep that place the changes brought about by the pandemic. clean and safe for those babies.”

“I’ve taken on the task of break— SHENEKA ing down walls in at least 100 rooms creating ducts for ‘negative air,’ sucking it out so people are safe and the virus “God has a plan for all of us. If God calls, he is doesn’t spread.” Sometimes working 14-hour going to call you, pandemic or not.” He adds, “I days, always careful to protect “my guys” so that pray for my fellow co-workers though.”

Johnnie Mae, Jim, Sheneka and Ron, no lonthey don’t get the virus.

“It’s a special place and I’m here for a reason.” ger hidden unseen, no longer silent unheard. The Repeatedly, and with conviction, he speaks of ministry’s eyes seeing goodness and speaking respecting the patients. “I go into a room and I God’s glory. pretend they are my family. I don’t care who they are, I’m there for them.” The word “respect” is THE DIRECTION OF THE PATIENTS’ EYES important for Jim. He uses it to describe how he What else happens when a ministry looks toward treats others, how he hopes people look at him, the back, to the right and left corners, to those not and how he does his job. front and center?

Sheneka is proud of her five years in environIn the frame of Catholic Social Teaching, the mental services and her promotion two years ago common good is measured with participation and to the NICU. “I make sure that unit is clean and solidarity. sanitized. Every day I come bringing in my bright Our residents and patients are flourishing attitude and glossy smile.” because behind the closed doors of rooms, and Her voice rises with excitement speaking of around the corners of the hallways, and in the the birth of triplets so tiny and how she looked for- porticos of chapels and meditation rooms, even

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CARING FOR THE CAREGIVERS crowded elevator assembly areas, our residents and patients are experiencing goodness and, as Jesus would point out, God’s glory.

Ron relates a time he came off the elevator from the kitchen area and found himself surrounded by waiting wheelchairs, all the residents’ eyes on him, thinking “What the heck?” And then they ask him, “What’s for lunch?” “What would you choose?” “Did you make the meatloaf yourself?”

“I was the only one they wanted to speak to.

And I saw all these eager faces looking to me, and I felt joy.” He pauses and you can tell he is tearing up, then he says, “Yeah, I’m feeling the tears.”

Participation is human flourishing. The feeding of the five thousand in Jesus’ story (Matthew 14:13-21); the feeding of the crowd of residents in the ministry story, the long-term care setting where Ron works.

“I love the people. I wouldn’t give up this job for all the world,” says Johnnie Mae, who works in Environmental Services. She goes on to talk about one resident, Ruth Ann. “She doesn’t have many visitors, so my girlfriend and I come and visit her.

We buy her stuff at Christmas, you know. We are all together here.”

We are all together here.

Solidarity is human flourishing. The compassion in Jesus’ one-on-one encounters in Jesus’ story; the compassion in one-on-one encounters in the ministry story.

CONCLUSION

Ministry leadership is as much sitting around the cafeteria table as pulling up a chair at the board table. True ministry calling is as much listening to one worker in the basement as speaking to an assembly from the auditorium podium.

The always-central, ever-challenging question at the heart of what we call Catholic identity: what makes us distinctive?

Perhaps it is the direction that we focus our attention. Perhaps it is the direction of our eyes.

Perhaps it is the direction of the eyes of Jesus in the gospels becoming the direction of our eyes as a ministry, my eyes as a ministry leader.

Or more importantly, the direction of the eyes of all people — looking toward, and listening to, the faces and the voices that are no longer invisible, no longer unheard.

And perhaps, in the so-called hidden life of our co-workers becoming visible, we will see the heavens being torn open and the Spirit descending like a dove.

And the voice now heard —the world acclaims them as heroes — the Father proclaims them as Beloved–sons and daughters.

FR. JOSEPH J. DRISCOLL is director of ministry formation and organizational spirituality, Redeemer Health in Meadowbrook, Pennsylvania.

QUESTIONS FOR DISCUSSION Fr. Joseph Driscoll, DMin, director of ministry formation and organizational spirituality at Redeemer Health in Pennsylvania, directs our gaze to the other health care heroes of the pandemic, asking us to seek them out in the backgrounds and off to the sides. While they’re perhaps not likely to be featured on the nightly news or serve as spokesperson for their health care system, these are the health care workers who keep the frontline functioning and the patients safe.

1. Throughout his article, Fr. Driscoll invites us to look through the eyes of Jesus to find the goodness and worthiness of the people around us. How effective do you feel his lines from Scripture are in identifying the people in our workplaces who show similar qualities? Do you have any ideas for how we can train our eyes to look beyond the front and center to better see all those working to make a difference in health care?

2. What did you think of the dialogue spoken by Ron the cook, Johnnie Mae of laundry, Sheneka of environmental services and Jim of environmental services about the respect they deserve and the pride they take in their work? How genuine did it sound? Do you think they get asked those questions very often?

3. What specific practices of communication and recognition are in place to acknowledge and thank your ministry’s hidden heroes? Can you think of other ways to maximize the communication between them and the people they care for? Or how to maximize opportunities for management to participate in such exchanges too?

4. Name some of the hidden heroes in your ministry. Recall the last time you spoke with them and how they embody the mission and values of your organization. Are there ways you can elevate their stories so they are celebrated too?

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Well-Lived Mission Includes More Than Patient Care STEVE TAPPE, MTS

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outh Dakota made some inauspicious lists last year. In April 2020 we were the site of the largest COVID cluster outbreak seen in the country at that time. In September we experienced the highest per capita surge in the country. Through the course of the pandemic, we are second in the nation in total COVID-19 cases per 100,000 residents. All of which is to say, COVID has hit the Avera Health system hard.1 Avera Health is 19,000 employees strong, including 1,200 physicians and advanced practice providers. In addition to our large virtual presence, we have hospitals, clinics, long-term care and home care in South Dakota, Iowa, Nebraska and Minnesota. We were co-founded by the Benedictine Sisters of Yankton and the Presentation Sisters of Aberdeen. Our rural roots run deep, and COVID has touched our people’s lives in community after community.

COVID’s impact on patients and families was hard to miss. But we could also see the impact of the virus on our caregivers. We knew they were working extremely hard, with incomplete information and a great deal of uncertainty about the future. Not that they had a choice; we were in a global pandemic and needed everyone. We realized that this pace couldn’t be sustained, and very early on we began to worry about the well-being of our caregivers both in the moment and after the surge.

We worried about what happens when the pace slackens and we have time to think about what we’ve seen and done. Or, more importantly, the things we have been unable to do. Nurses and physicians became proxy family members. They

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experienced so much death, and despair was often their unwelcome companion.

You don’t work in a clinical setting in health care without being familiar with death. It is, after all, the natural outcome of every life. But not death this way. Not this much death. Not death suffered in alienation from those most important to them.

And our caregivers bore witness to all of it.

MISSION HELPS GUIDE RESPONSE

As we recognized the burden our people were under, we let the mission dictate our response. In health care generally, the focus is on the patients and communities we serve. Avera’s mission statement reads, in part: “Our mission is to make a positive impact in the lives and health of persons and communities …” Taking care of patients is intuitive. We don’t really have to remind someone to take good care of a patient. What is perhaps less intuitive throughout health care is the need to care for all who work to carry out this ministry.

From the orientation process, through mission formation, leadership development and physician formation at Avera we stress this: The mission doesn’t start and stop with patients. Our duty to live the mission applies just as strongly to all of

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us who work for Avera as it does to the patients cal and physician leaders, the decision was made we serve. Bob Sutton, Avera’s president and CEO, to temporarily close many of our clinics and to sees it as his duty to live the mission with all the cease elective surgeries. These were very difficult people who serve in our system. We must posi- and consequential decisions that would greatly tively impact our patients, communities and employees.

Our challenge was to balance This foundation has been indispatient care, care for our frontline pensable for us throughout the pandemic. All along we knew we had to workers who have been heavily positively impact employees as they battled this virus. Our challenge was to burdened, and care for all our balance patient care, care for our frontemployees who missed out on line workers who have been heavily burdened, and care for all our employa year’s worth of life events, ees who missed out on a year’s worth of life events, celebrations, time spent celebrations, time spent with family with family and a hundred other things. and a hundred other things.

How could we bring peace and hope in a season of tumult and despair?

We cared for our people in a number of ways, impact our patients and communities, some peoall of them motivated by our mission to make a ple’s compensation, as well as the organization’s positive impact in people’s lives and our ethical bottom line. But, they were the right decisions and in keeping with our mission. Despite the heroic obligation to be who we say we are. efforts of our supply chain folks, we feared there would not be enough personal protective equipSOLIDARITY Physicians have been at the leadership table for ment (PPE) to protect our people. And so the many, many years at Avera. The strength of those hard, but right, decisions were made. The mantra ongoing relationships paid dividends during the became, “Keep doing the next right thing.”

Inevitably, the financial situation was not great. most stressful months of the pandemic. Very early on during an incident command call, when faced Leaders were the first group to step up and take with one of the myriad unprecedented decisions, pay cuts. Eventually, we asked the same of physiSutton looked to the physicians and said, “This is cians and advanced practice providers. We even a clinical decision. We need you to tell us what to relied on service line physician leaders to deterdo here.” That set the tone for having a fully inte- mine the appropriate compensation adjustment. grated command structure where physicians led All along we were open and transparent about the financial situation of the organization. With all alongside administrators.

We also increased the frequency of communi- the information available to them, health care procation. We began hosting weekly town hall phone viders responded gracefully, and we shouldered calls with our medical group. Prayer and mission the financial burden together.

We had open discussions about solidarity and were always the first two items on the agenda.

This was followed by an update on our system: truly stood together as one Avera. We are proud bed counts, trends, surge plans and so forth. The that we were eventually able to repay our providcalls included physician leaders, supply chain, ers for their lost productivity and reduced comclinical specialists and others who spoke to the pensation. When the CARES Act dollars came needs of the day. Even if we didn’t have much through, it was our frontline workers we took care good news to share, we still shared what we knew. of first.

Transparency is hugely important at Avera, and caregivers appreciated knowing as much as pos- LISTENING sible while we navigated our way through this One of the most important things we did was uncharted territory. listen to understand. When people are experiIn conjunction with our service lines and clini- encing illness or suffering that we are unable to

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ameliorate, one of the best things we can do is lis- were quite literally risking their lives and giving ten to their experiences and understand that they everything they had to fight this virus and take are suffering. People want to know that you see the best possible care of patients. And then they what they are going through and that you care that would have to go home and explain to friends, they are going through it. No one expected that community members, and even family why it is we could remove their burdens or make COVID so important to mask and socially distance. Often disappear. But, we did need to see and understand those explanations and pleas fell on deaf ears. It what they were experiencing. was exhausting and infuriating. Health care has We listened through purposeful rounding, typically (and rightfully) been hailed as heroic surge plan calls, town halls, service lines and and caring and worthy of respect. In many of our many other venues. It was powerful to simply communities, as politics wormed its way into scihave our administrative leaders be present on the ence, this ceased to be the case, and many of our floors and in the clinics as they opened back up. caregivers felt they were fighting a war on two You didn’t have to look very far to see how unbe- fronts. lievably busy the floors were and how hard people Leaders who had been rounding regularly durwere working. ing this time heard these sentiments loud and We regularly delivered treats and practical clear. They stood up for our caregivers in encouritems in our hospitals and clinics. These were dis- aging mask mandates and really trying to comtributed to any employees we saw. The message municate to our elected leaders and the public was always the same: We see you, we know how at large how serious and devastating the virus is. hard you are working, and this is a small expres- Did it change hearts and minds? Honestly, probsion of thanks. We would engage and listen to sto- ably not many. But our leaders worked very hard ries and see the tears. The impact it had on both to do what was right, and our caregivers noticed. our frontline workers as well as those doing the We also realized early on the ethical challenges rounding was powerful and humbling. we might be confronted with. We responded by We also allowed time and space for employ- creating allocation resource teams consisting of ees to talk about their experiences. In a multitude of venues we asked some We regularly delivered treats and simple, powerful questions: What has been hardest for you? What have been practical items in our hospitals and the silver linings for you? What are clinics. These were distributed to you hopeful about? I will never forget some of the answers. One of our any employees we saw. The message providers lost a parent in the hospital and didn’t get to say her final goodwas always the same: We see you, byes. Tears and vulnerability were we know how hard you are working, common as people gave voice to their experiences. and this is a small expression of There were moments that caused us to rethink how we live and work, thanks. too. In health care we work long and hard hours and often it is a point of pride with physicians, nursing leaders, mission leaders and us. Outside of work, our lives were also busy administrative leaders in each of our regions. with activities and commitments. The pandemic These teams would be there to support and help allowed many of us to spend quality time with our make difficult decisions should we run out of families without distraction and without having beds, or ventilators, or staff. to rush off to the next thing. We hope this leads to We conducted scenarios and tabletop exera better work-life balance for all of us. cises so the teams would be as prepared as possible. We made sure our physicians knew the teams were in place. Being on one of these teams was DO THE RIGHT THING Most of us who lived through this last year are well not comfortable. Essentially, you were tasked with aware of the political challenges. Our employees ethically deciding who stayed in the hospital and

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who went home to die. For me, it was the worst part of the pandemic. Terrible and uncomfortable as it was, it was the right thing to do. I thank God we never had to call those teams into action.

live and work in solidarity with them, and we will keep doing the right thing, even when it’s the hard thing.

STEVE TAPPE is vice president of mission, Avera Medical Group, in Sioux Falls, South Dakota.

HOPE

In the beautiful Canticle of Zechariah we read, In the tender compassion of our God, the dawn from on high shall break upon us, to shine on those who dwell in darkness and the shadow of death, and to guide our feet into the way of peace.

In the darkest days of the pandemic when we asked people what they were hopeful for, the most common answer was a vaccine. If you’ve been to a vaccine distribution site, it certainly feels like a new dawn. It feels like darkness is being chased away. People are together, there is laughter, there is hope, and there are often people sitting in their cars crying their eyes out with joy and relief.

This pandemic has been remarkable for a multitude of reasons, but particularly in that it has left no one unaffected. Literally every single person has been impacted. This forced solidarity may well be the thing that brings us through. The fear, the stress, the trauma, the uncertainty were not experienced alone. They have been shared by our colleagues.

Even though we have shared many of these experiences together, the effects of the pandemic will linger like a struck chord. There is post-traumatic stress, there are feelings of failure, there is grief and there is loss. But the mission of Catholic health care will continue. We must not and cannot fail our caregivers. We will listen to understand, we will be open and vulnerable together, we will

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NOTES 1. South Dakota was second in the nation behind North Dakota in total cases per 100,000 residents at 12,353. It was sixth in deaths per 100,000 at 204. “Coronavirus in the U.S.: Latest Map and Case Count, (updated frequently), https://www.nytimes. com/interactive/2020/us/coronavirus-us-cases. html?_ga=2.144274293.1357127005.15988996542049456945.1594308232#states.

The 518 employees and 126 non-employees connected to Smithfield makes it the largest cluster in the country at 644, according to tracking by The New York Times. The previous top cluster was 585 cases aboard the USS Theodore Roosevelt in Guam. Lisa Kaczke, “Smithfield Foods Now Largest Coronavirus Hot Spot in U.S.,” April 15, 2020, https://www.argusleader. com/story/news/politics/2020/04/15/cdc-siouxfalls-smithfield-foods-becomes-largest-coronavirushotspot-us/5138372002/.

South Dakota surpassed 3,000 active COVID-19 cases while becoming the state with the highest per capita surge in the nation, according to nationwide tracking

by The New York Times. Iowa and North Dakota follow the state in hot spot rankings. Morgan Matzen, “South Dakota Is Nation’s Top Hot Spot for COVID-19, Rapid City Journal, Sept. 3, 2020, https://rapidcityjournal.com/ news/local/state-and-regional/south-dakota-is-nationstop-hot-spot-for-covid-19-2-143-test-positive-in/ article_95b61179-005e-5f57-ad4b-f866dbc324ad.html.

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CARING FOR THE CAREGIVERS

Spaces for The Soul of Care KATHY OKLAND, RN, MPH, EDAC AND ADELEH NEJATI, AIA, PhD, EDAC

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OVID-19 has laid bare the finite capacities of resources to care for our communities and our country, not the least of which is the very capacity to care. Providing care is physically and emotionally demanding, which is why it’s essential that health care systems provide staff with places to recharge and find renewed peace for the soul. These spaces are essential for health and the health care workforce.

The pandemic not only exposed but exacerbated many of the vulnerabilities of the health care system and those who deliver its services.

Often, nothing has been done about it. As we confront the greatest health care challenge of our time, there’s a compelling conversation to be had about how health care systems can create spaces that allow staff to have separation and solitude from stressors. Health care workers have stories of retreating to a corner in the cafeteria, their car or a bathroom stall to gather themselves before resuming the remainder of their shift. This experience is shared by physicians, technicians, therapists and nurses alike.

While any health care worker can experience stressors, the pandemic also has raised the visibility of nurses and their capacity to care for patients in a climate of sustained surge, unprecedented supply shortfalls and immense emotional toll. Nurses make up the largest part of the health care workforce in the U.S. and globally, and it has been recognized that nurses play a vital role in improving health outcomes around the world.

What has not been widely addressed is how the design of the work environment can contribute to nurse well-being. It is important to note that pre-pandemic, nurses were already stressed, under-resourced and exhibiting signs of fatigue and distress.

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THE DILEMMA

According to nurse leaders, the emotional health and well-being of staff are among the top three challenges of the pandemic.1 Sixty-six percent of nurses worry that their job is affecting their health.2 By some estimates, clinicians account for nearly 20% of the COVID-19-infected cases in the United States.3 In July 2019, the World Health Organization formally designated burnout as an occupational phenomenon, not a medical condition. While awareness of this situation has increased, there has been little done to provide designated areas for retreat and relief for those affected.

There is reason to celebrate the attention given to mindfulness, meditation and massage chairs, yet little consideration is being given to the physical settings for respite and how they are appointed in support of emotional and physical comfort and recovery. The root cause, contributing factors and means to address fatigue and burnout are complex. No single process or design intervention will produce significant, sustained results. Without areas designed and devoted to decompression and rest, individuals caring for others will not have the opportunity to be at their best. It is for that reason we wanted to examine the past and present dilemma, what current research reveals and actionable insights that sup-

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port places for restoration in health care environments today.

THE DATA

provide oversight to care. Results indicated that the majority (63.6%) of nurse leaders also suffer from a stress level of 7 or higher. Taking a walk was the main activity nurse leaders mentioned as a way to relieve stress in their work environments. The main feature of an ideal break room was stated as being “quiet.” The nurse leaders requested a high level of privacy (from patients and families) for outdoor break areas in order to have a restorative effect. When asked to identify a single element to improve break room utilization, nurse leaders responded that nurses needed enough time to take breaks. Asked to identify the single greatest barrier preventing break room utilization, their response was the same: not having enough time to take breaks.

Convenience is key to nurses for any spaces they use at work. Whether they visit a conventional break room with lockers, a lunchroom and rest room — or an idealized respite room designed for privacy, views of nature and close to their patient assignment — both require considerations for COVID-19. To protect health care workers from infectious disease transmission, planning for their entry and exit is important. Masks, goggles, gowns and respirators are standard, with

Health care facilities are one the most stressful work environments for their employees, and this is especially true for nurses. Hence, one of the concerns of current health care research is how the needs of nursing staff can be better incorporated into the design of health care environments.

Identified as the first controlled study at Legacy Emanuel Medical Center in Portland, Oregon, researchers investigated the influence of taking work breaks in a garden on nurse burnout. The impact of nurses taking daily work breaks in a hospital garden was shown to reduce burnout and feelings of anger and tiredness. The garden outperformed quality interior break rooms, and the study supported taking a break in a hospital-integrated garden as part of a multi-modal approach to reduce burnout for nurses.4 A 2015 study of more than 1,000 medical surgical nurses in the United States showed that the majority (68.1%) of nurses suffer from a stress level of 7 or higher on a scale of 0-10. Taking breaks was mentioned as the main activity nurses did within their work environment to relieve stress. The results indiTo protect health care workers cated that staff break areas are more likely to be used if they are in close from infectious disease proximity to nurses’ work areas, offer transmission, planning for their complete privacy from patients and families, and provide a mixture of entry and exit is important. Masks, opportunities for individual privacy goggles, gowns and respirators and socialization with co-workers.

Having physical access to private outare standard, with some variation door spaces (for example, balconies or porches) was shown to have a sigbased on an organization’s specific nificantly greater restorative effect in infection prevention policy. comparison with window views, artwork or indoor plants.5 In 2020, the coauthors of this article, supported some variation based on an organization’s specific

by Chief Nurse Executive, National Patient Care infection prevention policy. Practical considerServices, Linda Knodel with Kaiser Permanente, ation must be given to accessible and individualreplicated that study of designing staff restor- ized storage for personal protective equipment ative environments in health care facilities with (PPE), both single-use (requiring disposal) and nurse leaders from the of American Organization re-use that may require cleaning, disinfecting, for Nursing Leadership (AONL) and the Nursing drying and hanging. For battery-powered proInstitute for Healthcare Design (NIHD).6 Repli- tection devices, power receptacles for rechargcating the study provided the opportunity to com- ing and/or battery packs need to be considered. pare and contrast perspectives of practicing bed- For respirators, canister and filter availability is side nurses and nurse leaders who manage and essential. This suggests that whether retrofitting

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existing space or designing for new construction, The concept focuses on the connection even support spaces for rest and retreat require between the human mind and body, and how to careful consideration and planning. Astute plan- optimize health through design technology and ners will seek out evidence-based research that treatment strategies. After reviewing recent supports the complexities inherent in health care planning and design.

Preventing nurse burnout and The majority of the nurse leadrecovering from workplace stress ers reported that high-quality break spaces were “fairly” or “very” imporrequires supportive policies and tant for increasing nurses’ job satisfaction (85.6%), increasing nurses’ job perprograms to ensure that nurses formance (83.5%), and alleviating their have appropriate breaks, as well work-related health concerns (72.9%).

We asked nurse leaders, now with the as health-promoting respite areas COVID-19 experience, if the need for break and respite accommodations to make sure those breaks are is more important to them. The great restorative and refreshing. majority of them (80%) reported that the need for a staff restorative environment is even more important than ever before. empirical evidence and its incorporation in leadFurther analyses showed that the perceived ing industry guidelines and standards, it is time to level of stress in the work environment was a sig- put research-informed ideas into action and intenificant predictor of the importance that nurse grate innovations into the design of staff restorleaders assigned to break areas. In addition, when ative environments. nurse leaders took more restorative breaks themselves, they were more likely to emphasize the DEMONSTRATING THE DATA importance of high-quality break areas. Nurse Preventing nurse burnout and recovering from leaders who viewed their current break spaces as workplace stress requires supportive policies and unsatisfactory strongly believed that improving programs to ensure that nurses have appropriate these areas would be of benefit to nurses’ health breaks, as well as health-promoting respite areas and well-being, especially given their experi- to make sure those breaks are restorative and ence from the pandemic. It is the belief of the refreshing. The critical factor is having an interesearchers (and authors), that raising awareness grated platform of policies, programs and enviabout spaces for rest for nurses will do the same ronmental design interventions. Without doubt, for other care team disciplines involved in the health care providers have been experiencing patient and family experience. Other than the “on incredible burdens due to COVID-19. However, call sleep room” or the chapel (if the facility has there are stories from the pandemic of places that one), few spaces exist to support quiet and private have created spaces to reduce stress and burnout environments for retreat and renewal. among health care professionals.

For the first time, a building standard acknowlTo promote the well-being of health care staff, edges supportive policies and environmental Kaiser Permanente proposed relaxation areas in features for staff restoration as part of their rat- their medical centers. Executives were asked to ing system. The WELL Building Standard is an identify available spaces including family/visitor evidence-based system for measuring, certify- waiting areas that were not being used during the ing and monitoring the performance of building pandemic. They were also asked to furnish these features that impact health and well-being. This areas with dimmed lighting, calming music, arostandard includes restorative opportunities, pro- matherapy, healthy snacks and massage chairs.8 grams and spaces as part of their “Mind” concept, When COVID-19 hit New York City, David which aims to promote mental health through Putrino, director of the Rehabilitation Innovapolicy, program and design strategies to address tion Lab at the Mount Sinai Health System, conthe diverse factors that influence cognitive and verted his lab into recharge rooms for front-line emotional well-being.7 health care workers. His focus is how technology

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can help human health and well-being. In these recharge rooms, he started by adding artificial plants that create a cocoon-like natural surrounding for a person. Beautiful images of natural scenes were projected on the walls with added music and aromatherapy. A survey revealed that 15 minutes in a recharge space across 146 visits resulted in, on average, 65% reduction in stress.9 At Dignity Health Marian Regional Medical Center in Santa Maria, California, clinical educator Sarah Phillips created two relaxation rooms for fellow staff to have spaces of respite and quiet during these stressful times. The spaces are filled with items from Sarah’s home and community donations. Located directly across from critical care, they are quiet with low light and include greenery, aromatherapy, relaxing white noise, massage chairs and inspirational reading materials. The rooms have had significant use by staff since being created. 10 Armed with the awareness that human behaviors are influenced by the physical environment, that rest equals restoration, and that research supports both, what are the next steps to create the climate and conditions for rest?

