Hospital models a community's capacity to care for vulnerable citizens
By JUDITH VANDEWATER
PENSACOLA, Fla. — Shortly after Stacey Hockaday Stokes began work as a part-time housekeeper at Sacred Heart Hospital of Pensacola, state tax collectors seized and shuttered the extended stay motel where she and her husband Lionel lived. The hotel management kept the two weeks' advance rent they'd paid, and that was enough to hurl the middle-aged couple into temporary homelessness.
The Stokes were looking for a place to start fresh when they moved in 2007 from New Jersey to Escambia County on the Florida Panhandle. There is much to like here, to be sure. The glistening beauty of the Gulf of Mexico on a cloudless day and miles of white sand beaches lure vacationers and retirees. In addition to the tourism industry, a nearby military base, and fishing are important to the local economy. So, too, is Sacred Heart — the hospital is one of the largest employers in Escambia County.
As a Catholic hospital, Sacred Heart has a special preference for the poor and vulnerable that extends to patients and employees alike. That commitment was a godsend to Stokes. When she was in crisis, several hospital managers took up her cause. Patient and staff advocate Ann Erickson arranged for Stokes and her husband to move off the street and into temporary quarters and arranged for complimentary meals in the hospital cafeteria. Erickson taxied the couple around in her pickup for days to check out rental housing. They found a trailer, and Erickson drew on the hospital's employee emergency loan fund to front the security deposit and first month's rent, and to get the utilities turned on. Erickson recommended Lionel Stokes to several colleagues looking for a lawn man while he continued to search for permanent employment.
Not long after the couple settled into the trailer, Erickson and David Powell started a campaign to steer Stacey Stokes toward the hospital's nurses' aide training program.
Crisis and opportunity
Powell, executive director of organizational effectiveness at Sacred Heart Health System, believes in the transformative power of well-timed kindnesses and opportunities. They can lift a person from despair, change the course of a life and even alter the economic future of a family. So delicately, but determinedly, he encourages coworkers and community members to take advantage of training opportunities that will improve their self-esteem and earning power. He scouts the hospital's service staff, and seeks other potential candidates for the hospital-funded CNA training program from workforce and social service agencies and from the population at women's shelters. The hospital's program includes job placement assistance for participants who pass the state certification exam. Some graduates have gone on to become licensed practical nurses or registered nurses.
Powell and Erickson gave Stokes the encouragement she needed to push through her performance anxiety and the fatigue that came from going to class and studying while holding down a night shift housekeeping job. Stokes persevered.
Along with Stokes' CNA certification, she got a full-time CNA job at the hospital that came with a pay increase and benefits. Four years past her brush with homelessness, Stokes has stable, full-time employment as a patient care technician at Sacred Heart and her husband has a permanent slot on a landscaping crew. But Powell isn't done; he's encouraging Stokes to pursue an RN credential.
"Sacred Heart saved us," said Stokes. "I feel I have a sense of purpose, that I belong here."
Building community
Poverty is deeply rooted in Pensacola. It's invasive and intractable. The U.S. Census Bureau determined that 19.3 percent of Escambia County residents lived below the federal poverty line in 2010. And, according to local antipoverty activist and civic leader Jean Norman, that was up from 15.3 percent in 2007. One out of six children qualified for free or reduced price lunches on the basis of family income in the last school year.
As the region's economy weakened in recent years — it was particularly hard hit by the national housing market bust of 2008, and the Deep Water Horizon oil spill of 2010 — Sacred Heart joined with Norman, and representatives of 80 churches, schools, businesses and economic and social service agencies in Prosper Pensacola, an antipoverty coalition.
The coalition's goal is to cut poverty in Escambia County in half by 2020. The task is daunting, but coalition members stay motivated by focusing on their wins. A big recent win came in the form of an $8.5 million Health Profession Opportunity Grant through the Patient Protection and Affordable Care Act. Pensacola State College is using the money to keep low-income students, particularly single parents and young adults who have aged out of the foster care program, in school pursuing training in health careers.
When the health professionals grant director made a presentation at Sacred Heart earlier this year, more than 30 people applied to go to college.
