VNA CEO

Time Out!

2011-10-18T16:08:00.001-04:00

I've been blogging for almost two years. 506 total posts, 507 including this one. Because I haven't been posting as much these past few months, some quick math will reveal that I was posting at a pace of more than once per day for well over a year. Social media experts, some of whom really are experts and many of whom are merely self-anointed Facebook and Twitter addicts who are trying to parlay their passion into a profession, say that frequent posting is important. Similar experts describe the endless economic possibilities and boundless business upside associated with maintaining a blog. Particularly if you're a CEO. They'll tell you it's something you just gots to do...

So I did it. Faithfully. For a long time.

Was it valuable? Well... yes and no. For me, it's been valuable. At the peak, I was getting close to a thousand unique visitors a day and several other industry blogs linked theirs to mine. In the I'll-scratch-your-back-if-you-scratch-mine world of social media, I always wondered if those other bloggers really liked what I had to say... or whether they were just in search of reciprocity. No matter, many flocked to my blog. And many commented. It was good. For me. At industry association meetings, colleagues walked up to me and said: "hey, I like your blog"... or even, on occasion, I'd get questions and feedback about something specific that I said. I never exactly became an internet sensation, but my ego felt sensational. A highlight came earlier this year when at a big conference for home care CEOs, a speaker, touting the benefits of social media, put up there in front of the ballroom my own blog front page. He spoke, gushed actually, about how great my blog was. My hits went through the roof for the next two weeks. I received emails from strangers telling me how cool I was. Nice.

But what's the business value? How does this translate into real value for my organization? That, I'm still not so sure about. It might be there, but I've just not been able to mine it. Yet.

That's why this isn't a farewell. It's a time out. I'm going to stop posting for a while and see if anybody misses me out there in cyberspace.

The world is changing and those social media experts, self-anointed and otherwise, might yet be right. If so, I'll be back.

In the meantime, if you're in search of the best home care, hospice or private care services on the planet, check out www.bostonvna.org.

If you're looking for me, I can be found at rspadoni@vnab.org.

Thanks...

The VNA of Boston story continues... and finds its way to Boston!

2011-08-08T17:24:00.001-04:00

If you've been following along, you know that the VNA of Boston story started far away from here (in Europe, in fact). Here's where it gets interesting... as we've now made our way to Boston. Here's Rebecca's post:

Today we arrive in Boston, about a quarter century after the founding of district nursing in England. In 1884 Abbie Crowell Howes, the unmarried daughter of a well-to-do Boston family, travelled to Liverpool to learn about Rathbone’s system of district nursing for the sick poor with hopes of establishing a similar program in Boston.

The period of reconstruction following the end of the Civil War in 1865 ushered in an era of rapid industrial, economic and population growth often referred to as the “Gilded Age”, a term coined by Mark Twain. During the 1870s and 1880s, the U.S. economy grew at the fastest rate in its history, and northern coastal cities were quickly transformed as new industries flourished and people flooded in to fill the need for workers. As in Liverpool of the mid-1800s, these new residents, in the over-crowded and poverty-stricken inner cities, often succumbed to sickness and disease leaving their families without income and threatening the social fabric of the community. At the same time, the professional and business classes became very wealthy, and many women pursued charitable activities to ease the suffering of the working classes and to promote improvements in education and health.

One such group in Boston was the Women’s Education Association (WEA). In 1871, Mrs. Charles Pierce and Mrs. B F Brooks sent out a circular proposing the establishment of an organization to support the expansion and quality of educational opportunities for women. At the first meeting, 75 women joined as charter members. Members would propose ideas for promoting the education of women, form committees with other ladies who had similar interests, and receive small grants from the Association to help jumpstart their project. The Association would remain involved for one or two years, with the expectation that the project would either take root in the community and become self-supporting or would fold. Several of the organizations started by members of the WEA include Radcliffe College, the MIT Women’s Laboratory, The Boston Training School for Nurses (the second oldest nursing school in the US based on the Nightingale model), The Boston Cooking School (where a scientific approach to food preparation was taught and where Fanny Farmer trained), the Marine Biological Laboratory at Wood’s Hole (a place where both men and women could conduct research and women were encouraged to be a part of the community of scientists – Rachel Carson formed many of her ideas at the MBL), and the Boston Children’s Museum.

Abbie Howes and her friend Phebe Adam were members of the WEA and upon Howes' return from Liverpool; she approached Adam to propose they request a grant from the WEA to start a program of district nursing in Boston. In her book, The Evolution of Public Health Nursing, Annie Brainard describes Howes as finding satisfaction and happiness in service to others. “As a social worker she had no interest in any personal rewards such as office or leadership for herself, but with rare persistence and tireless enthusiasm gave herself, at all times to the service of the poor and needy.” She describes Adam as “a lady of dominating personality” who “to some seemed stiff and forbidding, though to those who knew her better was a loved and revered leader. She had intellectual tastes and had taught school for some years. At the time of which we speak she was connected with the Shaw Day Nursery in Boston and, having already realized the need of nursing care in the homes of many of her little charges, quickly became interested in Miss Howes’ suggestion.” (For more on the Shaw Day Nurseries see http://bwht.org/shaw.

In addition to learning all they could about the Liverpool organization through visits and an active correspondence with Rathbone and his nursing superintendents, Howes and Adam also studied the situation in Boston. Howes proposed collaborating with the Boston Dispensary, an organization of physicians who had served the poor of the city since 1796. They approached Dr. W. H. H. Hastings, the Superintendent of the Dispensary and he happily agreed to the partnership. Hastings wrote “No one knows better than a Dispensary physician, how hard it is to treat a patient when there is but little to do with, and no one to properly carry out his instructions. He feels powerless, and perhaps suggests a hospital; but that recommendation is declined for fear that it may lead to the breaking up of the home and the scattering of its members. It is in such cases as these that the work of your nurses is needed to complete the efforts of the medical adviser, and accomplish the greatest amount of good for the suffering poor.” (http://en.wikipedia.org/wiki/Boston_Dispensary).

In 1885 Adam became the chairperson of the WEA’s Committee on Industrial Education – and shortly thereafter proposed the idea for District Nursing. Brainard notes that “at first it was necessary to convince the Committee that the work, which at first sight, seemed to partake only of charity, was, in fact largely educational. In this they succeeded, although at first assistance was reluctantly given, and the name “Instructive District Nursing” was adopted in order to ally the work with other educational efforts. By the end of the first year, however, ample proof having been obtained that teaching, as well as nursing, was a large part of the work, the undertaking was heartily endorsed.“

In her report on the activities of the Industrial Education Committee for the year 1885, Adam writes “In concluding our report we desire to express our gratification at the assent of the Association to work we hope to begin with the New Year, and which, for lack of a better name, we call ‘Instructive District Nursing’. It is too early for us to give details of what we propose and hope to accomplish, but, to those who question the acceptance of this work as not within the scope of an Education Association, we desire to say that one of the important portions of the work of a nurse thus employed is as a teacher, and largely consists in the instruction she is able to impart to the family and friends of the patient. Whatever may be the value of lectures on health and on the care of the sick, given to the poor and ignorant, it cannot be doubted that their practical usefulness and assistance must be vastly increased by direct lessons in a sick-room. The skillful application of a simple bandage or poultice at the bedside of a patient reaches at once even the lowest intelligence, and a competent nurse can give instruction of the greatest value in all matters of diet, ventilation, etc – lessons not confined to the immediate sick room, but spreading their beneficial influence throughout the neighborhood in which she works. We ask the interest and cooperation of all the members of the Association, and any suggestions or information bearing upon our work will be gladly received.“

In her April of 1887 report to the WEA Adam, now President of the Instructive District Nursing Association writes – “you will remember that our Association undertook the work of Instructive District Nursing in February 1886, and reports have been read at each meeting of its continued success and the growing interest in the work. At the meeting last April the Committee thought it best to withdraw from the Association, as has been the custom in the past whenever any enterprise had reached the stage when it could stand alone. The President of the new Instructive District Nursing Association reports that it continues to prosper.”

