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					                                                          HEBREW SENIORLIFE REPORT ON TEACHING



                                                          INNOVATIONS
                                                          Teaching Tomorrow’s Geriatric Care Today

           Hebrew Rehabilitation Center
           Short-Term, Post-Acute Care
           Medical Acute Care
           Long-Term Care
           Adult Day Health Program
           Outpatient Specialty Services


           Home Health Care Continuum


           Institute for Aging Research


           Center Communities of Brookline
           Senior Housing


           Simon C. Fireman Community, Randolph
           Senior Housing


           Jack Satter House, Revere
           Senior Housing


           Orchard Cove, Canton
           Continuing Care Retirement Community
           Short-Term, Post-Acute Care
           Long-Term Care


           NewBridge on the Charles, Dedham
           A multigenerational community on the
           Dr. Miriam and Sheldon G. Adelson Campus




1200 Centre Street • Boston • MA 02131 • (617) 363-8000
www.hebrewseniorlife.org
INNOVATIONS
HEBREW SENIORLIFE REPORT ON TEACHING




Teaching Tomorrow’s Geriatric Care Today




Contents
3    2007

Physician Training

4    Focus on the Care of Older Adults

6    Geriatrics Comes of Age at Harvard Medical School

7    HMS Patient-Doctor II Course
     Integrating Geriatrics into Medical Training

8    Harvard Medical School Multi-Campus
     Fellowship in Geriatric Medicine
     Developing Best Practices for Geriatric Care

Profile

9    Daniele Ölveczky, M.D., M.S.

Nurse Training

     External Programs
10   Sharing Our Wisdom

     Internal Programs
     Teaching Our Own
12   The Career Development Program

13   The Safe Patient Handling Program

14   The Dementia Care Program

17   Clinical Pastoral Education
     Caring for the Whole Person

18   The Palliative Care Program
     Teaching Care Beyond Cure

20   Final Thoughts

Inside Back Cover   Teaching Activities & Programs Donor List
                                                                                                                                                 HEBREW SENIORLIFE 2007 REPORT ON TEACHING




                                                                                                       200
                                                                                                         Hebrew SeniorLife is built on four pillars of health
                                                                                                         care, teaching, housing and research. Our mission
                                                                                                         driven initiatives to educate the health-care work force of today and
                                                                                                         tomorrow are more relevant than ever. By 2030 the population of
                                                                                                         people over 75 will increase from 19 million to 33.5 million as the baby
                                                                                                         boomers cross the threshold from middle age to senior citizen and
                                                                                                         the current ratio of one geriatrician for every 2,546 older Americans
                                                                                                         is predicted to become one per 4,254. The shortage of the nation’s
                                                                                                         nurses is projected to grow to more than one million by the year 2020.
                                                                                                         Similar shortages are forecast for physical therapists, occupational
                                                                                                         therapists, speech-language pathologists, social workers, chaplains,
                                                                                                         psychologists, and dentists to care for senior patients, especially in
                                                                                                         long-term care facilities and home care.

                                                                                                            When Harvard Medical School students come          certified by the Alzheimer’s Association, and
                                                                                                         to Hebrew SeniorLife’s flagship health facility        every SCU staff member received intensive
                                                                                                         Hebrew Rehabilitation Center (HRC) for their          training in caring for people with dementia.
                                                                                                         first experience conducting physical exams on          The HSL Chaplaincy Institute began offering
                                                                                                         patients, they often expect to find a homogenous       the only accredited Jewish geriatric chaplaincy
                                                                                                         group of older people with age-related medical        training program in the U.S. The Palliative Care
                                                                                                         problems. By the time they complete their             Program began a formal program of educating
                                                                                                         rotation, the HRC patients and residents and          staff across disciplines to prevent and relieve
                                                                                                         physicians have taught them that seniors have a       suffering along the continuum of illness.
                                                                                                         wide range of health issues, functional abilities,       When health-care professionals begin their
                                                                                                         spiritual concerns, cognitive abilities, and life     training, they make career decisions based




                                                                                                                                                                                                                   H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G
                                                                                                         perspectives. Students leave HRC enriched by          on experiences with faculty role models, the
                                                                                                         their clinical and personal contact with residents,   satisfaction level of the professionals they work
                                                                                                         patients and staff, and with exposure to the           with, and the opportunity a specialty offers
The framework behind every HSL program is composed of dedicated, expert teachers.                        principles and practices of geriatric medicine.       for integrating science and humanity into
In 2007, the Department of Professional Development conducted 366 educational programs                      The past year was marked by outstanding            cutting edge treatment. HSL trains more than
for 3,700 nurses, certified nursing assistants, and students. Physicians in the Department of             achievement and groundbreaking initiatives            600 students, interns, residents and fellows in
Medicine and the Institute for Aging Research (IFAR) contributed over 3,000 hours of teaching            at Hebrew SeniorLife (HSL). HSL became a              multiple geriatric disciplines to prepare them
during encounters with more than 2,000 students at all levels of medical education. Allied health        formal academic affiliate of Harvard Medical            to be the clinicians, leaders, researchers and
and rehabilitation staff hosted students and collaborated on numerous interdisciplinary initiatives.     School. A Specialized Care Unit (SCU) was             policy-makers of tomorrow.æ
                                                                                                                                                                                                                         3
                                                                   DEPARTMENT OF MEDICINE




                                                                                                                                                                                  “    The most important role the HSL Department of Medicine can
                                                                                                                                                                                       take locally, in Massachusetts, and nationally is to develop
                                                                                                                                                                                       the next generation of leaders in geriatric medicine, nursing
                                                                                                                                                                                       and allied health professions. The goal of the comprehensive
                                                                                                                                                                                       geriatric training programs based at HRC is to leverage the
                                                                                                                                                                                       teaching sources we have available in an efficient way to




                                                                                                                                                                                                                                                                  ”
                                                                                                                                                                                       improve clinical care of elderly people and affect changes in

                                                                 Focus on the Care                                                                                                     public policy and health-care economics.

