Betty

Tuesday afternoon, I was sitting in my office when the phone rang. It was one of my former patients from the Diabetic Clinic.

She had been a patient here for at least 5 years – besides diabetes, she had an ovarian mass that we had been watching closely.

She and her husband both work; she works at a nursing home. Neither of their jobs offered insurance. Her husband suffered a heart attack last year, so they are paying hospital bills for that. She came in to see me in November to look at healthcare through the Marketplace. She picked a plan that fit into their budget with low monthly premiums, but a higher deductible. She was thrilled to have insurance that would start January 1, 2014.

So, when she called – my first thought was that she had found the high deductible to be more than they could afford. But, no – what she called to tell me was that she had been diagnosed with cancer. I assumed it was the ovarian mass, but was wrong again. She has been diagnosed with cancer of the esophagus, liver and lung. She is 55 years old.

I felt physically sick.

Glad that she has access to care; glad that she wanted me to know; a stark reminder that none of us knows what tomorrow brings.

Please keep her in your prayers.

Keith

I first introduced Keith on January 15, 2013 as one of my heroes.

Last week I worked in the pharmacy with him for the whole evening. One thing that never changes about Keith is that he loves to talk. So, while we worked, we talked.

When I last wrote about him, he had been diagnosed with Stage IV prostate cancer with bone metastasis. The prognosis at the time of diagnosis was 3 months with conventional therapy. Well, there is nothing conventional about Keith – so he chose experimental therapy.

September will be 3 years since he was diagnosed. It has been a tough journey for Keith and his family, but through it all, he has continued to work at his “real” job AND has continued to volunteer regularly at the clinic.

I am awed and amazed at that. There have been times when he was so exhausted he could hardly stand up; the only times he has missed his scheduled work days here are when he has an appointment at the University of Michigan on a Tuesday. Otherwise, he comes here.

He has always been one of my heroes, and during this time he has taught me – and others – about living, about faith, and about hope.

The Final Diabetic Clinic

“Sad.” “Relieved.” “Grateful.”

“It’s like a divorce you knew was coming, but didn’t want.”

Those were the words I heard from the patients in the Diabetic Clinic as we had our last-ever meeting. It was the last one because they all qualify for healthcare insurance. Two purchased healthcare insurance through the Marketplace; one qualifies for Medicare this month; the others all qualify for the Healthy Michigan Plan – Michigan’s Medicaid expansion program.

It was a bittersweet evening. We have been doing the Diabetic Clinic for around 10 years. It was the vision of Andi Scholl, PA-C. He wanted to try something different and new for diabetics – a clinic devoted to them done in a group setting. The patients all came in at 5 p.m. They had their vital signs (blood pressure, pulse and respirations) done, as well as their weight. Each one would talk to one of the nurses about what they needed that night – medication refills, to see the provider, test strips, etc. Then the group would meet together to share an educational program and a healthy snack.

When the provider came in, the ones that needed to be seen would have a chance to be seen individually. Each patient received a month’s worth of medications and glucose test strips to go with the meter the clinic provided.

The clinic was created by an amazing group of volunteers in addition to Andi. There was Pat Morgan, RN, and Sean Codier, a student at Hillsdale College who is now an MD with the U.S. Army and stationed in Korea.

Over the years, many others have volunteered their time and talents: Natalie Wyma, PA-C; Dr. Steigerwald; Dr. Schall; Linda Cosier, LPN; Marilyn Williams-Bayer, RN; Char Byers, RN; Mary Skupinski, RN; and, Cindy Horwath, RN. The pharmacist for the Diabetic Clinic has been Tim Skupinski, RPh.

I have some mixed feelings as this program comes to an end. It has been an amazing group of professionals to work with. The group of patients, for the most part, have been motivated, compliant and eager to take control of their lives. They have come each month to take part in the group. The names and faces have changed frequently over the years, but the support and care they gave one another stayed the same.

We will miss seeing them and they will, at least initially, miss seeing us. But, they are so much better off insured. They are a success story today – thanks to the Affordable Care Act.

NEHM in NOLA

Candace, a volunteer nurse at the clinic, and I attended the annual National Episcopal Health Ministries conference in New Orleans this month.