Board of Managers
IDNA – 1887 – Second Year of Operation

President
Miss Phebe G. Adam
Secretary
Mrs. F. W. Chandler
Treasurer
Miss A. E. Wheelwright

Members
Miss Hannah A. Adam (sister of Phebe)
Mrs. J.W. Andrews
Mrs. Wm. Appleton
Miss Anne P. Cary
Miss Clara T. Endicott
Mrs. J.S. Copley Green
Miss Margaret Greene
Miss Abbie C. Howes
Miss C.I. Ireland
Miss Mary Minot
Mrs. Oits Norcorss
Miss Mary Russell

Advisory Board
Mr. Wm Endicott, Jr.
Dr. Francis Minot
Mrs. Chas D. Homans
Mrs. S. T. Hooper
Dr. Vincent Y. Bowditch
Mr. Lewis Wm. Tappan, Jr.
Mr. George Wigglesworth

First 4 IDNA Nurses Employed By the WEA (7,182 visits to 707 patients were done in the first year)
Amelia Hodgkiss Hired Feb 8, 1886 New England Hospital for Women & Children
(left in November of 1886 after finding the work too stressful)
Elizabeth Rinkler Hired June 15, 1886 Boston City Hospital Training School
Calina E. M. Somerville Hired Nov 1, 1886 Boston City Hospital Training School (went on to become Superintendent of Nurses Lawrence General Hospital)
Emma Gordon Hired May 1, 1887 Boston City Hospital Training School (also travelled to study with Rathbone/Nightingale District Nurses in London)

Boston Medical Center and the VNA of Boston working together...

2011-08-08T15:54:00.002-04:00

The VNA of Boston story continues...

2011-07-28T11:37:00.000-04:00

Rebecca writes:

We saw in the last post that Rathbone was able to overcome widespread skepticism that any good could come of trying to nurse the sick poor in their own homes when the conditions in these homes were so desperate. He successfully argued that the nurse’s efforts would result in longer lasting improvements if she addressed the environmental problems and the treatment would be less disruptive to the family and community if the patient could be nursed in place. However, there was a second difficulty – how to find enough trained nurses to meet the great need.

Florence Nightingale returned from the Crimean wars in 1856 a highly respected and famous woman. She widely promoted her beliefs about nursing as a profession, including the idea that nurses should receive rigorous training. The first modern nursing school was established at St Thomas’s Hospital in London with the first class of nurses starting in June of 1860. The curriculum was based on Nightingale’s vision of practical nursing skills learned at the bedside, the importance of creating a sanitary environment, the ability to observe the condition of the patient accurately and an emphasis on the strong moral character of the nurse. There was also a course of study including lectures on scientific and medical topics. These nurses were known as “Nightingale Nurses”. They represented a very different type of nurse from the untrained and sometimes unscrupulous women who had been serving as nurses in the poorest districts and the workhouses. The plan was for these trained nurses to establish more schools in hospitals around the country.

At this very time Rathbone was looking for trained nurses to staff his District Nursing organization in Liverpool and wrote to Nightingale in I861 asking how he could find suitable staff. Nightingale responded that it would not be possible to send any of her new nurses to work in Liverpool full time, but that she could send one to Liverpool to establish a training school in the Royal Infirmary. Thus it transpired that Rathbone also became closely involved in nursing training and in seeing that Nightingale’s vision was implemented in training programs throughout the country. This was the first contact in what became a life-long friendship with much correspondence and great mutual admiration between Nightingale and Rathbone based on their shared concern for the well-being of the poor and working classes of Great Britain. Rathbone wrote “in any matter of nursing Miss Nightingale is my Pope and I believe in her infallibility” and that he was “proud to be one of her journeymen workers”. At his death she wrote that he was “one of God’s best and greatest sons.”

In 1881 Florence Nightingale published a booklet entitled “Trained Nursing for the Sick Poor” reflecting on the progress that had been made in the 20 years since District Nursing had begun in Liverpool. The booklet was partly a plea for funding of national training programs with consistent standards and also for homes where district nurses could live together in order to develop an esprit de corps and where their meals and housekeeping would be taken care of, similar to what was provided for nurses who worked in hospitals. She also wrote about the unique nature of District Nursing.

“A District Nurse must first nurse. She must be of a yet higher class and of a yet fuller training than a hospital nurse, because she has not the doctor always at hand; because she has no hospital appliances at hand at all; and because she has to take notes of the case for the doctor, who has no one but her to report to him. She is his staff of clinical clerks, dressers and nurses. These district nurses – and it is the first time that it has ever been done - keep records of the patient’s state including pulse, temperature etc, for the doctor.”

“If a hospital must first of all be a place which shall do the sick no harm, how much more must the sick poor’s room be made a place not to render impossible recovery from the sickness which it has probably bred! This is what the London District Nurses do; they nurse the room as well as the patient, and teach the family to nurse the room.”

“A District Nurse must bring to the notice of the Officer of Health, or proper authority, sanitary defects, which he alone can remedy. Thus dustbins are emptied, water-butts cleaned, water supply and drainage examined and remedied, which looked as if this had not been done for one hundred years.”

“Hospitals are but an intermediate stage of civilization. At present hospitals are the only place where the sick poor can be nursed, or indeed, often the sick rich. But the ultimate object is to nurse all sick at home.“

The next installment from Rebecca

2011-07-14T19:17:00.002-04:00

Rebecca continues the story of the first Visiting Nurse Association:

As we saw in my last post, Rathbone and Robinson considered their 1859 experiment in district nursing to be an unqualified success. They could see that the efforts of the nurse resulted not only in a marked improvement in the health of the individual patient, but also in the well being of the entire family.

However, they faced skepticism from the medical and philanthropic communities when proposing the establishment of district nursing on a larger scale. Opposing groups argued the poor could already receive free medical help in hospitals and at free dispensaries. Those in the upper class, who were familiar with the living conditions of the poor, found it hard to believe that occasional visits from a trained nurse would make any real difference. They contended that any help would be a short term gain, especially when the patient was still living in the dirty conditions of their crowded and busy homes.

True to the nature of his ancestors, William Rathbone VI stood by his conviction that this was a necessary and good plan and refused to be discouraged. He commented that “It is a work which is not immediately understood”. He offered four main arguments in support of district nursing:

1) It is about chronic conditions

“There frequently occur cases of serious illness, which are either unsuited, or not admissible into general hospitals; cases for example of chronic disease combined with extreme poverty. Such are some classes of incurable diseases as cancer, consumption (in its later stages) and paralysis, bronchitis, rheumatism, ulcers, etc. and many diseases connected with confinements.”

2) Benefits of receiving care in the home

“The invalid often objects – or his family objects – to his removal from a place which, however wretched, is still a home. The comfort to the sick and to all the family which the nurse is able to give, the relief of knowing that the invalid need not be removed to the hospital, the restoration of order, the awakening of new hopes and the introduction of a more cheerful element – such are the happy results of the nurse’s work, which help to abate the bitterness, the feeling of having been abandoned by God and man, so deplorable and yet so natural in those, who, often without any fault of their own, find themselves plunged in inexpressible wretchedness.“

3) Limited resources at hospitals

“There are not, and there never can be, hospitals large enough and numerous enough to take in all cases of grave illness among the poor.”

