Ladder to Leadership Team Creates New Path for End-of Life Care

    • June 15, 2009

Each year, Ladder to Leadership fellows gather to cultivate innovative professional skills and tackle health care dilemmas that challenge physicians, nurses and administrators in their communities. In recognition of the fact that millions of Americans and their caregivers struggle to find resources and support at the end of life, members of the 2009 Ladder class with extensive experience in elder care, came together to find a solution to this long-standing health care dilemma. 

“In my work, I’ve learned that we live in a death-denying culture,” says Andrea Prudhom, R.N., director of nursing at the Cayuga County Nursing home in Central New York. In her 20 years in health care, Prudom, a Ladder fellow, has repeatedly seen that caregivers, patients and many health care professionals simply do not have the skills needed to genuinely help people negotiate the many complex issues that arise in the last year or so of life. 

“Many of us were familiar with the issue so when we broke into our five Ladder project teams,” says Prudhom, who is also a hospice nurse, “our group decided to create a program that would train health care professionals to be end-of-life doulas. The doula [an inventive use of the word currently used to describe a woman who gives care at the beginning of life] would work with patients and families to help them prepare financially, spiritually and emotionally so that their loved ones could progress to the end of life with more peace and more dignity,” Prudhom said. “We also hoped to alleviate much of the stress experienced by health care professionals in these situations.”

“We looked at the current gaps between a potentially terminal diagnosis and hospice care,“ says Tamara Wheeler, R.N., a Ladder fellow and nurse administrator at the Masonic Care Community in Utica, N.Y., about 100 miles from Cayuga, “and began to work on a model that would offer support beginning 18 months before the end of life. We decided that was a realistic time frame for people with certain chronic diseases.”

Giving Care Providers New Options

Nearly 1.4 million patients used hospice services in 2007, according to the National Hospice and Palliative Care Organization, but Wheeler and Prudhom are among the many health care administrators who see that hospice, which is only available in the last six months of life, does not even begin to address the needs of the many people involved in the care-giving process. “In addition to the issues families face, I’ve learned that my staff needs guidance here also,” Wheeler said. “We wanted to help people build on their skills set.” For this reason, the group is writing an end-of-life doula curriculum that will be the basis of a certificate program that will allow health care professionals to take a leadership role when working with families and patients. Certified nurse assistants, nurses, even physicians and social workers would all be possible candidates for end-of-life doula certification. 

The Ladder group hopes to initially put their unique concept into practice in Onondaga County, N. Y., and then offer it as a model to other communities. The end-of-life doula program is an example of the leadership concepts explored and refined in Ladder to Leadership training. The program encourages collaborative, cross-agency projects that teach fellows how to increase efficiency and apply their ideas to real work issues. 

A partnership between the Robert Wood Johnson Foundation (RWJF) and the Center for Creative Leadership (CCL) aims to identify the nonprofit leaders of tomorrow and to equip them for the challenges ahead. RWJF awarded a $4 million grant to CCL to design Ladder to Leadership: Developing the Next Generation of Community Health Leaders, a national fellowship program that, over four years and in nine U.S. communities, will develop nearly 300 emerging leaders in health-related nonprofits.

A kickoff event last September in Syracuse welcomed the first Ladder to Leadership cohort of 29 fellows from central New York State. All program participants work in groups on different projects that address actual health-system challenges in their own communities. The fellows praise RWJF’s funding of this high-level training for community health organizations, which often lack the resources to produce a core group of new, skilled leaders to replace those retiring.

“Health care is always operating in a crisis mode,” explains Diane Blasczienski, a member of the Central New York cohort. She is coordinator of patient services in the health care division of Oswego County Opportunities (OCO), a community action agency in Oswego County, N.Y. “People within OCO tend to stay for years—then when there’s a sudden turnover, you can’t replace the positions fast enough, “ she says. “This is a common trend in the world of health care, in particular with leadership positions, as nurses are very rarely taught skills other than clinical skills. I hope this funding comes back around for another four years, because this is one of those unique programs that a lot of upcoming young leaders could benefit from.”

Blasczienski has sat through several leadership-training programs. But “none of them compares to what’s being done by Ladder to Leadership,” she says. “Here, you have 16 months of constant participation, so it becomes one of those life-sustaining learning experiences.”

The second Ladder to Leadership cohort is underway in Cleveland, Ohio. Others will follow in Albuquerque, N.M.; Birmingham, Ala.; the Mid-South Delta region of Arkansas, Mississippi and Tennessee; New Jersey; a rural area in eastern North Carolina; Portland, Ore.; and Starr County, Texas. The program was featured in the January 31, 2009, Ithaca Journal and the February 9, 2009 New Mexico Business Weekly.