First, observation and evaluation. Tour the areas deemed for break and respite in their current state. Ask staff where they go to decompress and/ or make sense of difficult days. Pause and consider the characteristics of those environments.

Do they align with the research findings that call for quiet, private areas with natural light? If so, listen and challenge any assumption that locations for renewal require significant renovation, reconstruction or even its own room. Rethink real estate, then innovate.

Second, a perfect place for health care workers to rest without policies, programs and a philosophy behind it is doomed to fail. Leadership advocacy and support is as essential as the need is to destress itself.

Finally, who is supporting the needs of caregivers? If spaces for rest were conceived of as an intervention for them, would they be supported and designed differently? Further, this work is more than solving a problem. What if instead, it is viewed as serving people’s souls? Would design decisions for these spaces be philosophically and financially supported?

For health care professionals to be at their best,

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there must be available resources for their rest and recovery — that which supports caregivers supports patient outcomes. Creating healing environments and places for respite are critical preconditions to providing healing for patients and families and for those who care for them.

KATHY OKLAND is a nurse and health care consultant interested in the influence of the environment on patient and caregiver experience. She lives on Spirit Lake, Minnesota. ADELEH NEJATI is an associate principal, health care planner and researcher with HMC Architects in San Francisco.

NOTES 1. American Organization of Nursing Leadership and Joslin Marketing, “Nursing Leadership COVID-19 Survey Key Findings,” August 4, 2020.

2. AMN Healthcare, “2019 Survey of Registered Nurses: A Challenging Decade Ahead,” November 12, 2019.

3. Tinglong Dai, Ge Bai and Gerard F. Anderson, “PPE Supply Chain Needs Data Transparency and Stress Testing,” Journal of General Internal Medicine 35, no. 9 (2020): 2748-49.

4. American Hospital Association, “Hospitals and Health Systems Continue to Face Unprecedented Financial Challenges Due to COVID-19,” June 2020.

5. Makayla Cordoza et al., “Impact of Nurses Taking Daily Work Breaks in a Hospital Garden on Burnout,” American Journal of Critical Care 7, no. 6 (2018): 508-12.

6. Adeleh Nejati et al., “Restorative Design Features for Hospital Staff Break Areas: A Multi-Method Study,” HERD: Health Environments Research & Design Journal 9, no. 2 (2016): 16-35.

7. International WELL Building Institute, “WELL Building Standard v2,” last modified 2020, https:// v2.wellcertified.com/wellv2/en/overview.

8. Kaiser Permanente, Care for the Caregivers’ Relaxation Rooms, 2020 Draft Proposal.

9. Minyvonne Burke, “Coronavirus Stress Among Hospital Workers Leads to Creation of ‘Recharge Rooms’” NBC News, July 22, 2020, https://www.nbcnews.com/news/ us-news/coronavirus-stress-among-hospital-workersleads-creation-recharge-rooms-n1234607.

10. Dignity Health, “Dignity Health Central Coast Nurse Creates ‘Relaxation Rooms’ to Offer Respite to Health Care Staff,” April 9, 2020, https://www.dignityhealth. org/central-coast/locations/frenchhospital/about-us/ press-center/2020-04-09-relaxation-rooms.

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TWO NEW RESOURCES!

Considering a Modern-Day Parable for the Pandemic BRUCE COMPTON

A 5th Anniversary Edition of the Guiding Principles Includes a ModernDay Parable for Pandemic

Renewing Relationship Essays as we Evolve and Emerge from Pandemic Includes essays from Cardinal Peter Kadwo Appiah Turkson, President of the Pontifical Council for Justice and Peace, former USAID Administrator Andrew Natsios, and many more global health leaders

ACCESS THEM AT CHAUSA.ORG/ GLOBAL-HEALTH

O

ur world seemingly got smaller as isolation, border closings and the need to slow the spread of COVID-19 took hold. For global health partnerships, the impact has yet to be fully realized. With passports packed away and medical mission trips cancelled or postponed, it may seem as though nothing was happening. However, there is good news to report as well as some realities to consider.

Thinking about partnerships during this time led CHA to invite Fr. Michael Rozier, SJ, to write a parable for the pandemic and global health. He had authored the Modern-Day Parable that is a part of CHA’s Guiding Principles for Conducting Global Health Activities, so with his experience in global and public health, he was a natural fit. You can read his parable on the following pages and watch the video that is available at www.chausa.org/guiding principles. For my part, I’ve reflected on the activities that have not been able to happen because of the travel bans, as well as what I’ve heard about the evolution and/or devolution of partnerships. This led to me reach out to colleagues across the globe — in Haiti, Rwanda, Kenya, Peru and several other countries to hear about their lived experiences. In the hope that it reawakens our desire to partner to build health care capacity and to listen first to what the local community says it needs to recover from the pandemic, I am sharing some of the highlights of what we heard.

A leader in Rwanda’s words stay with me: “Local leadership should be at the heart of our ‘preparation’ for partnerships and unforeseen circumstances just as the parable points out.” He watched the video of the parable for pandemic and was surprised we had our partners in mind when the U.S. death tolls were so high. In general, the people with whom we communicated expressed these themes around preparation/preparedness and trust building in relationships: Long-lasting partnerships have flexed to do capacity building through technology.

New partnerships have allowed financial assistance to go to existing local partners versus spending monetary resources on air travel and vacation time for volunteer mission trips.

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Local partners taking more ownership and being more definitive in priority setting and decision making in their community facilities has resulted from less interaction with international partners.

Partnerships that relied on travel and inperson meetings are using technology and trust of local partners to invest in priorities.

Partners trying to assist from afar are identifying and sharing culturally appropriate guidance and tools for local partners related to social distancing, masking, clinical protocols, vaccines, etc.

Partner clinicians from high-income countries who initially said to themselves “this isn’t my partnership!” when referencing the fact that they didn’t get to travel, shifted to “we can accomplish a lot using technology.”

Every experience is different. Some U.S. partners reached out to the in-country hosts as soon as the pandemic started; others connected only when the in-country host reached out to the U.S. partner.

Global partners need to realize how important it is to stay in touch with one another in challenging times. I hope you find the parable and Guiding Principles useful on your journey to assist our brothers and sisters around the globe.

Remember that the same technology that kept our own organizations connected can be utilized to build deeper relationships and trust in the future — especially if we can assist in helping fund virtual capabilities so that education, consultation and open communication lines can become more frequent.

Connecting, whether remotely or through mission trips that focus on the requested activities of the host country, will be the lights with oil that will shine as examples for all who do global health work.

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A Modern-Day Parable for Pandemic Ten Volunteer Groups, an Adaptation of Matthew 25:1–13, Parable of the Ten Bridesmaids

by Michael Rozier, SJ, PhD

he coronavirus pandemic has forever altered our lives. Pope Francis said it is helping us to see that the good of each person individually is tied up with the common good of society as a whole, and vice versa.

And he insisted, “A virus that does not recognize barriers, borders or cultural or political distinctions must be faced with a love without barriers, borders or distinctions.”

If, on the other hand, solutions to the crisis are tinged with selfishness or egoism, the Pope said, “we may perhaps emerge from the coronavirus crisis, but certainly not from the human and social crisis that the virus has brought to light and accentuated.”

Instead, everyone — and Christians in particular — have a duty to work to promote the common good.

Thinking globally, we understand that COVID-19 created or exacerbated social divides. There were literal

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divides as communities and many families quarantined and remained socially distanced. There were also divides in resources where goods and services stopped flowing to the places where they would meet crucial needs.

In the case of medical mission trips, surplus donations and other global health activities, when planes were grounded and passports tucked away, we must ask: what was happening in the communities where reliance to health mission trips has been built? Did partnerships grind to a halt, or were new means created? Did experiencing scarcity — some foods, toilet paper, PPE — build greater awareness of daily struggles in countries where health systems are nascent?

As we try to imagine life where we have a safe vaccine for COVID-19 and can get back to normal and resume our international medical missions, let us instead engage our imagination in the way that Jesus often challenged his disciples. A simple parable opens us up to both the promise and peril of global health projects and how our activity or

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inactivity during the pandemic will define our treatment of neighbor.

Then the kingdom of heaven will be like this. Ten bridesmaids took their lamps and went to meet the bridegroom. Five of them were foolish, and five were wise.

When the foolish took their lamps, they took no oil with them; but the wise took flasks of oil with their lamps. As the bridegroom was delayed, all of them became drowsy and slept. But at midnight there was a shout, ‘Look! Here is the bridegroom! Come out to meet him.’ Then all those bridesmaids got up and trimmed their lamps. The foolish said to the wise, ‘Give us some of your oil, for our lamps are going out.’ But the wise replied, ‘No! There will not be enough for you and for us; you had better go to the dealers and buy some for yourselves.’ And while they went to buy it, the bridegroom came, and those who were ready went with him into the wedding banquet; and the door was shut. Later the other bridesmaids came also, saying, ‘Lord, lord, open to us.’ But he replied, ‘Truly I tell you, I do not know you.’ Keep awake therefore, for you know neither the day nor the hour.

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QUESTIONS TO REFLECT ON THE PARABLE

Then the kingdom of heaven will be like this. Ten groups of international volunteers had their projects suspended because of the COVID-19 pandemic.

Five groups were foolish, and five of them were wise. When the foolish had their projects suspended, they stopped working on them altogether, assuming they would resume where they left off once the pandemic was over; but the wise focused on what they could do in the meantime. They stayed in touch with their international partners. They sent the resources the partners most needed. They continued formation programs for their volunteers. They learned about how the pandemic was affecting their partners’ communities.

As the virus continued to circulate the globe, the groups of volunteers got involved with other worthy projects.

But one day there was a declaration, ‘Look! It is now safe to travel! Come, let us go off at once.’ Then all ten groups of volunteers began preparing for their next trip. The foolish said to the wise, ‘We have lost touch with our partners

and do not know what we can do. Let us help your partners instead.’ But the wise replied, ‘No! More is not always better and it is not just about helping, but about relationships. The trust we have built over time is precious and cannot be wasted; it is better that you start from the beginning, both with your volunteers and with your partners, to build the relationships that have been lost.’ And while the foolish groups gathered together to figure out their next steps, the pandemic had ended, and the volunteers who were ready resumed their former projects and began new ones. And the planes took off. Later the other groups reached out to their neglected partners, saying, ‘Please, let us come and help.’

But their partners replied, ‘Truly we tell you, we thought we knew you.’

Keep engaged in the work that can be done, therefore, for you know neither the day nor the hour.

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The original parable depends on knowledge of wedding customs in the time of Jesus. That we know relatively little about those customs makes the job of interpretation more challenging. The same is true when building partnerships across cultures. Even without knowing those customs, though, the parable draws our attention to the difficulty of preparing now for a kingdom that is to come some time in the future.

Just as the bridesmaids have an experience where they are a part of a group, considering this parable and the questions that follow with others may be of benefit. v

What does a relationship with international partners look like when travel is not possible? How might it be strengthened?

v

Has the shortage of supplies at home or work during the pandemic altered your appreciation for scarcity? How might this inform your global work going forward?

v

Even as we wait for activity in the future, how can we personally prepare for that moment? What can I build within myself to be a better partner?

v

What are my greatest hopes for global work in the future? What are my biggest concerns?

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CARING FOR THE CAREGIVERS

Caregiving During Challenging Times ELLIE M. HANSON, MPH, LMSW

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hile the promise of spring means caregivers may face more days when they can be outdoors, we are still in a season of spotty weather and social isolation. This year, of course, we have an added layer of complexity with the coronavirus pandemic.

By the time winter started this year, most of us had already been holed up in our houses to isolate ourselves from others for several months. The place in which we usually seek refuge can feel like a cage that holds us away from the rest of the world.

Caregivers must be constantly thinking of the person they care for and how they may have to navigate situations that arise. If you are a caregiver, you are already aware that every situation comes with its own tricky issues. For those reasons, I want to share a few tips that I have learned from my work with an Alzheimer’s support group that I facilitate from my work at an adult day care facility and from interacting with seniors as a social worker. There are ways we can do more than just cope in our roles of care providers, and even to enjoy it as sacred and peaceful time spent with people we care about.

DON’T TAKE ON TOO MUCH

As we approach the spring and summer holidays, we can take lessons from other special occasions.

The holidays are usually rich with tradition, perhaps baking Easter sugar cookies made from great-grandma’s recipes or putting up seasonal decorations collected over years past. It can be fun and magical to get swept up in the holidays, but it can also mean a lot of extra work for you. As a caregiver, you are already busy as you keep an eye on your loved one and care for them throughout the day (and night!).

Think of activities you can do together that are

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rather simple and do not require extensive preparation and cleanup. A caregiver told me that he stayed up at night for days before Thanksgiving, simply dreading the huge meal he has prepared for over 20 years for the family. The meal requires hours of prep work, wrapping it all up to transport a few hours away to the relatives’ home and then finishing the cooking there. Two nights before Thanksgiving, he decided to call the relatives and say that he was not going to make the traditional meal that year. He decided to make a smaller meal with fewer sides but kept the turkey as he enjoys making it once a year. By reducing his list of things he had to get done, he was able to enjoy the holiday more and stress less. This caregiver shared that once he made that phone call, it felt like “a ton of bricks was lifted off my back” (those were his exact words!). You already take on heroic feats each day, there is no need to make things harder for yourself. Think about the parts of the holidays that you want to keep and try to keep large projects for another time.

LIMIT TRAVEL

Another suggestion that I have heard from caregivers is to limit driving and traveling time. Long drives can pose a problem, especially when it is

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time to use unfamiliar restrooms. Adult diapers and other incontinence products can be used, but they are often uncomfortable for the wearer; I have heard from some caregivers that their loved one simply refuses to wear them or keep them on. Using a public restroom can be challenging, for both the caregiver and the loved one. When I worked at an adult day care program, we assisted the residents in using the bathrooms and often a participant with dementia would take off clothes that can be a challenge to get back on, or the person might forget how to use the toilet. This can make it tricky to use public restrooms, especially if family restrooms are unavailable. Since travel is already limited due to the pandemic, it should be easy to limit time on the road. The overall message is it helps to keep the to-do list short, relax with your loved ones and make new memories to cherish.

TAKE WALKS AND EXERCISE

for some suggestions of home exercise for you.

Exercise is an excellent stress reliever. When you are a caregiver, your health is twice as important as you are caring for not only yourself but also someone else. Exercise will help you have the energy to keep going, to maintain your health, and the time you spend exercising can be a special time for either yourself or for you and the person you care for.

HONOR WHAT IS GOING ON, BE HONEST AND OPEN

It is unfortunate but true that there is a stigma surrounding Alzheimer’s and dementia. It may not be something you want to share with anyone. Remember that there is nothing for you to feel embarrassed or ashamed about! That old saying “the squeaky wheel gets the grease” is very true; if you do not share your situation or your struggles with family or close friends, they will not be able to help you out. Be honest if you need a break. Family members can help in different ways.

Family members nearby can help out with respite options and family members far away can provide an ear to listen and a friendly face for a video call. Use the resources and connections that you already have to help you. Caregiving is hard and it is perfectly normal to need help once in a while.

Have honest conversations with your family about what is going on with the person you care for. This will make it easier for them to understand how you are feeling and it may bring you closer. Family members may offer to Zoom each week or send fun mail (receiving mail can make

By this stage in the coronavirus pandemic, you have certainly heard that walks are a good idea.

Of course, this is not anything new to us, but the reminder to get outside (and out of that house) is a good one. Cabin fever is a real thing and during the pandemic, I think a lot of us are feeling the symptoms. Getting outside with someone who has Alzheimer’s can be challenging. Remember that creativity and flexibility are two of your greatest skills as a caregiver. If your loved one can walk, go for a walk with them around the neighborhood and point out different things you see to engage her or him. For example, look for fun yard decorations, pets loungExercise is an excellent stress ing in windows or beautiful flowers reliever. When you are a caregiver, that you walk past. Talk about the shapes you see in the clouds or the difyour health is twice as important as ferent types of trees and plants around you. For safety, make sure to not walk you are caring for not only yourself on icy days and if you are walking on but also someone else. sidewalks, be careful of uneven edges that could cause someone to trip or fall. Try to avoid using the car as it will be an extra the loved one feel special and remembered). For hassle for you and take away from the relaxation of a man with early onset Alzheimer’s who loves old the walk. If walking is not an appropriate activity American cars, members of his family sent him for your loved one, perhaps you can use weights vintage postcards featuring different cars from to exercise while they sit nearby, or practice yoga the ‘50s, and they sent books with lots of pictures before they wake up. Consult their physician or and illustrations of the cars.

If your social network is lacking, there are physical therapist to see what exercises are appropriate for them or your own health care providers national resources available to you and there are

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CARING FOR THE CAREGIVERS

virtual support groups just for caregivers. Both and that will allow you to stay fresh, energized the Alzheimer’s Association and AARP offer sup- and less stressed about your many duties and port groups specifically for caregivers. These are responsibilities.

Consider your own situation and think of what currently online due to the pandemic, but you can find a support group near you on their web- you need. Is there a time that is just yours during sites. There are also many books on Alzheimer’s the day? If you can, make a special time for yourdisease and other types of dementia, such as the self. You can use the time to do things you already well-known book The 36-Hour Day by Nancy L. enjoy or to find new hobbies. Journaling is a wonMace and Peter V. Rabins, which some consider to be the best resource book It is crucial to be in tune with your on dementia for caregivers available. I have even seen books that help explain own needs, just as you are with the Alzheimer’s to young children who may loved one you care for. be confused or scared by the new things grandpa has been doing or saying. The take-home message here is: you are not alone. derful hobby that can be customized to an indiConnect with the community around you and vidual’s preferences; a visual person may draw familiarize yourself with available resources. Do their memories and a more analytical person may not make things harder for yourself by reinvent- enjoy writing out their feelings that day. Journaling is a good activity for caregivers because it ing the wheel or trying to do it all on your own. helps connect a person to their feelings and emotions. Journaling allows us to set aside time just TAKE CARE OF YOURSELF, BODY AND MIND As a caregiver, you are so focused on the well- for us to reflect and process what has happened. being of someone else that it is very easy to sim- If you are not into journaling, even a simple daily ply forget that you have needs as well. A caregiver reflection would work, perhaps while you drink shared with me that she had an internal battle your morning coffee.

It is important to take time to care for yourwith herself over the amount of time her husband was sleeping. Normally an early riser, the wom- self. If you have a few minutes alone, you will be an’s husband (in the mid-stage of Alzheimer’s dis- able to check-in with yourself. Ask yourself what ease) started sleeping until past noon. At first the you need right then: sometimes just a snack or to woman would wake him up early to get started breathe deeply for a few peaceful minutes helps with the day. She felt badly letting him sleep all us feel better. It is crucial to be in tune with your day and worried he was sleeping too much. The own needs, just as you are with the loved one you woman decided, after speaking with her hus- care for.

Remember above all that you are doing this job band’s doctor, that she would let the man sleep in until 11 a.m. She made this decision after gather- of caregiving out of love. It is one of the kindest ing the appropriate facts to make sure it was all acts a person can do for another, caring for someright to let him sleep that much, and it was. Now, one when they cannot care for themselves. Careshe wakes early and spends the morning with givers are strong, and I hope these suggestions herself. She says that she is incredibly grateful combined with what you are already doing makes for that time in the morning, which allows her to this time a little easier on you and your loved one. videochat with her support group or others without having to worry about what her husband is ELLIE M. HANSON is a social worker in St. Louis doing. This time also offers her some time to take who specializes in working with the older adult care of herself; carving out time just for you is so population. important. It offers you a mini-respite each day

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Pacific Press Media Production Corp./Alamy Stock Photo

Finding God in Daily Life “In these days, my thoughts turn especially to the elderly and infirm, and those who generously care for them.

Upon all of you and your families I invoke the joy and peace of our Lord Jesus Christ. God bless you!”

— Pope Francis, General Audience at Vatican City on September 16, 2020

CARING FOR THE CAREGIVERS

Long-Term Care Homes Bravely Respond to COVID SR. M. PETER LILLIAN DI MARIA, O.CARM, AND SHANE COONEY

“No one has greater love than this, to lay down one’s life for one’s friends.” (John 15:13)

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ealth care workers around the world are living Jesus’ message. The stories of frontline staff, especially those in long-term care who continued to work during the COVID19 pandemic, will not be forgotten. They will be honored for the bravery they displayed daily and for the many examples of compassion they demonstrated to all they served.

2020 was an incredibly difficult year for them, their families and the people they cared for. As the deadly COVID-19 virus emerged, it was merciless in the way it attacked the most vulnerable among us, our precious aged and infirm. For a population that is already susceptible to illness, this insidious virus posed an enormous threat and ushered in new and unexpected struggles for caregivers.

LONG-TERM CARE HOMES TAKE ACTION

At the 19 nursing homes, independent living facilities and assisted living facilities that are served, sponsored or cosponsored by the Carmelite Sisters for the Aged and Infirm, sisters and staff worked around the clock to keep their residents safe, despite knowing the risk that they could be exposed to the virus and possibly bring it home to their own families — a fact faced by all those who work in eldercare facilities throughout the country.

Those serving in long-term care understand that part of the reality of their work is to accompany residents through sickness and the dying process, and for many of them, the privilege of walking this journey is one of the reasons they dedicate themselves to this work. However, COVID-19 presented a new obstacle to this relationship, as the virus posed a serious risk to residents and caregivers alike. Prior to the emergence of the virus, caregivers were able to be truly present with people, not only during times of joy, but also during times

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of suffering. Staff and sisters have always been at the bedside of the dying, providing comfort to both the residents and their families. When one of our residents dies, caregivers are used to taking the time to process their emotions with each other and with the resident’s family members. They often reflect on the person’s life during meaningful rituals and services held to honor the memory of those who have passed.

When COVID-19 upended everyone’s life and forced long-term care communities to change, this privileged relationship was altered, and the emotional pain and sense of sorrow felt when a resident passed away were only intensified. There was no longer time to process emotions and heal.

Instead, the focus had to be turned quickly to the next resident who was critically ill or staff member who became ill. Though our dedicated staff members tried their best to be present to those they serve, it was an incredibly difficult challenge in the midst of an experience that had no precedent.

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CAREGIVERS’ DEDICATION TO SERVICE AMID THE BURDEN OF GRIEF

The long-term care ministry is a special vocation, one that allows for close relationships between caregivers and the residents they serve. Caregivers learn of residents’ stories, their hopes and dreams, and their joys and challenges. They become familiar with the pictures of the people and important moments that fill residents’ rooms.

They are introduced to spouses, siblings, children and grandchildren. The caregiving staff become an integral part of residents’ lives and an extension of their family.

It was inevitable that the mounting losses were going to be a heavy burden on everyone, but especially on those ministering to the many people affected by COVID-19. In addition to the challenges taking place inside the homes each day, there was the additional pressure of news accounts that seemed to focus only on the number of resident deaths or possible failures in infection control protocols. There was little attention given to the pain of the caregiving staff who continued to bravely care for the residents in that frightening time. As the focus in the media remained on the surging death count, those serving in the homes were in the thick of the moment, left to grieve each person who passed without having time to share their feelings. Especially in the early days of the pandemic, they had to continue to serve the remaining residents, not knowing where the hidden enemy would strike next. Despite these trying times, the mission of the Carmelite Sisters was always in focus. Venerable Mary Angeline, Foundress of the Carmelite Sisters, would be heartened by the perseverance of all those who continued to serve the elderly in such a difficult time.

THE CARMELITE SISTERS CONFRONT COVID-19

As the severity of the pandemic increased, the leadership of the Carmelite Sisters for the Aged and Infirm and its education arm, the Avila Institute of Gerontology, recognized that those on the frontlines would need support in many areas as they tried to manage the physical, emotional and spiritual challenges of the pandemic. The stress of the health risks posed by COVID-19, combined with the many demands placed on everyone to implement new policies and procedures aimed at lessening its spread, provided an urgency for the leadership of the Congregation to act quickly.

