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Trevor Bonat (Host): Hi, my name is Trevor Bonat and I serve Trinity Health as the Chief Mission Officer at Trinity Health Pace and Turning Out the Home. I'd like to invite my guest for this podcast to introduce herself.

Carrie Hays-McElroy,RN (Guest): Hi, my name is Carrie Hays-McElroy, and I serve Trinity Health as the Chief Clinical and Compliance Officer for Trinity Health Pace.

Host: Hey, Welcome Carrie. Thanks for joining us. I'd like to begin by asking you what brought you to your current role at Trinity Health?

Carrie: So, without giving you my entire professional history, I started off my nursing career in the UK, and believe that everything that has happened in my career has actually what has brought me to this particular role. So, I have in Community Health. After I came to the states, I've worked in Home Health, I've worked in nursing home settings. I came through case management leadership roles within case management, quality improvement, risk management. And then, actually joined Trinity Health back in 2003, at one of our hospitals here in Michigan and established the Senior Services that hospital. And while I was working on that, that was in 2015 was, Iinformed about a position for VP of Clinical Operations for the relatively newly forming National Health Ministry of Trinity Health Pace. And so thankfully that was brought to my attention and came into this role then at the very, ground roots of developing this National Health Ministry.

Host: Fantastic. we are in a consolidation of Tourney Health Pace and Mercy Life and it's been wonderful to work with you with this past year and merging these two, programs. And it's exciting to say the least, and I imagine it must have been so exciting to be there at the ground floor, building something from scratch. So, I'm glad for your expertise in that. So, for more than a year now, all of us have been coping with the global pandemic. And in your role as a leader at Trinity Health Pace some certain that you've experienced the impact of this pandemic in so many ways. And I'm wondering if you'd be able to share a story from your experience, that highlights how it's impacted you, the ministry and perhaps ways that you've responded.

Carrie: Yep. Thanks Trevor. It's interesting as I reflect on how the pandemic has impacted our ministry, because I think it's, it's very different from how it's impacted other ministries across Trinity Health, partly because in the acute care space and even in the home health space, colleagues have been impacted by an influx or a surge of patients that they're having to care for with COVID-19, really make a lot of adaptions the care that's provided in those settings.

In the Pace model, just to sort of emphasize for those that really don't understand Pace too well. Pace is the program of all-inclusive care for the elderly. And what that means is that we are at the insurance provider. We are the primary health provider. We are the home care provider. but we're also the adult day health provider, and a lot of the services historically have centered around the physical location of the adult day center.

And with pandemic, we had to physically close down all of our day center operations, and really limit our clinic operations. And so rather than seeing our patients, we call them participants rather than seeing more of them and seeing them more often, the greatest challenge to us was that we weren't seeing them as often as we had been before. So, our teams, really had to pivot on a dime and think about creative ways that they could continue to serve those participants, in order to maintain them safely in the community. And these are some of the oldest, frailest members of Trinity Health. These are people who in order to be in our program are over the age of 55. They meet all of the requirements to receive nursing home level of care. But in order to be in Pace and while they are in Pace, we provide services that are designed to keep them out of nursing homes. So, these are really frail, vulnerable adults when we are unable to bring them into the day center. Not only are our colleagues challenged by not being able to have eyes and ears, helping to support those participants so often, but the participants themselves are impacted because they're not coming in for the recreational activities, the socialization that they may receive, the exercise programs and rehabilitation programs that they would normally receive in the day center.

Plus their caregivers, their family caregivers, with whom many of them live were additionally impacted because they also then were additionally challenged because they may have been unable to go to their workplace, at least in the early, earlier days of the pandemic. And were at home 24 hours a day, seven days a week with some older adults that are living with dementia. And so there's additional strain on those families. So, our Pace colleagues, quickly pivoted, as I said to providing most of the services in the day center, people who are not used to necessarily working out in the community and going out to participant homes to provide care would be moved into different roles.

They would have to be cross-trained going into home environments, and there was a lot of fear and anxiety about going into those environments and really making sure that they had all of the necessary, protections, PPE, and guidance in order to be able to provide that service. We also had to think about how were we going to continue to make sure that our participants got all of the needed nutrition that many of them need. Because when we have our day centers open, we are able to provide congregate meals for them. Sometimes that's breakfast and lunch, and sometimes even a cold meal to take home.

