THE BERKSHIRE EDGE—VIM’s broad definition of healthcare, integrating housing, food insecurity, employment, and education, is key to the life-changing comprehensive care it provides.
BY ROBBI HARTT
To understand how Volunteers in Medicine-Berkshires, Inc. (VIM) came into being, you need to talk to Art Peisner, a retired executive and management consultant who was there in the early days before the clinic opened and has served as VIM board chair since 2007. He traces VIM’s origins back to two couples (one couple were both physicians) who had recently retired and relocated to the Berkshires—and a New Year’s Eve dinner conversation that began with the casual question, “Have you found a doctor up here?” and morphed into the more puzzling question, “If we’re finding it this hard to find a doctor, what about people who don’t have insurance?”
That was back in 2003. “They began to look into it,” Peisner notes, “creating a 10-page list of people and organizations that ultimately developed into the first iteration of VIM.” With help from Berkshire United Way, they hired a grad student at the Harvard School of Public Health to conduct a needs assessment, which revealed more than 10,000 uninsured people in the region—people who not only had no regular physician but also had no way to go to the ER in a medical emergency, get dental care, or obtain a prescription, simply because they couldn’t afford it.
In May and September of that year, the foursome held public meetings. Later they held an all-day conference, facilitated by Peisner, to develop a strategic plan. Far beyond what most people imagined when they thought of health care, their shared vision was “to provide access to free, comprehensive health care” for income-qualified uninsured or under-insured people living in the Berkshire region, thereby creating (per their mission statement) “a society in which everyone has an equal opportunity to achieve good health.”
“I got interested personally and became more involved,” Peisner states. Over the next 12 months, the group talked to potential volunteers (namely retired physicians who lived in the area part- or full-time), hospitals, and organizations. In early 2004, after hiring an executive director, Nora Hayes (who had a public health consulting firm in Rockland County), to develop a start-up plan, they opened their first clinic at 777 Main Street in Great Barrington, renting a physician’s office that had recently been vacated. Peisner adds, “We saw our first patients in December 2004 and added a dental practice in spring 2005.”
Those initial offerings were financed almost exclusively by VIM’s board, with some additional support from foundations. Word spread rapidly, and the clinic grew rapidly as well, so they hired more staff and rented additional space. “We realized we needed a medical practitioner to be available when volunteers weren’t,” Peisner explains—thus, the model of doctors and dentists donating their time, supported by a paid staff of nurses, hygienists, and other essential staff evolved. Patients learned about VIM by word of mouth, signs posted in areas likely to find people who fit the demographic of the study results, and direct mailings. Most patients came from the Latin American community. Due to HIPPA laws, patients were treated with absolute confidentiality, though many still needed reassurance to agree to come.
Identifying the pain points—and expanding what “healthcare” means
What makes VIM-Berkshires, Inc. unique? “We’ve always had a very strong ‘social determinants of health’ program,” Peisner notes. “Not so surprisingly, 80 percent of a person’s overall health is related to non-clinical factors. We have three people on staff who do nothing but help connect patients to existing organizations that can help them in those areas.” VIM’s broad definition of healthcare—integrating housing, food insecurity, employment, and education—is key to the life-changing comprehensive care it provides.
Today, VIM’s services (as detailed on its website) have been expanded even further to include “comprehensive medical, restorative dental, behavioral health, optometry, nutrition and exercise counseling, integrative pain management, and round-trip transportation.” Its patient-centered philosophy, multicultural/multilingual staff, care coordination and follow-up, and collaboration with other area healthcare providers and social service organizations are all integral to its overall success.
Keeping a culturally local perspective
Ilana Steinhauer, who interned with VIM before becoming executive director in 2014, now also serves as clinical director and family nurse practitioner. “Often we focus on what is happening outside our own community—for instance, the recent exportation of migrants from Texas to Martha’s Vineyard—when those issues are happening here, too,” she says. “VIM has been a culturally curious organization that’s approached its patients with cultural humility since the very beginning. We provide direct health care, with a robust community health worker program staffed by expert navigators from the community we serve. That’s how you build trust.”
Ilana Steinhauer, recipient of the NAFCC’s Robert Wood Johnson Foundation Award for Health Equity, provides compassionate, comprehensive care to her patients. Photo courtesy of VIM-Berkshires, Inc.
She continues, “All things happen at once here, which is extremely unique.” To illustrate, she cites two recent examples. One was a mother and daughter who were seeking asylum and sent up from the border; they immediately received medical, clinical, and behavioral health services, in addition to help with enrolling in school and English language classes, connecting to legal and food-pantry support, and setting up a bank account. The second, a local man who had not visited a doctor in 40 years, needed acute clinical care, assistance establishing eligibility for insurance, and help filing taxes. “Some of our hardest cases have been in the last few months,” Steinhauer states. “If VIM didn’t exist, people would die.”
Steinhauer notes that VIM-Berkshires, Inc. cares for a lot of people who support our local economy—housekeepers, landscapers, veterans, part-time employees, and factory workers. “Without a healthy work community, the businesses that are already struggling would shut down,” she states. Helping patients build credit to buy a house or enroll in GED classes, along with coordinating free transportation to allow them to take advantage of important opportunities, are all spokes on the VIM wheel that serve both the patients and the community at large.
Caring for the community starts with VIM’s employees
“Being a nonprofit doesn’t mean you’re not a business,” Steinhauer points out. “Our most valuable asset is our employees. With 14 employees and 160 volunteers, there are a lot of people to look out for in addition to the 1,300 patients we serve. We must ensure that we can take care of our people, who could do other jobs but choose to do this. That means devoting 80 to 90 percent of our budget to staffing, planning strategically for additional space as our needs increase, and creating a culture of caring with staff that trickles down to everyone else.”