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Mother Mark Louis Randall, O.Carm., who was the Prioress General of the Carmelite Sisters at the time, and the congregational leadership team knew that time was of the essence. They began convening weekly meetings with Carmelite System leadership and administrative leaders from each home. These conference calls provided the opportunity for those closest to the threat to discuss what was happening inside their facilities, express their feelings about what they were experiencing, and provide information and support to their peers. The meetings also provided an opportunity for congregational and system leadership to better understand what administrative leaders needed from them. In addition, Mother Mark sent out a weekly bulletin that provided information on dealing with the pandemic, inspirational quotes, stories for encouragement, and a spattering of COVID-19 memes, so that all would not lose their sense of humor.

Mother Mary Rose Heery, O.Carm., Prioress General of the Carmelite Sisters since September 2020, indicated the importance of being able to both respond in the moment of crisis and look ahead to the months and years to come. “Good leaders always have to have a sentinel view to lead people forward,” she said. She championed the initiative to mobilize Carmelite leaders to pull together by developing a committee to both deal

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other Mark Louis Randall, immediate Past Prioress General of the Carmelite Sisters, prepared a holy card to give to families as they were able to visit their loved ones again. It’s a reflection on “The Finding of the Child Jesus in the Temple”: When Jesus was 12 years old, he went with Mary and Joseph to the temple in Jerusalem for the feast of Passover. On the trip home, Mary and Joseph discovered that Jesus was not with them, so they traveled back three days to find him still in the temple. As you reunite with your loved one today, may you know the joy and relief that Mary and Joseph felt when they caught sight of Jesus. May the Holy Family bless and protect you and keep your family safe, now and in the days to come.

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needed. The workshops provided the social workwith the present and plan for the future.

As a result, two committees were formed, ers, pastoral care and recreation staff with tools the Recovery Committee and the Shepherding that could help guide their colleagues. The Avila Committee. These committees were intended Institute of Gerontology wanted to ensure that to address the complexity of issues surrounding everyone serving in Carmelite homes recognized the pandemic. The Recovery Committee focused that they were not alone in their struggles and that on assisting the homes to cope with the current asking for help was something to be encouraged.

The Shepherding Committee started by reachrealities and consequences of the pandemic. This included the constantly changing infection con- ing out to the Carmelite homes located in the East, trol protocols, ethical issues, policy development, since those were suffering the greatest number of staff recruitment and reassurance to the public that Carmelite nursing The stress of the health risks posed homes would be safe places for the elderly going forward.

by COVID-19, combined with the The Shepherding Committee many demands placed on everyone focused on anticipating emotional difficulties that would arise from the to implement new policies and many losses associated with COVIDprocedures aimed at lessening its 19. Those losses were not confined to the loss of life; they also included loss spread, provided an urgency for the of routine, loss of connection with others, and loss of opportunities, among leadership of the Congregation to others. One need became immediact quickly. ately evident: caregivers would need help to process their emotions that they had not had an opportunity to reflect upon cases and deaths in the country at the time. Since in the early days. Joan Murphy, a social worker it was impossible to visit the homes, virtual meetat St. Patrick’s Manor in Framingham, Massa- ings were coordinated using Microsoft Teams. chusetts, gave a sense of just how drastically the The stories shared during these meetings were atmosphere changed: “In the facility, it was quiet tragic, touching and inspiring, and many within — deafening quiet … there was no talk, no chit- the community were helped by the opportunity chat, nothing. There was a deafening silence that to meet with the committee. came over everybody.” Reflecting on why she and so many of her colleagues continued to show up COMMUNICATING IN CRISIS WITH “CARE” to the home to serve residents, she noted simply, As some nursing homes began to gain stability “They needed us.” during the summer months, families were eventually allowed to visit, albeit with strict protocols. The visits were held outdoors with time THE SHEPHERDING COMMITTEE REACHES OUT In May 2020, the Shepherding Committee began limitations, social distancing and masking. To its work. Its name reflects the image of Jesus as help homes prepare for what would be emotional the Good Shepherd protecting and guiding his reunions, a 25-minute in-service was developed flock. The Shepherding Committee consists of to address sensitive communication with family various experts in the fields of social work, psy- members feeling the emotional strain of isolachotherapy, education and public health. The tion and the anxiety of not being able to visit their Committee’s mission is simple: be available to loved ones over a long period of time. Staff were listen to and validate the emotions that the peo- asked to recall what it was like for the family the ple on our staff are feeling and guide them on a first day they brought their loved one to the home, path of healing and hope. As the committee met recapping common emotions felt by families durto discuss ideas, it became clear that workshops ing what was always a difficult transition. Each on grief, self-understanding, team building, resil- person experienced his or her own set of emoience and accessing mental health services were tions at the time of admission. The predominant

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Staff were told that all the emotions that families had dealt with during admission might surface again because they were visiting their loved ones for the first time after a prolonged period of separation. emotions tended to be fear of having their loved one feel abandoned or concern of not being present when their loved one needed them most.

Staff were told that all the emotions that families had dealt with during admission might surface again because they were visiting their loved ones for the first time after a prolonged period of separation. The acronym “CARE” (Compassion, Affirmation, Recognition of the Relationship, Empathy) was used to assist with communication techniques.

In the CARE model, staff members are first asked to remember to listen compassionately to what a resident’s family was feeling during their visit. They should then affirm family emotions by acknowledging them and being careful not to judge why the person felt that way. Next, staff would recognize the relationship between the family member and the resident, noting how devastating the loss of physical presence was. Lastly, caregivers could communicate empathy with the family by realizing that COVID-19 frustrated and angered them too. The in-service also prepared our staff members for possible statements that the

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family might make. Staff were asked to role-play some dialogue with one another to prepare and formulate messages of support for the family and assure them that the staff remained faithful to caring for each resident during very uncertain and trying days.

MOVING FORWARD WITH FAITH, HEALING AND HOPE

There is much to be done, and each of us has had time to reflect on how the pandemic challenged us in our daily lives. As new therapies and vaccines begin to improve our outlook, the Shepherding Committee is planning for when it can visit the homes again. When that time comes, we hope to provide a day of ritual and healing that will help residents, families, sisters and staff to start to move past the grief of the moment and look toward hope for the future. That is a process that will take time. Mother Mary Rose said of this moment, “The sprint is over, and now we have to be in the distance run to recover.”

We have seen the importance of faith, which feeds our spiritual side and helps us understand the purpose of our lives and brings meaning to why we do what we do. It affirms the importance of family and friends, whose relationships nurture our very being, and brings hope when we feel hopeless. Most importantly, it brings us to the love that was given to so many by long-term caregivers living the Gospel to show no greater love for one another.

SR. M. PETER LILLIAN DI MARIA, O.Carm, serves as a member of the congregational leadership team of the Carmelite Sisters for the Aged and Infirm. SHANE COONEY is head of education, the Avila Institute of Gerontology.

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Upcoming Events from The Catholic

Health Association

Webinar: Advanced Issues in Sponsorship – Session Three: Sponsor and Mission Leadership Relationship May 12 | 2 - 3:30 p.m. ET

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2021 Virtual Assembly

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CARING FOR THE CAREGIVERS

Jeanne’s Hands LISA PICKER

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veryone noticed her hands. They were delicate but worn. Her pale Irish skin had been protected from the sun most of her life, but there were signs of how she exposed them to useful pursuits. They had been productive hands, engaged in the activities a devoted daughter, sister and aunt as well as a beloved art teacher and follower of God could offer.

They were hands that regularly turned the pages of her worn bible, brushed away tears from the faces of her students, nieces and nephews. Her hands knew how to get dirty with paint and plaster or found objects she could turn into something beautiful or fun. She was what Mr. Rogers would classify as “a helper.” She taught and nurtured many children at a local school, barely making enough to provide for herself. Her name was Jeanne, and she was my sister-in-law.

We began noticing a change in Jeanne around the time the coronavirus hit. Slight lapses in her memory, increased anxiety and an inability to concentrate on even the smallest things left her frustrated. Crying spells and sadness replaced the positive, quirky attitude we had always known.

These changes could not be ignored, as on the day she tried to make a simple bank deposit and couldn’t. “I know how to do this,” she protested.

“I have done this a thousand times.” This time, however, was different.

With a family history of anxiety and depression, it was easy to first chalk it up to all things COVID. After all, everyone seemed to be afraid and overwhelmed and to have increased levels of uncertainty. When the security rug of life is pulled out from under an entire country, these things happen. I know this because I’ve worked in adult medicine for years. The number of patients calling for help with anxiety, mood changes and sleep issues was off the charts this year, and it was concerning. Understandable, but unusual. It’s not uncommon to see such spikes around the holi-

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days, with a death or a divorce, a major life event.

Unfortunately, I am personally acquainted with mental health issues. In my 2018 article in this magazine, “His Name was Liam,” I wrote about our struggles and the loss of my son to suicide.

The effect of the coronavirus pandemic on our society worries me.

Jeannie came by those delicate pale hands naturally. She was born into a large, complicated, loving Irish family with five sisters and two brothers.

It is a family I was lucky enough to marry into.

Everything and every day provided reasons to celebrate. We all loved deeply and lived life as if no accomplishment or event was too small to go unnoted. Family is everything to this group. So, when we noticed changes in Jeanne, we needed to find out why.

One of the first things clinicians are taught while studying and diagnosing is when you hear hoofbeats, don’t go looking for zebras. It means when presented with a list of symptoms, you research and entertain the most obvious reason for the patient’s symptoms before jumping to the

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worst-case or most outlandish scenario. Why? In theory you can only transmit sporadic CJD Because nine times out of 10 it is there in the obvi- from an injection, through nerve tissue or spinal ous that you’ll find the answer. Unfortunately for fluid, not from normal, day-to-day physical conJeanne, that wasn’t the case. Our family was about tact. Meeting the challenges of the disease as they were quickly multiplying was intimidating. We to deal with a huge unknown.

After weeks of tests that included imaging, were told it was important to set priorities early lab tests, EEG and lumbar punctures, we finally in the disease process and come to agreements in received a confirmed diagnosis from the Cleve- advance about how to handle what was coming. land Clinic. Jeanne had not had a stroke, which We remained hopeful, but realistic.

There are wonderful support systems in place. we had thought most likely, nor was she suffering from situational anxiety, early onset Alzheimer’s Once the family learned more about Jeanne’s or the stress of COVID. Any of these would have disease, we knew what was likely to happen. We made sense from her health history. The diagno- just did not know whether it would or when. We sis was Creutzfeldt-Jakob Disease, or CJD. What is decided to try to control the things we could and this disease with a funny name? How did she get it allow each other the room we needed to try to and how is it treated? Why is it affecting her mem- process this tragedy. We had our work cut out for ory? Those questions swirled in our minds, but us when we all decided we would care for Jeanne ourselves. one thing was certain: this diagnosis was a zebra.

After she was released from the hospital but CJD is a fatal neurodegenerative disease caused by abnormal protein in the brain. The dis- before she could be settled into her sister’s house ease usually claims its victim within 6-12 months as her new home, she stayed with her niece for a after the onset of symptoms. We felt shock and few weeks. Her two great-nieces, who had been disbelief. The sadness was palpable. Some profes- close to Jeanne their whole lives, were built into sionals describe CJD as Alzheimer’s on steroids. the care plan. They wanted and needed to learn A similar condition known as Mad Cow disease how to help care for their aunt, what that entails appeared in the late 1980s in the United Kingdom, and how it is done. These are hard life lessons in where a panic ensued as cattle literally began grief and loss, living and dying. Even at the toughkeeling over and dying from Bovine Spongiform est times and in its most fragile state, the family Encephalitis, which was later found to be caused unit can be a powerful force.

We held weekly family meetings to address and transmitted by infected cattle feed. CJD is the difficult topics like what to do if Jeanne lost her human form of Mad Cow. Jeanne was diagnosed with a sporadic case of sight or experienced terrible seizures. We talked CJD, which means it was neither transmitted nor about how aware she would be of what was hapinherited. We likely never will know how she developed it. Because of its Should we tell Jeanne she was ravenous nature and the rapid course dying? Should we protect her from of decline, particularly with memory and other cognitive functions, we the knowledge that she was going had to move quickly. In Jeanne’s case she knew what she wanted to say, she to go through something none of us just could not find the words. People had personally experienced? with CJD suffer with balance and gait problems. It can affect mood and perception. Some patients develop difficulty swal- pening to her and for how long would she coglowing or become incontinent. The disease can nitively be able to understand what the changes cause blindness, hallucinations and seizures. At meant. Should we tell Jeanne she was dying? the end, patients generally lapse into a coma, and Should we protect her from the knowledge that most die from cardiac arrest or complications she was going to go through something none of us had personally experienced? The only certainty from pneumonia.

We learned quickly that people are afraid or we had was that ultimately Jeanne was going to uneducated about the disease. We certainly were. die, so everything else was an unknown. We came

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The hands that had lovingly cared for her famup with a plan of care and put a calendar together.

As a family we decided the best way to care for her ily and students, that so often had reached out and ourselves was to address her symptoms one to the lonely and needy, were lifeless now. As I at a time as they presented themselves. It was too observed the love and care we were all taking to overwhelming to think about all the things that make sure Jeanne’s body was treated with gentle dignity even after she died, I thanked God for could go wrong.

The lessons we learned from Jeanne’s con- bringing me into this family and their generosity dition and suffering, how we tended to her care in including me in Jeanne’s care. While that lovely together, and her death were life-changing for pair of hands would never touch or embrace any me. The raw beauty I witnessed as our family tended to her needs and The raw beauty I witnessed as our helped usher her into the next life family tended to her needs and was strong, woven with grace and love. All of our talents, all of our helped usher her into the next life was strengths, as well as our fears and strong, woven with grace and love. frailties, were bonded together for her.

We were not given the 6-12-month window of of us again, I realized they were at work in the rest the first diagnosis, it was just two months. Jeanne of us. I saw them in my sisters-in-law, in my nieces slipped over into God’s arms on a beautiful Sun- and nephews, in my daughters, in my brother-inday morning. The church bells began to ring law Mike, and in all the other family and friends shortly after she took her last breath. How like that stepped up when they were needed.

I think of the saints of our time and of those Jeanne to wait for her favorite day of the week.

Because we were in the time of COVID and from days past — Martha and the work she did because of the concerns about transmission of with her hands. How both of the Marys tended to Creutzfeldt-Jakob disease, the funeral home ful- Jesus’ body. How Jesus himself washed the feet of filled the regular mortuary functions, but they his own disciples. How his hands bore the nails were not able to dress or attend to the special that would save a world. I can’t help but believe grooming we wanted for Jeanne’s body before that hands are an extension of our hearts. I will burial. We did this ourselves. Tears of exhaus- never forget Jeanne’s hands. tion and sadness mixed with the waters we used to wash her fragile body. We dressed her and LISA PICKER is a registered medical assistant who brushed her beautiful thick hair. My daughter Zoe lives in St. Charles, Missouri. placed some fresh cut flowers around her. Finally, we painted her nails and placed those beloved IN MEMORY OF JEANNE M. HUNTER hands gently together.

May 17, 1953 – August 23, 2020

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Health Disparities and People with Disabilities JOAN F. PETERS, JD, MPH

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he COVID-19 pandemic has brought much needed attention to avoidable health disparities that long predate the pandemic. This overdue examination of disparities needs to include health disparities that exist between people with disabilities and nondisabled people, which are even more pronounced among racial and ethnic minorities with disabilities. At this moment of seeking to remedy disparities throughout society, health care providers can take a number of steps to aid the work of closing the gaps of equitable care for people with disabilities.

Not only should the work to end disparities include thoughtful focus on people with disabilities, it must involve them in meaningful ways from the start. It is crucial that individuals with disabilities be included in any discussion or plan to reduce health disparities. “Unless you pay attention to people with disabilities from the outset in rethinking solutions, you’re going to perpetuate the long-standing disparities among people with disabilities, including those who are racial and ethnic minorities,” said Barbara (Bobbi) Linn, a long-time disability activist. Linn, who has a speech impairment and motor disabilities as a result of cerebral palsy, has a master’s degree in rehabilitation counseling. In 1985, she established Bronx Independent Living Services, which is part of a national network of Independent Living Centers that are resource and advocacy centers run by and for people with disabilities.

A substantial number of residents in the United States have a disability. The term disability encompasses a broad group of conditions that include mobility, sensory, communication, mental health and cognitive issues. The number of Americans living with a disability varies depending on the definition of disability; according to

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the Census Bureau there are at least 40.7 million Americans with a disability, including children, or 12.7% of the population, living in the community outside of institutions.1 An estimated 2.1 million more people with disabilities live in institutional care facilities.2 Approximately one in nine working age adults has a disability.3 The percentage of adults in the U.S. living with disabilities varies by race and ethnicity. Approximately one in four Black adults has a disability compared to one in five whites and one in six Hispanics.4 People with disabilities are sometimes presumed to be in poor health, but health status is in fact separate from disability. However, there are significant differences in health status between people with disabilities and their nondisabled peers. People with disabilities are four times as likely to report their health as fair or poor than people with no disabilities.5 Avoidable differences in health outcomes between groups of people that are not due to underlying medical conditions and that are linked to a history of social, economic or environmental disadvantages are termed health disparities.6 Health disparities have typically been discussed in the context of racial and socioeconomic status.

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In the last decade or so, there have been health, have substantial influence on health outincreasing calls to recognize people with disabili- comes. The social determinants of health are ties as a group affected by health disparities.7 “If defined as the “conditions in the environments you are going to point out health disparities, then where people are born, live, learn, work, play, you’ve got to point them out for people with dis- worship and age that affect a wide range of health, abilities, too,” said Joe Bravo, the recently retired functioning, and quality-of-life outcomes and executive director of Westchester Independent risks.”15 Addressing social determinants of health Living Center. Bravo began using a wheelchair is critical for improving health and reducing longafter a spinal cord injury at age 12. standing disparities for people with disabilities.

While comprehensive research is limited, data These modifiable factors can be organized into show that people with disabilities do experience six broad, often intertwined categories.

Economic stability, including income, preventable health disparities.8 To highlight three: Obesity. Adults with disabilities are more employment, debt and medical bills.

Education, including literacy, higher educalikely to be obese (40%) than adults without disabilities (28%).9 tion and vocational training.

Diabetes. About 1 in 6 people with disabili Neighborhood and built environment, ties (16.7%) has been diagnosed with diabetes, including housing, transportation, walkability compared to 1 in 14 people without disabilities and safety.

Food, including hunger and access to healthy (7.4%).10 Smoking. Adults with disabilities are more food Community and social context, including likely to smoke (23.1 %) than adults without disabilities (12.3 %).11 family, friends, social interaction, support sysIt is important to note that among people tems, community engagement and discrimination.

Health care, including health coverage, prowith disabilities, members of some racial and ethnic minority groups often show even greater vider availability and cultural competency.16 disparities.12 Many of the health challenges Many of the health challenges experienced by people with disexperienced by people with disabilities abilities are preventable given a multi-pronged approach with are preventable given a multi-pronged improved access to medical care, health promotion and disease approach with improved access prevention, and social circumto medical care, health promotion stances.13 Reducing these avoidable health disparities will lead to and disease prevention, and social better health outcomes for people with disabilities and lower health circumstances. care expenditures. Given the number of Americans with disabilities, reducing “When you’re talking about people with dishealth disparities can have a significant social and abilities, it’s hard to separate the social determieconomic impact. nants of health from each other,” said Linn. “If you need to use accessible transportation, it affects everything — your ability to get to work, go to the THE SOCIAL DETERMINANTS OF HEALTH While some aspects of health, such as biology and grocery store, get out to see your friends. Discrimgenetics, are not modifiable, about 80% to 90% ination is everywhere — in employment, educaof the modifiable health factors are behavioral tion — not just in the community.”

In addition to discriminatory attitudes, people and social.14 In the general population, only about 10% to 20% of these modifiable health factors are with disabilities can face physical and/or communication barriers. related to medical care.

Greater income correlates with better health.17 Social, economic and political resources and structures, called the social determinants of However, the poverty rate for working age adults

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with disabilities is more than twice the rate of adults with no disability (28% compared with 13%).18 In 2019, before the pandemic began to affect the U.S. economy, just 33% of people with disabilities of working age were in the labor force, compared with 77% of people without disabilities.19 Education, too, shows disparities. People with disabilities are less likely to have a high school education.20 Laws, including the Americans with Disabilities Act (ADA), mandate accessibility and prohibit discrimination against people with disabilities among covered entities. Yet clearly discrimination against people with disabilities persists.

“Are people with disabilities being hired for jobs?

No, that’s one of those things that hasn’t occurred after the ADA. We thought discrimination would be over. No, it isn’t,” reflected Bravo.

And employment necessitates reliable transportation. People with disabilities who do not drive and need accessible transit often face difficulties. “A lot of rural areas don’t have much in the way of accessible transportation. While New York City has a big paratransit system, there are many problems with it, like having to reserve all rides at least one day in advance, which makes doing anything without advance planning impossible,” said Linn.

Food, too, is an issue that cuts across multiple determinants: economic stability, neighborhoods, and community and social context. The CDC gives the example of people who lack access to grocery stores with healthy foods and who are then are less likely to have good nutrition. That raises their risk of health conditions like heart disease, diabetes and obesity, all of which can lower life expectancy. 21 Disability is one of the strongest factors for food insecurity based on economic reasons.22 But disability can add another layer of practical complications. A 31-year-old professional who became quadriplegic after a spinal cord injury at age 14 cited his own experience of difficulty simply getting into stores because of locked cart corrals in front of grocery stores. He said, “Non-disabled people can just swing around them, but if you are in a wheelchair, you definitely can’t get past that door.”

Once inside, stores can present other problems. The man, who did not want his name used in order to protect his privacy, described his expe-

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riences, “A lot of store owners don’t know about disability, and even if they do, they’re not trained on how to deal with people with physical, mental or emotional disabilities. With supermarkets, a ton of their items are on higher shelves. You’re going to need somebody to help you if you’re in a wheelchair or can’t see. Sometimes the employee doesn’t want to get their reacher. You don’t want to make a big deal of these things, but some store owners just don’t realize people with disabilities are human.”

In terms of community and social context, people’s relationships and interactions with family, friends and community members can have a major impact on their health and well-being.

One noteworthy component of this determinant is “social capital,” an important marker of social cohesion that has significant ramifications for health.23 Social capital deals with shared group resources. Simply getting information allows for greater independence and participation in the community. The young man who struggled with grocery stores noted that he didn’t know he could become employed without losing his eligibility for government benefits immediately. (The program allows benefits to phase out.) He only found out because, “I was in a circle of friends who also had spinal cord injuries who were advocates themselves. They all taught me ‘you can work and still get services you need. You just need to sign up for this particular government program.’ No one else was telling me that.”

REDUCING BARRIERS TO CARE

People with disabilities encounter substantial barriers to health care. They are less likely to access the level of medical care needed to maintain health. While a slightly higher percentage of people with disabilities have insurance coverage than people without disabilities, adults with disabilities are 2.5 times more likely to report skipping or delaying health care because of cost.24 One reason that people with disabilities forgo needed medical care may be that it simply costs more to have a disability. They may be paying for unreimbursed medical and pharmaceutical care, accessible transportation, specialized equipment or assistive technologies, as well as caregivers. They may thus have less money to spend on copays, deductibles, etc.