4) Cost

“The work done by district nursing is, in proportion to its results, far less costly than that done by the hospitals. “

(Rathbone quoted from Annie Barinard’s 1922 book, The Evolution of Public Health Nursing)

As I read these arguments from over 150 years ago, I am struck by how Rathbone’s conception of the unique contributions and benefits of visiting nursing are still relevant today. In modern times we would also talk about prevention of illness and the reduction of avoidable hospitalizations, but these are simply extensions of the idea that visiting nursing is a sensible way to manage chronic conditions and to avoid expensive hospital stays.

Rathbone also insisted on three main principles. First, that the work was not a work of charity and of temporary relief (which Rathbone and other reformers of the era felt would undermine the desire for self-reliance – what they termed pauperization), but of nursing and making a positive contribution to the long term well being of the person, the family and the community. Second, that the effort was to be independent of any religious motivation or influence, and lastly that the work is done by trained nurses.

Rathbone was successful in finding the funds necessary to expand the program and within four years Liverpool was divided into 18 districts, of which all were provided with visiting nurses. Wealthy ladies contributed their time as Lady Superintendents to oversee the work and to ensure funding. They took on much responsibility, and would help manage the nurses’ time, consult on new cases, hear reports on old cases, promote the service to find new cases, arrange for the supply and distribution of medical comforts and appliances, maintain an inventory of necessary supplies and a record of their use, raise the money for the continuance of the work and keep financial records. Basically, they provided all the administrative functions of the modern organization. These positions were highly coveted and were often handed down from mother to daughter. I imagine that the position provided purpose to the lives of women who would otherwise have few options for contributing to society and undertaking meaningful work.

This was the organization Abbie Howes so admired on her trip to Liverpool in 1884 – and the one she successfully recreated in Boston in 1886 with help from her friend Phebe Adam and the Women’s Education Association.

Next week I will write one last time about England in order to share how Florence Nightingale influenced William Rathbone and to summarize some of her thoughts on the development of District or Visiting Nursing.

Continuing to tell our good story...

2011-07-01T13:05:00.001-04:00

The next installment...

2011-06-20T15:03:00.000-04:00

From Rebecca:

This week we arrive in Liverpool, England circa 1859 and the creation of the first of district nursing program, upon which Abbie Howes and Phebe Adam modeled the Instructive District Nursing Association of Boston in 1886. William Rathbone VI (Feb 1819 – Mar 1902), of the Rathbone family featured in last week’s blog, is considered to be the founder of modern district nursing, and the focus of this week’s post.

In 1859, Rathbone’s first wife became gravely ill and he hired a nurse, Mary Robinson, who came into their home and greatly eased the pain and suffering of her last days. It occurred to Rathbone that this service would provide tremendous relief to the sick poor whose difficult and harsh lives often prevented them from seeking medical care. He asked Robinson if she would be willing to take part in a 3 month trial of nursing the sick poor in their homes, a pilot which he would organize and fund. She agreed and Rathbone set about arranging for the necessary equipment, medicines and nourishments.

Given his familiarity with the situation of the poor citizens of Liverpool, he believed the district nurse would have the greatest impact if she not only attended to the immediate physical ailments of the patient, but also took into consideration their social and family situation as well. His vision was that the nurse would not simply provide short-term relief, but that she would also plant a seed of long-term and widespread improvement by educating the patient and the family to caring for their own sick and instill in them the importance of healthy living and the principles of proper hygiene.

After just one month of work, Robinson asked Rathbone to be released from her contract. Although she was accustomed to sickness and death, the level of suffering and squalor she faced in serving the sick poor of Liverpool was overwhelming. She felt that her efforts were hopeless and were dwarfed by the level of need. Rathbone urged her to continue, and tried to impart in her his belief in the tremendous positive effect her work would have on the lives of those she cared for. “He showed her how much relief from suffering her care brought to the sick; how her teaching and example, must, in time, bear fruit; and that the satisfaction of knowing she had been instrumental in putting even a few families on their feet, and of blazing the path in a new field of work, would compensate her for all her present discouragements” (Brainard, The Evolution of Public Health Nursing, 1922, p 108).

Rathbone’s strong belief in the merits to the plan convinced Robinson, and she continued through her 3 month contract at which time Rathbone’s hopes were fulfilled. She was able to see her success in not only addressing the immediate ailments of the patient, but also in achieving permanent improvements in their health and standard of living. Also, in many cases, the improvement were not limited to the patient, but also their families, whose well being depended on the presence of both a mother and father as caretakers and breadwinners, and also on the community who saw the positive impact on their neighbors and changed their own behaviors. Thus it was at the end of the three month period, Robinson resolved to make district nursing her life’s work.

Rathbone felt confident that his experiment had amply demonstrated the potential benefit district nursing would bring to better the health and stability of those whose grim lives were often shadowed by loss and despair; people who would have otherwise been thought of as hopeless cases. Rathbone was determined to expand the service, but faced several barriers, including the skepticism of his peers. The prevailing opinion was that the problems faced by the multitudes of low-wage workers were insurmountable and that it would be a hopeless exercise for a nurse to try to make a difference. Also, many in the medical community did not believe that proper care could be provided in the busy and dirty conditions of the home and suggested that a hospital was only appropriate venue for care. And, even if Rathbone could convince people to support the project, finding a supply of trained nurses to provide this service throughout the impoverished districts of Liverpool was going to be almost impossible.

Next week we will see how Rathbone overcame these difficulties through a deep and persistent belief in the usefulness of the plan, by widely sharing his enthusiasm for the effort and by turning to Florence Nightingale for help and advice. Rathbone and Nightingale ended up becoming close friends each with a great admiration and respect for the work and ideas of the other.

Congratulations to our very own Boston Bruins!

2011-06-18T21:55:00.001-04:00

Me and a million of my closest friends descended upon the streets of Boston today to congratulate the Stanley Cup Champion Boston Bruins!!! Pictured here, Series MVP, Tim Thomas.

More of the VNA of Boston story...

2011-06-14T11:09:00.000-04:00

Here's the next installment of the story... from Rebecca:

In 1859, Liverpool was a well established port city pulsing with commerce and industry. The population exploded in the 200 years between 1700 and 1900 as immigrants and waves of workers from the countryside flocked to the city, drawn by the demand for labor created by the industrial revolution and trade of all sorts. Our interest is in the Rathbone family of Liverpool, a family of prominent businessmen and philanthropists, and in particular in William Rathbone VI who established the first modern District Nursing organization in 1859, upon which our agency was modeled after in 1886.

The original William Rathbone brought his family to Liverpool in the early 1700s to pursue opportunities for his family in this growing port city. Initially, he worked in a saw mill and in 1742, at the age of 46, he established his own timber business, Rathbone Brothers. Subsequent William Rathbones (there are 13 generations now) built on this foundation and grew the family business, expanding into the cotton trade, shipping, ship building and eventually merchant banking.

From the beginning, the Rathbone family had a high sense of social consciousness and each generation engaged in significant public service and philanthropy. The early Rathbones were Quakers and Nonconformists, meaning they rejected the governance of the Church of England and were advocates for religious freedom. They consistently opposed the slave trade, which was a major part of business in Liverpool. At its peak in 1799, 40% of the worlds’, and 80% of Britain’s slave trade passed through Liverpool’s ports.

William Rathbone V and his wife Elizabeth, the parents of the our William Rathbone, expanded on this work and were large supports of Kitty Wilkerson’s efforts to provide people with a place to wash their clothes and bedding during the cholera outbreak of 1832. (the result of which was the establishment of the first public baths and wash-houses in Liverpool) The famous American prison and mental health reformer Dorethea Dix spent a formative year living with the William Rathbone V and his wife in the late 1830s. While there, she met a group of men and women who advocated for government involvement in social welfare and learned about the British lunacy reform movement, whose methods of detailed investigation of madhouses and asylums she applied to her work on reform for the care of the insane poor upon her return to Massachusetts in 1840. At their deaths, obituaries said of William and Elizabeth Rathbone: "His name was a 'household word', synonymous with truth and honour and charity” and "Her life was one of constant, careful, conscientious helpfulness, on a scale that can have no record".