At a recent staff meeting, Steinhauer discussed the terms “burnout” vs. “flooding” with staff, explaining that “burnout means you no longer care, while flooding means the opposite—that you care so intensely that it creates a flood of emotions and anxiety.” She then posed the question, “How are we taking care of ourselves?” and highlighted a grant to support each employee in choosing an activity in the coming months to “reset” as a group and to look after their individual health and well-being. Whether due to Covid, inflation, or a host of other factors, VIM services have never been more critical.
Staying the course during COVID
During the pandemic, VIM never closed. In fact, it grew exponentially, nearly doubling its budget to add 250 new patients; provide $500,000 to patients to help with rent, food, utilities, and childcare; and achieve a 98 percent vaccination rate (resulting in zero hospitalizations). It did all this by using a hybrid model of in-person and telehealth patient treatment, which included teaching patients how to set up Zoom on their smartphones. It also paid patients when they contracted COVID and needed to stay home, and provided childcare during the summer so parents could continue working.
According to Steinhauer, “VIM’s impact during COVID has been enormous, not only for our patients but for our entire community. By helping to keep our 1,300 patients healthy, the local hospital system never became overwhelmed. By helping to keep our workforce healthy, businesses could remain productive. And, by providing access to childcare and safe spaces for supervised learning for kids, parents could keep providing for their families.”
Meeting increasing financing needs
Now, 18 years since its beginning, with a full load of cases, supporting ongoing care for so many patients is the new challenge. “With an annual budget of $1.8 million, increasing each year, we focus on fundraising a lot,” Peisner states. The breakdown of income is 60 to 65 percent from individuals, 20 to 22 percent from foundations, 5 to 6 percent from state and local government funds, and the rest from local businesses, non-profits, churches, and investment earnings.
They are now working hard to build up reserves, using the higher visibility of healthcare organizations during the pandemic to supplement their funds. “COVID gave us a chance to share our story. Although we weren’t able to hold our annual galas, we were able to raise even more money through letter-writing campaigns that highlighted our needs,” he says. Smaller recent events have also been highly successful.
Extending essential services to our immigrant community
Natalia DeRuzzio, who serves as a patient services manager, understands from personal experience how daunting it is to move to a new country (she emigrated from Colombia as a young adult). “I came with privilege, and it was still so hard to find guidance, a familiar face who spoke my language, a space where I could open up,” she explains. She is able in one day to determine eligibility (income at or below 300 percent of Federal Poverty Guidelines, which translates to $35,000/year for one person or $70,000/year for a family of four), orient patients, and assess their social needs (using the PREPARE screening tool).
From there she can link them efficiently to necessary services through partner organizations and support networks. “All of the separate pieces are locked together. We’re not just trying to help them survive but thrive—find a job, prosper, and connect with the community to help them do for themselves,” she explains.
“We’ve seen a huge outpouring of children coming into the area in the past few years,” DeRuzzio states. “They now make up 5 percent of the school district population, so we created a new position to help children from different backgrounds succeed in school.”
America Lopez, who serves as VIM Community Health Worker, also serves as Immigrant Family Liaison for Berkshire Hills School District, empowering families to better advocate for their children.
A recent collaboration with The Mahaiwe Performing Arts Center created the Spanish-language Community Advisory Network (SCAN), bringing inclusivity into our arts community. Other collaborations with organizations such as Berkshire South, Simon’s Rock, and CrossFit GB provide swimming lessons, group hikes, and yoga classes to support health and safety. VIM also awarded close to $100,000 in scholarships for children from 100 families to attend local camps this summer. “Our patients are hard-working people, and summer is the busiest time for immigrant workers. We’re trying to help them move ahead without waiting till the next generation,” DeRuzzio says.
Providing award-winning—and life-changing—care
VIM-Berkshires, Inc. has been recognized not only locally but nationally as an outstanding healthcare organization. This October, the National Association of Free & Charitable Clinics (NAFCC) awarded Steinhauer the Sixth Annual Robert Wood Johnson Foundation (RWJF) Award for Health Equity. Dr. Stephen Wittenberg was also recently honored as the 2022 recipient of the Massachusetts Medical Society’s Senior Volunteer Physician of the Year Award, the third VIM volunteer physician to be so honored. In addition, VIM-Berkshires, Inc. won in each of the four categories in which it was nominated (top nonprofit, top wellness center, top general practitioner, and top dentist) in the first-ever Rural Intelligence Readers’ Choice Awards in December 2021, covering Berkshire, Litchfield, Dutchess, and Columbia counties. Finally, in March 2017 the organization won a Gold Medal, (including a $15,000 cash award and $10,000 credit toward medical or dental equipment) from Henry Schein, Inc.
“Our responsibility is to ensure that all people can thrive in the Berkshires, and every year our population grows,” Steinhauer shares—a statement supported by statistics like 7,000 visits last year and an increase in the number of patients served from 560 in 2019 to 1,300 currently. DeRuzzio adds, “We empower people, create bridges when they are not there, and overcome barriers, regardless of limitations. We’re thinking about every aspect of their lives, so we can care for patients not only when they’re sick. Our patients feel that, and we feel their gratitude.”
Robert Davenport, VIM Medical Director, echoes that sentiment, saying “The most important part of the job for me is the absolute gratitude I get from the patients. VIM has resurrected many feelings that led me into medicine in my youth. Volunteering here has re-energized me.” For the 1,300 served, the 174 who serve, and the countless numbers who benefit indirectly in the surrounding community—VIM is indeed a life-changing organization worth celebrating.