                                                                 of Older Adults                                                                                                                                                    - Robert Schreiber, M.D., physician-in-chief, HSL




                                                                    The Hebrew SeniorLife Department of              Many of the 35 consultants on staff also hold
                                                                 Medicine is dedicated to educating present and      HMS faculty appointments.
                                                                 future clinicians and researchers to strengthen         Faculty based at Hebrew Rehabilitation Center
                                                                 the knowledge base in geriatrics, devise more       teach future physicians across the spectrum of
                                                                 effective systems of care, research medical and      medical education, beginning with Harvard
                                                                 psychosocial aspects of aging, and significantly     Medical students in the Patient-Doctor II course and
                                                                 increase the skilled work force of professionals    continuing with medical interns and residents from
                                                                 ready to care for the burgeoning numbers of         Beth Israel Deaconess Medical Center (BIDMC)
                                                                 older adults. Medical Department members            and Brigham and Women’s Hospital (BWH)
                                                                 are also on the front lines advocating for policy   and dental students and advanced trainees from
                                                                 changes and dramatically increased federal          Harvard School of Dental Medicine and Boston
H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G




                                                                 funding for all levels of medical education, and    University Goldman School of Dental Medicine.
                                                                 reimbursement for the time physicians spend in      Hebrew Rehabilitation Center is also a principal
                                                                 critical teaching responsibilities.                 training site for the Harvard Medical School Multi-
                                                                    As one of the few academic departments based     Campus Fellowship in Geriatric Medicine.
                                                                 in a post-acute and long-term care institution,         Each year, Department of Medicine and
                                                                 the Department of Medicine is comprised of          the Institute for Aging Research (IFAR) staff
                                                                 20 geriatricians and internists, one dentist, and   contribute a total of more than 3,000 hours of
                                                                 two psychiatrists, most of whom hold faculty        professional teaching to over 2,000 students at all
                                                                 appointments at Harvard Medical School (HMS).       levels of medical education.æ
                                                                                                                                                                            Lewis A. Lipsitz, M.D., vice president of academic medicine,            Robert J. Schreiber, M.D.,
4
                                                                                                                                                                            Irving and Edyth S. Usen and Family Chair in Medical Research           physician-in-chief
                                                                    PHYSICIAN TRAINING




                                                                 Geriatrics
                                                                 Comes of Age
                                                                                                                   ����������������������


                                                                    This year, in a major milestone for geriatric           Lewis Lipsitz, M.D., HSL vice president
                                                                 medicine, a formal, direct academic affiliation           for academic medicine, says that geriatrics is                                                                                               Hebrew SeniorLife geriatrician
                                                                                                                                                                                                                                                                      Zaldy Tan, M.D., instructs Harvard
                                                                 was established between Harvard Medical                 an increasingly important medical specialty,                                                                                                 Medical students in a course
                                                                 School and Hebrew SeniorLife. The affiliation             but has been underrepresented in medical                                                                                                     called “Patient-Doctor II.”

                                                                 recognizes the contributions HSL has made               education and practice. Hebrew SeniorLife
                                                                 to the clinical and research missions of Beth           has been at the forefront of geriatric physician
                                                                 Israel Deaconess Medical Center (BIDMC)                 education for decades, including essential
                                                                 and Harvard Medical School during more than             training of HMS students, geriatric internists
                                                                 40 years of collaboration.                              and specialists, and researchers.


                                                                 There are many reasons why the affiliation benefits HMS and HSL, and will lead to                                       HMS Patient-Doctor II Course
                                                                 expanded partnerships among the HMS affiliated hospitals and research centers:

                                                                    Since 1979, HSL has partnered with BIDMC to
                                                                    found, develop and manage HMS’s academic
                                                                                                                             IFAR has collaborations with investigators at
                                                                                                                             HMS, as well as with researchers in academic
                                                                                                                                                                                  Integrating Geriatrics
                                                                                                                                                                                  into Medical Training
                                                                    program in aging. Many patients from HRC who             centers around the world. IFAR ranks in the top
                                                                    need acute care are admitted to BIDMC, where             10 percent of all institutions that receive grants
                                                                    their care is supervised by HSL and BIDMC                from the National Institutes of Health (NIH).
                                                                    geriatricians and Harvard geriatric fellows.             IFAR’s research programs have a direct impact
                                                                                                                             on geriatric health care, and form the basis for
                                                                    The Institute for Aging Research is the primary          many public policy and public health initiatives.
                                                                    grantee for the Harvard Research Nursing Home
                                                                    Program and HRC is the principal research and            Faculty members in the HSL Department
                                                                    teaching site for Harvard’s Hartford Foundation          of Medicine teach several HMS geriatric,                For eight years, Hebrew Rehabilitation Center      on the post-acute units and long-term care
                                                                    Center of Excellence in Geriatric Medicine.              science and medicine courses, and provide
                                                                    In addition, HSL serves as the home for the NIH-         extensive didactic and clinical training to
                                                                                                                                                                                  has been one of the major academic centers for        residents are eager to participate, and sensitize the
                                                                    funded Harvard Cooperative Program on Aging              HMS medical students in the Patient-Doctor           second-year Harvard Medical School students           students to the issues older people deal with on
                                                                    subject registry and as the education core for           II course. The HSL faculty and clinical setting      in the Patient-Doctor II course. The eight to         a daily basis. HRC patients are among the most
                                                                    Harvard’s Alzheimer’s Disease Research Center.           consistently receive high ratings from HMS
                                                                                                                                                                                  12 students assigned to HRC spend a full year         challenging and frail the students will encounter,
H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G