William Rathbone VI, the founder of modern District Nursing in Liverpool, was born in 1819 and was a partner in the family business, Rathbone Brothers and Co, from 1842 to 1885. Throughout his youth he was surrounded by the reform and philanthropy work undertaken and supported by his parents. Later in life he wrote that he regarded wealth and business success chiefly as a means to the achievement of public and philanthropic work and he wrote that after meeting the reasonable living expenses of himself and his family, a man’s wealth should be considered "a trust for which he owes an account to himself, to his fellow-men, and to God; it is not an absolute freehold which he may use solely for personal enjoyment and indulgence."

Next week, I will delve deeper into William Rathbone VI’s achievements and the Liverpool District Nursing organization, arguably his most far reaching effort that has had long term influence on nursing in England and the United States.

What is a public health dental hygienist?

2011-06-07T12:02:00.000-04:00

Here's an important initiative sponsored by the Massachusetts Department of Public Health. VNA of Boston's own Barbara Belony is a member of the Senior Oral Health Working Group and appears a few times in this video.

Kevin Youkilis, Red Sox third baseman, stops by to say hello

2011-06-07T10:09:00.000-04:00

Youk (aka Kevin Edmund Youkilis) has won a Gold Glove, played in two All-Star games and been a member of two World Series Champion Red Sox teams.

And he's a nice guy.

Shown here with some of our All-Star VNA of Boston managers...

The VNA of Boston story continues...

2011-06-03T13:36:00.001-04:00

Here's the next installment from Rebecca...

In this posting, I continue to share the historical insights I’ve been gleaning from reading Annie M. Brainard’s 1922 book, The Evolution of Public Health Nursing. As we enter the 1800s, we observe how the evolution of public health nursing from a service of the Church to a more independent function sets the stage for the entrance of public health nursing as an important component of the modern health care system in the early 1900s.

The Modern Deaconess Movement

It is said that travelers from Protestant countries would return home with stories of the wonderful care given by the Daughters of Charity, the ancient sisterhoods of Beguines and other groups of nursing sisters, the match of which was not to be found in their own countries. So great was the need for similar services that in 1815 an English doctor called for an order of women to be created, who like the Daughters of Charity would be “selected for good, plain common sense, kindness of disposition, indefatigable industry and deep piety; let them receive - not a technical and scientific – but a practical medical education.”

His call was not heeded in England, but in 1822, Theodor Fliedner, a young Lutheran pastor, established a Protestant sisterhood in the German town of Kaiserswerth. Inspired by an order of Mennonite deaconesses he had observed while visiting Holland and also by the work of Elizabeth Fry, a prison reformer in England, Fliedner and his wife created a Women’s Society with the mission of visiting the sick poor in their homes. Like his predecessor Vincent de Paul, he realized that the wealthy ladies interested in giving charity were not particularly suited to the work. So, as with de Paul, he sought out women of the working class with an interest in the vocation of helping the poor and nursing the sick. Fliedner took his organization a step further and provided these women with three years of training before they could be named Deaconess. Fliedner garnered great international respect and his most famous pupil was none other than Florence Nightingale. Nightingale first visited Kaiserwerth in 1846 as a crusading health care reformer, and was so favorably impressed that she later returned to enroll in Fliedner’s program, graduating in 1851.

On a side note, while researching information on deaconesses I stumbled across an article about Boston’s Beth Israel Deaconess Medical Center. I learned that the New England Deaconess Hospital (which later merged with Beth Israel) was founded in 1896 by a group of Fliedner’s deaconesses whose first 14-bed infirmary was opened in a converted five-story brownstone at 691 Massachusetts Avenue, not so far from the VNABA’s office at 561 Massachusetts Avenue (KELLY – I assume we were at 561 in 1896 yes?)

In Conclusion…

As I continue to study the history of visiting nursing and how the VNABA has grown as an organization, I will be interested to see how the roots of visiting nursing, so steeped in the culture of charity, underlie our modern identity and how we are perceived as a profession. I can’t help feeling that there must be a tension between the business entity we are today and the charitable efforts provided by our predecessors. There is a theme which runs through Brainard’s book; that the modern public health nurse is still animated by the same “spirit of service to mankind” that motivated the early deaconesses and sisters through the centuries. Even though Brainard proposes modern ideas of organization and business she still frames the career of a nurse as more of a calling or vocation rather than simply as a profession or gainful occupation. I am sure this partially reflects the time in which she was writing, but I do wonder how much our modern perception of nursing as a career still harbors an unspoken expectation that the choice to be a nurse goes beyond that of merely choosing an occupation and crosses into the realm of engaging in a “service to mankind” and if so, is there a resultant blurring of the line between the personal and the professional in the role of nurse which still persists today?

Make Way for...

2011-06-02T13:17:00.000-04:00

Ducklings, Bruins and Nurses.

"Make Way for Ducklings" is a fantastic children's picture book, first published in 1941 and written and illustrated by Robert McCloskey. The book chronicles the story of a pair of mallard ducks who decide to raise their family on a small island in the pond at nearby Boston Public Garden.

In October of 1987, a bronze statue depicting Mrs. Mallard and her eight ducklings was placed nearby that same pond. The work was by local artist, Nancy Schon. I understand that there is a similar piece in Moscow (gift of Mrs. Bush to Raisa Gorbachev in 1991).

Through the years, some have had fun with the sculpture, including dressing them up to commemmorate the fact that our Boston Bruins (last night's loss... ugh) are in the Stanley Cup Finals for the first time in over 20 years.

The photo below is a clever photoshop version of the ducks in honor of our great nurses.

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

2011-06-01T14:48:00.000-04:00

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.

VNABA Traveling Display in the Community at Grove Hall

2011-06-01T14:41:00.000-04:00

The VNABA Traveling Display recently appeared at the Grove Hall branch of the Boston Public Library. Our thanks to head librarian Paul Edwards, who graciously hosted the event.

I'm pictured next to two nursing students and then on their sides by two of our own nurses, Keren Diamond (far left) and Adele Pike (far right). Carol Bourne, also of the VNA of Boston, is third from the right and librarian, Paul Edwards is next to Adele.

This is part of our effort to celebrate our 125 years of caring out in the community and near those whom we serve...

The VNA of Boston story continues...

2011-05-31T13:56:00.000-04:00

The next installment from Rebecca:

In this posting, I continue to share the historical insights I’ve been gleaning from reading Annie M. Brainard’s 1922 book, The Evolution of Public Health Nursing.

Social Reform in Elizabethan England and the Reformation of the Church

Beginning in the mid-1500s, monasteries, which had been providing care and support for the poor and sick in England for centuries, were dissolved under the English Protestant Reformation. The first Poor Laws, a system of taxation to alleviate the suffering of the “deserving” poor, were put into place by Elizabeth I in 1601. Thus in England, the care of the poor was no longer an individual problem dependent on charity, but had become a national duty. The poor laws were eventually abolished in 1948 when the British National Health service was established.

In the early 1600s, European countries began to emerge from the chaos of the Middle Ages and with that came a renewed recognition of the inequality between the wealthy and the poor. In France, the religious orders were still the primary distributors of charity for the poor, but after the Reformation there was more freedom for the charity to be independent of the strict structure of the monastery system.