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Apart from financial concerns, the process of COVID, some facilities had started screening for actually accessing care brings on particular physi- social determinant factors and giving people with cal, attitudinal and communication challenges. A disabilities referrals to community resources to 2009 report found that the ADA has had limited meet non-medical needs.27 impact on how health care is delivered for peoCOVID has highlighted the need for clinical ple with disabilities.25 It noted significant archi- and non-clinical systems to work more closely tectural and programmatic accessibility barriers together. But in making the necessary changes to still remain, and health care providers continue the systems that affect the health of people with to lack awareness about steps they are required to take to ensure that People with disabilities must be able patients with disabilities have to have meaningful input. Because access to appropriate, culturally competent care. It cited “the people experience very different absence of professional training on disability competency issues disabilities, multiple disabilities should for health care practitioners is be represented. one of the most significant barriers that prevent people with disabilities from receiving appropriate and effective disabilities, the legal protections for them and care.” their particular needs must be kept in mind to preIn other words, the existence of services does vent existing health disparities being perpetuated. not guarantee that people with disabilities will While many components of the social determibe able to use them.26 One woman in her 50s who nants are beyond the scope of the health care sysuses a wheelchair cited the lack of training among tem, providers can take specific steps that lead to those responsible for transferring her from her improvements in the lives of people with disabiliwheelchair to equipment in her doctor’s office ties and that can in the long term reduce health such that she had to bring people with her to help disparities. In addition to compliance with the her. She called the experiences “discouraging and ADA, employee training on how to work better alienating,” and they have caused her to delay care with people with disabilities is needed.28 Employwhen possible. She expressed her frustration that ers’ diversity and inclusion commitments should health care facilities “aren’t designed for sick peo- include people with disabilities as well as racial ple.” This woman also wanted to remain anony- and ethnic minorities. Moreover, true change mous to protect her privacy. requires involving people with disabilities on a People with disabilities can attest that commu- more fundamental level. People with disabilities nication and provider attitudes directly impact “need to be in people’s consciousnesses. We have the quality of care. Before Linn went into surgery to be part of the conversation on priorities. Otha few years ago, she tried to explain to the anesthe- erwise, our concerns won’t be addressed,” said siologist that she was concerned how the anesthe- Bravo. sia would interact with her other medications. She People with disabilities should be invited to sit said the anesthesiologist just walked away from on advisory groups, boards, panels, policy comher mid-sentence. While the surgery was success- mittees and related groups within health care ful, Linn wondered whether someone without a systems as well as in external initiatives with speech impairment would have received a differ- which health care providers and administrators ent reaction. are involved. People with disabilities must be able While these experiences are anecdotal, they to have meaningful input. Because people experiillustrate ways that health care systems often do ence very different disabilities, multiple disabilinot meet the needs of people with disabilities. ties should be represented. These opportunities need to be truly disability-friendly, taking place in physically accessible locations, with written MOVING AHEAD Social determinants typically have been seen sep- materials available in multiple formats, includarately from clinical care. However, even before ing simplified information for people with cogni-

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tive impairments or limited English proficiency; American Sign Language Interpreters should be available as needed.

In terms of physical accessibility, designs for facilities and spaces should be reviewed by people with disabilities before plans are approved. People living with a disability can see problems with apparently “ADA-compliant” projects that nondisabled people may not think of. Including people with disabilities in the planning process can prevent costly remedial measures later on. Here too, it is important to involve people representing various disabilities. A person with a mobility disability may be focused on wheelchair accessibility, while a low vision person may emphasize signage. Moreover, the ADA is a floor not a ceiling.

One frustrated women with a mobility disability described arriving at health care facility that had only the legal minimum of handicapped parking spaces, which were both in use, leaving her unable to use one for her appointment.

In addition to an organization’s own patient base, there are many local resources for finding people who could give valuable input about disability access and use. Independent living centers, the cross-disability resource and advocacy centers for people with disabilities, are located in every state. Many national disability organizations have local chapters. While the concerns of older people do not always overlap with those of people with disabilities, area agencies on aging also can be a resource. By developing working relationships with a range of community partners and resources, providers can help break down the silos of information and better meet the needs of patients with disabilities.

Most immediately, COVID vaccination outreach efforts should be inclusive of people with disabilities. Information should be accessible in a range of formats. Vaccines should be administered in physically accessible locations by staff sensitive to and knowledgeable about people with disabilities.

CONCLUSION

Improving the health of people with disabilities may require a change in mindset. Bravo said, “Attitudes have gotten better, but I don’t think people see us as equals. And they still feel sorry for us.”

For true health equity and the reduction of avoidable health conditions, people with disabilities

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must be included in rethinking the social determinants of health.

JOAN F. PETERS lives in Brooklyn, New York, and writes on disability, chronic illness and public health issues.

NOTES 1. “Anniversary of Americans With Disabilities Act: July 26, 2019,” U.S. Census Bureau, accessed January 18, 2021, https://www.census.gov/newsroom/facts-forfeatures/2019/disabilities-act.html.

2. “Understanding Disability Statistics, ADA National Network, accessed February 10, 2021, https://adata.org/ factsheet/understanding-disability-statistics.

3. Nanette Goodman et al., Financial Inequality: Disability, Race and Poverty in America, National Disability Institute, 2017, https://www.nationaldisabilityinstitute. org/wp-content/uploads/2019/02/disability-race- poverty-in-america.pdf.

4. “Adults with Disabilities: Ethnicity and Race,” Centers for Disease Control, last reviewed September 16, 2020, https://www.cdc.gov/ncbddd/disabilityandhealth/ materials/infographic-disabilities-ethnicity-race.html.

5. Gloria L. Krahn et al., “Persons with Disabilities as an Unrecognized Health Disparity Population,” American Journal of Public Health 105, no. S2 (April 1, 2015): S198-S206, https://doi.org/10.2105/AJPH.2014.302182.

6. Krahn et al., “Persons with Disabilities.”

7. Krahn et al., “Persons with Disabilities.”

8. Charles Drum et al., Health Disparities Chart Book on Disability and Racial and Ethnic Status In the United States (Durham, NH: University of New Hampshire Institute on Disability, 2011), https:// iod.unh.edu/projects/health-disparities-project/ health-disparities-chart-book.

9. S. Paul et al., Annual Disability Statistics Compendium: 2020 (Durham, NH: University of New Hampshire, Institute on Disability, 2020), Table 11.3, https://disability compendium.org/sites/default/files/user-uploads/ Events/2021_release_year/Final%20Accessibility%20 Compendium%202020%20PDF_2.1.2020reduced.pdf.

10. “Disability and Diabetes Prevention,” Centers for Disease Control, reviewed November 16, 2020, https:// www.cdc.gov/ncbddd/disabilityandhealth/features/ disability-and-diabetes-prevention.html.

11. Paul et al., Compendium, Table 11.2 12. Rachel N. Blick et al., “The Double Burden: Health Disparities Among People of Color Living with Disabilities,” Ohio Disability and Health Program (2015), accessed

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January 4, 2021, https://nisonger.osu.edu/sites/default/ files/u4/the_double_burden_health_disparities_ among_people_of_color_living_with_disabilities.pdf.

13. Drum et al., Chart Book.

14. Sanne Magnan, ”Social Determinants of Health 101 for Health Care: Five Plus Five,” NAM Perspectives Discussion Paper, National Academy of Medicine, 2017, https://doi.org/10.31478/201710c .

15. “Social Determinants of Health,” Centers for Disease Control, accessed January 5, 2021, https:// health.gov/healthypeople/objectives-and-data/ social-determinants-health.

16. Samantha Artiga et al., Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity, Kaiser Family Foundation, May 2018, https:// www.kff.org/racial-equity-and-health-policy/issuebrief/beyond-health-care-the-role-of-social- determinants-in-promoting-health-and-health- equity/.

17. Blick et al., Double Burden.

18. Silvia Yee et al., Compounded Disparities: Health Equity at the Intersection of Disability, Race, and Ethnicity, Washington, DC: National Academies of Sciences, Engineering, and Medicine (2018), https://dredf.org/ wp-content/uploads/2018/01/Compounded-DisparitiesIntersection-of-Disabilities-Race-and-Ethnicity.pdf.

19. Gina Livermore et al., “National Disability Employment Awareness Month: Still Important After 75 Years,” October 2, 2020, Mathematica, https://www. mathematica.org/commentary/national-disabilityemployment-awareness-month-still-important-after75-years.

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20. Yee et al., Compounded Disparities.

21. “Access to Foods that Support Healthy Eating Patterns,” Centers for Disease Control, accessed January 5, 2021, https://www.healthypeople.gov/2020/topics-objectives/topic/socialdeterminants-health/interventions-resources/ access-to-foods-that-support-healthy-eating-patterns.

22. Yee et al., Compounded Disparities.

23. “Social Cohesion,” Centers for Disease Control, Office of Disease Prevention and Health Promotion, accessed March 9, 2021, https://www. healthypeople.gov/2020/topics-objectives/topic/ social-determinants-health/interventions-resources/ social-cohesion.

24. Krahn et al., “Persons with Disabilities.”

25. The Current State of Health Care for People with Disabilities, National Council on Disability, September 30, 2009, https://ncd.gov/publications/2009/sept302009.

26. Deborah J. Edwards, Dikaios Sakellariou, Sally Anstey, “Barriers to, and Facilitators of, Access to Cancer Services and Experiences of Cancer Care for Adults with a Physical Disability: A Mixed Methods Systematic Review,” Disability and Health Journal 13, no. 1 (2020): 100844, https://doi.org/10.1016/j.dhjo.2019.100844.

27. Artiga et al., “Beyond Heath Care.” See also Yee et al., Compounded Disparities.

28. “Core Competencies on Disability for Health Care Education,” Alliance for Disability in Health Care Education, 2019, http://www.adhce.org/.

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“In the diversity of peoples who experience the gift of God, each in accordance with its own culture, the Church expresses her genuine catholicity and shows forth the ‘beauty of her varied face.’”

POPE FRANCIS | Evangelii Gaudium (Joy of the Gospel), #116 | 2013

JOIN US IN CONFRONTING RACISM BY ACHIEVING HEALTH EQUITY

WeAreCalled.org

Reflection

‘I See You’ JIM SMITH

W

hen visiting a local liquor store to purchase wine, I am immediately greeted by staff when I open the door. I hear a loud and hearty “Hello!” or “Welcome!” Most often, staff are quite busy ringing up customers, yet without fail they go out of their way to look to the store’s entrance and call out their greeting. I have to say, it feels pretty good. It’s why I come back to that store.

elderly woman walking slowly with the help of a nurse’s aide at her side. With one hand, the aide — a young woman probably in her early 20s — was holding on to the belt wrapped around the elder’s waist, and with the other hand pulling the woman’s wheelchair. Then in a frail, somewhat frightened voice, the resident said, “I have to sit. I can hardly breathe.” Immediately, the aide helped the woman into the chair; the aide hunched on her knees, placed her hand on the resident’s hand, and with her own eyes met the woman’s unsettled gaze. The aide said not a word in those moments, yet her expression spoke eloquently. “I see you.

I’m here. You’ll be all right.”

That afternoon in a planned presentation to the staff about our core value of respect, I described to the group what I had witnessed earlier between the young aide and the resident. As I finished the description, I met the aide’s eyes and acknowledged her for her simple, In their daily encounters, who will extraordinary service. There is little doubt that at her core, the truth see them, acknowledge them, in such of her own dignity and beloved-ness a way that the spark of their beloved was stirred.

You may be familiar with this identity is stirred and awakened?

Gospel snapshot (Luke 5:13-25): The scene inside a packed house, Jesus identity is stirred and awakened? It might just be standing beside a paralyzed man on a stretcher a customer at the counter, someone who looks who has just benefited from an outrageous act. them in the eye, smiles, asks how they’re doing. In Because of the crowd, the man’s friends — his caregivers — have punched a hole in the roof and that simple moment, a connection is made.

I was walking the halls at one of our skilled gently lowered the man to the feet of Jesus with nursing communities when I came up behind an ropes. Jesus looks up at the caregivers as they peer I carry no illusion that with their “hello” these good folks are thinking “Look! A beloved child of God, unique in all the universe.” No, to them I’m just a guy willing to spend some money in their store. So why does it feel good? Because it touches into a universal human desire to be known and to know, to be loved and to love. A simple hearty “hello” can stir a truth buried deep: “I am somebody,” in the words of the Rev. Jesse Jackson; “I am “beloved of God,” in the words of faith. And as God’s beloved, we are all worthy to be seen, to be known, to be loved. I’m smiling as I write, because it would likely confound those store employees to hear this. “Gosh, we’re just here to sell wine,” might be their response.

Yet it is just as true for them. In their daily encounters, who will see them, acknowledge them, in such a way that the spark of their beloved

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PAU S E . B R E AT H E . H E A L .

Hope In Despair down from the edges of the gaping hole.

Moved by their faith, he proclaims the paralytic’s sins to be forgiven and for the man to be healed. Jesus affirms the faith of the man’s caregivers as the reason for the healing. He sees them and affirms their place in the crucial ministry of compassionate care.

Inside or outside a pandemic, our caregivers must be seen. Do we see and attend to their grief when a beloved resident dies? Do we acknowledge their moral distress as they watch a patient diminish during months of isolated lockdown? Do we pay attention to and affirm the simple words and gestures

Burrowed deep within each caregiver is that spark of the Divine, that beloved identity. they use to honor the dignity of those in their care? Do we greet them with warmth and appreciation, whether in the break room or in an email? Do we ask for their opinion and ideas and value their response? Is our culture grounded enough in care for the caregiver, such that we are consistently attentive in these and other ways?

Burrowed deep within each caregiver is that spark of the Divine, that beloved identity. Every encounter with our caregivers in which we lovingly embody the message “I see you” is a sacred moment and helps stir that beautiful spark into flame.

For just this moment, bring your attention to your breath.

INHALE deeply and settle yourself into your body.

EXHALE the stress and tension you feel.

In these days of despair, a moment to pause is both a gift and a necessity.

GENTLE YOUR BREATHING, your gaze and

your heart as you consider: Where have I found hope in the past days?

THINK FOR A MOMENT.

In these days of despair where have I found hope?

[Pause to consider] DWELL in the hope you have found and bring

it with you into the rest of your day. Even now, God is with you, as near to you as your breath. Continue giving yourself the gift to pause, breathe and heal, knowing you are not alone.

And hope does not put us to shame, because God’s love has been poured out into our hearts through the Holy Spirit, who has been given to us. ROMANS 5:5

JIM SMITH is director, mission integration for Benedictine, a Minneapolisbased nonprofit with 33 senior care communities in five states.

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© Catholic Health Association of the United States

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Illustration by Jon Lezinsky

THE COVID CONUNDRUM

As health advocates seek equity in providing vaccines, many people refuse to get inoculated SALLY J. ALTMAN, MPH

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t had been a rough last few months of 2020 for Kim Daniel, a resident of Preservation Square, an impoverished neighborhood just a mile northwest of downtown St. Louis. She had lost seven family members ranging in age from 22 to 81, three of them to COVID-19.

Daniel, 54, has suffered all her life with a congenital heart disease that has taken her to death’s door several times. And as 2021 rolled around, she had been feeling poorly. She had gotten tested for COVID in November, and thankfully the results were negative. But her doctor suggested that her feelings of fatigue and malaise might be related to her anxiety over the pandemic. As Daniel paraphrased him, maybe it’s “the atmosphere of things.”

As 2021 dawned, the Pfizer vaccine entered into Daniel’s atmosphere of things.

You might think it would give her some hope.

St. Louis City’s public health officials made the vaccine available to eligible residents on a winter day at Union Station, a five-minute drive from Daniel’s home.

More than 1,800 residents got their first dose there on Jan. 30.

But Daniel, who likely would have qualified for a shot, said she wanted no part of the vaccine.

“This is too early, too soon, too new,” Daniel said.

But would she at least talk to her cardiologist about the vaccine?

“No. I won’t ask him because I’m not going to take it.”

Don’t you want his advice?

“I appreciate doctors and what they do, especially those who are willing to take the time to listen to me and will respond accordingly. But for me, in my life, the doctor’s opinion is not the final opinion, so I don’t.”

Daniel may be wrong about the efficacy of the vaccine, but her point of view isn’t based on ignorance. She reads widely and because of her lifelong health issues has a half-century of experience with some practitioners who have treated her and people she knows with indifference and sometimes cruelty.

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Photo by Wiley Price

Kim Daniel distributes boxes during a food drive at the Flance Early Learning Center on Feb. 5, 2021.

The nonprofit racial equity storytelling project Before Ferguson Beyond Ferguson has written about Daniel and seven other nearby families in serial fashion since the start of the pandemic.

As of this writing, not one of them has been vaccinated, nor do they want to be.

This amounts to no more than anecdotal evidence, but studies also show widespread resistance to the vaccine among people of color and those who may be most vulnerable to COVID-19.

This is particularly vexing for those who work in public health. Even before the pandemic — actually for decades — they had been clamoring for access to health care for people in marginalized communities. Without it, advocates say deaths from curable and treatable diseases fall far more heavily on people of color — a slow rolling genocide.

A case in point: Researchers at Washington University and Saint Louis University studied the social determinants of health in zip code 63106 where Kim Daniel lives, along with approximately 11,000 other people of color. They then applied the same lens to 63105, just 10 miles away, which is home to some of the region’s wealthiest and mostly white residents. They found that the average lifespan of a baby born in 63106 in 2010 would

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be 67 years old. Compare that to a life expectancy of 85 years for a newborn in 63105. And this, of course, was before COVID came along.

The pandemic made these disparities even more vivid. Analysts are finding that Black Americans have been dying from the virus at a rate 1.5 times as high as white Americans in cases in which race was known.

That should be a wake-up call to both white and Black Americans, public health advocates say.

It should not only spur people to get the vaccine when they are eligible and when it can be supplied, but also to address the health care delivery system as a whole. With a new administration calling for racial equity and improved health care, perhaps this is more possible now.

But health workers on the front lines are facing a high degree of skepticism among those they want to help.

Along with Kim Daniel consider Beverly Jones, a community activist and social worker living in 63106. As a young adult recovering from a drug addiction, Jones pulled herself together, finished college and went on to an advanced degree.

“Are you going to get the vaccine?” a reporter asked.

“I am in no big hurry to get it.”

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“Why not?”

“It’s just too much. You all want us to just trust you all. You all rushed through this thing, put it together in six months, and now we are just supposed to fall in line and just go get it? No, no. I think you all need to do a little bit more, first, because my trust level ain’t all that great. It took me about 10 to 12 years to even get a flu shot.

“I’m just not willing to just keep opening myself up to new stuff. I’m just not.”

“So if they contact you, you’re not ready yet?”

“Yeah. I’m not ready yet.”

Tyra Johnson, who is also participating in the 63106 Project, is the single mother of three children, one an infant, and two who are preschool age. She is so fearful of COVID that she only rarely lets her children play outdoors and has decided to homeschool rather than sending her eldest two children back to classrooms.

Johnson has mostly relied on information she gets from her friends and what she finds on Facebook.

“Some people, they’ve been getting it, and they don’t know what’s all in it,” Johnson said.

“I saw a live video on Facebook. A lady took it and she dropped dead. It’s not safe.” Misinformation about the vaccine is spreading rapidly, and can make messaging a challenge for those trying to encourage vaccination.

Johnson is willing to quarantine and stay at home, but she is absolutely against getting the

B

efore Ferguson Beyond Ferguson, a nonprofit racial equity storytelling project, has been shining a light on the lives of people in the 63106 zip code as they deal with the daily impact of the pandemic.

St. Louis media outlets agreed to collaborate with Before Ferguson Beyond Ferguson and carry stories in serial fashion — a new “episode” approximately every six to eight weeks. So far eight families have been covered with one or more installments; reporting and research is underway for one more family. The project thanks its funders listed on its web page, including significant support from The Pulitzer Center.

The stories can be found at https://before fergusonbeyondferguson.org/63106-project/.

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vaccine. “I’m not taking it. Everybody in my family agrees and feels the same way.”

Steven Jones is 32 years old and the father of four daughters. He suffers from epilepsy, which has put a crimp in his ability to find work. Many of his neighbors have had to keep working with the general public, their faces just inches from potential contagion every day.

When asked if he registered for the vaccine, Jones hesitated, then said: “Overall, vaccines are great. (But) I have a problem with how fast they pushed it, the red tape that they cut through to get it done. They usually say it takes two to five years of getting it out to people, getting the data back, and seeing if any short or long-term effects are happening ... We don’t even know if those weapons even fire correctly or they’re gonna backfire.”

So no, neither Jones, nor his mother, nor the mother of his children, nor his children want to get inoculated.

And then there is Misha Marshall, a health care worker. Marshall works daily in pediatric clinics across the region as a medical technician.

“Do I think a vaccine is a great thing?” Marshall said. “Sure. Yes. Am I ready to get it? No. It’s too new. It’s way too new. Will I ever get it? I can’t say.”

Few public health experts find this skepticism surprising. Local experts Angela Brown, Bethany Johnson-Javois, Herb B. Kuhn and Dr. Will Ross, writing in The St. Louis American on Jan. 30, cited a study saying that Blacks were “the most reluctant group by far” to want to get inoculated when vaccines became available.

While this COVID conundrum is a nationwide problem, St. Louis gets a lot of attention as it has long been considered a locus for racial disparities since the police shooting of Michael Brown in 2014 and subsequent civil unrest.

The PBS News Hour interviewed Jason Purnell, vice president of community health improvement with St. Louis-based BJC HealthCare. He noted that the region is to some degree flying blind in its response because “we’re not tracking in a rigorous or reliable way where the greatest need is.”

Indeed, in a briefing in early February, the White House noted that nearly half the data collected on people infected by the virus and those receiving vaccinations did not contain information on their race or ethnicity.

Purnell, Brown, Johnson-Javois, Kuhn and Ross all say African-Americans have ample reason to be skeptical of their doctors and the health system in general.

“There are certainly legitimate reasons for dis-

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Early Learning Center, where Kim Daniel works and where Tyra Johnson once sent her children, finds herself in a delicate position when it comes to vaccine hesitancy.

Timmer, who is white, works with a diverse staff of 32 whom she wants to protect from COVID. So it makes sense to encourage them to get the vaccine when it becomes available.

Even so, Timmer says she is unlikely to make it a requirement, although Flance does require other vaccinations.

Timmer has polled Flance staff concerning the COVID vaccines and has found that no one has received an injection, and “a significant number” have said they will not get it. She finds this dismaying, but unsurprising. “We prefer that people get the vaccine for their health, not because it’s beneficial to Flance. But we fully respect our staff and the journey their lives have taken them in making their own medical decisions,” she said.

Timmer says she understands that “the medical industry has not been fair or equitable to minority communities. They have no reason to trust the medical community right now. They just don’t.”

Many African-Americans are familiar with the Tuskegee trials in which African-Americans were told they were getting treated for syphilis when they were not.

Stories such as these are not only in history books but again “in the atmosphere of things.”

Timmer recounted a story she heard from a nearby resident who frequently comes to the weekly food giveaways that the center started during the pandemic. Striking up a conversation, Timmer asked the resident about his family.

The elderly gentleman noted that he was one of 22 children. Remembering that he was married, Timmer asked if he had any children. “No,” Timmer recalled him responding. “I was part of a forced sterilization.”

“This was a human being that lived across the street,” Timmer said. “Our medical community sterilized him.”

More evidence of indifference and cruelty: Numerous studies show that physicians failed to

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Denise Hollinshed

trust based upon both history and contemporary experiences with public health and health care,” Purnell said. “Among the best ways to address distrust are to lead with empathy, listen intently, share information transparently and respond with accountability. We do have information to address concerns, but it has to be shared by trusted messengers in the spirit of supporting informed choices.”

Purnell noted that health care advocates should avoid regarding all African-Americans as skeptics. He cited a survey of 1,340 respondents from the National Foundation for Infectious Diseases, which showed Beverly Jones far greater acceptance among older AfricanAmericans, with 68% of those 60 and older saying they plan to get vaccinated. Just 38% of those aged 18 to 44 said they had similar plans.

Purnell noted health care workers can provide solid answers to skeptical queries about the vaccine.

Among them: Clinical trials were designed to include diverse populations, and COVID vaccines are highly effective whether people are getting the Pfizer, Moderna or the Johnson & Johnson versions. They are far more effective than the vaccines for influenza.

When choosing between the vaccine or simply accepting the risk of contracting the virus, COVID-19 is by far the more dangerous option, according to information provided by The New York Times. “COVID vaccines carry little known risk. But the perils of COVID-19 have been well documented,” the Times noted. “About 20 percent of people who come down with COVID-19 symptoms develop serious, potentially life-threatening illness.”

Known side effects of the vaccine are similar to those for flu and other common vaccines.

Allergic reactions occurred in just one-half of 1% of participants.

Most people will be able to receive the vaccination at no cost, and almost everyone for less than $25. No one in the United States can be turned away if they are unable to pay.

Tami Timmer, executive director of the Flance

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respond appropriately when African-American patients said they were in pain. A meta-analysis of 20 years of studies covering many sources of pain found that African-American patients were 22% less likely than white patients to receive any pain medication, according to a report published by the American Association of Medical Colleges.

Testimony before a U.S. Senate committee revealed that in 1972 as many as 2,000 impoverished Black women with multiple children were forced into sterilizations without their consent or knowledge. Many others provided their consent but only after being told that they could not receive their welfare benefits until they did. The surgeries were performed with funds from the U.S. Office of Economic Opportunity.