We both were presenters at the conference. Candace did a presentation on “Preparing Better Healthcare Consumers” and mine was on the topic of the Affordable Care Act.

This annual conference is my favorite – I have attended every conference put on by NEHM. I love everything about it – the locations, the keynote speakers, the education, the opportunity for a time of rest and retreat, and most of all – the people. Over the years I have met so many people – some have attended one conference, some have attended all of the conferences, and everything in between. It has been a privilege to get to know Bishop Rabb – we have some friends in common from our years in Atlanta; Maryfran Crist has been an inspiration; Matt Ellis – the CEO of NEHM; and Sue Hacker Nelson, who is always ready and willing to help.

And, New Orleans. What an incredible place to visit. I think I was born in the wrong time and place. I love that city – and I have to admit, I am like a moth drawn to a light when it comes to Bourbon Street. You just can’t keep me away. Candace and I had quite the adventure on Bourbon Street during this visit – it involved torrential rain, a flooded Bourbon Street, no cabs, and a poor innocent woman who decided spending the evening with us was a good idea?! Anyhow….

We did take some time to sightsee – the Old Ursuline Convent, St. Louis Cathedral, Jackson Square and we walked through the French Quarter. We ate at The Court of Two Sisters, and of course, we had beignets at Café Du Monde.

It was a fun respite in the midst of a crazy year. Candace came home super inspired and ready to take on bigger and better projects. THAT is what I love about attending these conferences – coming back refreshed, inspired, energized and ready to take on the world!

Thanks NEHM for doing all of that for all of us! I think that NEHM is the best, and maybe most invisible, thing about being an Episcopalian. It is truly a hidden jewel.

And, in the spirit of full disclosure – NEHM has changed their name to Episcopal Health Ministries – but it didn’t have the same flair to say EHM in NOLA!

Marilyn Williams-Bayer’s Eulogy

Marilyn Williams-Bayer’s Eulogy

May 30, 2013

Let us pray:

O Lord, you are the Father of mercies and the God of all comfort; look with compassion we pray upon all gathered here now. Grant that this service of comfort, which we now hold in your name, may bring to all a sense of heavenly nearness and great trust in you. And may the peace of Christ, the peace that passes all understanding, abide with us and rest upon us. We pray through Jesus Christ our Lord. Amen.

For those of you who don’t know me, my name is Jill Pavka. I am the Executive Director of St. Peter’s Free Clinic and was privileged to have Marilyn as a friend.

We write our own eulogies while we live – in the way that we live and in the lives we touch.

It is rare for someone come into our lives and to touch us so deeply.  But, Marilyn was one of those extraordinary people for many of us here today.

In my blog, I described Marilyn as a hero; the dictionary defines a hero as:

1.  A remarkably brave person: somebody who commits an act of remarkable bravery or who has shown an admirable quality such as great courage or strength of character

2. somebody admired: somebody who is admired for outstanding qualities or achievements

In so many ways, Marilyn was a hero.

She came unexpectedly into our lives here at St. Peter’s Free Clinic when Dr. Collins “ordered” her to volunteer at the clinic. I am not sure what his motivation was – whether he thought Marilyn needed us, or we needed Marilyn, but both were true. We needed each other.

She started volunteering as a nurse. And what a gifted nurse she was. Her passion, her compassion – the patients loved her. I guess I didn’t realize fully all of her talents, but over time her role as a counselor became one of the more important ones at the clinic. She was able to offer our patients something that we had never had to offer before – a depression support group. Well, we called it a group, but more often than not it was one-on-one counseling for a troubled soul. Marilyn would listen, and life would get better. She gave undivided attention to people who needed it most.

She was one of the nurses to work with our Diabetic clinic as well. This small group of select and special patients meant the world to her; and she to them. They counted on her counsel, her wisdom, and her smile.

Over time I learned some of Marilyn’s journey – her long battle with metastatic breast cancer. I remember when she told me that at the 5 year mark when most people celebrate, she didn’t.
She did not trust that the disease was gone – and she was right. Soon after that she was diagnosed with metastatic disease – and her long battle began. I think she was on chemotherapy of one sort or another most of the time that I knew her. She never dwelled on herself; her interest was in those around her.