So, we looked into alternative ways of sending meals out to the participants' homes. We had to look at ways of making sure that they continue to get their medications in the homes. and we needed to then look at how could we maintain that socialization that many of our older adults desperately need. And so we put into place a number of collaborative groups. We called them think tanks, and colleagues from around the country at all of our Pace organizations, in multiple states get together on a regular basis and share some creative thinking around virtual ways to do,you know, bingo that's, you know, a classic example, but also some exercise and rehabilitation programs that we were able to do virtually as well as being able to maintain a connection with their other colleagues, because again, they weren't coming into the day center and interacting with each other on such a regular basis.

Host: Wow. when you drew that comparison between, acute care and even home health settings and, Pace, it was very stark that difference, you know, they were managing the influx of patients and caring for them as they were coming in. We didn't have them coming in at all. And, to be maintaining the integrity of the care, think, give the core value of integrity, the integrity of our care as in a very different setting, really striking. So, thank you, Carrie, for that. people are getting vaccinated against COVID-19, it is spring, mask mandates are changing. are some of the challenges you think that we will face as we move forward? And do you have any hopes or fears or thoughts as we move into this peri and post COVID world?

Carrie: Yeah, but I definitely have many hopes. but I have, some slight fears too. And a classic expression that I'm, using right now is that, you know, that there is light at the end of the tunnel and that light is getting closer, but we are still in the tunnel. We're not completely out of this yet. one of my fears is that, people, this is going to sound pretty bad, but people will rush towards the light. And I don't mean it in, the way that sometimes that might be interpreted, but that we may be rushing out of the tunnel, with great enthusiasm. I want to make sure that we, get there in the appropriate timeframe.

We are beginning to be able to bring some of our most vulnerable participants back into the day center, in small numbers. We are going to continue to be very cautious as we do that and really maintain physical distancing. We're going to continue to maintain masking at least for a little while longer. As we, really do work through ensuring that our participants all have access to vaccinations and we've done a fantastic job of being able to get vaccines out to our older adults and, or have being able to get them to places where they can get the vaccine. But I think that the hopeful part of that is, that we have learned so much because we have been so flexible. We have really looked at our model of care. We've looked at all of our practices. We've collaborated so well across all of our Pace organizations and, learned from everybody's creative ideas that's now become hardwired into the way that we do work.

whether we do that virtually or whether we do some of that increasingly in-person, we are going to maintain these collaborative groups. We're going to maintain a balance between increased support for participants at home at the same time as being able to appropriately provide them with the congregate care that some of them have been used to. So, I think that's what really gives me you know, anticipatory joy around what I call the silver linings of the pandemic. And, there have been many tragedies. There's been emotional and physical and spiritual challenges that we've all faced for one reason or another, but there are silver linings and we're going to learn from them and we're going to become a better and stronger organization as a result of that.

Host: Amen. Absolutely. been amazing to see, home care aides who were used to doing work in the centers, going out into the homes and overcoming that fear and, using our core value of safety, such that they feel safe in that. And they're going to be better for it. Right? We're all. And, And all of us in all of the different ways, that we've been doing things differently, it will be better for completely flipped the delivery of care on its head and been able to persevere through that. were talking about bringing some of the most frail and vulnerable participants into the centers, now, it, got me thinking about our, core value of commitment to those who are poor. And if there's one thing that Pace does really well and you, express this so well is reaching out to the margins and those that are most peripheral, most, in need, most vulnerable and wrapping our care around them in a preferential way. I mean, everybody needs care in Pace, they can't go into Pace without needing a incredible amount of care, but even within that population, really seeing those who, who need it the most while caring for everybody. So that's really neat. Well I'm so grateful to you for sharing really incredible story and, just like to thank you, Carrie, for expressing so clearly what we've done in Pace. And, I'm really proud to a part of that.

And, hope they've you've expressed for the future taking those learnings and taking that silver lining from Pace and carrying it into that light when we emerge from it in an appropriate time. So, Thank you so much Carrie. And I really appreciate it. And thanks everybody for listening.