In light of all of that, Timmer says she has learned to tread softly when it comes to vaccines — any vaccine. “We only had about 60 percent of our staff get free on-site flu vaccines,” Timmer recalled.

Even so Timmer said Flance has asked to become a distribution site for the vaccine when more supplies become available. “Foremost right now we are educating our staff,” Timmer said. “I send out at least twice a week videos, links and information regarding registrations.”

The center has been working closely with the City Health Department, she said.

Meanwhile African-Americans in the forefront of medical science are mounting a much more aggressive campaign. Sixty Black members of the National Academy of Medicine signed on to an op-ed in The New York Times calling on African-Americans to get vaccinated. “Disinformation about the coronavirus and vaccines has pervaded social media, feeding on long-held … distrust of health institutions in Black communities,” wrote the lead authors, Dr. Thomas A. LaVeist and Georges C. Benjamin. “The lies are an assault on our people, and it threatens to destroy us.”

Also joining in: the Association of Black Cardiologists, an 1,800-member nonprofit organization with a mission to bring attention to the adverse impact of cardiovascular disease on AfricanAmericans. Adding to its news release advocating for vaccinations, the Association of Black Cardiologists published a series of photos showing their members getting injections. The captions included their comments. “Taking the vaccine is a no-brainer for me,” said Dr. Michelle Albert, a San

Francisco cardiologist and the association’s president, who stepped up for the Moderna vaccine.

Public health experts both on the national and local levels are also expressing concern about resource allocation. Missouri Gov. Mike Parson took criticism for funneling disproportionate amounts of vaccine to outstate regions. On March 10, he said he would send more vaccine to St. Louis and expand eligibility.

Health care advocates have called on states to use the Social Vulnerability Index, a measurement devised by the federal Centers of Disease Control.

The index applies to every zip code nationwide and includes measurements on factors such as poverty, housing and access to transportation. On that scale 63106 rates as highly vulnerable. With 1.0 standing as the highest for vulnerability and 0.0 the lowest, zip code 63106 scored .0862. By comparison 63105 came in at .0176. The measurements are from 2016, the latest available. https:// www.atsdr.cdc.gov/placeandhealth/svi/fact_ sheet/fact_sheet.html With a tool like that, policymakers would know better where to allocate their resources, and nongovernmental organizations, such as faith groups, would know better where to focus their attention.

Testimony before a U.S. Senate committee revealed that in 1972 as many as 2,000 impoverished Black women with multiple children were forced into sterilizations without their consent or knowledge.

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One such group in St. Louis is already at work.

Faith and For the Sake of All coordinates activities among dozens of church groups aimed at improving the health and well-being of people in Black communities. The Rev. Gabrielle Kennedy serves as director for the organization. She has refused to wait around for governmental bodies and health care systems to create a fair and equitable rollout.

“There are systems that have to work and we understand all of that, but we couldn’t wait for that system to do what it was supposed to do,” Kennedy told St. Louis Public Radio in November.

“We had to try and find a way to do it ourselves.”

Kennedy said the organization started by providing sites for COVID testing and flu shots. Now

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it is mobilizing to educate people about the vaccine and, just as importantly, undertaking outreach efforts to ensure skeptical residents have all the information they need to make an informed decision about receiving an inoculation. Faith and For the Sake of All hosts panel events and small group discussions with area congregations to create relationships between Black communities and area health professionals.

Kennedy notes that some families are eager, in some cases desperate, to get vaccinated, including those who are caring for elderly relatives.

In all cases, Kennedy said, health workers and policymakers need to re-build relationships with African-Americans. “Without acknowledgement of past wrongs, and regular intentional interactions, it will be difficult to build trust.”

This article includes additional reporting from JEANNETTE COOPERMAN, DENISE HOLLINSHED, AISHA SULTAN and RICHARD H. WEISS. SALLY J. ALTMAN has devoted her career in public health to working with key stakeholders on health access issues as a health care administrator and a journalist. JEANNETTE COOPERMAN is a St. Louis journalist and an essayist for Washington University’s The Common Reader. DENISE HOLLINSHED served as a crime and urban affairs reporter for the St. Louis Post-Dispatch for 21 years and is now a freelance writer.

AISHA SULTAN is a nationally syndicated newspaper columnist, award-winning filmmaker and features writer. RICHARD H. WEISS is founder and executive editor of Before Ferguson Beyond Ferguson, a non-profit racial equity storytelling project.

A previous article about the 63106 Project also appeared in the Fall 2020 issue of Health Progress.

RELATED RESOURCES The St. Louis American article about the COVID paradox — overcoming disparities and vaccine mistrust: http://www.stlamerican.com/news/local_news/acovid-19-paradox-overcoming-disparities-and- vaccine-mistrust/article_77bd30b0-636c-11eb- ad2e-efd02717be82.html.

National Foundation for Infectious Diseases: https:// www.nfid.org/.

“Answers to All Your Questions to Getting Vaccinated for COVID-19,” The New York Times, Feb. 19, 2021, https:// www.nytimes.com/interactive/2021/well/covid- vaccine-questions.html.

Association of Black Cardiologists vaccine news release: https://abcardio.org/recent-news/abc-advocates-forvaccinations-in-communities-of-color/.

Social Vulnerability Index fact sheet: https://www.atsdr. cdc.gov/placeandhealth/svi/fact_sheet/fact_sheet. html.

“There are systems that have to work and we understand all of that, but we couldn’t wait for that system to do what it was supposed to do. We had to try and find a way to do it ourselves.”

— REV. GABRIELLE KENNEDY

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A Shared Statement of Identity for the Catholic Health Ministry We are the people of Catholic health care, a ministry of the church

continuing Jesus’ mission of love and healing today. As provider, employer, advocate, citizen — bringing together people of diverse faiths and backgrounds — our ministry is an enduring sign of health care rooted in our belief that every person is a treasure, every life a sacred gift, every human being a unity of body, mind, and spirit.

We work to bring alive the Gospel vision of justice and peace. We answer God’s call to foster healing, act with compassion, and promote wellness for all persons and communities, with special attention to our neighbors who are poor, underserved, and most vulnerable. By our service, we strive to transform hurt into hope.

AS THE CHURCH’S MINISTRY OF HEALTH CARE, WE COMMIT TO:

romote and Defend Human P Dignity ! Attend to the Whole Person ! Care for Poor and Vulnerable Persons ! Promote the Common Good ! Act on Behalf of Justice ! Steward Resources ! Act in Communion with the Church !

© The Catholic Health Association of the United States

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Closing the Loop With Ministry Assessments BILL BRINKMANN

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atholic health care in the United States has lots of pieces. It includes many organizations, a diversity of sponsors, and multiple operational models and processes. Yet, these Catholic health ministries, sometimes independently and sometimes in cooperation with the Catholic Health Association, have produced a robust collection of ethical guidelines, effective formation processes, compassionate pastoral care procedures, meaningful community outreach, and approaches to finance that aim to balance justice and sustainability. Along with that, many Catholic health care systems have been conducting assessments of how effective these activities are at accomplishing their stated mission.

OUR MISSION

Although the many organizational ministries of Catholic health care have expressed their mission in a variety of formulas, these statements are generally cohesive in their intent to “answer God’s call to foster healing, act with compassion, and promote wellness for all persons and communities with special attention to our neighbors who are poor, underserved and most vulnerable.”1 This is a special mission, which commits us to respond to a powerful call. And, much has already been done by the ministries to develop, clarify and implement this mission. For over a century the Catholic bishops of the United States, in collaboration with Catholic health care and CHA, have been refining moral and ethical guidance for the healing ministry in the Ethical and Religious Directives for Catholic Health Services (ERDs), a fundamental source of guidance on how to manage a Catholic health ministry.

Further, the founding sponsors of these ministries and their successors have developed formation programs and values training that are supportive of the mission. And, the sponsors have encouraged everyone working in the healing ministry to participate in formation or spiritual development programs. Perhaps the most useful development in the understanding of the mission of Catholic health care is The Shared Statement

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of Identity for the Catholic Health Ministry. This short document (pocket card) is well recognized and becoming the de facto mission statement for many Catholic health ministries. Each ministry’s Community Health Needs Assessments and its strategic plan provide the specific context for the actions that must be taken to fulfill the mission. I know of no other organization that provides more thoughtful analysis of its mission statement than the Catholic health ministry. The Gospel call to heal, the ERDs, the foundational stories, the sponsors’ unique charisms and the resources of CHA have all been utilized in deepening the understanding of our mission. Truly, the mission is a treasure that can inspire those who come to serve with us.

THE PROCESSES TO PERFORM THE MISSION

The movement from understanding our mission to implementing it effectively requires an institution to establish and continuously improve many processes, including clinical practice, pastoral care, administrative function, financial strategy and many more. Most people want to believe that they are engaged in meaningful work: work that is helping others. The Shared Statement not only lists the goals of our mission, it also invites the commitment of all those working in Catholic health care to fully engage in the ministry. One

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of the primary intents of the spiritual formation and values training that health care systems and CHA have produced is to provide a sacred context for the work that is being done throughout the ministry.

That said, if we view Catholic health care as a whole, the processes it uses to accomplish its mission can be surprisingly dissimilar. While the Shared Identity document provides our context — our inspiration and our commitments to promote and defend human dignity, attend to the whole person, care for poor and vulnerable persons, promote the common good, act on behalf of justice, steward resources and act in communion with the Church — the manner in which these commitments are carried out in the individual ministries has great variety. This is true not only when we compare the processes implemented between Catholic health systems, but even in hospitals within the same system there is often a lack of consistency.

The Total Quality philosophy with its strong emphasis on process documentation, measurement and improvement has spread slowly through health care in general, including Catholic health care.

This, unfortunately, has delayed how quickly best practices can be implemented. For example, the report “To Err Is Human: Building a Safer Health System” issued by the U.S. Institute of Medicine in 1999 has tracked health care’s reluctance to readily embrace established safety protocols. And, in the field of spiritual formation, systems seem much more willing to share the materials they have developed than they are to accept the materials developed by other systems.

sumer Assessment of Healthcare Providers and Systems, or HCAHPS, survey questions concerning the attentiveness of the staff, but it must also include clinical measures such as infection rates and return visits as well as feedback on pastoral care. Stewarding resources can include financial measures such as cash on hand and budget compliance, but it should also attend to how the organization is impacting its physical environment.

Many ministries have developed systems to help them determine how well they are fulfilling their commitments to their mission.

For over 10 years I was a member of a team that supported ministries conducting self-assessments of how well they were living their mission as expressed by the Shared Statement of Identity.

One of the primary intents of the spiritual formation and values training that health care systems and CHA have produced is to provide a sacred context for the work that is being done throughout the ministry.

MISSION OUTCOMES

How do we know how well we are implementing the commitments we made in the Shared Statement? To answer, we must measure the outcomes of the many processes put in place to serve those who come to us for healing. Most importantly, these outcomes must impact our patients positively. They must be measurable and be related to the commitments we make in the Shared Statement. Rarely can a single measure capture all the impact of one of our commitments. Attending to the whole person, for example, can be partially assessed through several of the Hospital Con-

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We conducted these assessments in over 150 hospitals in eight different Catholic health care systems. In general, the maturity and effectiveness of processes varied significantly. The greatest strengths seemed to be in processes related to Care for Poor and Vulnerable People and to Stewarding Resources. The greatest opportunities for improvement in my opinion were in the commitment to Acting on Behalf of Justice, specifically how we engage, recognize and compensate our employees.

In 2019 the Catholic Health Association, in cooperation with many of the Catholic health systems, produced the Ministry Identity Assessment resource. It makes use of the commitments embedded in the Shared Statement as well as the good work that has been ongoing in the ministries to provide an extensive description of a process for conducting a ministry assessment. The purposes of ministry assessments are to improve care by identifying potential process improvements and to inform ministry sponsors about the effectiveness of the ministry.

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USING MISSION ASSESSMENTS FOR PROCESS IMPROVEMENT

One ministry assessment discovered that the system had “Holistic Care” as a key component of its mission statement, but that it did not have a precise definition of holistic care. Caregivers were not certain of its meaning and what processes of their work were affected. To remedy that, a team of clinical, quality, safety and mission representatives worked together to develop a definition of holistic care for system-wide implementation and is now measuring patient reaction.

Another system assessed itself as relatively low in enabling co-workers to recommend changes to processes. The system decided to create formation materials that could assist leaders in empowering associates and placed associate engagement scores on the executive compensation formula.

The finance department at one system office felt detached from the mission, which caused a perceived lack of purpose. A series of reflections was developed to assist the department in seeing their role in stewarding the mission.

A review of HCAHPS data concerning the attentiveness of nurses and physicians toward patients revealed that a particular ministry was performing below national norms. To improve clinician attentiveness, a team was charged with

determining causes and developing a plan of corrective actions.

These are among the significant lessons learned by ministries that have systematically engaged a mission identity assessment process: The utility of the ministry assessment process is only realized when the results of the assessments are used to enhance the processes that have been developed to meet stated commitments.

What is learned in these assessments should be used in a continuous process improvement effort.

This is what is meant by Closing the Loop.

There is already voluminous data available that relates to the commitments of the Shared Statement. This includes patient feedback required by government programs as well as ministry-developed patient satisfaction programs; many financial measures, already in place, that relate to the commitment of stewarding the ministry; community needs assessments data that relate to justice; and ongoing relationships with local bishops that reflect our communion as a ministry of the Church.

The adage from the Total Quality movement holds true: “what gets measured gets improved.”

As a rule, leaders focus attention and corrective action on process outcomes that are measurably unfavorable.

CLOSING THE LOOP WITH MINISTRY ASSESSMENTS OUR MISSION

OUR PROCESSES Clinical

The shared statement of identity for Catholic health ministry.

Pastoral Planning

The Gospel call to heal Community needs Assessments Sponsor intent

Selection Formation Financial

OUR IMPACT Ministry identity assessment

Measurable Related to our ministry commitments Much data Available

Quality Logistics Environment Collaboration Etc.

Feedback from ministry assessment informs sponsors and leaders.

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Feedback from ministry assessment drives process improvement.

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Formation programs should identify the relationship between our ministry commitments as outlined in the Shared Statement and the outcomes we are experiencing, thereby highlighting the mission context of every person’s role in the ministry as well as appropriate responsibilities for participants and leaders in the ministry.

The measurement of ministry outcomes can provide vital feedback for sponsors in their role as stewards of the mission of Catholic health care.

CONCLUSION

PAU S E . B R E AT H E . H E A L .

Our formation programs, process improvement and ministry assessments should be directly derivative of the commitments outlined in the Shared Statement. They should address why and how we: promote and defend human dignity, attend to the whole person, care for poor and vulnerable persons, promote the common good, act on behalf of justice, steward resources and act as a ministry of the Church. Alignment of these activities will strengthen our efforts to “answer God’s call to foster healing.” I believe that, as the collective ministry of Catholic health care, we are called to continuously document, improve, share and measure our practices.

Measuring the outcomes of these processes can then lead us to establish benchmarks that can demonstrate what is possible and assist all our ministries to improve the care we provide. Some common benchmarks that the ministries have used in this endeavor are: 1) ranking in the tenth percentile on HCAHPS measures of caregiver attentiveness; caregivers’ willingness to recommend their ministry to others as a great place to work; an A++ Bond rating; and high-ranking measures of clinical excellence, such as infection control. The pursuit of excellence is a spiritual journey that is nourished by our being grounded in the mission and exercised through our management of a holistic healing process.

BILL BRINKMANN has worked for Mercy Health and Ascension as a vice president for mission initiatives, with an emphasis on leadership formation and Catholic ministry identity. He is a retired U.S. Navy Captain.

RESOURCE 1. A Shared Statement of Identity, https://www.chausa. org/mission/a-shared-statement-of-identity.

Joy in Sadness For just this moment, bring your attention to your breath.

INHALE deeply and settle yourself into your body.

EXHALE the stress and tension you feel.

In these days of sadness, a moment to pause is both a gift and a necessity.

GENTLE YOUR BREATHING, your gaze and your heart as you consider: Where have I found joy in the past days?

THINK FOR A MOMENT. In these days of sadness where have I found joy?

[Pause to consider] Even now, God is with you, as near to you as your breath.

Continue giving yourself the gift to pause, breathe and heal, knowing you are not alone.

Weeping may stay for the night but rejoicing comes in the morning. PSALM 30:5 © Catholic Health Association of the United States

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NEW

Sponsor Resource

A VALUABLE GUIDE

about the distinctive role of sponsors for the health ministry of the Catholic Church.

The guide highlights the vocation, personal qualifications and ongoing formation of individual sponsor members. It also outlines core competencies of the sponsor body and explains the development of ministerial juridic persons (MJPs) and evolving models of sponsorship.

AVAILABLE AT CHAUSA.ORG/STORE

How to Strengthen Catholic Identity in a Diverse Workforce CHAD RAITH, PhD

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ne of four focus areas of the Catholic Health Association’s recently released 20212023 strategic plan is to “articulate and strengthen the Catholic identity of our health ministries.” To advance this goal, CHA details the important role mission leaders play in this work, including the professional competency to build strong Catholic identity and implement key mission activities within the organization. The continued focus on Catholic identity should be a welcome pillar for our health care ministries and an expected competency of mission leaders. Catholic identity has not only formed the original theological, ethical and spiritual context for our ministries, but it also provides the necessary vision and nourishment to sustain them into the future.

But given the religious diversity among those serving in Catholic health care, the question of strengthening Catholic identity necessarily leads us to ask: How do we strengthen the Catholic identity of health care ministries that employ a large number of non-Catholic staff and caregivers? What does it look like to enable these individuals to flourish in their calling to serve in Catholic health care while simultaneously maintaining and deepening the Catholic identity of those very same ministries? While this is certainly not a new question, we still have much to discern as we navigate the tension between the self-identity of our ministries and the inclusion of a diverse workforce.

ECUMENICAL AND INTER-RELIGIOUS CONVERSATIONS

There are two different kinds of conversations that guide our approach to strengthening Catholic identity within a diverse workforce. One is called “ecumenical” and is “intra-Christian,” involving the engagement of Catholics with non-Catholic Christians. The other is called “inter-religious”

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and involves the engagement between Catholics and people of non-Christian faith traditions. That there are two distinct conversations is reflected in the fact that the Second Vatican Council produced two distinct documents, one to guide ecumenical engagement (Unitatis redintegratio) and one to guide inter-religious engagement (Nostra aetate). Both conversations have a similar goal: to promote the unity and flourishing of human beings with one another and with God. But they hold different assumptions. Inter-religious dialogue is based on the belief in a unity that should exist among human beings due to all people being made in the image of God and made for the God of that image. It presupposes that every human being has the natural or innate ability to see and pursue God through the use of their reason and free will. Ecumenical dialogue, however, presupposes this natural unity but also includes a unity made possible by faith in the person and work of Jesus Christ. Ecumenism comprises all those efforts that seek to overcome the conflict between Jesus’ calling that God’s people shall be “one” (see,

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for example, John 17:21) and the actual state of affairs, namely, a divided Christian people.1 The latter unity builds upon and deepens the former, and the former finds its ultimate depth and meaning in the latter. As these unities are advanced, so does human flourishing advance, as does our Catholic identity.

The two documents mentioned above — Unitatis redintegratio and Nostra aetate — have shaped and should continue to shape how we think about advancing Catholic identity in ministries that include significant numbers of nonCatholics. For this reason, I want to highlight four important points that stand out from these documents: First, Unitatis redintegratio states in unequivocal terms the Catholic Church’s desire for restored unity: “The restoration of unity among all Christians is one of the principal concerns of the second Vatican synod.”

The document does not limit participation in ecumenism to clergy but rather encourages “all the Catholic faithful … to take an intelligent part in the work of ecumenism.” This means that the work of healing division is not just for theologians and ministers and is not limited to church settings. Each of us carries a responsibility, including within the health care setting, to move us forward in the calling toward unity.

Second, Christians who are not Catholic are not guilty of any “sin” of separation: “The children who are born into these Communities and who grow up believing in Christ cannot be accused of the sin involved in the separation, and the Catholic Church embraces upon them as brothers, with respect and affection.” The relationship between Catholic and non-Catholic Christians is therefore familial: we are sisters and brothers in Christ, and it is from that standpoint that we work towards greater unity. It is a family affair.

Third, the restoration of unity is not a matter of a triumphalist, return-to-the-Catholic-Churchor-else endeavor. Rather, increase in unity will occur only as people go through ongoing reformation and renewal. “Reformation” implies the need for transformation and change, while “renewal” implies that such change is for the sake of increased vitality, meaning and identity.

For reformation and renewal to occur, there is the need for “interior conversion” of both persons and organizations that leads to humility and

change — this is often given the name “spiritual ecumenism.” Such transformation is the soul of the ecumenical movement. The Catholic ecumenical endeavor, then, is a common pilgrimage of reform and renewal alongside non-Catholic brothers and sisters toward the fullness of what is desired by Jesus. (This is precisely the vision set forth recently by Pope Francis I in his encyclical Evangelii gaudium.)

Lastly as Nostra aetate teaches, non-Christian religions possess ways of living, teachings and

Christians should collaborate with people of other religions to “promote good things, spiritual and moral,” such as “social justice and moral welfare, as well as peace and freedom.”

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beliefs that contain truths about God and about human beings that although different at times from Christianity nonetheless contribute to the flourishing of human beings. Christians should collaborate with people of other religions to “promote good things, spiritual and moral,” such as “social justice and moral welfare, as well as peace and freedom.” The document concludes by rebuking any attempt to discriminate against people based on their religion.

A DEAD-END MODEL

These four points should inform our approach to strengthening Catholic identity while providing a hospitable workplace. But the more practical question remains: how do we actually go about advancing Catholic identity in settings sometimes largely composed of non-Catholics in a manner that reflects our common pilgrimage of reform and renewal?

One popular model, I believe, ultimately leads to a dead end. It can be captured with the famous slogan “doctrine divides, service unites.” The reasoning goes like this: While theologians wrangle over getting all their doctrinal ducks in a row, a world is dying and in need of the healing service of the church. We might not agree on, say, the Pope or the Eucharist, but we can come together

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to do things like feed the poor or care for the sick, and in doing so we will testify to the gospel and to our unity in deeds rather than words. Doctrines or beliefs if they are addressed at all, are often limited to a set of basic teachings — the “lowest common denominator” — on which all parties can agree, and elements of unique identity and practice, such as praying in the name of Jesus or crossing oneself, are often sidelined.

The presupposition here is that a neutral as possible health care space is best suited for allowing those from different backgrounds to serve in our ministries. In these “neutral” spaces, Catholics and non-Catholics alike are able to conceive of and talk about the healing ministry in terms that can be easily harmonized with their own tradition. The goal, again, is merely the common, united service of caring for the sick.

While the focus on our common service to advance real, transformational initiatives — as opposed to focusing merely on theological “ideas” — is certainly commendable, this approach will consistently result not only in weakening Catholic identity but also in falling short of moving us into all that God desires for the flourishing of human persons. Recall that the focus of our pursuit of unity is not (or at least should not be) unity for unity’s sake. Rather, the focus of unity is ultimately human flourishing through a deeper participation in the person and work of Jesus Christ.2 Jesus calls his people not only to pursue what is good but also what is true. And the ultimate goal in our pursuit of truth (doctrine) and pursuit of goodness (practice) is in fact a pursuit of deeper participation in Jesus himself, who is, according to Paul in his first letter to the Corinthians, is the source and summit of all things. Deeper participation in the work of Jesus results in a deeper oneness among people, both in terms of our common humanity and in terms of our graced participation in God. This means that if there are in fact doctrines and practices that can lead people to a deeper participation in Jesus, they must be part of our work of unity. Common service initiatives and lowest-common-denominator approaches are not enough to move us collectively into this fullness.

It will also leave our health care spaces generic and bland in their identity, lacking the distinctive culture it could otherwise have that might genuinely set Catholic health care apart in the market.

But how do we bring to the table doctrines and practices that are unique to Catholicism and potentially divisive for those who are not Catholics without resulting in a triumphalist, returnto-Rome-or-else approach? How do we avoid sidelining different beliefs and practices while still embodying the hospitable setting described above by Unitatis redintegratio and Notra aetate?

How do we maintain a strong self-identity as a Catholic health care ministry and also be inclusive of those who are not Catholic?