When I think of Marilyn it is how she would come into the clinic on Tuesday nights – all four foot something of her, with the brightest blue eyes and a smile that would light up the world. And, her necklaces – she always wore a necklace. She had hugs for all of us, and always asked about our lives – she remembered everything.

Marilyn was a daughter, a sister, a mother, a wife, a nurse, a counselor, a friend. We each remember her with our own snapshot of her – with the joys, the struggles, the disappointments and the wonderful memories. She was someone different for each of us; that is just how life works. The person we know may or may not be someone else’s experience of that person; but each part of the person is true in their relationship with one another.

The Book of Common Prayer reminds us that this is an Easter liturgy.  In the midst of our sadness and sense of loss, the liturgy powerfully proclaims Christ’s victory over death.  From beginning to end, with the lessons, the music, the anthems, and the prayers, we hear the Church’s faith proclaimed that life does not end at the grave but goes on in a far more magnificent manner than we can possibly imagine or comprehend. 

 

Marilyn knew what it meant to be a representation of Christ to the world around her. Marilyn’s faith was an important part of her life; I remember her reflecting on whether she had made a difference in the world. Her background, growing up in the Salvation Army, was very much part of who she was.

She touched so many lives; she has been a witness to Christ in the world through her actions and her love.

 

 In the gospels we have the words of Jesus that we all yearn to hear for ourselves and those we love, “Well done, good and faithful servant.”  Marilyn: well done, good and faithful servant.  Well done, indeed.  She was a role model for us all.

 

The people we meet on our journey through life become a part of us. The two things that influence our lives more than anything else are the books we read and the people we meet.

In times of grief, the presence of family and friends mean so much. They bring support and sympathy – and that can be a wonderful source of strength.

Because we all belong to the great fellowship of Jesus Christ, we are able to encourage and strengthen one another. Each of you here has a story. I hope that during the time downstairs – you will share these stories with Marilyn’s family.

Grief is a journey, and today is just the beginning of that journey.

This gentle and wise quote from the Northumbria Community speaks so to my heart, and I hope it will to yours as well: “Do not hurry as you walk with grief; it does not help the journey. Walk slowly, pausing often: do not hurry as you walk with grief. Be not disturbed by memories that come unbidden. Swiftly forgive; and let Christ speak for you unspoken words. Unfinished conversation will be resolved in him. Be not disturbed. Be gentle with the one who walks with grief. If it is you, be gentle with yourself. Swiftly forgive; walk slowly, pausing often. Take time; be gentle as you walk with grief.”

For all of us – staff, volunteers, and patients there will be a huge hole in our life here at St. Peter’s Free Clinic, and we share in your grief.

A Prayer of Thanksgiving for National Nurses Week - May 6-12

When I falter, give me courage. 

     When I tire, renew my strength. 

          When I weaken because I'm human, 

               Inspire me on to greater length. 

If doctors and patients become demanding, 

     And days are too short for all my duty, 

          Help me remember I chose to serve, 

               To do so with grace, and spiritual beauty. 

In humility, Lord, I labor long hours, 

      And though I sometimes may fret; 

          My mission is mercy.
               Abide with me, that I may never forget.  

                                                                             ~ Author Unknown 

We pray in thanksgiving for all doctors, nurses, and healthcare staff. The clinic could not exist without each and every one of you.

Thank you to NEHM - I stole this prayer from their email today!

Is the Clinic Still Needed?

St. Peter’s Free Clinic opened 11 ½ years ago with a mission to provide healthcare services to the low-income, uninsured residents of Hillsdale County. During this time, we have provided nearly 29,000 visits to 4,385 individuals and dispensed medications with a retail value of $9.8 million.

So, now the question is: do we still need the clinic?

The easy answer is yes; but it is much more complicated than that.

We serve a very vulnerable population, and we have no desire or plan to go away anytime soon. When I spoke with JJ Hodshire from Hillsdale Community Health Center, he said, “We continue to support St. Peter’s Free Clinic and see the clinic as an important part of the healthcare safety net in the foreseeable future.”