                                                                                                                                                                                                                                                                                                           H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G
                                                                                                                             students. HSL faculty also teach internal
                                                                    HSL’s extensive system of integrated care                medicine residents from BIDMC and BWH                learning to take a medical history and perform a      so students begin to learn the principles and
                                                                    offers physician-trainees unique opportunities           during their clinical rotations at HSL.
                                                                    to learn aspects of care not available in other
                                                                                                                                                                                  medical examination. In addition, they learn to       practices of geriatric medicine.
                                                                    sites. Physicians on multidisciplinary teams learn       HSL has the largest concentration of senior          apply critical thinking skills essential to forming       Fourth-year students who return as tutors say
                                                                    about the continuum of care for chronic disease,         Harvard faculty members in the field of               a diagnosis. Zaldy S. Tan, M.D., M.P.H., director     their HRC experience prepared them well for
                                                                    functional assessment, palliative and end-of-life        geriatrics, including two professors, three
                                                                    care, geriatric psychiatry, family dynamics, and         associate professors, and two assistant
                                                                                                                                                                                  of the HMS Patient-Doctor II course, says the         specialty rotations as they progressed through
                                                                    innovative models of long-term care.                     professors of medicine.                              complexity of geriatric care gives the students the   HMS. Rebecca Brown, M.D., whose grandmother
                                                                                                                                                                                  opportunity to hone their diagnostic skills in a      is a resident at HRC, was one of the first HMS
                                                                 Hebrew SeniorLife’s affiliation with Harvard Medical School fosters the continued world-                          way they would not necessarily be able to with        students to train at HRC. In 2008, Dr. Brown will
                                                                 class education and training of tomorrow’s geriatric clinicians, educators and researchers.                      younger and more acute patients. Many patients        return as an HMS geriatric medicine fellow.æ
6                                                                                                                                                                                                                                                                                                                7
                                                                                                                                                                            PROFILE
                                                                    PHYSICIAN TRAINING                HMS MULTI-CAMPUS FELLOWSHIP IN GERIATRIC MEDICINE                                                                                   PHYSICIAN TRAINING   PROFILE




                                                                 Developing                                                                                                       Daniele Ölveczky, M.D., M.S.
                                                                 Best Practices for
                                                                 Geriatric Care                                                                                                   Dr. Daniele Ölveczky has known that she
                                                                                                                                                                                  wanted to specialize in geriatrics since
                                                                                                                                                                                  she was a third-year medical student at
                                                                 Since 1979, the Harvard Medical School Multi-         research and education programs around the                 the John Hopkins School of Medicine.
                                                                 Campus Fellowship in Geriatric Medicine has           world. This is the largest number of geriatric             Now a first-year Harvard geriatric fellow in
                                                                 attracted physicians who aspire to become             fellows trained by any single teaching institution         the clinician-researcher track, Dr. Ölveczky
                                                                 leaders in the field. The success of the program       in the U.S. All 10 of the current fellows rotate           describes the program as challenging,
                                                                 has been due in large part to the reputation of the   through HRC for at least three months to learn             supportive and full of resources to allow
                                                                 physicians in Hebrew SeniorLife’s Department          how to provide primary care for elderly people             fellows to pursue their interests.
                                                                 of Medicine who mentor the fellows. Hebrew            with multiple illnesses. As one of the main sites
                                                                 SeniorLife has contributed to the clinical and        for the HMS fellowship program, HRC provides               Growing up in Trinidad and Tobago, Dr. Ölveczky’s
                                                                 academic training of 164 geriatric medicine           administrative leadership, financial, didactic and          shared the family home with her grandparents.
                                                                 fellows and another 40 investigators who now          clinical education resources.                              “My grandparents were so alive in my life,” she
                                                                 hold leadership positions in geriatric clinical,                                                                 says, adding that the elderly in Trinidad are
                                                                                                                                                                                  revered for the contributions they have made
                                                                    Alan P. Abrams, M.D., M.P.H., program director, says that during the one-year                                 throughout their lives. “Elderly people are some
                                                                    program required for certification, all fellows develop expertise in clinical care, the                        of the most regal, graceful, insightful people
                                                                    structure and economics of the health-care delivery system, designing a research                              that I have ever met,” she says. Dr. Ölveczky
                                                                    project, and teaching geriatrics to interns and residents. Fellows can choose to                              thinks there is a critical need in American
                                                                    pursue a second year as clinician-educators or geriatric researchers. Researchers                             society to change how we think of getting
                                                                    often work with a mentor from HSL’s Institute for Aging Research on a project to                              older, how we see the benefits of aging, and
                                                                    advance understanding of a medical syndrome, care delivery issue, or basic science                            to change our health-care policies to deal with
                                                                    affecting the health of elders.                                                                               the reality of burgeoning numbers of elders.
                                                                                                                                                                                  “It is time for society to have a dialogue and
                                                                    Susan Mitchell, M.D., M.P.H., associate research director for the fellowship
                                                                                                                                                                                  really listen to what the demographics tell us,”
                                                                    program, HSL staff physician and a senior investigator in the Institute for Aging
                                                                                                                                                                                  she says. “We will have a lot of people over        “Our mandate is to take care of
H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G




                                                                    Research, says the fellows have a major impact on HRC because they are on call
                                                                                                                                                                                  65, and no one to care for them.”
                                                                    on nights and weekends to care for residents and patients. “No other long-term                                                                                    patients and their families,” says
                                                                    care institution in the country has such a high level of coverage and up-to-date                              The most challenging aspects of geriatrics -
                                                                    care 24 hours a day,” says Dr. Mitchell.                                                                                                                          Dr. Ölveczky. “Geriatrics, more than
                                                                                                                                                                                  taking care of complicated frail patients and
                                                                                                                                                                                  their families - can also be the most satisfying.   other fields of medicine, combines
                                                                                                                                                                                                                                      the medical/scientific domain
                                                                                                                                                                                                                                      with the human/social domain.”

8                                                                                                                                                                                                                                                                            9
                                                                     NURSE TRAINING                 EXTERNAL PROGRAMS




                                                                  Sharing Our Wisdom
                                                                  HRC has served as a clinical placement for more nursing assistants and nursing
                                                                  students than any other long-term care facility in New England, with almost 500
                                                                  students in 2007. The Hebrew SeniorLife Department of Professional Development
                                                                  identifies and responds to major issues in geriatric nursing practice by creating                                                                                        Patricia Bonner, B.S., R.N.,
                                                                                                                                                                                                                                          clinical nurse specialist
                                                                  meaningful educational programs and materials that enhance practice standards
                                                                  throughout the organization. The department fosters interdisciplinary teamwork and
                                                                  forms partnerships with many organizations to bring state-of-the-art knowledge and
                                                                  care to HSL residents and patients. Major initiatives for 2007 included the Affiliate
                                                                  Nursing Program, Safe Patient Handling, Palliative Care, Wound/Skin Care, Alzheimer’s
                                                                  Association Dementia Training, and the Career Development Program.