RECEPTIVE ECUMENISM

While there is no easy answer to this question, we can begin to move toward a fruitful approach through the concept of “receptive ecumenism.”3 In receptive ecumenism, the fundamental posture of all parties is a self-critical stance that assumes the ability to benefit — to receive — from another’s tradition. In Paul Murry’s words, “Receptive Ecumenism is concerned to place at the forefront of the Christian ecumenical agenda the self-critical question, ‘What, in any given situation, can one’s own tradition appropriately learn with integrity from other traditions?’”4 The ecumenical journey is understood as one of ongoing “conversion” and transformation along the path to deeper participation in the fullness of Jesus. Rather than an adversarial stance that pits one tradition against the other, or a lowest-common-denominator approach that seeks baseline minimal agreement, those engaged in receptive ecumenism under-

Deeper participation in the work of Jesus results in a deeper oneness among people, both in terms of our common humanity and in terms of our graced participation in God.

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stand their traditions to be on a shared journey toward a fuller living out of the faith. This journey requires the gifts of each tradition to be shared in order to move further toward conversion — or, in the words of Unitatis redintegratio, further in “renewal” and “reformation.” The goal is not for each person to become less of who she or he is but more of who they are through the mutual sharing of gifts: again, it is not unity for unity’s sake but for

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the full participation in the universality that God desires for the human race.

What would receptive ecumenism look like for our health care ministries as we seek to “articulate and strengthen” our Catholic identity? There’s a threefold implication.

1. Listening and Learning. Strengthening Catholic identity will require a fundamental posture of listening and learning from those who are not Catholic. In his encyclical Evangelii gaudium, Pope Francis noted how Catholics must “have sincere trust in our fellow pilgrims, putting aside all suspicion and mistrust, and turn their gaze to what we are all seeking: the radiant peace of God’s face.”5 We must invite those who are not Catholic to be fully who they are in order that Catholics might benefit from the gifts they possess; we must allow their traditions to lead us toward “renewal” and “reformation” in our Catholic identity.

I have witnessed, for example, Christians who are not Catholic express a warm and personal relationship to Jesus that has led their Catholic coworkers to newfound vibrancy and meaning in their Catholic practices. I’ve also seen the spontaneity of certain prayer practices, whether with patients or with other coworkers, help Catholic coworkers become more comfortable in praying spontaneously themselves with patients and coworkers. For these gifts of exchange to occur, Catholic health care systems must convey the hospitality necessary to make non-Catholics feel comfortable expressing themselves in and through the traditions they follow.

2. Engaging Fully. Catholics have an obligation in service to non-Catholics to bring forth the fullness of their tradition in order that others might benefit from those gifts for their own edification and renewal. While conventional wisdom might suggest that sidelining distinctive Catholic beliefs and practices to create a more “neutral” health care space would be a sign of hospitality, receptive ecumenism suggests otherwise. From the perspective of receptive ecumenism, the Catholic engages more fully in her beliefs and practices as a service to those who are not Catholic. Genuine love of neighbor seeks the welfare of the neighbor through the exchange of gifts. Unless our ministries live into the fullness of their Catholic beliefs and practices, we will come to the ecumenical

table empty-handed with no gifts to offer.

I have worked with, for example, a number of coworkers from non-Catholic backgrounds who initially believed only “spontaneous prayer” was genuine prayer. But when they encountered the beauty and power of prayers thoughtfully written in advance of the moment they are prayed, they began to see the value and meaningfulness of praying the prayers written by others or writing out their prayers in advance. Other coworkers who knew very little about the Catholic understanding of the relationship of nature and grace — that is, how God’s grace and presence comes into the world through (rather than despite) those things He has created, especially human beings — began, once they grasped this harmo-

Genuine love of neighbor seeks the welfare of the neighbor through the exchange of gifts. Unless our ministries live into the fullness of their Catholic beliefs and practices, we will come to the ecumenical table empty-handed with no gifts to offer.

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nious relationship, to see how their work truly was the ongoing extension of God’s healing in the world. Many other examples could be highlighted around symbols, rituals and language. But in sum, for Catholics to live more deeply into their Catholic identity is not to create more division among God’s people but rather to offer gifts to exchange in the common journey toward the full catholicity that God desires.

3. Remaining Intentional. Receptive ecumenism is not automatic. The impulses toward creating neutral spaces and striving for lowestcommon-denominator teaching and practice are very strong; in many ways it reflects the path of least resistance. For the mutual exchange of gifts to actually take place, then, we must intentionally provide space and time for this exchange to occur — whether virtual or in person, whether a class or a lunch-and-learn, whether in formal or informal settings. We need not shy away from engaging challenging Catholic teachings and practices that

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may have been (and may continue to be) divisive or difficult. We need not focus simply on baseline agreement and common acts of service. Instead by listening and learning, engaging fully, and remaining intentional, health care settings can be places of abundance of gifts as we provide opportunities in the midst of service to allow for mutual edification on our common journey toward the fullness of what Jesus desires for his church.

MISSION LEADER AS TRANSLATOR

What is the role of mission leader in strengthening Catholic identity as it is carried out in the practice of receptive ecumenism? In its strategic plan, CHA says it hopes to “translate and give witness to our shared Catholic heath identity and core commitments” as part of its promotion of Catholic identity. The notion of “translation” will be increasingly one of the critical roles mission leaders will play in advancing Catholic identity.

The exchange of gifts in receptive ecumenism can easily stall due to miscommunication, misunderstanding and misapplication. When gifts are presented in a language and with concepts that are foreign to the receiver, they can be seen as irrelevant at best and as threats at worst. There will need to be individuals in the midst of the conversation that are knowledgeable enough not only of their own but of each other’s traditions to help facilitate the exchange. Mission leaders are best poised to act as these translators. They must seek to help translate different traditions into language and concepts that are intelligible to the receiver and help communicate these beliefs and practices in a way that the receiver sees how they are truly gifts and not threats.

Consider the hypothetical example of a man of faith in the Baptist tradition asking me about the faith environment at my health care system. In order to illustrate one of our spiritual practices, I say to him, “Well, before we open the clinic each day we all gather together and say the Our Father.”

He then looks at me confused, and says, “Is that some Catholic ritual you guys do?” Now consider the same exchange, but in my response I don’t call the prayer the Our Father but rather the Lord’s Prayer. Now the man smiles and says, “Wow, that’s incredible. I really should be a patient there.”

What changed? Nothing in substance, only in language. But knowing that Catholics commonly use the phrase “Our Father” and Protestants commonly use the phrase “the Lord’s Prayer” allows a point of translation to occur. While this is a small,

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somewhat superficial example, the point can be applied to a host of other beliefs and practices — for example, crossing oneself, the crucifix, the place of Mary, sacraments, Catholic hierarchy, religious orders — that will need to be translated in order that mutual gift exchange can occur successfully.

NAVIGATING CONFLICT

What happens, however, when traditions are in conflict with one another? Up to this point I’ve painted a largely harmonious picture of the mutual sharing of complementary gifts. But the reality is that people continue to have irreconcilable (at least at the present time) differences in their approach to the faith. These differences might not make a significant difference on the front line of health care. But as we climb the decision-making ladder, particularly when it comes to setting a health care system’s strategy, these differences could significantly affect the Catholic identity of our ministries — though to what extent is still an open question. So how do we deal with the fact that leaders from traditions that are not only not Catholic but are potentially in conflict with Catholic theology, morality and spirituality are making strategic decisions on behalf of Catholic ministries? What if, for example, a nonCatholic senior leader who neither understands nor practices Catholic social teaching sees health care, say, as a privilege for those who can afford it rather than a right fundamental to human flourishing and makes decisions about charity-care efforts that will negatively affect indigent patient populations? How do we navigate this potential conflict?

There is no easy answer to this question. What we can say, however, is that the exchange of gifts in receptive ecumenism rarely, if ever, occurs in a neutral space. More often than not there is a host tradition that provides the space (and hospitality) for the exchange of gifts to occur. In any situation of hospitality, for the full benefits to arise for both host and guest, there are ways of conducting oneself appropriate to each. If, for example, I were invited to a person’s house for dinner, and I walked in and tracked mud on the floor, plundered the cupboards, drank all the wine and left without expressing an ounce of gratitude for the hospitality, the hospitable event would not be fulfilled due to my shortcomings as a guest to conduct myself in a more fitting way. This is not to say that in such situations the host must stop being hospitable to

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the guest, or that the host would never host that guest again. But it is to say the host-guest experience would not bear its full positive fruit due to the failure of the guest to act with sensitive receptivity to the host. (The breakdown could just as well occur due to poor hosts, too!)

To bring the analogy to our health care ministries, the host space is the Catholic theological, ethical and spiritual tradition. This is the context in which our ministries were given birth, and it remains the context in which our ministries are carried out. Those from other traditions who serve in our ministries are welcomed as guests within the context of the Catholic tradition and will remain so. They will inevitably bring ideas, strategies, experience, skills and behaviors to the table that will enrich Catholic identity. But in order for the full fruit of gift exchange to occur, the guests must have an understanding of the host space — and providing that understanding is ultimately a responsibility of the host — and they must enact their roles in a manner fitting to the host space. What this means in leadership decisions is that leaders of our ministries must understand the Catholic theological, ethical and spiritual tradition and how that tradition influences our delivery of health care (which means that formation must remain an essential component of our ministries), and their decisions must ultimately align with or complement that tradition.

How do we ensure this alignment occurs? All analogies break down, and this analogy of hostguest is no exception. In a typical host-guest situation, the set of rules and expectations is implicit, embedded in the social structures we take for granted. We would not think of an accountability structure tasked with ensuring that guests conduct themselves in a manner fitting to their hosts or hosts fitting for their guests. But within Catholic health care, we do indeed have accountability structures in place to guide the realization of a consistent and ever-fuller Catholic identity. In the May-June 2019 of Health Progress, Fr. Charles Bouchard, OP, wrote on sponsorship and the role of sponsoring boards, which provides a good starting point for thinking through these issues. As he noted, sponsoring boards have “an official ecclesial status and have real authority over a ministry of the church.”6 The sponsoring

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boards themselves need to be deeply rooted in the Catholic theological, moral and ethical tradition, not solely for the sake of knowing that tradition but also in order to be able to distinguish between genuine gifts brought to the ministry from people who are other than Catholics and threats that can move us away from Catholic identity.

CONCLUSION

Our health care ministries are poised to be key places of healing divisions among God’s people.

We are uniquely placed to bring together people from a variety of backgrounds into a shared space with a shared vision and common service. We must capitalize on this setting to allow for mutual edification in the faith. We must facilitate the exchange of gifts. Only in this way can division be overcome. And as more division is overcome, our ministries’ Catholic identity becomes stronger, for as the Catechism of the Catholic Church notes, the separation that exists among God’s people is a “wound” to the church. Healing those wounds will result in strengthening Catholic identity.

CHAD RAITH is the vice president of mission integration for strategy and innovation for St. Louisbased Ascension.

NOTES 1. John 17:21 is an important text for both Pope John Paul II’s Ut unum sint (http://www.vatican.va/ content/john-paul-ii/en/encyclicals/documents/ hf_jp-ii_enc_25051995_ut-unum-sint.html) and Pope Francis’ Evangelii gaudium (http://www.vatican.va/ content/francesco/en/apost_exhortations/documents/ papa-francesco_esortazione-ap_20131124_evangelii- gaudium.html#_ftnref192).

2. Walter Kasper, That They May All Be One (London: T&T Clark, 2005), 67.

3. Paul D. Murry, ed., Receptive Ecumenism and the Call to Catholic Learning: Exploring a Way for Contemporary Ecumenism (Oxford: Oxford University Press, 2008).

4. Murry, Receptive Ecumenism, 12.

5. Pope Francis, Evangelii gaudium, 244.

6. Charles E. Bouchard, “Sponsors Are Called to Be Prophets and Reformers,” Health Progress 100, no. 3 (May-June, 2019), 53.

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Commitment to Quality and Safety Is Part of Catholic Health Care’s Mission JON POPOWICH and GORDON SELF, DMin

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ealth care has long espoused a commitment to quality. Evidence of the pursuit of quality has been framed across a continuum involving the implicit to the explicit — from a historical and presumed obligation within professions to an understanding of it as an emerging science requiring new and specific skills.

Although there are multiple definitions of what quality actually looks like, from both patient and provider perspectives, there is general consensus that it incorporates dimensions that include acceptability, accessibility, appropriateness, effectiveness, efficiency, equity, and perhaps most important, safety.1 Patient safety — and elimination of preventable harm — has become its own area of emphasis, and for good reason, based on an abundance of evidence. The word iatrogenesis comes from the Greek and means “brought forth from a healer”; iatrogenic illness therefore encompasses the suffering patients endure in adverse events such as hospital-acquired infections, pressure injuries, incorrect medications or doses, wrong site surgeries and other incidences. These circumstances profoundly impact those we serve and those who serve. And so for the Catholic health care ministry — steeped in a mission of service — the language of quality and patient safety must also be part of our vocabulary and accountability.

Fulfilling this accountability requires an honest and critical examination of the performance of mission and the expectations of quality and patient safety to understand the relationship between them. We need to make courageous and intentional efforts to identify and address blind spots — those places where we may tell ourselves

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that we are a mission-inspired culture or excelling in quality and patient safety, when this may not always be true. Embracing the intentionality and discipline required to continuously improve should be part of our mission.

Culture is fragile and is affected by many things, including significant stress. Crises, such as the current COVID-19 pandemic, can reveal the gaps between espoused values and values that seem more expedient for the situation at hand.

For example, the challenge of living our mission when we had to restrict visitors to our facilities had undeniable impact on patients and families.

We knew the standard of care was strained in cancelling elective surgeries and other ambulatory procedures to free up critical bed space. On the other hand, those crises served as opportunities for learning and improvement and can often show the best of who we are.

While such morally difficult decisions arise from necessity, crises should not serve as a shield to excuse our response in navigating the many issues we routinely face. Our commitment to mission, quality and patient safety will be influenced by economic and political drivers, regulatory pressure, disruptive behavior, social justice and other population health needs. How we navigate such issues reveals an organization’s true colors.

By aligning mission and quality in an organi-

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zation’s consciousness, we are more apt to communicate a compelling message that mutually reinforces our commitments. Initiatives targeted to improve quality and patient safety should draw on the moral and ethical imperatives of our mission, which call us to take risks and be vulnerable for the sake of another; mission, too, benefits from the critical thinking, rigor and methodology of quality standards — particularly patient safety science — that improve performance and engagement.

We have inspirational messaging that speaks to our mission, but it’s ultimately when we translate these as calls to action for improved quality and safety that real change occurs. And as we process the things that are revealed to us, our mission imperative will compel us to confront our quality and patient safety data, even when it is not expedient. There are no shortcuts.

We make the same connection in selecting candidates for all teams and departments, and in particular with new staff. For example, every two weeks, the authors present back-to-back, onehour blocks of time in our orientation program.

The first session introduces new staff to our mis-

sion, values, vision and ethical tradition, including the legacy of our founding congregations. The second session leads participants into a fulsome understanding of our commitment to patient safety and quality. We reference each other’s key messages, underscoring the inherent relationship between mission, quality and patient safety that is foundational to our identity as a Catholic organization.

Other mechanisms are used to reinforce this message: patient safety reviews, mission formation programs, and throughout our COVID-19 response, in which being successful in one domain is contingent upon success in the other.

Consider for a moment the experience of suffering. As a ministry of the Catholic Church, our mission calls us to respond to those who are marginalized and vulnerable. The example of the Good Samaritan was used to frame the Health Ethics Guide in Canada precisely because Jesus’ directive to “go and do likewise” was not optional.2 It is an ethical and moral imperative that defines our very identity and sets Catholic health care apart from other service providers whose found-

BUILDING A CULTURE THAT SUPPORTS MISSION, QUALITY AND PATIENT SAFETY

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o better understand the challenges inherent in shaping a culture that supports mission, quality and patient safety, it is worth exploring what they have in common. Three things come to the fore: “We Already Do This”: Health care is populated by people who care about the welfare of others and who want to do their best. This is something to recognize and be proud of. But it can lead to the assumption that quality and patient safety are therefore inherently assured and need no further exploration. Mission can suffer from this as well; we are a Catholic organization and therefore “everything is mission.” The truth is that mission, quality and patient safety (and many other domains) cannot be evaluated simply on how we feel about our care; they require deliberate technique, good data, action and study.

Disbelief in Suboptimal Performance: Tied to the first point, mission, quality and patient safety can suffer from a love/hate relationship with the concepts of compliance and commitment, and specifically with evaluation. When standards are met or exceeded, people are likely to think it is automatic verification — proof of what they knew all along, without knowing why. Likewise, when data shows that performance is less optimal, people are prone to believe the methodology was wrong, or worse yet, look for bad actors, rather than consider the system as the reason.

Overemphasis on Symbolism: Symbolism is important, but don’t mistake the symbols of things for the things themselves. Mission is not merely a masthead on corporate documents; it must be present in our actions, choices and decisions. In the highly accountable realm of health care, swift but reactionary issues of management can be taken as a proxy for quality. Mission, quality and patient safety each contain subjective as well as objective elements. Unless those definitions and elements are clear and agreed upon, symbols can be confused with more substantive content, analysis and investment.

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ing stories differ from ours. Like other health service organizations, we are committed to fiscal stewardship and savvy business acumen, but ultimately ours is a ministry that sees suffering as something to which we must respond, even if it is not convenient, lucrative or beneficial.

As we know from the world we live in, suffering takes many forms. There are many poverties evident to us as we care for those in need. One form of suffering is that of suboptimal care, in which adverse events can cause harm.

Responding to this awareness calls upon the philosophical and practical or technical acumens of mission, quality and patient safety.

Mission is a response to the recognition of unmet need, and calls us not only morally, but also practically, because compassion felt in the heart and acted upon with the hands is powerful healing.

Quality and patient safety also have moral components, and the actions of care play a technical role in analyzing, ameliorating and ultimately reducing incidents of suffering that result from incomplete and failed attempts to care for those in need. Near misses, adverse events and deviations from standards of practice all can result in harm to our patients and residents. We have no business remaining in health care if we cannot provide care equal to, or greater than, the local governmental health care authority.3 The Japanese have a term “Kaizen,” which is often referenced in literature when discussing continuous improvement in quality.4 There are many translations, but perhaps one of the more poetic is “repent and enhance.” We believe that the pursuit of mission, quality and patient safety are aligned to this concept. Repentance requires more than acknowledging the harm done and apologizing for the wrongdoing or error. It also demands intentional effort to identify the contributing factors that led to the damage and being accountable for mitigating preventable harm in the future.

In mission terms, we might describe repent and enhance as metanoia, a turning around. Like St. Paul falling off his horse, this honest examination of our behavior and earnest commitment to see ourselves for who we really are in relation to

another is ultimately a moral enterprise. Quality and patient safety data, along with regular systems review, inform such examination of conscience.

Mission responds to the learning and insight that emerge to send us forth.

For example, in 2018 we discovered a potential patient safety issue regarding operating room air exchanges at one of our hospitals. Questions and discussion crossed the spectrum: Are there building system issues? Are there equipment and building system calibration issues? Who is accountable? Was monitoring not done? How widespread is this type of concern in the industry?

Quality and patient safety also have moral components, and the actions of care play a technical role in analyzing, ameliorating and ultimately reducing incidents of suffering that result from incomplete and failed attempts to care for those in need.

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Are the standards themselves based on the most current infection control and other data? And, importantly, disclosure: How will we talk to patients about this?

The investigation and disclosure process to patients and families was complex, inviting significant legal, financial and public exposure. In principle, everyone understands the necessity to disclose and take corrective action to prevent harm in the future. Most organizations have a policy for disclosing issues to the public. But the very process at arriving at that decision point can involve tension and differences of opinion regarding acceptable levels of risk.

This type of tension regarding disclosure was known and named several years earlier when the authors wrote Covenant’s original disclosure policy. We didn’t rely solely on the literature support and evidence from the quality and patient safety world. As important as this is, our departure point was the interpretive lens of mission and the sound methodology of our mission discernment process. This integrative approach between mis-

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sion and quality reinforced the commitment to transparency and clearly identified the distribution of ethical obligations within the complexity of multiple competing priorities.

The work of quality and patient safety is messy, complex and multifactorial. Earlier forays into quality in health care tended to focus on ‘soft’ skills or explored more philosophical concepts, but patient safety has since become a bona fide discipline, based in engineering, psychology and medicine. Reviews require detailed environmental and human factor analysis, understanding of cognitive biases, organizational and individual behavior, process mapping and proper contextualization of statistical data. Findings need to be shared internally, and often externally, to mitigate future occurrence in our organization or the broader world of health care. This cannot be biased by pressure from board, senior teams, risk managers, politicians or funders who are nervous about what the evidence will show.

We also recognize that there will be some interpretation of data that could lessen or heighten the sense of culpability. System issues rightly require a systems approach that does not place the entire burden of accountability on individuals alone. Our mission that upholds a holistic view in health care of body, mind and soul reinforces that we equally need to bring a thorough systems review, too.

How do we improve the broader world of health care with our learning? In addition to the insights we gain from our specific reviews, Dr. Donald Berwick of the Institute for Healthcare Improvement maintains there are moral determinants of health that must factor in our quality reviews.5 Often this is manifest in stories. Berwick uses the language of solidarity, which is language familiar to, but not monopolized by, Catholic health care. Quality and patient safety, understood as a moral enterprise driven to reduce suffering, certainly requires compassion, but it also requires rigor, science and demonstrated willingness to shift long-standing practices to prevent future harm. This requires change management, strong leadership and board and senior team expectations to drive organizational performance.

Our COVID-19 response illustrates this integrated and mutually reinforcing approach to mission and quality. Covenant, like most health care organizations faced with unprecedented impact by the pandemic, constantly needed to adjust its practices in keeping with both the latest scientific evidence of viral spread and exposure. It also had to use detailed review and continuous improvement techniques to understand outbreaks. And it has been critical that our mission and values shape the overall narrative in the face of real and perceived public and staff health risks, and that our organizational voice and our responsibility

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hat can leaders do in order to ensure the areas of mission and quality are not only kept front and center, but also lived, in a Catholic health care organization?

Realize Purpose: The ultimate aim of Jesus’ healing ministry is to bring hope and healing and to reduce suffering. The mission of Catholic health care is intimately tied to this core purpose. The pursuit of patient safety, which is a key element of quality, is a lived example of this purpose. Eliminating harm that is preventable not only optimizes care, it is a demonstration of the care and concern we have for those we serve. To continuously improve our practice based on data, learning and engagement is an important part of the ministry.

Dedicate Resources and Acknowledge Risk: A positive attitude, belief in values and the desire to provide the best care goes a long way. But bringing the mission alive and achieving increased performance in quality and safety does not happen simply through faith. Leaders must dedicate resources (including time for honest reflection and evaluation) to this pursuit. Examination involves risk; you must have courage to move forward in areas that are controversial, and you must build and support your teams to do the same.

Apply Critical Thinking and Technique: Mission, quality and patient safety are not just about how we feel, nor are they convenient shields to protect us from uncomfortable truth. They need to be viewed with both ideology and methodology in mind. Believing in them is important, but the practice of actual technique and implementation of change are necessary for an organization to flourish.

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We must remember that being a witness to suffering requires utmost attention and respect.

Suffering haunts the caring heart, but it is also the catalyst that restores brokenness. were maintained. Under federal and provincial health legislation in Canada (e.g., Public Health Act), although the Chief Medical Officer of Health has the authority to direct public health emergencies, organizations cannot shift away their responsibilities.6 Covenant Health’s responsibilities have been to follow the legally binding orders, which included sensitive topics like visitor restrictions, but also to ensure that we keep front and center the moral and mission-based calling to care. And to reduce the suffering caused through the burdens of isolation that many patients and residents have experienced. Further still, to help families understand why this was required and what we could do to support communication through other creative, virtual means. Our mission of service and compassion compelled us to find ways to respond despite the restrictions and ever-changing dynamic.

Likewise, our mission compelled us to mitigate and reduce suffering given the risk of occupational exposure we faced, whether actually or potentially. The long hours and trying conditions in which our clinicians worked only elevated the risk of an adverse event. Solidarity, understood as an expression of both our mission and our quality and safety commitments, required us to respond to the suffering our staff experienced, as well as to what they feared might happen.

Our commitments required us to provide staff with timely, accurate information, with safe personal protective equipment, sleep rooms and food. It was also important for leaders to have the courage to support teams when things went wrong. Outbreaks can be exacerbated through errors, as we have all learned in the pandemic, and

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there have been multiple quality improvement efforts in reviewing these.

The act of living our mission and giving the highest quality of care is ultimately an act of love.