In 1633 Vincent de Paul, a German priest, formed a group named the Daughters of Charity, Servants of the Sick Poor. They were a community of women who took simple, private annual vows, were not cloistered, and dedicated their lives to visiting the sick poor. Brainard sees in this group the start of a more organized and systematic approach to the care of the sick poor. de Paul found that while many wealthy women were eager to be of service, they did not really have the skills to care for the sick. He found that all too often they would send their servants in their place, and as such were essentially buying the benefits of charity work. He introduced the idea that charity didn’t have to be the work of just the wealthy, but even those of humble means could partake. He originated the idea of drawing women from the peasant or laboring classes who were desirous of serving their community and who were better suited than their wealthy counterparts to the labor of charity. He oversaw the work of the group, introduced standardization of processes and held regular meetings to stay informed of the caregiver’s progress. de Paul was the first to say progress could not be made without understanding the root causes of poverty and that just giving money to the affected person or community was actually a barrier to self sufficiency.

A continuation of the VNA of Boston story...

2011-05-23T11:41:00.000-04:00

From Rebecca...

In this posting, I continue to share the historical insights I’ve been gleaning from reading Annie M. Brainard’s 1922 book, The Evolution of Public Health Nursing. I briefly touch on the Middle Ages and the Protestant Reformation which I’m sure made my eyes glaze over in school, but it is amazing what a little personal interest and application of knowledge does for one’s motivation to learn history!

The Middle Ages and the Institutionalization of Care for the Poor and Sick

Europe in the Middle Ages experienced large differences between the rich and poor, and the progress towards civil society was slowed if not reversed. It was a violent and chaotic time as small groups battled for control of lands, wealth and power. Brainard also notes that there were several centuries of devastating weather patterns, floods and earthquakes resulting in famines and outbreaks of disease including frequent and ravaging epidemics of the Black Plague. It is said that possibly 1/3 to 1/2 of the population of Europe died in the plague of 1348.

It was a dangerous time to be out and about, and the work of visiting the sick poor was largely limited to what noble women could do for the peasants employed on the lands of their husbands. As the years passed, care of the sick poor was centralized to a greater degree and administered by organized institutions such as early hospitals and monasteries. Early hospitals accommodated a wide range of people in need; travelers, locals, the poor and the sick. I would imagine that the wealthy would have availed themselves of private care, perhaps provided by physicians, in their homes.

Brainard mentions a few wealthy women from this era who dedicated their lives to caring for the sick poor and their fortunes to founding hospitals for their care. She tells of Fabiola, a wealthy Roman woman who founded the first hospital in Rome around the year 380. She also writes of Radegund, Queen of France around 550 CE who used the revenues of the lands she was granted at her wedding to establish hospices and to perform other charitable work on behalf of the poor.

Independent Sisterhoods in the Middle Ages

Brainard then covers the advent of sisterhoods that were independent of the formal Church structure. She sees in them the thread of public health nursing that started with the early deaconesses and was carried through the Middle Ages, a time in which there was not much concern for the sick poor. The first of these sisterhoods was the Beguines, a non-monastic, loosely affiliated group started in the late 1100s. They sought to serve God without retiring from the world and resisted the attempts of the church to cloister them and limit their independence. They tended to live on the outskirts of town and made their life’s work caring for the poor. Eventually, larger groups of Beguines came together to live in communities called a Beguinage, where they also built hospitals but they never stopped caring for the sick poor in their homes. By the 1300s the number of Beguines was estimated to be about 200,000. At various times throughout the centuries the church attempted to repress the movement and curtail their independence, but the service they provided to the community, and their desire to perform this role independent of the church, was so strong that the movement persisted.

Brainard mentions several other similar groups in Europe, who, like the Beguines, consisted of women who banded together to serve God by caring for the sick poor in their homes independent of the church. Among them were the Sisters of Mercy, The Sisters of the Common Life, and several others that were aligned with the Protestant Church after the Reformation. However, Brainard points out a couple of weaknesses in the system of independent sisterhoods. There was no central organization overseeing their actions, such as there was in the days of the deaconesses and nursing care was provided by each individual as she saw fit. Also, all too often there was a self-serving element, as visiting the sick poor had become a popular form of penance.

Stay tuned for future installments...

VNA of Boston at the Massachusetts State House

2011-05-23T11:32:00.001-04:00

From Janice Sullivan...

The VNABA had a wonderful event last Thursday in Nurses’ Hall at the Massachusetts State House. It was a high visibility location and we got some great community feedback. Thanks to Renard Charity, who represented the Board of the VNABA, and to DeAnne Mignault, an RN on the Downtown team, who made us all proud with her story of why she is a home care nurse and how her patients inspire her every day.

State Senator Sal DiDomenico (second from left) and State Representative Gene O’Flaherty (far right) served as co-hosts of the event. They presented Rey Spadoni with a citation from Governor Deval Patrick in recognition of our 125th anniversary and in appreciation of our commitment to public health nursing in the Boston community.

The traveling display is on the move again and will be at the Grove Hall Boston Public Library branch in Dorchester starting today. All board members and staff, especially those who live or work in the neighborhood, are welcome to join us on Thursday, May 26 at 4 p.m. for a small reception at the library.

Multi-task Much?

2011-05-21T12:36:00.001-04:00

The word "supermom" comes to mind.

Tiffany Goodwin, a Virginia mom, caught this foul ball at a minor league baseball game last Sunday in Richmond. Her 8-month old son, Jerry, seems disinterested. He will, however, be hearing about this photo for the rest of his life.

Ironically, Tiffany's husband, Allen, commented just beforehand that he's been waiting 38 years to catch a ball at the game. He's wearing the blue shirt on the right and as you can see, he's giving it a serious go. But Tiffany made the catch. Good thing she wasn't distracted at the time.

Where it all began…

2011-05-19T13:43:00.000-04:00

Here's the first of a four part post from Rebecca regarding the Visiting Nurse Association of Boston (i.e., the visiting nurse/home health) story...

I have a penchant for thoroughness, which in this case means I cannot resist summarizing for you the relevant points of Annie M. Brainard’s 1922 book, The Evolution of Public Health Nursing, in which she traces the roots of the organized visiting nursing profession in England and America from the early Christian movement of the 1st century through the mid-1880s. The points I found relevant are many and so I may have to cover them over a couple of postings as I roll out some of the history behind public nursing.

Having set out to understand the history of visiting nursing, I fear that if I omit recounting this early history we might miss some kernel of information which would help put the course of visiting nursing in perspective. I think that Brainard had a couple of motivations in writing this history in 1922. First, although she acknowledges that “human sympathy and love must have moved people to visit and care for the sick and suffering from the very beginning of time”, she wants to make the point that nursing is a profession, and that public health nursing is a distinct profession within nursing.

Second, she emphasizes that public health nursing is a very different enterprise from private duty nursing even though to the casual observer they appear to involve the same skills. Brainard wrote another book entitled The Organization of Public Health Nursing in which she contrasts the role of the public health nurse with that of the private duty nurse. She argues that the structure of the organization supporting the public health nurse is a crucial part of the success of the entire field of public health nursing. I am eager to read her second book soon as I have a feeling that many of her points will still be relevant today!

Early Roman Christian Society and the First Organized Efforts to Care of the Poor and Sick

Brainard identifies the deaconesses and deacons of the early Christian church as the first organized visiting group. In Greek, the word deacon means “servant” or “helper” and these early Christian devotees strove to serve in accordance with the teachings of Jesus, “I was sick, and you visited me: I was in prison, and you came to me.” (Matthew 25:36, American King James Version).

Deaconesses had a prominent role in serving the community up through the fifth century, when their office was diminished as the church became more established and opportunities for women were increasingly curtailed. Brainard cites from a history of early Christianity that the role of the deaconess was to “Minister to the infirm, to strangers and widows, to be a [mother] to orphans, to go about into the houses of the poor to see if there is anyone in need, sickness or any other adversity, [she] is to care for and give information to strangers; [she] is to wash the paralytic and infirm that they may have refreshment in their pains…[she] is also to visit inns to see if any poor or sick have entered or any dead are in them.”

