Springfield & Western MA Community Partners
Holyoke / Springfield & Western MA Partners
- Baystate Health, Advance Care Planning Team
- Berkshire AHEC
- Berkshire Scholars at Berkshire AHEC
- Health New England
- Highland Elder Services
- LifePath, Inc.
- Porchlight VNA/Home Care
- Valley Medical Group
- Western MA Transitions in Care Cross Continuum, sponsored by Baystate Health; and theri 456 Care Provider Organizations Members
Baystate Health Advance Care Planning Team
Samantha Kennedy and Jodi Kashouh, MS, RN-BC, CNL
Tim Moriarty, MPA, CHI-Spanish, Manager, Interpreter & Translation Services, Baystate Medical Center
Baystate Health Advance Care Planning Team works closely with Honoring Choices MA (HCM) to collaborate on sharing Honoring Choices documents, tools, and care planning model. Baystate Health has made the HCM Health Care Proxy available to all patients on their Patient Portal. They have sponsored the translation of the HCM Health Care Proxy into three additional languages, Swahili, Nepali, Tagalog, directly helping people in their community and sharing the translated documents with the Honoring Choices Partner network. We have trained staff as Health Care Planning Ambassadors, and are working together to improve serious illness care conversations and transitioning from MOLST to POLST Program.
Gena DiSimoni Johnson, Executive Director
Berkshire AHEC’s (Area Health Education Center) mission is to promote healthy communities and healthy lifestyles. We do this through education of health professionals, promoting health and wellness, and engaging in population-based public health strategies, all in collaboration with community partners. Founded in 1979, Berkshire AHEC supports the health and human services workforce with continuing education programs and by providing continuing education credits for nurses, social workers, mental health professionals and others. Our Medical Interpreter Program is designed to facilitate and enhance the communications between patient and provider during a health care encounter. Our public health initiatives, including the Berkshire Tobacco-Free Community Partnership, work with other organizations to promote health and use policy, systems and environmental strategies to address critical health issues. Berkshire AHEC is proud to support the future of health care through our AHEC Health Scholars’ Program at Berkshire Community College (BCC). AHEC Health Scholars is a program for health career students interested in supplementing their education by gaining additional knowledge and experience in local community needs. For more information, go to https://www.berkshireahec.org/
Berkshire AHEC's Health Scholars Program
Sheila Dargie, Center Director
Berkshire AHEC Scholars’ Program is developed in collaboration with Berkshire Community College (BCC). AHEC Scholars is a program for health careers students interested in supplementing their education by gaining additional knowledge and experience in local community needs. This program offers a defined set of academic and community-based activities that is supported by interdisciplinary curricula to enhance interdisciplinary skills to better support patient centered care, have opportunities to work with students, faculty and community professionals outside the traditional classroom and much more. Students participate from nursing (ADN and LPN), physical therapist assistant, respiratory care and community health workers (certificate or associate level). Honoring Choices has regularly contributed to the curriculum by offering the HCM Health Care Planning Ambassador webinar to the scholars to enhance their knowledge and skills to confidently engage adults in health care planning conversations. Scholars receive the HCM health Care Planning Ambassador certificate.
Health New England
Rebecca Starr, MD, Medical Director Medicare Advantage
Jennifer Loranger, Medicare Project & Operations Manager
Health New England is a non-profit health plan serving members in Massachusetts. Their mission is “to improve the health and lives of individuals, while being deeply committed to and closely connected with our neighborhoods.” They offer a range of health plans to meet the needs of both individuals and employer groups. Located in Worcester, Health New England serves Berkshire, Franklin, Hampden and Hampshire Counties in Western Massachusetts and Worcester County. Health New England’s Care Management programs help members facing long-term health challenges. Experienced case managers and care coordinators provide education and support to members to stay informed and healthy.
Highland Elders Services
Welcome Highland Valley Elder Services (HVES), Florence, MA, serving 24 area communities in their western Ma region. HVES helps older adults & families through a range of programs such as Case Management, Family & Caregiver Support, Home Health Services, Home Delivered Meals and much more. Their Information & Referral line helps consumers & care providers in Western MA. Start with theri Inforamtion and Referral line, 413 586-2000.
“At LifePath, we listen first, and then help each person find the best options for their unique needs,” says Andrea Baker RN BS Nurse Manager. LifePath helps elders and persons with disabilities maintain independence and quality of life in their own homes and communities. They help busy caregivers to find relief and help loved ones to choose the right path. LifePath, Inc., is an Area Agency on Aging and Aging Services Access Point. For over 40 years, they have offered options for independence to adults in Franklin County, plus Athol, Petersham, Phillipston, and Royalston in Worcester County. Additionally, Adult Family Care, Personal Care Attendant, and SHINE serve Hampshire County and parts or all of Hampden County, and Elder Protective Services and Personal Care Attendant serve Berkshire County.
“At Porchlight, we believe care should be given where you’re most comfortable-in your own home, where life is as you know it,” says Holly Chaffee, President & CEO. Porchlight VNA/ Home Care is well-respected for their long standing 100 year commitment to serving adults in western Massachusetts. They provide short term and long-term care in your home and comprehensive resources for all home health needs, including: skilled nursing, therapies, 24-hour care, social work, maternal and child health. With offices in Lee and Chicopee, they offer compassionate and person-centered care to adults in Berkshire, Hampden, and Hampshire Counties. Porchlight VNA is a free-standing non-profit and serves as the Board of Health for several towns in Berkshire County and regularly conducts community education and engagement programs. Porchlight VNA is rated five stars by the Centers for Medicare and Medicaid Services (CMS). They have received several HomeCare Elite™ Awards of Excellence and MA Department of Public Health deficiency-free surveys demonstrating their commitment to quality and safety. Porchlight Home Care is an Accredited Agency by The Home Care Alliance of Massachusetts.
Valley Medical Group (VMG) is committed to supporting and educating our patients as they consider serious illness and end-of-life options for health care.
The VMG Advance Care Planning Committee is working to further this initiative. Goals include:
· Provide educational resources for patients about advance care decisions and options.
· Encourage completing Health Care Proxy forms beginning at age 18; add completed forms to the patient’s electronic medical record (EMR).
· Introduce discussion about the MOLST at annual wellness visits beginning at age 65 or with chronic or life-threatening illness and add completed forms into the patient’s EMR.
· Support and educate primary care providers in the delivery of meaningful communication with their patients about serious illness and end-of-life decision-making.
456 Provider Organizations of the Western MA Transitions Care Cross Continuum
Jodi Kashouh, MS, RN-BC, CNL
Healthcare Quality Specialist
Division of Healthcare Quality
Baystate Medical Center
Western MA Transitions in Care Cross Continuum (TICCC), sponsored by Baystate Health is an Alliance/Community Partner.
TICCC's 456 member organizations are part of the Honoring Choices network. The members have access to the "Who's Your Agent?" Program and Tools Kit to actively engage adults in effective health care planning discussions and connect adults to person-centered care in their community. We work with the TICCC on several projects including training some of their members as Honoring Choices Champions, and collaborating on National Health Care Decisions Month. On September 19, 2017, they will be hosting the third in a series of MOLST: Meeting the Challenge Workshop for Western MA care providers.