But genuine love involves compassion and kindness. It also involves risks – the risks of seeing suffering, the risks of error, the risks of courage and authenticity, and the risk of forgiveness given and grace received from those we care for and with each other. We must remember that being a witness to suffering requires utmost attention and respect. Suffering haunts the caring heart, but it is also the catalyst that restores brokenness. We live our mission and improve quality and patient safety when we serve, when we continuously learn, and when we transform ourselves, our organizations and our systems.

JON POPOWICH is the chief quality and privacy officer and GORDON SELF is the chief mission and ethics officer at Covenant Health, a Canadian health care organization operating 17 hospitals and care centers in 12 communities across Alberta.

NOTES 1. See, for example, https://www.ahrq.gov/ talkingquality/measures/six-domains.html or https://www.hqca.ca/about/how-we-work/ the-alberta-quality-matrix-for-health-1/.

2. The Health Ethics Guide is the Canadian equivalent of the Ethical and Religious Directives for Catholic Health Care Services. Health Ethics Guide, Catholic Health Alliance of Canada, 3rd edition. Ottawa, 2012. See, for example, the introductory reflection on the Good Samaritan at http://chac.ca/ethics/Health%20Ethics%20 Guide_2013.pdf.

3. Francis G. Morrisey, “What Does Canon Law Say About the Quality of Sponsored Works,” Health Progress 88, no. 2, March-April, 2007, 10-11.

4. Lean production and kaizen, https://www.lean production.com/kaizen.html.

5. Donald M. Berwick, “The Moral Determinants of Health,” JAMA, published online June 12, 2020, https:// jamanetwork.com/journals/jama/fullarticle/2767353.

6. See https://www.alberta.ca/office-of-the-chiefmedical-officer-of-health.aspx.

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H E A LT H E Q U I T Y

HOW TO ADVANCE EQUITY WITH DIVERSE GOVERNANCE DARREN M. HENSON, PhD, STL

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ore than six years ago, the Catholic Health Association joined the American Hospital Association (AHA) to promote four strategies that hospitals and health systems could take to commit to health equity. Increasing diversity in governance was among the strategies highlighted. Practically speaking, this means increased diversity on boards of directors, considering characteristics from race, to gender, to socioeconomics to geography and more, so that leadership is broadly representative of those served and reflects a variety of lived experiences. Each hears and bears witness to different community viewpoints that can enrich the discernment in setting the organization’s strategic direction and commitments.

The shared vision of equity by the AHA and groups. Medical history contains far too many CHA included a focus on governance because accounts of physicians, scientists and health care diverse voices bring unique perspectives and institutions using such people against their will or experiences. When decision-making bodies also knowledge. The silencing of wronged individuals involve inclusive practices, such as generous lis- and abuse by the health care system exist far betening to community narratives, the result is more yond the federally backed Tuskegee syphilis study fully informed strategies. Together, diversity and inclusion create a pathA health equity strategy that way to advancing equity — a lived experience where all persons have a includes commitments to diversity fair and just opportunity for human and inclusion within governing flourishing, which includes being as healthy as possible. bodies serves as one way to Leaders of organizations heard reconcile relationships with people outrage from their members in light of the injustices that unfolded in the of historically marginalized groups. spring and summer of 2020. Voices from many community sectors called for accountability and action. There were quick where Black men were manipulated for scientific and timely responses in denouncing the injustic- and professional gain,2 or the story of Henrietta es.1 The deplorable disparities starkly unmasked Lacks’ cell lines taken without her consent.3 The by the coronavirus pandemic, coupled with the stories of those injustices live on not only in the outcries for social and racial justice, underscore annals of history, but also among communities of the need for and the benefits of diversity and in- color today. Repairing and reconciling history’s clusion among governing bodies. wounds entails practices of inclusion where diA health equity strategy that includes commit- verse communities have historically been absent ments to diversity and inclusion within govern- from board rooms, advisory committees and othing bodies serves as one way to reconcile rela- er decision-making formats. tionships with people of historically marginalized Racial and ethnic diversity has long been lack-

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ing within governing bodies as reflected in bien- strategies assume the role of advocate and ambasnial surveys conducted by the AHA’s Institute for sador. They represent the community voice to the Diversity and Health Equity.4 Diversity among local hospital or health system, and conversely, women and men on governing bodies has skewed they take messages from the health care organizatoward men.5 In addition to race/ethnicity and tion back to the community. Board members can gender, other factors of diversity merit consider- fulfill a key equity strategy, namely the accurate ation and local context. When I lived in rural Kansas, diversity included Trust and accountability are racial and ethnic differences, in addition to representation from differessential for expanding health ent sectors such as manufacturing, equity. Populations that have been professional services and farming.

Health care systems can also fohistorically underrepresented, cus diversity and inclusion efforts whether people of color, women, among local boards, such as advisory boards and councils that freor persons with disabilities, for quently serve as pipelines to larger fiduciary boards. example, have experienced much Such efforts are important besuffering because of lack and lapses cause those involved in governance are not just filling chairs around the in accountability. table, but rather they reflect meaningful relationships with the community. Individuals whose lives and families de- reporting of information to the community. The pend upon different economic sectors and who stories involving equitable tactics undertaken by hail from different zip codes bring unique view- a hospital to address disparities are then returned points of the local community, community health to the community through trusted individuals. and experiences of flourishing and interdepen- These processes can help heal wounds of mistrust dence. These diverse perspectives can engender and build a community where people have access the community’s trust when the board acts and to the same information and can work together in hold management accountable to the voices from areas of common interest and benefit.

Presence Health in Chicago, now part of the community.

Trust and accountability are essential for ex- AMITA Health, adopted this model. When formpanding health equity. Populations that have been ing community leadership boards for each of its historically underrepresented, whether people of twelve local hospitals, the system reported the color, women, or persons with disabilities, for ex- composition of the boards according to gender ample, have experienced much suffering because and ethnic/racial characteristics.6 The health sysof lack and lapses in accountability. Diverse rep- tem ensured that community leaders closest to resentation on governing bodies brings forward the voices of diverse populations were included the stories from these communities. Individuals on these boards. who represent diverse communities bring inCHA’s new initiative, We Are Called: Consight into effective strategies for building trust fronting Racism by Achieving Health Equity, is and pursing equity. Charged with oversight of the a prophetic call to action.7 Leadership and govmanagement team, the board can inquire about ernance diversity has been and always will be a and require key performance indicators on equity foundational component for strengthening health strategies that involve both the people served in equity, and its importance is ever more evident the clinical setting and the people in the work- amid the COVID-19 pandemic when people of force supporting the care. color are disproportionately impacted by disease With these or similar reports in the hands of and have less vaccine access and usage. Pursuing the board, those member champions of equity a foundational strategy to advance health equity

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via board diversity will serve hospitals and health systems well into the future. It is one step toward building trust and furthering the designs of new systemic structures that will bring about health care that is more just and more virtuous. When we bring together different people, each made in the image and likeness of God with hearts and minds centered on extending Divine healing to all of creation and all people, grace and reconciliation will abound. Diverse and unique as we are, together we are called to love tenderly and act justly with our God. DARREN M. HENSON served as system vice president of Mission & Discernment AMITA Health, and previously Presence Health. Most recently he was director at the American Hospital Association’s Institute for Diversity and Health Equity.

NOTES 1. CHA, “A Call for Racial Justice and Reconciliation,” May 29, 2020, https://www.chausa.org/newsroom/ news-releases/2020/05/29/a-call-for-racial-justiceand-reconciliation; AHA “Statement on George Floyd’s Death and Unrest in America, June 1, 2020, https:// www.aha.org/press-releases/2020-06-01-statementgeorge-floyds-death-and-unrest-in-america.

2. Harriet A. Washington, Medical Apartheid: The Dark

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History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Harlem Moon Broadway Books), 2006.

3. Rebecca Skloot, The Immortal Life of Henrietta Lacks (New York: Crown Publishing Group), 2011. For more information on ethnic and racial disparities, see The 2003 Institute of Medicine Report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” including a paper by Jennie R. Joe, “The Rationing of Healthcare and Health Disparity for the American Indians/Alaska Natives,” p. 528, https://www.nap.edu/ catalog/12875/unequal-treatment-confronting-racialand-ethnic-disparities-in-health-care.

4. See IFHDE, Study of U.S. Hospital Surveys, https:// ifdhe.aha.org/benchmarking-study-us-hospitalssurveys.

5. Morgan Haefner, “‘We’ve Made No Progress’: Healthcare Boards 87% White, Leverage Network Study Finds,” Becker’s Hospital Review, February 23, 2021, https:// www.beckershospitalreview.com/hospital-management-administration/we-ve-made-no-progress-healthcare-boards-87-white-leverage-network-study-finds. html.

6. Dougal Hewitt and Pamela Mitchell-Boyd, “Engaged Local Governance Can Transform Communities,” Health Progress 99, no. 5, Sept-Oct. 2018, 50–54.

7. For more on CHA’s initiative We Are Called: Confronting Racism by Achieving Health Equity, https://www. chausa.org/cha-we-are-called/.

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GOVERNANCE ETHICS IN HEALTHCARE ORGANIZATIONS Gerard Magill and Lawrence Prybil Based on empirical studies undertaken with boards of directors and CEOs in the United States, this groundbreaking book develops a new paradigm to provide a structured analysis of governance ethics consistent with clinical, organizational and professional ethics.

20% DISCOUNT AVAILABLE Enter the code FLR40 at checkout* www.routledge.com/9780367348403 Hb: 978-0-367-34840-3 *Offer cannot be used in conjunction with any other offer or discount and only applies to books purchased directly via our website.

Inquiries: contact, evie.lonsdale22@gmail.com

MISSION

CHA OFFERS RESOURCES ON CARE PROVIDER WELL-BEING

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t is hard to believe, isn’t it? A year has now passed since the beginning of the COVID crisis for our country and for the whole world. It was last March that CHA staff were sent home to begin working remotely. We gathered our personal belongings, important books and documents, computer equipment, packed them in our cars and headed home to set up “virtual offices.” Surely this would be for a few weeks, right? None of us ever imagined that this new virtual reality would last a full year and beyond.

As we adjusted to working remotely and learned the tricks of the Zoom world, we reached out to you. While this lockdown was inconvenient in the ways we had to work differently, it was costing you a lot more. We were (and remain) acutely aware of DENNIS the tremendous impact of the GONZALES pandemic on the health care ministry across the country, especially the direct caregivers on the front lines of the crisis.

Our first question was personal: How are you doing? We held many listening sessions with each of our committees to better understand how you were enduring but also to ask other questions: How can we help?

CARRIE What do you need from us?

MEYER In the early stages of the pandemic, we found there were McGRATH many ethical questions and concerns, especially around triage of patients and allocation of scarce resources. As time passed, spirituality questions arose, such as the provision of pastoral care and the sacraments for completely isolated COVID patients. Soon, we began to hear more and more about the impact the crisis was having on the well-being of caregivers and associates. We heard grave concern for those staff who were experiencing increasing physical exhaustion, fear, moral distress, compassion fatigue, mental and emotional stress and burnout. One

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year later, and still counting, this concern for personal well-being continues and intensifies.

Following a number of conversations with members, CHA set up a new focus area on our website concentrating on well-being resources.

It can be found at https://www.chausa.org/wellbeing/well-being. It contains a wealth of materials including body, mind, spirit supports; a curated collection of best practices from CHA members throughout the Catholic health ministry; COVIDrelated resources and research; a listing of events — upcoming and recorded — and pertinent reputable articles; resources and tools from across the globe focused on well-being; and staff contact information. This focus area continues to serve our members, and we encourage you to visit it often for program ideas, support and encouragement.

In May, we produced a four-part webinar series entitled Our Well-Being — A Webinar Series Sharing Wellness Resources. It shared CHA member practices, trusted wellness resources, practices and programs to help all involved in Catholic health care identify and address immediate needs brought on by the pandemic, as well as the eventual post-COVID reality. This series is free to all members and can still be viewed on our Well-Being site. Highly knowledgeable and experienced professionals presented the work being done to support caregiver and associate well-being from Providence St. Joseph Health, SSM Health and SCL Health. Attendance for the live version of each webinar was tremendous, and the feedback we received demonstrated the great need for information sharing and learning across the ministry.

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As our ministry and country navigated the the soul of Catholic health care.

We believe, more than ever, that the people many challenges of the pandemic, we continued looking for ways to support the sacred work of working throughout the ministry are the most caring for associates, patients and communities. treasured resource in Catholic health care. As In order to share best practices and get clear guid- such, CHA is committed to facilitating well-beance from you, a new task force came together, focused on the well-being of Attendance for the live version of ministry associates. The Well-Being Task Force is comprised of behavioreach webinar was tremendous, al health clinicians, human resources, and the feedback we received organizational development, mission integration and spiritual care leaddemonstrated the great need for ers from across the ministry. Their experience, expertise and passion information sharing and learning continue to provide great insight and across the ministry. creativity as the task force works to reexamine what it means to promote the inherent dignity of our caregivers and how to ing, resiliency and post-traumatic growth with create an environment that allows them to thrive our members. While this current crisis has underscored the serious challenges in our health and flourish.

Aware that the opportunity to share, dis- care system, it has also provided an opportunity cuss and meaningfully connect with others is to transform the way we work, connect and build critical to sustaining well-being for the long relationships. CHA will continue to work across term, the task force put together a Conversation systems to re-examine how we promote the inGuide: Sustaining Connection for Well-Being, herent dignity of our colleagues and create a www.chausa.org/docs/default-source/default- community that allows all to thrive and flourish document-library/well-being-guide-2020.pdf. — body, mind and spirit.

The discussion guide is a grab-and-go tool for anyone in our ministries to lead a conversation DENNIS GONZALES, PhD, is senior director, around well-being. In an hour, facilitators can cre- mission innovation and integration, and CARRIE ate community through connection. The guide MEYER McGRATH, MDiv, MS, is director, includes a template email invitation and open- mission services, the Catholic Health ing prayers along with resources and questions Association, St. Louis. to prompt discussion. It is a whole-person-care offering for everyone in Catholic health care.

Mindful that so many leaders across the ministry are holding these dialogues and conversations for others without having a space for themselves, HA would like to thank members of the WellCHA held four listening sessions for leaders.

Being Task Force who have generously given These sessions followed the framework and utitheir time and insights to developing materials, lized Zoom breakout rooms to foster meaningful programs and supports for caregivers during dialogue in smaller groups. The vulnerability, the pandemic, https://www.chausa.org/ commitment to ministry and sharing of personal well-being/well-being-task-force. well-being practices were humbling testaments to

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ETHICS

CHRISTMAS, ASHES, CHRISM AND CHOICES

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t present, I am defending the contents of the refrigerator from my wife. She has threatened the innocent cheeses, salamis and pâtés in the refrigerator with annihilation, so that there are no temptations in the house.

As we passed from the cel- narily, we are anointed with chrism when we are ebratory spirit of the holidays baptized or when we are sick, blessed with ashes into the austerity that often at the beginning of Lent, and renew our baptism marks the first months of the with water at the Easter liturgy.

In the maelstrom of COVID-19 and all that it new year, we negotiated a stay for some, but not all, of the con- has wrought, it is essential to recall these tradidemned. I reluctantly agreed to tions, as we ordinarily practice them, and to unthe demise of the pâtés, the stray derstand how they both reflect and support our slices of formerly frozen pizza, journey toward holiness. It is easy to forget death BRIAN the pepperoni and the smoked and redemption when the bodies of the dead are KANE mozzarella, ransoming them for kept from us and final rites are so abbreviated. the rest of the cheeses, the pro- Grief, at a distance, will inevitably numb us to love and connection with each other. sciutto, some crackers and the cherry preserves.

Ethical actions are not usually “crisis” deciAs we started 2021, my wife was eager to push forward with the disciplines of moderation, fast- sions, although they may seem to be that for those in the midst of difficult choices. In fact, it is our ing and exercise. I’m not quite there yet.

This cycle is not new. In fact, it is ancient. The daily habits, our virtues and vices, that most effecliturgical year begins with Advent and Christ- tively define our moral lives. In crisis, we usually mas. That leads us into Ordinary Time, then Ash default to the choices that we make day-to-day.

In my work as a clinical ethicist on critical Wednesday and Lent, the Chrism Mass, and Easter, with our annual baptismal promises. Then, care floors, my conversation with a family who once again, we return to Ordinary Time, where we have our regular habits until Grief, at a distance, will inevitably we begin the cycle anew. Christmas, Ashnumb us to love and connection es, Chrism and Choices…

As Catholics, liturgy is the pulse of with each other. our spiritual and ethical lives. Liturgy comes from a Greek word that means “public worship.” In the Catholic tradition, liturgy had to make difficult decisions about the care of refers to shared communal prayer, which is close their loved one inevitably turned toward trying to the original Greek, but not the same since for to understand how that person made their own us one does not literally have to be in the presence choices. We, the care team, would ask the family of others to participate in liturgy. There are the about what the person valued and how they lived. many prayerful acts that we, the faithful, follow, These conversations were often more about lisas a community. Some are sacramental, like the tening than speaking.1 Mass, but others are not, like the Liturgy of the What may have seemed to be extraordinary Hours or the rosary. decisions for the family were often not that at all.

Often, Catholic liturgy has a physical presence, Their duty, often, was simply to discern and honor which we have been missing this past year. Ordi- the wishes of the dying. Accompaniment is usual-

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ly what is necessary, rather than heroic decisions. Stay, until this is done.

The second lesson of our liturgical year is EasCatholic ethics navigates the difficulties of how to act, but it never changes the primary goal ter. What if Jesus died? What if Jesus overcame of our lives. So, what is the purpose of the pattern death? What if Jesus was resurrected? Easter is of our liturgical traditions and how do they relate the celebration of the moment when these “what ifs” became the “what is.” So, what is Easter? The to ethics?

We want to be ethical so that we are holy; to be Gospel of Luke, in particular, offers us a connecin relation with God and with each other. In short, tion between death and redemption.

St. Luke describes what happened after the our liturgical traditions should lead us to this goal of connectedness. How do they do this? Annually, death of Jesus (Luke 23:48 – 24:1). He has breathed his last, and those who had gathered for the specwe recall three fundamental truths.

The first lesson is: we all die. Every one of us tacle, “returned home beating their breasts … but — daily, weekly, monthly, annually. We all know the cost of our shattered relaWe want to be ethical so that tionships when death comes. We mourn for the loss of our connection with our we are holy; to be in relation families and our friends. In the time of with God and with each other. In a pandemic, we are even more aware that death accompanies us each day. The short, our liturgical traditions ashes of Lent remind us of this. Anointed with ashes, we mourn in the time before should lead us to this goal of Easter. connectedness.

In physical, emotional and spiritual death, we, the survivors, grieve. Together we shoulder the burden of getting our dead to all his acquaintances stood at a distance, includthe end of their journey. Then, we stand at the ing the women who had followed him from Galigraveside, look into the abyss, and we weep, and lee and saw these events.” Joseph of Arimathea we mourn. We hope that others will mourn for us, requests the body of Jesus from Pilate and places when the time comes. We believe that this world it in a tomb, as the Sabbath is about to begin. is not all.

But, what is notable is what follows. St. Luke This tension of grief and duty toward those then says that “The women who had come from who have died reminds me of the words of the Galilee with him followed behind, and when they writer Thomas Lynch when he described his own had seen the tomb and the way in which his body prospective burial in winter … was laid in it, they returned and prepared spices “I want a mess made in the snow so that the and perfumed oils. Then they rested on the Sabearth looks wounded, forced open, an unwilling bath according to the commandment. But at dayparticipant. Forego the tent. Stand openly to the break on the first day of the week they took the weather … And you should see it till the very end. spices they had prepared and went to the tomb.”

Avoid the temptation of tidy leavetaking in a room, We don’t know from St. Luke what these woma cemetery chapel, at the foot of the altar. None of en thought, but we know what they did. They that. Don’t dodge it because of the weather. We’ve stayed until it was done. In spite of what would fished and watched football in worse conditions. have been a very crushing grief and confusion, It won’t take long. Go to the hole in the ground. they examined the tomb and made sure that all Stand over it. Look into it. Wonder. And be cold. was as it should be. After the Sabbath, they reBut stay until it’s over. Until it is done.”2 turned to finish the task and found the empty “Until it is done.” The doing of this is signifi- tomb, with the two “men in dazzling garments,” cant. It is to make sure that the labor of the grave who asked them, “Why do you seek the dead is completed; to shoulder the grief and the sor- among the living?”

It is worth noting that St. Luke also writes that row of departure. And in the midst of this, to still believe that the moment of death has been over- after the women shared their experience with the come. We believe that the moment when the cas- community, people doubted them, in particular ket is lowered into the grave is not the final word. the apostles, and said that “their story seemed like

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nonsense and they did not believe them.”

This witness of the faithful women has always resonated. In spite of the grief, and the uncertainty, and the horror of the crucifixion, they still did what was necessary. In doing this, they were the bearers of our grief and the first recipients of the joy of Easter.

From those events, we, over 2,000 years later, have been given this gift of faith. As Christians, we believe that death has been overcome. We can now perceive a time when our relationships are connected by love, rather than being destroyed by sin.

The third liturgical and ethical lesson is Ordinary Time, which takes up most of the liturgical year. Our awareness of death and redemption should inform the way that we live our lives, day to day.

Ordinary Time is expressed in the constant choices of our lives, our everyday moments, where our beliefs are lived. The hopes of Advent, Christmas, Lent and Easter become embodied in us when each day we love, we learn and we live our choices.

Ordinary Time, seems … so ordinary. How do we describe the hugs that we give our children, the gentle touch for our loved ones, the charitable acts of everyday life, the daily tasks of care? Ordinary time is life lived in the hope of perfection.

Death, Easter, and our day-to-day choices define our ethics. Liturgy provides the communal connection. As we reach out to God, in prayer and in solidarity, we connect with each other. We share our common journey and support one another.

Christmas, Ashes, Chrism and Choice recalls our values. Then, our practice of these values

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in our day-to-day lives changes the world. The change may be small, a smile won from an individual act of compassion. Or, it may be more systemic, like a national effort to care for people who are poor and vulnerable.

Christmas, Ashes, Chrism and Choices … In the time between the start of writing this column and now, my wife and I are now in Ordinary Time.

Pita chips have been exiled to the basement, to be retrieved only when I can eat them alone. I have agreed to cook and stock vegan options for the freezer. And, we will both be more vigilant about getting exercise. (However, the occasional Five Guys Burger on a grocery run has not been discussed, so please don’t share this column with her …).

Looking forward to the rest of the 2021 liturgical year!

BRIAN M. KANE, PhD, is senior director of ethics for the Catholic Health Association, St. Louis.

NOTES 1. Given the brief discussion that I have outlined here, some may think that I am endorsing the idea that whatever the patient chooses should always be accepted. I am not. Rather, my point is that most patients try to seek out what is good and right, and to fulfill those goals in their own lives, imperfect as they may be. Families see that goodness, in spite of the many, many ways that we all fail to realize our own perfection. In short, I am guided by natural law thinking.

2. Thomas Lynch, The Depositions: New and Selected Essays on Being and Ceasing to Be (New York: W.W. Norton, 2020): 75.

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COMMUNITY BENEFIT

TO REDUCE DISPARITIES, BE MINDFUL OF HISTORY AND REFORM SYSTEMS MICHELLE HINTON, MBA

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uring the past year, COVID-19 has ravaged communities across the globe. More than 29 million Americans have been diagnosed with COVID-19 and sadly more than 525,000 have succumbed to this dreadful disease. Families are experiencing financial hardship, mental despair, lack of access to food and other basic needs.

COVID is shining a light on the prevalence of race-related health inequities and the widespread impact on communities of color. According to the Centers for Disease Control, racial and ethnic minorities are at an increased risk of getting sick and dying from COVID-19. Recognition of these disparities has brought to light the systemic racism that has marked health care in this country for far too long and have spurred on health care practitioners to review and respond to the explicit and implicit biases that stand in the way of change.

Critical to that effort is the need to assess priorities related to community benefit — the programs and services designed to improve health in communities — and to take steps to leverage those resources to reduce disparities experienced by communities of color.

People in communities of color disproportionately are predisposed to chronic conditions such as diabetes, high blood pressure and heart disease and, based on data from the CDC, are likely to die from these diseases at a higher rate than white Americans.1 Many people of color lack access to primary care, healthy foods and jobs. As we know, these are basic needs that impact the health and wellbeing of individuals. Known as social determinants of health, these elements comprise the conditions in which individuals live, work and play and can have a tremendous influence an individual’s health status.