The work of these early caregivers was steeped in charity and their actions were infused with the principles of self-sacrifice and of giving to those less fortunate. In accordance with their calling as servants of the church they would have shunned personal wealth, would have given away what they had, and when there was greater material need amongst the people, they would have applied to the church for support. Brainard sees in this system of deaconesses and deacons an organization very similar to what developed into the Public Health Nursing profession of her era. The work of the deaconesses was overseen by a central organization and large cities were divided into districts, with each district overseen by a deacon. The major difference between the two eras is that part of the deaconesses’ purpose was to spread the word of Christianity

The system of deaconesses broke down in the middle ages when the Councils of Orange in 441 and Orléans in 533 forbade the ordination of deaconesses. By this time, the popularity of the Christian church had spread far and wide. It had become a wealthy and powerful organization, and such had lost some of the purity of purpose possessed by the early followers of Christ. As we will see in the next post, women of the middle ages wanting to follow Christian teachings often sought other avenues for serving the poor and sick.

State House Testimony

2011-05-17T12:54:00.001-04:00

Governor Patrick testifies to the Joint Committee on Health Care Financing, May 16, 2011

Yesterday, in the Gardner Auditorium at the Massachusetts State House, I had an opportunity to testify to the Joint Committee on Health Care Financing and provide comments regarding Governor Deval Patrick's proposed health care reform bill. It's a bill with far reaching consequences for the entire health industry in the commonwealth, though it provides more in the way of structure and principles than it does in specifics. Nevertheless, industry groups trotted out arguments pro or con and gave, sometimes in painstaking detail, all the reasons the Governor's plan is salvation... or doomed to failure.

I was proud to be the only representative from the home care industry in attendance at the meeting, supporting the efforts of the Massachusetts Home Care Alliance.

Some of the key points made during the day are as follows:

The Patrick Administration: This bill is essential to reigning in costs and to sparking a continued economic recovery in the state. Creating more transparency around reimbursements to providers is essential. Health and Human Service Secretary JudyAnn Bigby, at one point, acknowledged that "home health care providers are underpaid." We agree.

The hospital industry: The bill is too highly regulatory and government-centric in approach. More of a public-private partnership would be more effective. The chronic problem of underpayments by government payers (and the resulting need for hospitals to make up for it elsewhere) is not addressed in the bill, nor the high cost of medical education.

The HMO industry: They touted more of a free-market position and one that capitalizes on what presently works in the system.

Here is the text of my remarks:

Chairman Moore, Chairman Walsh, members of the Committee and staff, I would like to thank you for the opportunity to offer comments today.

I am Rey Spadoni, President of the Visiting Nurse Association of Boston, the very first home care agency in the United States. We are proud to be celebrating our 125^th continuous year in operation, serving patients in and around the Boston area. We care for 2,000 patients every day.

We have a long history of responding to public health crises in the Commonwealth of Massachusetts… and of acting as a reliable and unfaltering safety net for our most vulnerable citizens and our most challenged neighbors.

Governor Patrick’s proposed bill and today’s testimony well document the fact that we are experiencing another crisis. We note the facts that Medicare reimbursements per Massachusetts enrollee are among the highest in the nation, we ranks thirty-third on avoidable hospital use and costs… and all this despite the fact that our commonwealth leads the nation in the percentage of residents who have health insurance… at greater than 98% covered.

It is another crisis… and my organization and the Massachusetts home health care industry… is poised once again to become a central and leading voice in developing the solution.

According to the Medicare Payment Advisory Commission, the estimated 2010 cost per day in an acute care hospital approaches $7,000. In home care, it’s $140. When a patient needs to be in a hospital, no other setting will suffice. But when a patient is in the hospital due to avoidable causes, $140 versus $7,000 is a very dramatic difference.

In figures from a study published in the New England Journal of Medicine in 2009, 20% of Medicare enrollees discharged from an acute care hospital are readmitted within 30 days of discharge. According to the researchers, three quarters of those readmissions can be classified as preventable. Readmissions which are estimated to cost our system well over $12 billion each year.

In the United States, 29% of all individuals who receive home care services… and remember that these patients are home bound and already among the sickest of all patients… will be readmitted to the hospital within the 60-day episode of care. At the Visiting Nurse Association of Boston, that number is 25%. That four percent difference, if applied to a larger population, represents a very substantial savings… and opportunity to improve the quality of life, independence and dignity of our sickest and most vulnerable populations. But that four percent difference did not happen by accident. It happened due to investments in technology, clinical centers of excellence that serve patients with chronic disease, staff training and the addition of support services designed to keep people at home and independent or achieving the highest quality of life levels possible for them.

Each day in the hospital, including all the avoidable ones, costs our system $7,000. A day of home care, $140.

Home care can be a central and critical part of solving the health care cost crisis. Innovations and cost saving possibilities here are numerous and should be prominently featured in emerging systems based on accountable or integrated care organizations… and encouraged, not disadvantaged, in new alternative payment methodologies. Without specific and designated representation on the health care innovation advisory committee, health information technology council, and other guiding bodies charged with overseeing the transformation of our state system, I fear we will not fully exploit the opportunities that lie in appropriately deinstitutionalizing the provision of health care services in Massachusetts.

It is the home care industry voice, and perhaps only that voice, that will advance this perspective and help make real this possibility.

Finally, at the Visiting Nurse Association of Boston, we care for residents in every neighborhood in Boston and every patient, regardless of their payer status. We are a valuable part of the delivery system safety net and encourage policy makers to consider the role that organizations such as ours plays in caring for those who, despite 98% insurance coverage in Massachusetts, still fall through the cracks which still do remain.

That has been our mission for the past 125 years. We are ready to carry it into the future.

Thank you. I would be happy to answer any questions you may have.

"Keep the nurse to make it healthy..."

2011-05-11T11:58:00.000-04:00

The next installment in the VNA of Boston story from Rebecca...

This week I would like to get back to telling our history --- but I’m struggling with where to begin. One of my goals in writing this blog is to gain an understanding of how the Visiting Nurse Association of Boston & Affiliates (VNABA) became who we are and what it means to be a present day home care organization, so determining exactly where to begin our story is not obvious. To start with the formation of the Instructive District Nursing Association (IDNA ---precursor of the VNABA) in 1886 feels like starting in the middle of the story. Should I start with the Women’s Education Association of Boston, the philanthropic organization which supported the formation of the IDNA? Should I start with the District Nursing organization founded by William Rathbone in England in 1859 upon which the IDNA was modeled? Or do I go all the way back to the first century to the groups of pious women who visited the sick poor in their homes?

As part of my crash course in the history of nursing I have been reading The Evolution of Public Health Nursing (1) written by Annie M. Brainard in 1922. Brainard was the editor of the journal The Public Health Nurse, a lecturer at Western Reserve University and the President of the Visiting Nurse Association of Cleveland in 1913. Her book is frequently cited in publications about visiting nursing and I was convinced to take a closer look because the glimpse I got from the online version at Google Books revealed the most detailed and personal information I had seen about the two women who were behind the creation of the IDNA – Phoebe Adam and Abbie Howes.

The author dedicates ten pages to the history of the IDNA and its founders. These ten pages start on page 203 of a 400 page book --- so by one measure that puts the genesis of our organization at about the halfway mark in the evolution of public health nursing (depending on the source --- also referred to as visiting/district/community nursing). The book provides a detailed account of the various visiting nursing organizations starting in the Roman Empire during the first century and continuing through the Middle Ages, the Age of Enlightenment, the Industrial Revolution, Florence Nightingale and into the early 1900s.

I will share the highlights of our pre-history as presented in this book over the next couple of blogs entries. It is written from a Western European/Christian perspective and as such does not consider the precursors to visiting nursing practice that may have existed in other parts of the world and within other cultures and/or religious traditions. However, I think it remains relevant to the cultural and historical roots of English and American organizations such as Rathbone’s District Nurses and the IDNA.