                                                                     In 2007, the Department of Professional                  Hebrew Rehabilitation Center education
                                                                  Development completed a project to improve              specialist Marylou Atkinson, R.N., B.S.N.,
                                                                  the efficiency and quality of its Affiliate Nursing         serves as a liaison with faculty from all of the
                                                                  Program while maximizing the resources of               affiliate nursing assistant and nursing programs.
                                                                  the Department of Nursing. This successful              “My role is to build partnerships with faculty,
                                                                  project involved streamlining and expediting the        and provide a positive learning environment for
                                                                  preparation and orientation of faculty and students     students so they want to continue in nursing,
                                                                  from certificate programs, community colleges,           and especially geriatrics,” she says. Two students
                                                                  and state and private universities to increase the      who completed rotations on the Medical Acute
                                                                  number of students receiving clinical experience        Care Unit (MACU) were recruited to return as
                                                                                                                                                                               Janene Devlin, R.N., B.S.N., education specialist,         Career Development Program students Therese Walsh, HSL clinical
                                                                  at HRC. This year HSL fulfilled a commitment             staff nurses, and many certified nursing assistants    and UMass Boston nursing students                          system analyst, and John McDonough, HSL senior staff accountant
                                                                  to increase the number of baccalaureate degree          return to care for residents and patients on every
                                                                  students from UMass Boston, Simmons College,            unit at HRC.




                                                                                                                                                                                      “
                                                                  Northeastern University, and Boston College. At             Many people are now making a career
                                                                  HRC students receive intensive instruction and          shift to nursing. An example is Dana Shear
                                                                  practice to prepare for careers across the continuum    whose first career was in health-care quality
                                                                                                                                                                                              The UMass students get a dynamic experience at HRC.
                                                                  of nursing, including direct patient care, education,   improvement. She completed a 13-week rotation
                                                                  research, leadership, and advanced practice.            on the MACU before taking the Massachusetts
                                                                                                                                                                                              The staff is very proactive in thinking about best care practices.
 H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G




                                                                     Associate degree students from Massachusetts         licensing examination to practice as an RN while
                                                                  Bay Community College, Roxbury Community                continuing nurse practitioner studies. According
                                                                  College, and Quincy College also receive                to Ms. Shear, “The staff was very receptive and
                                                                                                                                                                                              There is so much going on here-research, teaching, more
                                                                  geriatric experience during rotations at HRC.           responsive to students. In 13 weeks they moved




                                                                                                                                                                                                                                                                             ”
                                                                  Collaborations to generate interest in nursing while    us from student nurses responsible for bed baths
                                                                                                                                                                                              intensive care on the acute units. The staff is able to integrate
                                                                  students are still in high school continue, with        to entry-level nurses. The level of acuity on
                                                                  CNA students from Madison Park High School,             the MACU is that of an ICU stepdown unit.
                                                                                                                                                                                              the students, and acknowledge their contributions.
                                                                  Horizon Learning Center, and the American Red           You can’t get better training than that.”æ
                                                                  Cross learning essential skills at HRC.                                                                                      - Teresa Eliot Roberts, Ph.D., R.N., Instructor at Hebrew Rehabilitation Center
10
                                                                     NURSE TRAINING               INTERNAL PROGRAMS                                                                                      TRAINING ACROSS DISCIPLINES                      INTERNAL PROGRAMS




                                                                  Teaching Our Own                                                                                            The Safe Patient Handling Program

                                                                  The Career Development Program
                                                                                                                                                                                 The staff of Hebrew SeniorLife provides             with Heather Margulis, M.S.P.T., rehabilitation
                                                                                                                                                                              care for seniors across the spectrum of function      services manager, to develop mobility assessment
                                                                                                                                                                              from independent to fully dependent, and              tools, policies and procedures, and a mandatory
                                                                     The HSL Career Development Program                Massachusetts Bay Community College to                 many residents and patients need assistance or        training program for HSL staff. Inherent in the
                                                                  (CDP) began with the dream of HSL President          develop a continuum of courses. JVS offers classes      supervision with movement. In 2006, HSL began         training program is a major culture shift from staff
                                                                  and CEO Len Fishman and the vision of                in reading comprehension, math, writing and            a comprehensive, multi-step Safe Patient              trying to lift patients manually to always using
                                                                  a generous donor. The vision combined                English for Speakers of Other Languages (ESOL)         Handling (SPH) Program with the goal of               equipment and devices for lifts, and never lifting
                                                                  addressing the shortage of skilled geriatric         at HRC to enhance basic skills and prepare students    keeping patients, residents and staff safe during      a patient with fewer than two staff present. After
                                                                  nurses with the Jewish values of providing           who will continue on to Mass Bay Community             transfers, lifts, positioning and rehabilitation      direct care staff completed the HSL education
                                                                  ongoing opportunities for learning, and              College. Mass Bay provides the faculty and             therapy.                                              program, 48 “unit champions” received additional
                                                                  chesed, a Hebrew word that simply means              rigorous curriculum leading to eligibility for LPN        SPH aims to create a safe environment              training to become mentors and problem-solvers
                                                                  kindness. In this spirit, CDP strives to create      licensure. Admission to a nursing program is very      by minimizing or eliminating injuries. This is        on their units.
                                                                  positive caring connections between staff,            competitive in Massachusetts, and many schools         accomplished by the use of ergonomic principles           Physical Therapy staff use SPH to treat patients
                                                                  residents and families in an atmosphere of           have waiting lists. Because of the HSL/Mass            and equipment that eliminates manual lifting.         and teach them to progress to more independent
                                                                  respect and honor.                                   Bay partnership, however, CDP students have a          Barbara Denver, R.N., staff nurse at HRC, points       functioning. Margo O’Dea, a physical therapist
                                                                     The Career Development Program began              distinct advantage over other students in gaining      out that many HSL residents “age in place” on the     on the RSU, says that patients are often able
                                                                  in 2006 as a comprehensive educational               access to this type of program.                        units, and become more frail and at risk for falls.   to get out of bed sooner post-operatively, gain
                                                                  program to increase staff recruitment and                 The inaugural class of LPN students began          An additional goal of SPH is to help residents        confidence, and meet rehabilitation goals quicker
                                                                  retention, and provide a career ladder for           taking prerequisite courses in October 2006, went      and patients maintain their independence and          using the equipment. “HRC has the very latest
                                                                  certified nursing assistants to become LPNs.          on to nursing classes and clinical rotations at        functionality for as long as possible.                and safest equipment, so we are educating the
                                                                  Interest in the program was so widespread            HRC, and will graduate from Mass Bay in August            Safe patient handling is important because         staff about what is available,” says Ms. O’Dea. PTs
                                                                  and enthusiastic that the program expanded           2008. In addition to CNAs, the class includes          residents and patients can suffer falls, fractures,    arrange for patients to have the same equipment
                                                                  throughout HRC in 2007. Susan Natale, M.S.,          employees from HSL’s Medical Records, Fiscal           skin tears, loss of dignity, and other problems if    at home when possible.
                                                                  R.N., Career Development Program manager,            and Information Technology departments. The            not moved with an optimal technique. SPH is               HSL’s commitment to Safe Patient Handling
                                                                  says that CNAs face many obstacles to higher         second class began in September 2007.                  equally important to nursing and therapy staff.        extends far beyond the bedside and physical therapy
                                                                  education, including family and childcare                Another aspect of career development is            They can sustain musculoskeletal injuries that        gym. In addition to a policy for the Nursing and
                                                                  responsibilities, finances, inadequate academic       furthering the careers of licensed nursing staff.       cause pain and disability, which leads to time lost   Rehabilitation Departments, there is a corporate
                                                                  preparation, language, and transportation.           HSL received a Massachusetts Workforce                 from work and family activities, by using some        policy that affects every department across the
                                                                  The keys to the success of the program are           Training Grant that is funding three LPNs to           of the traditional methods that have now been         HSL organization, thereby extending protection
                                                                  recognizing the barriers to learning, and having     become RNs, and will cover tuition for HSL             proven to be ineffective at preventing injuries.       to everyone who moves people or equipment.
                                                                  the financial backing from donors that permits        students at Mass Bay, among other projects.            A national research study demonstrated that a             The most significant outcome in the first year
 H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G




