By Jack Cumming

When Cheryl Wilson was growing up in Australia, I doubt that she could have imagined that one day she would be transforming for the better the lives of elderly citizens of San Diego County in far off California.  Yet, that’s what happened.

Trained as a Nurse; Called as a Leader

Ms. Wilson was trained as a nurse at historic Prince Henry’s Nursing School in Little Bay, New South Wales. From there, she went on in 1979 to distinguish herself as a leader in clinical nursing. And came into senior living as Clinic Director at Front Porch’s Fredericka Manor, where she devised a program that later evolved into what we today call assisted living.

With that background, it’s not surprising that she passed up more highly compensated positions to accept leadership at St. Paul’s Senior Services, a church-affiliated senior-serving organization in San Diego. There she was able to fulfill a dream to bring innovation and excellence to older people of all socio-economic circumstances with compassion each and every day. No one can meet Cheryl Wilson without being impressed by her good nature, her wit, her love, and her transformative vision.

Serving Seniors Before COVID-19

This story would be wonderful if it ended there, but it doesn’t. Cheryl has long been the respected, even revered, CEO of St. Paul’s, but that was before COVID-19 arrived with shocking suddenness to upend the comfortable pre-crisis world we all enjoyed. The response to COVID-19 impacted one vital program particularly. PACE is one of the most compassionate and effective programs offered at St. Paul’s. PACE (Program of All-Inclusive Care for the Elderly) is a Medicaid alternative limited to a few select indigent people who otherwise would need skilled nursing care, and who must be accepted into the program by state government officials.

Funding for PACE comes in the form of capitated payments from Medicaid that are comparable to what the cost would otherwise be to care for the participants under the Medicaid fee-for-service system. The aim is to allow people who would be institutionalized to continue living in their homes. The participants come to the PACE Center one or two days a week for socialization, good meals, and medical services. The “all-inclusive” nature of the program requires the PACE administration to meet all of their needs. This may include home repairs, housekeeping, specialized transportation, and more, in addition to relationship geriatric medical oversight.

The PACE concept has proven to be highly successful. The geriatricians and other health workers get to know the participants and observe them in ordinary circumstances. This allows them to provide preventive care and more to meet needs without the fragmentation of services or the confinement that is usually required for people who are this stricken.

Better Care at Lower Cost

PACE works as a Medicare Advantage Program under Part C of the Medicare law, allowing care coordination that is elusive in the standard medical model. Moreover, it has demonstrated that the cost of providing care can be much less than the cost of care in the standard Medicare-Medicaid system. If we consider the capitation payments as a measure of the least that care might cost elsewhere, then it’s instructive to see how PACE has fared at St. Paul’s. According to the most recent IRS form 990, for the fiscal year ending August 31, 2018, the capitation revenue for St. Paul’s PACE was $66,764,656, and the total expenses were $49,899,905, yielding a margin of over 25%. That’s a very attractive outcome.

Moreover, and more importantly, the PACE participants typically fare better with their overall wellness and happiness than do their like-situated friends who remain in the conventional system. As an aside, it seems that such a “relationship” model for care could serve all people of all life circumstances better than does today’s often reactive medicine.

COVID-19 Changes Everything

Now comes COVID-19 to throw a challenge into this happy scene. Imagine the impact on a program that depends on specialized transport to bring very ill people regularly to a central location for happy moments. Those moments of congregate socialization were forbidden from one day to the next. More critically, care oversight which is central to the very survival of these people was suddenly cut off as they were required to stay in their homes. And, it was not enough for physicians and their teams to visit participants in those homes since many homes blocked visitors from entering the premises. This was a critical moment indeed.

Cheryl Wilson is the kind of leader that encourages people to take initiative to address problems. She does not demand the kind of personal allegiance that some leaders command. She gives praise frequently and lavishly. It’s part of who she is. Staff members respond to that kind of enabling leader that also has the perspicacity to recognize good ideas and to steer people away from pitfalls.

A Roving Clinic

The Medical Director at St. Paul’s is Victor Lee. With Cheryl’s encouragement, he and his group of servant leaders put their heads together to resolve the challenge and to respond to the crisis. What they came up with is truly innovative. They realized that they had vans that are usually used to bring folks to the Center. They took one of those vans, and with the help of maintenance staff, they quickly adapted the van to be a roving clinic.  The idea was that if people can’t come to receive care, the care would have to be taken to them.

There was a problem. The van was not tall enough to accommodate people who had to be able to stand up to provide services to wheelchair-bound patients. It’s emblematic of the teamwork at St. Paul’s that shorter nurses, who could stand up under the low ceiling, volunteered to staff the “roving clinic.”

How does the St. Paul’s roving clinic differ from a medical team that makes house calls? That’s significant. Since most places where participants live wouldn’t allow visitors, the patients were brought out and lifted into the van. There they could be examined and treated subject only to the limitations of what was possible in a roving, mobile clinic.

An Empowered Culture is a Thriving Culture

The culture of responsiveness to needs that Cheryl Wilson has fostered at St. Paul’s got these services to the needy quickly so that the commitment of all-inclusive care was fulfilled despite the COVID-19 obstacles. People gave of themselves, at great sacrifice and with amazing commitment, to sustain the welfare of those in their care.

A commitment like that which Cheryl Wilson inspires goes well beyond sterile business considerations like bond ratings and fears of liability. No sooner did the public outside the organization learn of what the St. Paul’s staff had accomplished, than a donor stepped forward to donate several hundred thousand dollars so that the program can be expanded and perpetuated.

Greatness Puts Others First

Cheryl Wilson would never see herself as the key to all this. She has a wonderful self-effacing manner. She views herself as fortunate to be surrounded by so many gifted people to whom she continuously expresses her gratitude and her praise. Yet, without Cheryl Wilson, a great organization like that of St. Paul’s would not be the demonstration that it has become for what is possible for our nation if we but have the leadership and will to bring it about.

On a Zoom call recently, Cheryl was praising everyone. Then, she let others have the limelight to share their successes. Afterward, when she was called on to say a few words, the Zoom facilitator said, “Cheryl, you’re muted.” That’s something we all hear regularly these days. Cheryl’s quick response was characteristic. “That’s how my husband likes it,” she quipped.  Cheryl Wilson is a woman who puts innovative service to humankind before all other concerns. As it turns out, that’s good business practice as well.