Wednesday, June 1, 2011

The "daunting prospect" - a report from the field...

This is a guest post from Janice Sullivan, our VP of External Affairs.  As part of a management initiative to make sure we all stay well connected with the purpose and mission of our organization, those of us who tend to be tethered to our desks are making sure we go out on home visits with our clinicians on a regular basis.  Here's what Janice had to say:

I had the opportunity to go on home visits with Roberta Dillon, RN, on a hot, humid day last week. Roberta’s “neighborhood” is in the Mattapan area of Boston. As I trailed after her, up the stairs to yet another un-air conditioned apartment, watching as she lugged the tools of her trade, laptop, BP cuff, thermometers and whatever else was carefully packed in her black bag, it hit me again….our clinicians do amazing work and help people who really, really need their expertise.

And again, I wondered at all these initiatives the federal and state governments are putting out there to encourage providers and payers to “contain costs” by coordination of care in less expensive settings. Why not just support (you can read that as “pay fairly”) home health care agencies like the VNA of Boston who do this work and do it extremely well.

Roberta picked me up in the neighborhood and I rode around with her all morning. She knows her way around the community and is a whiz at balancing driving, taking calls (hands free of course, wink), taking notes and keeping it all together – and she doesn’t drive slowly either. Some visits were more complicated than others, watching Roberta work with an older women (96) with dementia, and who was not at all happy with us being in the house, was a tutorial in diplomacy as Roberta convinced her to get a dressing changed that absolutely had to done.

I know we take care of plenty of younger patients, but what struck me was that aging with failing health is a daunting prospect. Aging, and trying to manage the various aspects of the health care you need is an even more daunting prospect. And aging, perhaps with some dementia, and trying to figure out the myriad of caregivers and providers involved in your care looks like it could downright impossible. Even with a constant caregiver in the house, and I met two husbands who could not have been more protective and tender with their wives, those primary caregivers are often not in the best of health either.

That’s where I think the VNA of Boston comes in….Roberta, in more than setting, called the doctor, assessed fall risks, answered questions about the home health aide, reconciled the medications, organized the pharmacy delivery, you name it….she was the manager of the healthcare team. Transitions in care, reducing re-hospitalizations, care coordination, geriatric care management are all buzzwords these days. In my opinion, that wheel does not need to re-invented – it exists at the VNA of Boston and needs to be supported by payers, including the government, not duplicated with all the costs associated with developing new infrastructures. Clone Roberta and others like her -- that may save thousands in a day.

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