Health systems can begin to support the total health of a person by investing in partnerships with community organizations through community benefit planning. Leveraging such resources will support health systems’ overall priorities

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through strategic partnerships and position them to strengthen community relationships.

One of the barriers for health systems hoping to partner with communities in pursuit of community benefit is rooted in a historical lack of trust among people of color toward medical professionals. There are many shameful examples in U.S. history when medical professionals have exploited Black Americans, such as the wellknown Tuskegee syphilis study that began in the 1930s and didn’t end until 1972. African-American men were denied treatment of syphilis and lied to about the study as part of a self-described research project. It is the very embodiment of ways in which Blacks were disenfranchised, and medicine and medical research were weaponized against people of color.2 Henrietta Lacks, a 31-year-old Black woman, died of cervical cancer after seeking treatment at Johns Hopkins Hospital. After her passing, medical researchers used Lacks’ cells in wide-ranging research projects that resulted in numerous medical breakthroughs, including vaccines, cancer treatments and in vitro fertilization. Unfortunately, for decades after her death, her family was uninformed about how her cells were being used.

Her story became widely known with the publication of The Immortal Life of Henrietta Lacks in 2011, prompting debates around the nation about patients’ rights and financial compensation related to medical advances.3 These historical examples have left indelible scars and resulted in deep and lasting distrust among people of color toward the medical professions. Rebuilding and restoring that trust requires an approach that engages communities and

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those with lived experience in both identifying affected by the pandemic Up-to-date culturally and linguistically apthe problem and offering solutions. Community benefit planning that engages members of the propriate messages and materials developed by community helps build trust and can address so- federal and grassroots organizations A speakers bureau of subject matter experts cial determinants of health, promote healthy habits for prevention and early detection and reduce available for virtual community engagement chronic disease. efforts During these difficult times, it is important For additional information regarding the Nafor hospitals to be diligent and strategic about tional COVID-19 Resiliency Network or to subaligning their investments with the needs of the scribe, see https://ncrn.msm.edu. community. It starts with the current community There are many issues affecting the health and health needs assessment and setting priorities well-being of communities, and we know the sobased on that process. Additionally, although it cial determinants are key indicators of a person’s isn’t required by federal regulations, committing ability to achieve his or her optimal health. As to a focus of health equity should be a priority in plans moving forward.

During these difficult times, it is Does your community health needs assessment address social deimportant for hospitals to be diligent terminants of health or COVID-19 and strategic about aligning their mitigation? Who are the stakeholders that participate in the assessinvestments with the needs of the ment? Do you engage community community. health workers? These are some critical questions that should be considered. Partnering with community, through shared we begin to adapt to a different normal, we know influence in the solutions, is essential in develop- change doesn’t occur overnight. Systems and ing trusting relationships and strengthening the policies will affect how we shift. We should be health and well-being of communities. prepared to invest the time and energy it takes to There are great examples to consider, such make changes that will lead to lasting reform if we as the Morehouse School of Medicine, which re- truly want to strengthen the health and well-being ceived a grant to work in partnership with HHS’ of communities and reduce the health inequities Office of Minority Health to mitigate COVID-19 of our society. among communities of color. Morehouse School of Medicine has been at the forefront of antici- MICHELLE HINTON is the director of impact, pating and responding to the needs of vulnerable population health and well-being for the Washcommunities that have traditionally suffered the ington, D.C.-based Alliance for Strong Families worst health outcomes during pandemics and and Communities. Hinton is based at their operaother disasters. To reduce the impact of COVID-19 tions center in Milwaukee, Wisconsin. on racial and ethnic minority, rural and socially vulnerable populations, Morehouse’s School of NOTES Medicine will establish the National COVID-19 1. Centers for Disease Control and Prevention, “Health Resiliency Network. Partners of the National CO- Equity Considerations and Racial and Ethnic Minority VID-19 Resiliency Network have access to: Groups,” https://www.cdc.gov/coronavirus/2019-ncov/ Capacity building training (For example, community/health-equity/race-ethnicity.html. See also Community-Based Prevention Marketing, which https://www.cdc.gov/nchs/hus/spotlight/Heart is using focus group discussions and interviews DiseaseSpotlight_2019_0404.pdf. to build research to strategically determine how 2. Centers for Disease Control and Prevention, The to communicate health messages to vulnerable Tuskegee Timeline, https://www.cdc.gov/tuskegee/ people and people of color.) timeline.htm.

Collaborative opportunities with other or- 3. Alexandra Witze, “Wealthy Funder Pays Reparations ganizations in their region and across the nation for Use of Hela Cells,” Nature, Oct. 29, 2020, https:// who serve similar populations disproportionately www.nature.com/articles/d41586-020-03042-5.

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T H I N K I N G G L O B A L LY

THE GUIDING PRINCIPLES

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HA’s Guiding Principles for Conducting Global Health Activities are in their fifth anniversary year. When they were first written by a work group made up of CHA members, no one could have foreseen how much they would resonate with the experience of a global pandemic.

In this article, my good friend and colleague, Georgia Winson, shares her thoughts on the BRUCE principle of prudence in relation COMPTON to her work in medical surplus recovery. Having been in medical surplus recovery myself, it felt appropriate to pair this principle with this activity, because although prudence is the ability to look at a con-

crete situation and know what ought to be done, it is never quite that simple in global health. Prudence gives us the knowledge of what must be done, when it must be done, and how it must be done. How does prudence play into the close partnerships that must exist when working in global health and medical surplus? This article provides practical guidance around the guiding principle of prudence.

PRUDENCE GEORGIA WINSON, MS, LCPC

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n recent years there has been increased understanding of the complexity and substantial impact, for both good and ill, of medical supply and equipment donations to low- and middleincome countries, or LMICs. High quality donations can result in immediate improvements for health care providers and their patients. A relational donation process, marked by respect and careful planning between donor and recipient, can build health care capacity and improve community health for years to come. Unfortunately, recipients in low- and middle-income countries also have been discouraged and burdened by inferior products and unilateral processes that fail to recognize their particular needs and the essential knowledge they bring to the table. Positive changes in global health, including standards and

is the virtue that disposes “Prudence practical reason to disern our

true good in every circumstance and to choose the right means of achieving it: ‘the prudent man looks where he is going.’” (Catholic Church 1994)

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accreditation for product donation, are providing hope for improved interactions and outcomes.

Improved global health initiatives need to be guided by prudence, authenticity, honesty, patience, excellence and humility, all six of the Guiding Principles. In modern parlance, prudence can evoke a sense of timidity or a rulebound approach. Neither of those characteristics are helpful responses to the urgency, nor do they inspire major investment in the creativity needed for decisive action in global health today. St. Thomas Aquinas’ virtue-based ethics gives us a much better understanding: he describes prudence as a cardinal virtue that seeks what is truly good. The truly good allows one to flourish, prepares one for the future and ultimately provides the abundant life that the Good Shepherd provides. More than a dull, intellectual process, prudence is the charioteer in a high-stakes race, understanding the obstacles on the track and directing the powerful virtues of justice, fortitude and temperance with agility, strength and precision. Prudence is the robust, practical and actionoriented virtue we need in global health!

Stronger relationships, better decisions, higher quality donations and commitment to improved

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that offer what is truly best for all concerned.

Case study: A Catholic hospital in Haiti has plans to open a laboratory with the potential to meet critical needs and generate necessary revenue. Hospital leadership realizes that robust information results in careful planning, producing sustainable outcomes, and preserving both precious time and resources. Essential preparation for making correct judgments includes indepth discussion and solid information about the market for proposed services, equipment needed, access to necessary consumable and replacement parts, as well as preventive mainte1. Thoughtful counsel: To Just don’t do it nance schedules. The hospireceive counsel one needs Good judgment requires tal, the medical product dore a l o p e n n e ss to t h e controlling our enthusiasm to do nor and others involved use experience of others, ingood so that we also do it multiple and diverse methc l u d i n g o p e n n e s s t o well, even in times of emergency. ods when discerning the God who interacts with the best way forward. The prodworld. Prudence in global Technical expertise is necessary but uct donor shares past expehealth, and specifically not sufficient for action. riences with lab donations, in medical product donaInternational activity requires including the difficulty in tion, requires commitment many things, including receiving consumables in to a recipient-donor relaassessment, planning LMICs. Hospital persontionship that both reveals and evaluation. nel consult with local venand documents the needs, dors on the availability and capacities, limitations, momeans of accessing consumtivations and future plans of all those involved. Discerning the appropriate- ables. Focus groups of local health care providness of a product donation, if it is to be prudent, ers provide accurate information about the need needs to engage multiple perspectives includ- for laboratory services, prioritization of specific ing persons with clinical, technical and admin- tests and the ability of locals to purchase services.

istrative/financial responsibilities. To provide counsel from past experiences and set a better 2. Correct judgment: For the sake of prudence, course for future endeavors, both formative and correct judgments must rely upon the careful summative evaluations are needed to build upon analysis of all the information gleaned through successes and create remedies for errors. While thoughtful counsel, all the relevant data and parthese written assessments are to clarify needs, ticipants’ experiences. the dialogue and shared problem-solving are Case application: Analysis of all informawhat build bonds among stakeholders. These per- tion results in a judgment that the laboratory is sonal bonds dramatically improve access to qual- necessary and has potential as a revenue source ity product and supply chain practices in LMICs. for the hospital. Judgments are made regarding Receiving counsel regarding cultural differenc- operations, including but not limited to priores and being attentive to power imbalances are es- ity services, pricing, potential vendors, marketsential to productive, cross-cultural relationships ing and the best fit for equipment. in global health. Finally, thoughtful counsel is es sential to prevent temporary relief for immediate 3. Commanding action: Good counsel and problems at the expense of sustainable solutions sound judgment point the way to constructive health outcomes in LMICs are possible if three components of prudence are integrated into medical product donation.

These components of prudence are: thoughtful counsel with God, oneself and others; correct judgment in considering all relevant information; and commanding action that is consistent with counsel and resulting judgments.

The case study that follows is an example for how organizations providing medical product donations to LMICs might incorporate these three components of prudence.

PRUDENCE

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PAU S E . B R E AT H E . H E A L .

action, but prudence has not accomplished its task until the charioteer has guided the team to the finish line. St. Thomas tells us that prudence applies the intellect and commands action. He echoes Aristotle in stating that prudence is “right reason applied to action.”

Case application: Acting on thoughtful counsel and sound judgment and building upon trusted relationships, prudence commands the following actions: A schedule of services aligned with current and future needs of local health care providers Service and fee agreements with potential customers of the laboratory Vendor contracts for parts, consumables and service as needed. Equipment acquisition for a harmonious inventory, utilizing equipment that can be supported with supplies and parts available through local vendors Preventive maintenance schedule and supply chain processes necessary for a fully functioning laboratory able to meet customer agreements Selection of donated equipment consistent with the hospital’s needs Engagement of allied nonprofits and manufacturers to supply equipment not available

through the primary product donor. Preparation of all equipment for donation, including the provision of manuals and initial stock of consumables; – assessment, repair and calibration as necessary; – crating to ensure safe transport; – coordination of shipping logistics for equipment; and the – ongoing evaluation for mid-course corrections and recommendation of process modifications.

Obviously, building a self-sustaining laboratory service in a low- to middle-income country will involve much more than outlined above, but the case study shows how prudence can lead to the attainment of a true good.

GEORGIA WINSON is the president and executive director of Hospital Sisters Mission Outreach and the Leadership Council Chair for the MedSurplus Alliance, Taskforce for Global Health at Emory University. She is grateful to Fr. Richard Chiola, PhD, for the engaging discussions and prudent editing of this article.

Grace in Chaos For just this moment, bring your attention to your breath.

INHALE deeply and settle yourself into your body.

EXHALE the stress and tension you feel.

In these days of chaos, a moment to pause is both a gift and a necessity.

GENTLE YOUR BREATHING, your gaze and your heart as you consider:

Where have I found grace in the past days?

THINK FOR A MOMENT.

In these days of chaos where have I found grace?

[Pause to consider] DWELL in the grace you have found and bring it with you into the rest of your day. Even now, God

is with you, as near to you as your breath. Continue giving yourself the gift to pause, breathe and heal, knowing you are not alone.

From God’s fullness we have all received, grace upon grace. JOHN 1:16 © Catholic Health Association of the United States

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A G E F R I E N D LY

WE OWE LONG-TERM CARE WORKERS A DEBT OF GRATITUDE AND OUR SUPPORT DOUGLAS R. EKEREN, MHA

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here is no question that the COVID-19 pandemic has taken a hard toll on all Americans, but staff in long-term care facilities have carried a particularly high burden. They experienced the loss of residents they cared for, sometimes staff members they worked with, and had the constant threat of taking the virus home to their families. And yet most stayed on out of a sense of commitment to the residents they serve. They did so while earning low wages, uncertain personal protective equipment (PPE), and a shortage of staff and supplies. We are indebted to the many women and men who have cared for residents during the pandemic and continue to do so. They have paid a price physically, emotionally and sometimes spiritually.

I would like to share the experiences that Av- staff on how to “don and doff,” and I think that era Health long-term care facilities have gone was the first time that we began to hear concerns through since March 2020. Avera has 22 owned, from staff. They were concerned about doing leased and managed long-term care facilities. Many of these facilities also We are indebted to the many have assisted and independent living as part of their operations. women and men who have cared for Prior to the pandemic, Avera’s residents during the pandemic and long-term care business unit, working with other departments at Avera, continue to do so. They have paid supported these facilities by monitoring financial and quality indicaa price physically, emotionally and tors, including measures of resident sometimes spiritually. and staff satisfaction. Assistance and education are provided, when needed, as part of this monitoring. The greatest opera- their work while wearing PPE. Would it protect tional challenge we typically faced was in staffing them, would they take home the virus to their families? We had a few employees near retirement facilities in rural areas.

Then, our first COVID cases in South Dakota who decided to leave earlier than planned so they occurred in early March 2020. Based on what we were not subjected to the risks of working in an knew from what had happened at long-term care environment that might have a COVID-positive facilities in the northwestern parts of the United resident. Education about the virus and about PPE States, Avera had activated its system-wide inci- became an immediate focus. Fortunately, as an indent command system, based in Sioux Falls. We tegrated health care delivery system, Avera was knew that we needed to prepare quickly for what able to rely on its infectious disease physicians, infection prevention nurses, educators and others was likely to impact our facilities.

Initially, we did not have adequate PPE for our to assist with this work.

We communicated with workers in a variety facilities, nor were staff trained in how to appropriately use most PPE. It was a significant under- of ways, including printed materials, video links taking to ramp up the supply chain to ensure we and instances where those with experience could had needed supplies. We also began to educate visit on-site for “learn and do” sessions. Those

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were helpful in that experienced staff could demonstrate safety procedures, invite staff to do them, and check that the teachings were taking hold.

We also initiated a weekly newsletter, the LTC Green Line, to provide information on policy changes, resource availability and regulatory changes as they rolled out. We instituted weekly phone calls for long-term care facilities, inviting those within Avera or others outside our system

who might be interested to participate. As knowledge of the virus changed quickly, we focused on sharing of best practices and recommendations about how to implement new policies or practices.

Staff told us that the restrictions placed on visitors, communal dining and activities were having a very negative influence on residents. Residents couldn’t see their family members or interact with their friends in the facility. It was heartbreaking

RESOURCES FOR HEALTH CARE STAFF WELL-BEING

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ur teams serving older persons are stretched beyond their capacity addressing the COVID-19 pandemic. CHA and LeadingAge offer resources that address the well-being of our staff.

CHA’s Well-Being website: https://www. chausa.org/well-being/well-being brings together a comprehensive collection of wellness resources identified in collaboration with CHAmember mission, spiritual care and physician leaders and insights from the national well-being experts.

These include audio and video resources for the body, the mind, the spirit. Resources for the body include a body scan exercise, a meditation video and a body/mind relaxation audio recording. For the mind, there’s a calming anxiety recording, an “Eye of the Hurricane” video and a recording on compassion in the time of coronavirus. The website includes spiritual resources, including options for online, live Holy Mass; virtual candle lighting sites or chapels where participants can leave an intention; meditative reflections and prayers.

Conversation Guide “Conversation Guide: Sustaining Connection for Well-Being,” developed by Rachel Lucy from PeaceHealth, Carrie Meyer McGrath from CHA and Lisa Reynolds from CHRISTUS Health, with the CHA Well-Being Task Force, is designed to bring support to ministry associates. This is a guide for a virtual conversation, with best practices for creating connection in a virtual space, a draft agenda, questions to prompts and ideas for reflection and suggested resources. Here is an excerpt:

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TAKE A MOMENT for YOURSELF to Pause.

Breathe. Heal. Be still. For just this moment, bring your attention to your breath. Inhale deeply and settle yourself into your body. Exhale the stress and tension you feel. On your next inhale, pray BE STILL. As you exhale, pray, AND KNOW THAT YOU ARE GOD. Repeat BE STILL AND KNOW THAT YOU ARE GOD. Keep breathing this prayer for a few moments.

LeadingAge Resources The LeadingAge Pandemic Playbook https://playbook.leadingage.org/?_ ga=2.95683740.1263246358.1610131383940500649.1579726923 devotes Chapter 8 to the wellness of staff and residents. Sections include Wellness: Staff and Resident Health; Wellness: Psychological Health; Lessons Learned: Wellness of Staff and Residents; and Lessons Learned: Psychological Wellness.

Here is an excerpt from the LeadingAge Pandemic Playbook, Chapter 8 — Wellness of Staff and Residents: “An organization that dedicates time, resources, and attention to the holistic well-being of persons served, staff, and other stakeholders may find that it is one of its wisest and most prudent investments. Promoting individual and collective wellness during a pandemic or other emergency is also a powerful way to build a sense of community. Organizations may find that sharing wellness resources among persons served and staff helps to form and strengthen bonds that enable everyone to find common ground… “

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for many of the staff to see residents impacted in dents, the incidence of positive COVID cases and this way. Staff also had to deal with the frustra- the deaths that followed were very challenging. tions of some family members who couldn’t see Front-line staff in a long-term care setting spend their loved ones. Occasionally those frustrations more time with residents than most family memwere unfortunately taken out on the very people bers do, even prior to the pandemic. Long-term who were caring for their family member. Staff care residents are like family to many of our staff, expressed frustration over this, but they could and to watch them deal with the symptoms of COVID and, in some cases, pass away, pushed some understand why people were upset.

We implemented outdoor visits, visitation of our people to the breaking point.

We called again upon the strength of our sysbooths, and hugging walls to try to provide options for increased interaction following the ini- tem to help us provide assistance to staff. We ential shutdowns. Local administrators and main- listed behavioral health experts from our Employtenance crews got very creative. A hugging wall, ee Assistance Program to develop presentations for instance, could be constructed using plastic geared specifically for caregivers in long-term that was flexible and strong, allowing a resident and loved one to hug Staff also had to deal with the through it. The wall could be sanitized for safety. Facilities shared their frustrations of some family best ideas and plans with each other.

This seemed to help everyone, inmembers who couldn’t see their cluding staff, as at least there could loved ones. Occasionally those be some level of visitation. We also began to allow families to choose frustrations were unfortunately an essential caregiver, a representative provided with some training so taken out on the very people who they could safely come into the faciliwere caring for their family member. ties, which also aided in improving the overall atmosphere. While all of these efforts have helped, they certainly do not care. They focused on the effects of working in an replace the normal interactions that are so impor- environment structured to keep COVID out of our facilities and to minimize the impact if it did enter. tant for residents and families.

Point of care testing became available start- The sessions were recorded and made available ing around September, allowing us to test staff to every one of our facilities to use for staff meetand residents. This was appreciated by some, but ings or on facility web pages so individual staff members could access them at their convenience. other staff didn’t like being tested so frequently.

Information, and frequently misinformation, Many staffers were grateful for these resources.

We also had staff express frustration with were among our greatest challenges. We decided early on that we wanted to be transparent with people who didn’t work in health care and were what was happening in our buildings. Along not taking the pandemic seriously. One employee with the new newsletter and phone conferences, talked about having to leave her Facebook group we also helped facilities implement video visits as they were constantly posting pictures about with families and encouraged administrators to outings to restaurants or bars, without masks or have town hall meetings with family members to ignoring social distancing. Some staff explained update them on COVID in the facility, whether that after spending the week in PPE and watching among the residents or the staff. Staff were en- residents pass away, they simply couldn’t handle the denial from some members of the public who couraged to participate in these sessions.

Our staff let us know when they or their col- wouldn’t acknowledge how COVID was truly takleagues were having difficulty coping with the ing a toll on their communities.

The arrival of new treatments like monoclonal day-to-day challenges of caring for residents, particularly when there was a COVID outbreak in antibody treatments brought some hope to staff at their facility. Witnessing the loneliness of the resi- our facilities. They could see that we were doing

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PAU S E . B R E AT H E . H E A L .

more to treat residents who tested positive. Avera was quick to implement this in long-term care settings, both our own and to other long-term care settings through our long-term care pharmacy.

This undoubtedly saved lives not only among the residents who received the treatments, but also among people in the community who could be admitted to limited hospital ICUs because we could care for and keep our residents in their home settings. This did not go unnoticed by staff. The arrival of the vaccine is bringing an even greater sense of relief to all, knowing that there is at last the potential of an end to the pandemic.

We have recently seen a downward shift in the number of positive cases in our long-term care facilities as well as in our hospitals. We are hopeful that will continue, despite the fact that many parts of the U.S. were at a peak number of cases in early 2021.

Given the duration of this pandemic, I am sure there will be more that we will need to do to assist staff who continue to work in this envi-

ronment. The long-term impact of working constantly in PPE and seeing people pass on when a short time ago they were fine simply isn’t known yet. We must be ready and willing to support our staff who are answering the call to care for people who desperately need our services. We have been fortunate. We have not seen staff abandon their long-term care jobs and the residents they are caring for. It is certain that some individuals have left rather than deal with the issues the current environment presents, but nothing different than what we experienced previously. We also have had staff who have answered the call to work in long-term care, ensuring that those in need would receive the care they deserve.

DOUGLAS EKEREN is regional president and CEO of Avera Sacred Heart Hospital in Yankton, South Dakota, and Avera Queen of Peace Hospital in Mitchell, South Dakota, and he leads Avera’s LongTerm Care Strategic Business Unit.

I Find Rest For just this moment, bring your attention to your breath.

INHALE deeply and settle yourself into your body.

EXHALE the stress and tension you feel.

On your next inhale, pray, I Find Rest.

And as you exhale, In Your Shelter I Find Rest, In Your Shelter KEEP BREATHING this prayer for a few moments.

(Repeat the prayer several times) CONCLUDE, REMEMBERING:

Even now, God is with you, as near to you as your breath. Continue giving yourself the gift to pause, breathe, and heal knowing you are not alone.

Whoever dwells in the shelter of the Most High will rest in the shadow of the Almighty. PSALM 91:1 © Catholic Health Association of the United States

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SERVICE

A Litany in the Pandemic CARRIE MEYER MCGRATH, MDiv, MAS DIRECTOR, MISSION SERVICES, THE CATHOLIC HEALTH ASSOCIATION, ST. LOUIS

L

For those unemployed or unable to work, g All of them struggling to meet their needs and the needs of their families, Christ, have mercy on them.

ORD, have mercy CHRIST, have mercy.

LORD, have mercy.

Holy Trinity, divine relationship of love, g Have mercy on us.

God of all Creation, Have mercy on us.

God of our Redemption, Have mercy on us.

God of Breath and Life, Have mercy on us.

For physicians, nurses and caretakers, g Risking themselves to care for others, God, have mercy on them.

For those who are chronically ill, isolated and at the margins, Exhausted by the relentless pandemic, God, have mercy on them.

For the grocery clerks, teachers and laborers, g Exposed to illness as they do their work, Christ, have mercy on them.

For servers, construction workers, musicians and many more.

For all of us, each person in our own g situation, Weathering the storm of the pandemic and waves of anxiety, Spirit, have mercy on us.

For all of us, each one in our own way, Reaching out, doing the good we can and waiting in hope, Spirit, have mercy on us.

Holy Trinity, divine relationship of love g Have mercy on us.

God of all Creation, Have mercy on us.

God of our Redemption, Have mercy on us.

God of Breath and Life, Have mercy on us.

Lord, have mercy.

Christ, have mercy.

Lord, have mercy.

“Prayer Service,” a regular department in Health Progress, may be copied without prior permission.

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Ministry Leadership Center A New Generation

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