Staff at Western Mass. Hospital are hopeful they can erase stigma surrounding long-term chronic care through consistent care models. Pictured here are Nurse Manager Carol Jayne, Dr. Ted King, Jim Moran, respiratory

Western Mass. Hospital had a patient not too long ago that several staff members remember clearly. Determined to fulfill a simple last wish – finish a plate of turkey and stuffing at the Thanksgiving table – she worked diligently with physicians, nurses, and therapists until November rolled around … and when she got home, she was well enough to stay there.That story bunks the notion that patients enter Western Mass. Hospital and never leave, and it’s a success story that speaks more to the norm than the exception at the hospital. While not every patient will see as dramatic a recovery, many improve in both small ways and large, and lead long lives.

Western Mass. Hospital, a state facility that operates under the Department of Public Health (DPH), has been in existence for nearly a century, beginning in 1909 as a tuberculosis sanatorium. It has since evolved to offer one of the most comprehensive suites of care for chronically ill patients in the state. Despite those advances, however, Jill Turomsha, director of Admissions, said the stigma surrounding state-run hospitals like Western Mass. – a place of last resort – is a hard one to shake.
“It’s a stigma that began in the early 1900s, and in many ways, it persists,” she said. “But over the years, the hospital has changed and shifted dramatically to meet the needs of the community.”

Turomsha noted that in 1937, Western Mass. Hospital opened a wing for the treatment of cancer, and by 1960 had begun to open its doors to patients with other forms of chronic disease, changing its name from the Westfield State Sanatorium to Western Mass. Hospital two years later. She said educating the public on the breadth of services available at the facility is a particular challenge for all public hospitals, not only in the effort to erase negative perceptions, but also to underscore the importance of long-term and specialized care.

A Deep Breadth

Today, for instance, Western Mass. Hospital includes an Alzheimer’s and dementia unit, reserved for those patients unable to be treated in other facilities due to aggression or other issues.

It also boasts a neurological disorders specialty unit that treats patients with a number of diseases including ALS, multiple sclerosis, and Huntington’s Disease; a respite care unit, which welcomes patients living at home for five days to two weeks at a time, up to four times a year; an end-of-life unit; an outpatient dental clinic for individuals with no insurance (the clinic is currently not accepting new patients due to the high number of patients); and a respiratory unit that opened in 1996 for ventilator-dependent patients and those with chronic respiratory disease.

Monica LeBlanc RN, clinical liaison, said the respiratory unit is the latest example in the hospital’s ongoing evolution to meet specific needs within the Commonwealth’s health care landscape.

“Very few places will take patients on vents,” she explained, noting that cost and staff proficiency level can often be prohibitive. “Up until very recently, these patients were literally living in acute care hospitals, because right up until the early ’90s, there was nowhere else to go.”

There are health care delivery benefits, she said, that are unique to state hospitals, especially in an increasingly cash-strapped health care industry that is also seeing severe shortages nationwide in skilled health care jobs, and therefore a growing inability to provide comprehensive, specialized long-term care for patients with demanding needs.

“I always tell people to tour the facility before they make a decision,” said LeBlanc, noting that due to its specialized repertoire, Western Mass. Hospital welcomes patients from all over the state, not just the local region. “They need to see what goes on here to understand. Once they do, they’re generally supportive of our work.”

Dr. Ted King, a pulmonologist at Western Mass., added that clinically, there are a number of treatments offered at the hospital that acute care and long-term care facilities can’t offer.

“Operated through the DPH, we’re a not-for-profit,” he said, “and in several ways that frees us from the constraints that acute care hospitals face. Our mission has become to fill the niches that other facilities can’t.”

King explained that for many acute care hospitals, ventilator patients must be moved from the facility after about 28 days – respiratory patients consume a large amount of care and resources, he said, beds are often needed for more critical patients, and reimbursements begin to run out. But since Western Mass. Hospital’s state-appointed role is to provide what is officially termed Long Term Acute Care (LTAC), the facility’s goals can be that much more long range.

“Our philosophy is different,” he said. “We’re able to think in terms of weeks and months, not hours or days,” he said. “We’re able to take the time for physical, occupational, and speech therapy, to wean people off ventilators when we can, to advance people’s diets gradually, and to deal with families much more often.”

Patients, A Virtue

The unit also helps to negate the idea that hospitals like Western Mass. are reserved for the treatment of the elderly or those at the end of their lives. The only state hospital of its kind in Massachusetts and one of only two facilities in the area with a long-term respiratory unit (Parkview Specialty Hospital in Springfield also has one), Western Mass. Hospital has carved a niche for itself in the care of long-term, chronic or ventilator-dependent patients, some as young as 30, such as identical twins Matthew and David Gonyea, who occupy the only double room on the floor; the rest are private.

James Moran, respiratory manager, said a major goal of the hospital is to help patients achieve as high a level of independence as possible. For some, that means living at the hospital but leaving for day trips. The Gonyeas are out regularly, attending baseball games, pizza parties, and concerts; they’re currently planning a trip to see the popular hip-hop group the Black Eyed Peas.

“It’s a myth that people with breathing machines can’t do those things,” Moran said, adding that for other patients being treated in the respiratory unit, independence means eventually returning home, armed with new skills and the benefit of long-term therapy to keep them healthier. For others, it means regaining the ability to eat, or to communicate.

“That sounds small, but for someone who can’t do either, it’s paramount,” he said, noting that speech therapy will be incorporated for patients who may be able to regain the ability to talk, but for those who can’t, staff will turn to developing new communication skills, such as using physical therapy to learn to write messages, or even a series of eye blinks to answer questions.

“It’s very labor intensive, hands-on care,” said Moran. “We’re also constantly serving as advocates for patients, who sometimes can’t speak for themselves.”
Still, King noted that part of the reason that stigmas surrounding chronic care persist is a lack of understanding or even acceptance of the reality – it makes a lot of people uncomfortable, he said, prompting them to turn a blind eye to what goes on behind Western Mass. Hospital’s walls.

That lack of understanding can lead to additional challenges, including staff shortages and financial strains. In the respiratory unit, a respiratory therapist must be on the unit at all times. There are 11 on staff now at Western Mass., but Moran said he’s short on every shift, reflecting a national shortage in the profession. Springfield Technical Community College, the only local college with a respiratory therapy program, currently has six students enrolled, but Moran fears that’s not enough; especially when, as a public hospital, Western Mass. can’t offer the attractive sign-on bonuses that many private facilities are currently offering.

“It’s a hard sell,” he said, “and not the happiest topic. People think that sick people should either die or get well. They don’t want to think about the long term, literally.”

Giving Thanks

But the tide is slowly turning, with the help of the stories of patients like Matthew and David Gonyea.

And others, such as those perhaps told around the dinner table – of the year a family member came home from the hospital, focused on little more than some Thanksgiving trimmings, and got to stay a little while longer than she’d even hoped.

Jaclyn Stevenson can be reached at stevenson@healthcarenews.com

Comments are closed.