                                                                  the development of responsive and innovative             Tammy Retalic, M.S., R.N., says the goal           typical nurse at the bedside, who cares for eight     has been the reduction in injuries to staff. HRC
                                                                  approaches to eliminating these barriers. Each       of the Career Development Program has gone             to 10 patients, can lift 2,000 to 3,000 pounds in     employee injury rates dropped from 105 reported
                                                                  applicant starts with an academic assessment and     beyond training LPNs to enhancing the ability of       an eight-hour shift.                                  incidents in 2006 to 57 in 2007, with the Medical
                                                                  identifies goals for him/herself. HSL pays for all    all staff to communicate with residents and with           The first step in implementing SPH was the          Acute Care Unit and one of the Specialized Care
                                                                  coursework and books and has invested in software    each other, to educate staff to provide the best care   replacement of all mechanical lifts with 43 state-    Units showing the most improvement.
                                                                  to build reading and math skills. In addition, HSL   for residents and patients, and to make people         of-the-art models. Lena Deter, M.P.H., R.N.,              “We are leading Massachusetts with our full-
                                                                  compensates students for much of the time spent      feel valued and respected as employees of HSL.         clinical nurse specialist in the Department of        fledged SPH Program,” says Ms. Deter. “What
                                                                  in classes, which are offered onsite.                 The vision that began with Len Fishman and the         Professional Development at HRC and a national        HSL has done in 10 months takes other hospitals
                                                                     HSL formed academic partnerships with             original philanthropists is bearing fruit every day    expert on SPH, was brought on board to design         two to three years to complete, and the program
                                                                  Jewish Vocational Services ( JVS) and                in the classrooms and patient care units of HRC.æ      and roll out the SPH program. Ms. Deter worked        is still advancing.”æ
12
                                                                     TRAINING ACROSS DISCIPLINES                         INTERNAL PROGRAMS                                                                                                                                                    INTERNAL PROGRAMS




                                                                  Teaching Our Own (continued)                                                                                                                 long-term care. When that time comes, family             responsive to the challenging behaviors associated
                                                                                                                                                                                                               members want to know their loved one will                with the disease,” says Martha Bruce, B.S.N., R.N.,
                                                                                                                                                                                                               receive the most expert medical and nursing              director of nursing for Behavioral Services.
                                                                                                                                                                                                               care available in a safe, comforting environment             Sandy Douglas, C.N.A., has provided dementia
                                                                                                                                                                                                               that respects the dignity and humanity of each           care at HRC for 14 years, and now shares the
                                                                                                                                                                                                               individual. Hebrew SeniorLife is answering               understanding and strategies she has mastered by
                                                                  The Dementia Care Program                                                                                                                    that need with the opening of an Alzheimer’s             speaking at training sessions. “Before the training
                                                                                                                                                                                                               Association-approved Specialized Care Unit               it was sometimes hard to know what to say to
                                                                                                                                                                                                               (SCU) to provide a continuum of care for those           some residents,” says Ms. Douglas. As a result of
                                                                                                                                                                                                               with Alzheimer’s or other related dementias.             the training, she modifies her schedule to suit the
                                                                     Providing expert, compassionate, life-               memory due to abnormal changes in the structure                                         Hebrew SeniorLife has long been in the                resident’s preferences, anticipates what a resident
                                                                  enhancing care for seniors who have dementia is         and function of the brain, sufficient enough to                                        forefront of applied dementia research, through          who is roaming the hall at night might need to
                                                                  one of the most important challenges facing society     interfere with daily living. Dementia is progressive                                 the Institute for Aging Research and the Aging           be comfortable, and even reassures her patients in
                                                                  and geriatric health care. Dementia affects nearly 10    and affects the whole brain and the whole person.                                     Brain Center. The decision to convert two                Russian. “Now I know how to talk one-to-one with
                                                                  percent of people over 65 and 40 percent of people      The disease leads to difficulties with speaking and                                    units at HRC to a 100-bed Specialized Care               each patient on the unit,” she says.
                                                                  over 85. Many people have a family member or            understanding language, difficulty performing                                          Unit underscores HSL’s commitment to create                  Helayne Goldstein Ramirez, L.I.C.S.W.,
                                                                  acquaintance who has Alzheimer’s disease, one of        basic routines such as dressing, impaired thinking                                   an optimal model of dementia care.                       director of Social Services, says that the staff
                                                                  the most common forms of dementia. Currently,           and planning, changes in sensory perception,
                                                                  4 million Americans have Alzheimer’s, a number          personality changes, intense emotional responses,                               In October 2006, Paul Raia, Ph.D., director of Patient Care and Family Support for the
                                                                  that is expected to double over the next 40 years.      and potential behavior problems. Eventually the
                                                                                                                                                                                                          Massachusetts Chapter of the Alzheimer’s Association, made recommendations to improve
                                                                     Dementia is defined as a global deficit in             person with dementia loses the ability to care
                                                                                                                                                                                                          the unit’s aesthetics, staff education, and therapeutic programming in order to implement a
                                                                  cognitive functioning, including impairment of          for him/herself and may require some form of
                                                                                                                                                                                                          “habilitation” model of care. Habilitation focuses on maintaining the skills, interests and abilities
                                                                                                                                                                                                          the resident has, rather than trying to bring back or rehabilitate lost function.