In closing today here is another poem from the fundraising booklet created by the IDNA nurses and Simmons College students in 1920. The last couple of lines give a sense of the optimism felt by the nurses of what was then the relatively new field of public health regarding the contribution the visiting nurse could make to the prosperity of the country by improving the health of its citizens.

Boost the Public Health Movement

Boost your town and boost your friend,
Boost the health centre you attend.

Boost the nurses round about you,

They can get along without you.

But success will quicker find them,

If they know that you’re behind them.

Boost the Public Health movement,

Boost for every new improvement.

Cease to be a chronic knocker,

Cease to be a progress blocker.

If you’d make your city wealthy,

Keep the nurse to make it healthy.

Note (1):

Brainard, Annie M. The Evolution of Public Health Nursing, W. B. Saunders Company, Philadelphia and London, 1922.

"It's what we do... we are nurses..."

2011-05-10T12:16:00.001-04:00

For most of my career, I've been fortunate enough to work with clinicians who heal and who care. Who bring skill and experience, and a frequently unquenchable compassion, into situations that many of the rest of us would do nearly anything to avoid. I may be inclined to exit... while they rush in.

Meet Barbara, a nurse manager from the Visiting Nurse Association of Boston. And here are a few of her photos of her native Haiti. Idyllic and beautiful, as in the sunlit bay above. Tragic and devastating, as in what follows.

Tuesday, January 12, 2010. A catastrophic magnitude 7.0 earthquake with an epicenter only 25 kilometers west of capital city, Port-au-Prince. Ultimately... 316,000 dead. 300,000 injured. 1,000,000 homeless.

And Barbara rushed in.

Here's her story... from the beginning.

Barbara grew up in Carrefour, a suburb of Port-au-Prince, with her mom, a teacher, and dad, an owner of an auto repair business, and brother and sister. It was a happy, largely uneventful time... until her father became sick. Among his ailments, Barbara's father also suffered from decubitius skin ulcers, which then (and even still today in Haiti) were poorly understood. Barbara, then 13 years old, remembers being angry when her father, a proud man who resisted family pressure to move to the United States, told her "not to worry" and that he would be around for "another ten years". Unfortunately, that was not to be the case.

At the age of 16, Barbara and her remaining family members moved to Florida and then eventually to Cambridge, Massachusetts. Barbara and her sister, Beatrice, held a variety of jobs and when Barbara decided she wanted to become a nurse, Beatrice, then a medical assistant, helped her to pay for the training. When Barbara completed nursing school, she began working and then helped to finance Beatrice's nursing education. Barbara continued on to earn her bachelor's degree and is now studying for a master's in health care administration.

Barbara remembers well that day in January, 2010. Reports of an earthquake began surfacing, with no one fully aware of its magnitude or impact. Beatrice called Barbara and gave her an update. It was far worse than expected. Far worse.

Barbara recalls: "We were looking at the news. We couldn't believe it. Nobody knew what was happening. We started calling our family there but no lines were open. We were so worried. We couldn't sleep. We tried calling the UN but couldn't get through. We just didn't know what to do. I was desperate..."

The overwhelming emotion was helplessness. "People there were dying and I thought, I'm a nurse. I have to help." Partners in Health, an organization dedicated to improving the quality and access to health care services in poor and developing areas, called Beatrice on Saturday and asked to deploy her to Haiti on the following Monday. A month later, Barbara's call came.

It was a two week assignment. The lead time was limited. According to Barbara, "you just pack your bag and go."

She recalls departing the airport in Haiti. She remembers looking around at the rubble, the devastation, the places where buildings once stood. "It was tough to see a country you left and is no longer there."

Barbara was stationed at the General Hospital in Port-au-Prince. "Once you got there, the gate was closed and you couldn't leave." And once there, she and her companions worked for 10 days straight, during 7PM to 7AM shifts. Barbara remembers being struck when she saw the former sight of a nursing school next to the hospital which she had seen as a child. "It was no longer there. It was completely flat. I wondered how many people were trapped underneath."

After a quick orientation from the physician-in-charge, Barbara was given a brief tour and was immediately "put to work." She described the first day as "one of the worst days of my life. There were 300 to 400 patients there all needing care... from TB to fractures to missing limbs to wounds... to people who were just dying. Just name it - it was right there looking at you..."

When asked how she responded to that, Barbara describes: "You start to work. Your forget about everything else. You just tried to save everyone you could. You just do whatever you can."

She remembers one young girl at the hospital. She had lost nine members of her family in the tragedy. "She was so thin. You could see only bones. She would not eat or drink... and she never spoke... except at night, she would scream out the names of her family who were now lost to her. I remember seeing a lady who stayed with her. She was from the local church and she slept on the floor, giving the girl a sip of water." Despite their efforts, the patient passed away.

Another patient, a 27 year old woman with renal failure and high blood pressure, was experiencing significant physical and emotional stress. Barbara knew the patient needed oxygen and fast, so she ran down the hall looking for a tank. A simple tank of oxygen. Plentiful in every hospital where Barbara has worked, but scarce in Port-au-Prince's General Hospital. Barbara called out: "This girl's going to die, her heart's going to give out soon... "... and remembers seeing the desperate look in the woman's eyes. The patient said to Barbara: "Please don't leave me. If you leave me, they're going to let me die." Barbara knew she was right.

The patient eventually received the oxygen and the vital dialysis she required and lived.

There was also an older woman patient who "could have been my mother." She had two wounds in her lower legs; "it looked to be a diabetic ulcer". Barbara watched this patient fade from an amiable, even joking, favorite among the nurses, to one who became more and more ill and despondent. At one point, she had no clothing or even sheets, leaving one of the nurses to donate some of her own clothing to the patient. The patient died, alone and in pain. Per Barbara, "there was no reason for her to die that way..."

Barbara looks back at the experience and feels that: "We didn't do enough. There's so much more to do there. And it's not over there. It's terrible what's happening in the tent cities there now. It's just horrible still... but I want to go back."

When asked why she wants to return, Barbara lowered her eyes and said, simply and solemnly: "It's what we do... we are nurses..."

If you're interested in learning more about Partners in Health, please click here.

If you'd like to help, click here.

Posted by Rey

It's National VNA Week!

2011-05-09T14:00:00.000-04:00

The following is from an email I just sent to our fantastic staff:

This week, we celebrate National VNA Week and acknowledge and celebrate the invaluable work we do to keep patients home, where they most want to be. It’s even more special this year because we also are celebrating 125 years of providing excellent care for our community. We have a proud history and we can look forward to our future…. the VNA of Boston & Affiliates is more relevant now than ever before.

We are there at the start of life and we are there at the end of life providing compassionate care so that patients have the best quality of life they can with dignity and independence. Here is a sampling of some of the comments we receive from our patients:

“VNA of Boston is consistently excellent! VNA has improved my quality of life & sense of wellness!!!”

“I was treated with the greatest respect and courtesy.”

“They made me feel safe and secure in helping me get better and made a good recovery in regaining my health back.”

“We have had multiple experiences - OT's, PT's, nurses - all have been great.”

“I was very impressed with the professionalism of all who helped me. Thank you very much!”

“The care was excellent and I would highly recommend the VNA to anyone. Everyone was great.”

Thank you all – to all the clinicians in the field and the staff in the office who support their work – for your expertise, your passion and commitment, and your contribution to the future of the VNA of Boston & Affiliates.

Rey

Nursing by Leg Power

2011-05-05T11:03:00.003-04:00

Here's the next post from Rebecca...