What he meant by that is that the clinic is part of the healthcare safety net system, made up of public and private institutions that deliver care in a variety of settings to individuals who are otherwise unable to afford or access care. Healthcare safety net providers, such as St. Peter’s Free Clinic, serve a diverse population including the working poor, the homeless, the undocumented and the uninsured, and in some cases, those with Medicaid. This group is included because of the difficulty in obtaining care – many providers choose not to provide care to those with Medicaid. In the past, the clinic has only provided care to those with Medicaid if they had a spend-down that made access to care impossible. We will evaluate the future of providing care to those with Medicaid as the situation plays out… can they access care? Can they afford care? Can they afford medications?

There are some who will remain uninsured either because of eligibility restrictions, insufficient subsidies that cause premiums to be unaffordable, or other barriers.

Some who “fall through the cracks” of healthcare reform include: the patient I have worked with to access healthcare through the Marketplace – with the subsidies, her insurance was going to be around $42/month. But, before her first premium was paid, the brakes went out on her car, and she had to have that fixed, in order to keep her job. She was living paycheck to paycheck – or more likely, paycheck to Thursday. And, she couldn’t pay the healthcare premium. She called the insurance company, but her policy was cancelled. Then, her hours were cut – from 40 per week to 25 per week. She now has no money to pay for healthcare, she isn’t eligible for additional subsidies because of the cancellation for non-payment of her premium, and she doesn’t qualify for Medicaid, even with her reduced hours.

Prior to the implementation of the Affordable Care Act, there were 41 million uninsured individuals in the United States; free clinics across the nation provided care to approximately 1.5 million of the uninsured. The Congressional Budget Office (CBO) predicts there will still be an estimated 29 million people in the United States without health insurance by 2019. So, even with the decrease in the number of uninsured, the need for free clinics will still exist.

The experience of free clinics in Vermont, Wisconsin, and Massachusetts – states where most of the uninsured received coverage due to federal waivers to expand Medicaid prior to implementation of the Affordable Care Act – show us the following:

v None of the free clinics closed; in fact, volume continued to grow.

v Free clinics helped enroll and navigate patients through the changes.

v Primary Care Provider (PCP) shortages, especially of PCPs who will accept Medicaid, resulted in free clinics providing care to Medicaid patients but not billing.

v Dental Care and Prescription Assistance remain huge gaps in service.

 

Today, the clinic continues to serve as many people as ever. For the first quarter of this year, we have seen an average of 57 patients per week with 73 new patients so far this year. We have dispensed medications with a retail value of $390,000.

Connie and I took the training in November to become Certified Application Counselors, and assisted individuals in applying for healthcare coverage through the Marketplace. We are continuing to assist with enrollment in the Healthy Michigan Plan, which is the Michigan version of Medicaid expansion – a program that provides healthcare to low-income working families. We have assisted over 60 individuals and families with applying for and enrolling in healthcare.

Obviously, the future of the clinic depends greatly on the availability of ongoing and sustainable funding. While the perception may be that the problem is fixed, it will not be an instant fix. It will take us months, probably years, to get everyone enrolled, and there will always be those who fall through the cracks. The support of our community is more important than ever.

Moving forward, the clinic will continue to provide healthcare, medications and other services to those who remain uninsured, as well as screening, enrolling in the appropriate healthcare product, and assisting with the transition to a primary care provider.

Enrollment in insurance through healthcare.gov is closed for now; the next open enrollment will begin November 15, 2014. The Healthy Michigan Plan enrollment is open all year round, so we will continuously be identifying those eligible for that program and assisting them as needed with enrollment.

The clinic is also looking at other services that are needed – we are offering a smoking cessation group; education on becoming a healthcare consumer; and we continue to assist individuals with finding the resources they need for a variety of issues including dental care and mental healthcare.

Moving forward, the board is constantly asking and discussing the future of the clinic, with questions such as:

—  What is the impact of the Affordable Care Act on our clinic?

—  How many of our patients will receive insurance coverage under the Affordable Care Act?

—  Where will they find care?

—  Who will remain uninsured in our community?

—  Will our clinic be needed post-2019?  Who will we serve?

—  What do we need to do to prepare for changes brought on by the Affordable Care Act?

—  What options are open to us for the future?

 

We are really excited as we help people access healthcare insurance; it has been a frustrating, crazy, but exciting, time. And, we look forward to continuing to provide healthcare to the low-income, uninsured residents of Hillsdale County – for as long as we are needed.