For the most part, though, Prosper Pensacola leaders say they measure success one person, one family, one advancement opportunity at a time. And they concentrate on three elements necessary to escape poverty: education, relationships and employment. (See below.)
Rubber hits the road
Prosper Pensacola activists consider Sacred Heart to be a best-case example of how a business can systematically improve the economic prospects of entry-level employees. Like all hospitals in the Ascension Health network, Sacred Heart pays a "socially just wage" that puts employees above the poverty line based on the cost of living in each market. Florida's minimum wage is $7.67 per hour; Sacred Heart's minimum living wage is $8.40.
For those unskilled workers who are new to the traditional workforce, Sacred Heart offers education in "soft skills" like punctuality, dependability and personableness. Erickson and Powell are part of a group of antipoverty activists at Sacred Heart who understand and respond to the practical struggles and barriers to success for hourly workers at the low end of Sacred Heart's pay scale, barriers which may include self-limiting thinking.
To demonstrate how changing a mind-set can break the cycle of generational poverty, Powell tells a story about his efforts to recruit to the CNA program a young man who worked in one of the hospital's service departments alongside his mother, grandmother, aunt and cousin. He encouraged the young man to get a high school equivalency degree, a prerequisite to taking the CNA course or pursuing any other educational opportunity, but the worker wasn't biting. It dawned on Powell that the man's grandmother, who headed the family, discouraged such ambition. When Powell spoke with her, she asked him, "'What's wrong with working in this department? I've been doing it for 40 years!"'
It took a while to break through, but the young man is now enrolled in adult basic education classes offered by Pensacola State College.
Success builds on success, that's why small achievements matter in the battle against poverty. A CNA license can be a stair step out of poverty for an entire family. "If we can reach one person, maybe I can reach the others in a family," Powell said. "If we can move one family out of generational poverty at a time, we've done our job."
Attaboy
Almost 95 percent of the service staff at Sacred Heart started as part-time employees, according to Mark Culp, Sacred Heart's director of hospitality services. He actively looks for ways to develop and advance service employees. Culp reminds them patients will remember having been treated with respect and kindness by the person parking their car, handling their food tray or wheeling them to the lobby following discharge. "You are the first and last point of contact with the patient," he tells them.
"It's important to build self-esteem," Culp said. He writes thank-you notes for jobs well done. "I personally want to keep employees, especially the good ones," Culp said.
When an employee's level of service falls short of expectations, he or she is held accountable and coached. But Culp is sensitive to the trials of low-wage employees, and he encourages workers to talk to him about problems at work and home. Some problems are easily solved. For instance, when an employee confided he was feeling ill because he couldn't afford to refill a blood pressure prescription till the following week, Culp walked the man over to the pharmacy to get the drugs to bridge the gap.
Relationship building
Lee Turner, Sacred Heart Health System's director of mission integration, said the hospital receives over 20,000 applications each year and hires roughly 900 people from that pool. During new employee orientation, he acknowledges that many of those fortunate enough to have made the cut may have accepted jobs that fall short of their immediate aspirations. He assures them, "You can move forward here. We are with you and cheering you on."
A big part of Turner's message to the new employees is to treat all people with respect. Solidarity with the poor and vulnerable is a sacred obligation and central to the hospital's Catholic identity, he said.
"We think we are all individuals and autonomous, but we are all deeply connected," said Turner. "We're connected through relationships, and I think all of our work is really about helping people be made whole and strengthening those relationships.
"At the heart of this is what we are called to do — take care of your neighbor, take care of each other, and be the best you can be now, is what Christ asks us to do," he said.
Marcia Nowlin, who represents the Escambia County School District on Prosper Pensacola, said Sacred Heart and the coalition are making a difference in the community. Nowlin directs the school district's Title 1 program and related services intended to improve the academic performance of disadvantaged children.
"My dream is that every organization within the community, every business, every church will do exactly what this hospital has done," she said. Businesses that give low-wage workers training and a career path build the "capacity of the community to love and care for our citizens." They build the capacity of employees to dream of a better future and move towards it, she said.
Employees apply social justice in a personal way
Sacred Heart employees rally to help teen mother
Early this spring, Carol Schmidt sat down next to a teenager who was openly sobbing into a cell phone. One of the teen's three-month-old twins was in a pumpkin seat on the floor, her 15-month old toddler balanced on her knee.