                                                                                                                                                                                                                  In October 2006, Paul Raia, Ph.D., director           strives to form a partnership with family members,
                                                                                                                                                                                                               of Patient Care and Family Support for the               because families are key to knowing the resident.
                                                                                                                                                                                                               Massachusetts Chapter of the Alzheimer’s                 Shelley Rosen is a member of the family advisory
                                                                                                                                                                                                               Association, made recommendations to improve             group and her father is a resident on SCU I. She
                                                                                                                                                                                                               the unit’s aesthetics, staff education, and               has noticed changes in the interactions between
                                                                                                                                                                                                               therapeutic programming in order to implement            staff and residents that contribute to a “positive
                                                                                                                                                                                                               a “habilitation” model of care. Habilitation focuses     emotion” experience. “A calmness has come over
                                                                                                                                                                                                               on maintaining the skills, interests and abilities       some staff, a change of attitude, an understanding
                                                                                                                                                                                                               the resident has, rather than trying to bring back       that you have to suspend your own reality to have
                                                                                                                                                                                                               or rehabilitate lost function.                           pleasant interactions with people with dementia,”




                                                                                                                                                                                                                                                                                                                              H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G
 H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G




                                                                                                                                                                                                                  Twenty staff members completed 20 hours of             says Ms. Rosen.
                                                                                                                                                                                                               Alzheimer’s Association classes to become certified           HSL has set in place the cornerstone of
                                                                                                                                                                                                               dementia trainers. They in turn provided 12 hours        dementia care: a supportive, non-challenging
                                                                                                                                                                                                               of comprehensive training to all direct care staff on     physical environment filled with caregivers who
                                                                                                                                                                                                               the Specialized Care Unit. Even staff who serve           can respond appropriately to dementia symptoms
                                                                                                                                                                                                               meals or repair broken equipment received a two-         and behaviors while supporting the preserved
                                                                                                                                                                                                               hour training so they would be more comfortable          function and humanity of the resident.æ
                                                                                                                                                                                                               interacting with residents. “The goal of this training
                                                                                                                                                                                                               is to teach staff to be more understanding and
                                                                                                                                                          Unalee Powell, C.N.A., Specialized Care Unit,
                                                                                                                                                          Hebrew Rehabilitation Center
14                                                                                                                                                                                                                                                                                                                                  15
                                                              CLINICAL PASTORAL EDUCATION




Caring for the
Whole Person
    Hebrew SeniorLife is committed to a whole-        each day. Many people reflect on their lives and
person approach to health, aging and well-being,      are able to make peace with their past.”
with an emphasis on meeting the spiritual and             CPE students and the chaplaincy staff are
emotional needs of residents and patients. In         also available to support the HSL staff. When
2006, the HSL Chaplaincy Institute welcomed           staff members have events in their own lives that
its first class of eight students to the only Jewish   are troubling, they can seek out a chaplain for
geriatric chaplaincy training program in the          reassurance, prayer or emotional support. Hali
United States accredited by the Association for       Diecidue, cantor and chaplain at HRC and a CPE
Clinical Pastoral Education (ACPE).                   student, points out that the staff become very
    Clinical pastoral education (CPE) is a            attached to the residents they care for over the
method of training clergy and other health-           years, and when the residents die, the staff deserve
care professionals to minister to people in           attention to their spiritual needs as they grieve.
need, applying the theology that is learned in            The CPE program has allowed the Department
the classroom to real-life situations. Caring         of Religious and Chaplaincy Services to expand
for older adults requires special expertise and       its reach by placing a CPE student on all 18
attention to palliative care, dementia, and Jewish    units, and with Hebrew SeniorLife’s Adult Day
understanding of end-of-life care. The goals of       Health Program. To meet HSL’s institution-wide
the CPE program are to teach students about           commitment to excellence in dementia care, CPE
Jewish pastoral care in a long-term care setting      students receive advanced training in meeting
and to expand pastoral services available to          the spiritual and emotional needs of dementia
residents and patients. The Rev. Mary Martha          patients. Rabbi Sara says that religious memories
Thiel, an experienced chaplain who ran the CPE        and rituals often remain accessible longer than
program at Massachusetts General Hospital,            other memories, and the residents with dementia
teaches, supervises and coordinates the program.      often find comfort in hearing prayers, singing,
Students include rabbis, rabbinical students,         reminiscing, and giving and receiving blessings.
and lay people. To become a certified chaplain,            Suzanne Offit, a fourth-year rabbinical
a student must complete 400 hours of combined         student at Hebrew College and a CPE student
classroom and clinical experience, and an             at Hebrew Rehabilitation Center, shares a quote
additional year of full-time chaplaincy work.         by Presbyterian minister and author Frederick




                                                                                                            H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G
    Rabbi Sara Paasche-Orlow, director of             Buechner, when describing the CPE program:
Religious and Chaplaincy Services, says the HRC       “The place God calls you to is the place where
chaplains help to promote a caring community.         your deep gladness and world’s deep need meet.”
“Our residents often face difficult situations,             For Ms. Offit, HRC is where that gladness
and they and their families deserve religious         and need meet. “Through the CPE program,”
and spiritual support,” says Rabbi Sara. “Aging       she says, “I have gained a deep understanding of
residents in long-term care often think about         how aging residents can benefit from interaction
‘what is the meaning of my life?; how can I live      with informed chaplains.”æ
with dignity given the challenges of aging?’ Our
chaplains help them find hope and have resilience
                                                                                                                  17
                                                                     THE PALLIATIVE CARE PROGRAM                                                                                                                                                     THE PALLIATIVE CARE PROGRAM




                                                                  Teaching Care                                                                                                                        In keeping with HSL’s mission to educate staff to
                                                                                                                                                                                                       relieve suffering toward the end of life, all direct care and


                                                                  Beyond Cure
                                                                                                                                                                                                       administrative staff received training in the principles and
                                                                                                                                                                                                       components of this palliative care model in 2007.




                                                                     Palliative care is patient-, resident- and family-      The Palliative Care Program works with the            aggressive, curative care treatment is still employed.   the-art palliative care will be offered to staff on an
                                                                  centered, optimizing quality of life by anticipating,   resident/patient, family, and primary health-            The goals of care are reviewed and revised regularly.    ongoing basis. The consult team members also serve
                                                                  preventing and treating suffering. Research              care team to personalize a plan of care based on         Dr. Comart emphasizes that communication is              as mentors and educators when they collaborate
                                                                  conducted by Susan Mitchell, M.D., M.P.H., a            the resident’s wishes and values. The purpose            a critical component of palliative care. “We help        with staff to address symptom management, ethical
                                                                  geriatrician at HRC and an Institute for Aging          is to relieve physical, psychological, spiritual         residents and families think, early in their stay at     issues, goal setting, grief, and the full realm of needs
                                                                  Research investigator, found that residents in          and emotional suffering due to pain and other             HRC, about their hopes for treatment, quality of         of residents and patients on their units. Team
                                                                  nursing homes across the country, especially those      symptoms. HRC is committed to pioneering one of          life, and how they want to manage their care,” she       members participate in research on the benefits of
                                                                  with dementia, often do not receive the benefits         the first advanced models for palliative care in long-    says. “Open communication involves talking about         palliative care, as well as policies and procedures to
                                                                  of palliative care as they reach the end of life.       term care, which will eventually be implemented          prognosis, likely paths of illness, treatment choices,   build palliative care approaches into everyday care.
                                                                  In response, HRC developed a Palliative Care            at all Hebrew SeniorLife facilities, and influence        and making decisions about what will help them               “Our ultimate goal is doing what’s best for the
                                                                  Program, with a consulting team that includes           geriatric palliative care throughout the U.S.            achieve comfort and peace of mind.”                      residents, patients, family and staff. With palliative
                                                                  David Tsai, M.D., a geriatrician who is board              Palliative care is different from hospice care.            In keeping with HSL’s mission to educate staff        care, as people move along the continuum, we are
                                                                  certified in palliative care medicine; chaplain Jody     Hospice care is usually offered when curative             to relieve suffering toward the end of life, direct       able to stay focused and connected, provide the
                                                                  Comart, Ph.D., a licensed clinical psychologist;        treatment has stopped and life expectancy is less        care and administrative staff received training in        best care, and help patients and families experience
                                                                  Anne Mahler, M.S., R.N., clinical nurse specialist;     than six months. Palliative care is available to every   the principles and components of this palliative         comfort and peace at the end of life,” says HSL
                                                                  and social worker Carol Hani, M.S.W.                    resident at any stage of illness, including when         care model in 2007. Education about state-of-            physician-in-chief Dr. Robert Schreiber.æ




                                                                  “      Palliative care improves the quality of life of residents/
                                                                         patients and families facing problems associated with a
 H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G




                                                                         life-limiting or life-threatening illness, through prevention
                                                                         and relief of suffering by means of early identification and




                                                                                                                                                                      ”
                                                                         impeccable assessment and treatment of pain and other
                                                                         problems - physical, psychosocial, and spiritual.

                                                                                                                                 - World Health Organization, 2002
18                                                                                                                                                                                                                                               Palliative Care team members Anne Mahler, M.S., R.N.;
                                                                                                                                                                                                                                                 David Tsai, M.D.; and Jody Comart, Ph.D
                                                                  FINAL THOUGHTS




                                                                  “  I love to hear the words ‘thank you.’ Hearing those words
                                                                     makes me feel like I have helped someone in need. That’s why I want
                                                                     to become a nurse. The best place to hear ‘thank you’ is in a hospital.
                                                                     When I started at Hebrew Rehabilitation Center, I wasn’t sure what to
                                                                     expect. I was surprised to learn that I would have to work so closely
                                                                     with patients and help them with activities of daily living like eating
                                                                     and getting dressed. At first I was scared, but then I got used to it
                                                                     and learned that they were not so different from me. I feel much more
                                                                     confident now and not afraid of trying new things.
                                                                     Working at HRC has been a good experience and a good start toward




                                                                                                       ”
                                                                     acheiving my goal of becoming a nurse. I want to go on to college and
                                                                     eventually become an RN.

                                                                     Jennifer Rodriguez
                                                                     Class of 2012
                                                                     Jennifer Rodriguez is a Madison Park Technical Vocational High School senior
                                                                     and trained as a Certified Nurse Assistant at Hebrew Rehabilitation Center




                                                                     ACADEMIC PARTNERS
                                                                     Bay State Community College                    Lesley University
 H E B R E W S E N I O R L I F E R E P O RT O N T E A C H I N G




                                                                     Beth Israel Deaconess Medical Center           Madison Park High School
                                                                     Boston University                              Mass Bay Community College
                                                                     Boston University School of Dental Medicine    Massachusetts General Hospital
                                                                     Brandeis University                            Mt. Ida Junior College
                                                                     Brigham and Women’s Hospital                   Northeastern University
                                                                     Bunker Hill Community College                  Regis College
                                                                     Dimock Community Health Center                 Roxbury Community College
                                                                     Harvard Medical School                         Simmons College
                                                                     Harvard School of Dental Medicine              Tufts University
                                                                     Hebrew College Rabbinical School               University of Massachusetts/Amherst
                                                                     Laboure College                                University of Massachusetts/Boston
                                                                     Lasell College                                 University of Massachusetts/Lowell