The teen had come to the lobby of Sacred Heart Children's Hospital in Pensacola, Fla., intent on leaving her children. She could not care for them, and she had nowhere else to turn. Schmidt was chief operating officer of Sacred Heart Hospital of Pensacola at the time. She has since been promoted to vice president of mergers and acquisitions integration for Sacred Heart's parent, Ascension Health of St. Louis.
"We pulled together right away," Schmidt said of the staff at Sacred Heart. "We called the pediatric social worker from the children's hospital. We got a couple of nurses down. We fed the mom. Everybody got clean diapers and formula." Social workers connected the mother to a community social service agency that assists parents in crisis, and hospital employees helped find her an apartment on a bus line so she could get to her job at a fast food restaurant. Someone paid her rent. Other employees bought her debit cards at Wal-Mart.
"Our associates opened their hearts and their wallets to her," Schmidt said. The mother returned to the hospital several weeks later to touch base with the people who had thrown her a lifeline and helped her keep her family together through a crisis.
"You can make a difference one life at a time or many lives at a time," Schmidt said. "I can't get her out of my mind. It tells me how important this health ministry is to the community."
Programs teach people to move past class-based frames of reference
According to author and educator Ruby Payne, education, relationships and employment are the keys to escaping generational poverty.
Prosper Pensacola and its members follow the steps for community engagement in combatting entrenched poverty that Payne set out in her books Bridges Out of Poverty: Strategies for Professionals and Communities and A Framework for Understanding Poverty.
A number of Prosper Pensacola leaders including four managers at Sacred Heart Hospital have been certified as Bridges Out of Poverty trainers. The training teaches professionals to better understand how to help others move past class-based perceptions about work and success that can trap people in generational poverty.
Payne's work identifies the different ways that poor people and the middle class relate to the world and problem solve in their daily lives. Payne maintains that in order to succeed in school and at work, one must understand and perform in accord with unspoken middle class norms and values. Those values and behaviors — things like knowing how and when to speak formally, or the benefits of saving or otherwise delaying gratification in pursuit of future goals — are generally learned by middle class children through observation and informal instruction, but the rules also can be formally taught to children and adults.
As part of Prosper Pensacola, Catholic Charities of Northwest Florida leads a mentoring program that pairs community volunteers with people who are determined to lift themselves and their families out of poverty. Called Bridges to Circles, the program marries Payne's work with that of author and entrepreneur Scott Miller. Miller's "Circles" model enlists middle class volunteers to improve the general knowledge base, the financial literacy and the money management skills of people living in poverty.
Catholic Charities also is adding to its tool chest a job program that will create a pool of employers who hire entry-level workers and help people succeed in the workplace once they land a job.
Bridges to Circles includes a 15-week classroom course where people examine the impact of poverty on their lives, and how decisions they make can break the cycle of poverty. "Most people focus on how to increase their income, whether that is getting a second job or becoming an entrepreneur," Bridges to Circles Community Organizer Haley Richards said. Participants learn what employers and educators expect by way of performance, and they are encouraged to conquer self-doubt and set goals.
Payne's program has been used in the Escambia County schools for decades as a catalyst for making the schools welcoming places for low-income parents and encouraging parents to be actively involved in their children's preschool, primary and secondary education.
Payne has called postsecondary education a ticket out of poverty, but paradoxically, poverty in itself is a significant obstacle for college-capable students.
Financially challenged students who do pursue career training can be derailed by an empty gas tank, unpaid utility bills or undependable child care. Prosper Pensacola member Pensacola State College is using an $8.5 million Health Profession Opportunity Grant to help students weather those crises. Grant director Keith Samuels said the grant pays for noneducational emergency expenses and supports the salaries of case managers employed by Catholic Charities of Northwest Florida. Catholic Charities and the college are building the infrastructure now. Case managers in this program likely will nurture students, direct them to community resources and teach them skills to cope with 'tyranny of the moment' obstacles including family dysfunction.
Samuels said by working collaboratively, social service groups, educators and employers in Pensacola are leveraging their assets and energy. "It's hard to explain, but this community has a synergy that is missing in other places," he said.