20
This report on teaching is a publication of
Hebrew SeniorLife’s Corporate Communications Department         Teaching Activities & Programs Donor List
Jennifer Davis
Director, Corporate Communications Department
Scott Edwards                                                   ENDOWMENT FUNDS
Senior Writer and Editor, Corporate Communications Department
Joseph Martini                                                  Geriatric Fellowships                                  Louis & Pearl Davidson Scholarship Fund For Geriatric Care
                                                                Gladys & Bertram Dank Medical Fellowship               Ethel, Isaac, Evelyn Dreayer Nursing Scholarship
Vice President, Marketing and Communications
                                                                Hyman & Shirley Hill Geriatric Fellowship              Employee Scholarship
                                                                Ida D. Marks Geriatric Fellowship                      Feldberg, Karp, Levy & Stern Families Geriatric Nursing Scholarship
Janet M. Cromer, R.N.                                           Men’s Associates Geriatric Fellowship                  Ethel Fitzpatrick Nursing Scholarship
Contributing Writer                                             Sadye & Jacob Schultz Fund                             Minnie Glickman, Harry Glickman & Carl Witty Families Geriatric Scholarship
                                                                Harold E. Shapiro Geriatric Fellowship                 William F. Lally Nursing Scholarship
                                                                Lois & Norman Silverman Geriatric Fellowship           Nancy L. & Harry Marks Nursing Scholarship
Thomas Joyce Design                                                                                                    Maurice I. May Presidents’ Scholarship
                                                                Women’s Auxiliary Geriatric Fellowship
Design Services                                                                                                        Edith E. & Irvin B. Petkun Nursing Scholarship
                                                                Career Development Program                             Fannie Pofcher/Golda Griefman Nursing Scholarship
                                                                                                                       Samuel W. Poorvu Memorial Nursing Scholarship
                                                                Bessie Dubinsky Memorial Nursing Scholarship           Rabb/Cahners/Goldberg Families Nursing Scholarship
                                                                Marshall S. Kates Memorial Fund                        George & Evelyn Reisman Nursing Scholarship
                                                                Anne Lunder Leland Fund                                Rudner Family Geriatric Scholarship & Training
                                                                Martin & Miriam Linsey Fund                            Dr. Harry & Lee Sagansky Nursing Scholarship
                                                                                                                       Julia & Theodore Scholnick Nursing Scholarship
                                                                Jewish Geriatric Chaplaincy Institute                  Margaret Sheehan Nursing Scholarship
                                                                Abraham & Sadye Shapiro Chaplaincy Endowment           Sloane Family Geriatric Nursing Scholarship
                                                                                                                       Harold & Anna Snider Ullian Geriatric Scholarship & Training
                                                                Scholarship Funds                                      Suzanne & Edward Waxman Nursing Scholarship
                                                                                                                       Dora Wilker Geriatric Research & Training
                                                                Max & Doris Berenson Nursing Scholarship
                                                                                                                       Women’s Auxiliary Nursing Scholarship
                                                                Center Pride/Center Wide Scholarship
                                                                Richard & Neal Coffman Geriatric Nursing Scholarship
                                                                Ollie & Eleanore Cohen Geriatric Nursing Scholarship
                                                                Jacqueline Confortes Covo Nursing Scholarship




                                                                DONORS

                                                                Scholarship Funds                                      Kathryn R. Bloom
                                                                Mr. & Mrs. Peter H. Berenson                           Maxwell V. Blum Family Foundation
                                                                Dr. & Mrs. Jon K. Berenson                             Eli H. Dubinsky
                                                                Mr. & Mrs. Mark Berenson                               Len Fishman & Dr. Susan Schnur
                                                                Lillian Brunswick                                      Linda & Michael Frieze
                                                                Joel S. Cherashore                                     Estate of Frances Huvos
                                                                Ollie A. & Eleanore Cohen Family Foundation            Jacqueline R. Kates
                                                                Joyce College & Alan C. Goldman                        My Thi Le
                                                                Joanne Cooper                                          Martin J. & Miriam Linsey
                                                                Mr. & Mrs. Robert Coultas                              Lunder Foundation, Peter & Paula Lunder
                                                                Mr. & Mrs. Oliver L. Davidson                          Martha Mann, Liz Kay, Irene Seff, Phil Kay
                                                                Alton* & Marjorie Dreayer                              Sidney R. Rabb Charitable Trust
                                                                Barry Dreayer                                          Sidney & Esther Rabb Charitable Foundation
                                                                Len Fishman & Dr. Susan Schnur                         Jennifer R. Raymond
                                                                Forman, Itzkowitz, Berenson & LaGreca, P.C.            Lois E. Silverman
                                                                Dr. Rose Goldman & Dr. Alan Drablin                    The Wilensky Foundation, Frank Gopen*
                                                                Susan & Jonathan Golovin
                                                                Mr. & Mrs. Daniel Hamermesh                            Jewish Geriatric Chaplaincy Institute
                                                                Mr. & Mrs. Stanley Kaplan                              Anonymous
                                                                Gary H. Kronfeld                                       Aileen B. Cabitt
                                                                Todd I. Lewis                                          Rosita & Steven Fine
                                                                Nancy Lurie Marks Family                               Marilyn & A. Leon* Goldman
                                                                Elizabeth Mills                                        The Hindman Family
                                                                Alfonso Perez                                          Levine Chapel, Inc.
                                                                Lynn Podber                                            Barbara A. Levine
                                                                Amy Pofcher                                            Suzanne & Norman Priebatsch
                                                                Mr. & Mrs. Harvey I. Pofcher                           Sidney R. Rabb Charitable Trust
                                                                Edward B. Rudner                                       Sidney & Esther Rabb Charitable Foundation
                                                                Sylvia Rudner                                          Dr. Ned & Sonia Saltzman
                                                                Judith P. & S. Lawrence Schlager                       Abraham Shapiro Charity Fund, Robert & Valya Shapiro
                                                                Mildred C. Scholnick                                   Women’s Auxiliary, Hebrew SeniorLife
                                                                Sharon & Lynn Scull
                                                                Mindy & Charles Spitz                                  Chaplaincy Program – Orchard Cove
                                                                Harold & Anna Ullian Charitable Foundation             Carol & Howard Anderson
                                                                Suzanne & Edward Waxman                                Evelyn Hindman*
                                                                Carl Zack & Andrea Cohen                               Marcia K. Myerberg
                                                                Susan Zakon                                            Andrea Rosenthal
                                                                                                                       Susan F. Solomon
                                                                Career Development Program
                                                                Anonymous                                              Dementia Care Program
                                                                Academy Health                                         Evelyn Axelrod Trust

                                                                                                                       *deceased

				
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