As I dig deeper into the agency’s history I am finding more and more information on the partnership between the VNAB and Simmons College. The two started cooperating in 1912 to offer academic coursework specifically for Public Health nurses. Simmons’ Department of Public Health Nursing was established in 1916 under the direction of Anne Hervey Strong, and in 1918 a full-fledged School of Public Health Nursing was created and run jointly by the Instructive District Nurse Association (known today as the VNA of Boston) and Simmons College.

This week, I would once again like to share something I found in the Simmons archive with much appreciation to an author from the past. The article, entitled Nursing by Leg Power (see below - apologies that it's a bit hard to read; if you click on the graphic, it will open in another window and may be easier to read) by Dorothy Deming, was published in November of 1929 in a journal titled The Survey. The Survey started as an in-house publication of the New York Charity Organization Society in 1902 and under the editorial direction of Paul U. Kellogg it became the “most eloquent and revered voice of the social justice wing of the twentieth-century American reform movement“until it ceased publication in 1952. (See note.)

I immediately liked the article as it is quite humorous. The author also artfully weaves in a wealth of information about what a Public Health Nurse is, what she does, how she is trained and the nuts and bolts of her vocation. Again, it is interesting to note the similarities with today’s visiting nurse experience…the challenge of defining exactly what a visiting nurse is, the diversity of cases seen, the complications of reimbursement, the extent to which education needs to be tailored for the visiting nurse and of course the uniform… just kidding! (I’m not so sure about the illustration comparing a visiting nurse to a mother monkey… but I guess in 1929, evolution was still a somewhat radical concept!)...

Note:

From a review of the book “Paul U. Kellogg and the Survey: Voices for Social Welfare and Social Justice by Clarke A. Chambers, University of Minnesota Press, 1971, review by Robert H. Bremner http://collections.mnhs.org/MNHistoryMagazine/articles/43/v43i02p072-081.pdf

VNA of Boston loses a dear friend

2011-04-29T21:58:00.001-04:00

The Visiting Nurse Association of Boston said farewell to Peggy Buckley this week. Here, from the Boston Globe, is her obituary. This will give you a good idea why she was so special... and why we'll miss her.

Traits that made her an accomplished social worker and a friend to whom everyone turned were apparent when Peggy Buckley was growing up in New York City.

“She had enormous insights into people and knew how to provide comfort and assurance to them, even as a young child,’’ said her older sister, Marlene of Bronxville, N.Y. “She would feel bad if another child was picked on at school. It bothered her. She always had an unusual sensitivity to the feelings of others when they felt hurt or wounded.’’

During about 40 years as a social worker in Boston, mostly in Charlestown and Dorchester, Ms. Buckley went beyond counseling clients. She worked to ease racial tensions during school desegregation and to reduce the number of lead poisoning cases among children.

Ms. Buckley, who since being diagnosed with cancer three months ago used her dwindling ability to speak to ask friends how they were coping and to give thanks for their care, died Monday in her Jamaica Plain home. She was 67.

“Over the past 20 years, she has helped thousands of seriously deprived and impaired clients reach their highest level of function,’’ Dr. Bennett Gurian, a former colleague of Ms. Buckley’s at Bowdoin Street Health Center in Dorchester, wrote in a nomination letter for the Bernice K. Snyder Award for excellence in social work, which she received in 2001. He added that “my life, as the only psychiatrist in this mammoth agency, has been made so much better by having Peggy Buckley as my collaborator.’’

As a clinician, Ms. Buckley “was always championing the underdog,’’ said her friend Tish Allen of Jamaica Plain.

Ms. Buckley also made time to champion the passions of her friends, as deft a social worker in private life as she was professionally.

“She was the most fantastic listener I have ever known,’’ Allen said. “You would have that feeling when you left of, ‘Oh, my God, I spoke 90 percent of the time.’ She would support you and make you the hero in her stories.’’

Ann Anderson of Jamaica Plain, whose friendship dates to when she and Ms. Buckley both lived in Charlestown, said: “Everyone felt free to tell her anything about anything. I think the single most striking thing about her, which is why she had so many friends, is that she was a wonderful listener.’’

That was also true when Ms. Buckley was a child, her sister said. Margaret Buckley, whose father was from County Kerry in Ireland and whose mother was from County Laois, was named for her maternal grandmother and grew up in the Bronx. While attending parochial school, she encountered classmates who had been wronged.

“She would come home and be very upset, and she would cry,’’ her sister said, “and my mother would suggest ways to handle it and how to approach the child and make the child feel better.’’

Ms. Buckley graduated in 1961 from St. Nicholas of Tolentine High School in the Bronx and went to the College of New Rochelle in New York, from which she graduated in 1965 with a bachelor’s degree in sociology. She became a volunteer through VISTA, Volunteers in Service to America, a national organization formed that year, and worked first in Richmond, Calif., developing youth educational and recreational programs. Then she moved to Chicago, where through the Hull House Association she worked with low-income adolescents, principally Native Americans and teens who had moved with their families from poor Appalachian regions.

“She was not in an office,’’ said her former husband, Zachary Klein of Jamaica Plain, who met Ms. Buckley in Uptown, a neighborhood on Chicago’s north side. “She worked with gang members who lived in the neighborhood we both lived in at the time.’’

Ms. Buckley, he said, “was very, very good at picking out leaders of kids and would work with the leaders in order to actually sway more than just that one kid’’ away from gang activities and back into school or toward programs that helped them earn general equivalency diplomas.

“She was always someone who believed in social work and that clinical social work was absolutely imperative in society, especially for poor people who couldn’t afford the services that the middle class got,’’ Klein said.

The two married in 1970 and divorced after moving to Charlestown, where Ms. Buckley was executive director of the Charlestown Community Center. Along with coordinating counseling, education, and recreation programs, she turned the center into a place where those with opposing opinions of court-ordered busing knew their views would be heard.

At home, Ms. Buckley and Klein voluntarily had their son bused to a magnet school in Roxbury, where he studied in a diverse student population.

“Peggy worked against racism, but she also understood there was a lot more going on here,’’ said Anderson, who lived in Charlestown at the time. “It was about people who had no control over their lives, except for their kids, and suddenly they didn’t have control over that, either. The community center was a place where it was safe to voice different opinions, but where there was a firm line drawn against violence.’’

Ms. Buckley received a master’s in social work from Boston University in 1978, the year she began working at Bowdoin Street Health Center in Dorchester. Along with counseling clients, she played a key role in a collaborative that helped reduce lead paint poisoning cases among neighborhood children. While at the center, she received a master’s in public health from BU in 1994, and “was very supportive to all the staff and helpful on a personal level,’’ said Kathy Cook, a pediatric nurse practitioner at the center. “If there was trouble with a shooting in the neighborhood and the family came in, she would not only console them, but she would help the staff deal with the trauma. She really did multiple roles.’’

Ms. Buckley, who spent the past several years working for the Visiting Nurse Association of Boston and Affiliates, vacationed with friends annually on Cape Cod or Martha’s Vineyard, always insisting they rent houses strategically positioned to be buffeted by restorative cool breezes.

She loved Christmas because the holiday brought families together, said her son, Matthew Klein of Brooklyn, N.Y., and took care to tell the story behind each ornament she placed on the tree.

“Materially, she was the opposite of self-indulgent,’’ he said, with one notable exception. She had a sweet tooth that was legend among family and friends. Sometimes when mother and son went out on errands, “we would stop at a corner store,’’ he said, “and she would let me get one treat, and she would get two treats. “She would say it was because her stomach was bigger.’’

Bryan Marquard can be reached at bmarquard@globe.com.

Twentieth Century Follies of the Public Health Nurse

2011-04-26T11:36:00.000-04:00

Our clinicians may not have to climb fire escapes every single day, but they still do go to great lengths to care for their patients.

Here's part two in the series from Rebecca...

While at the Simmons College archives looking for material on the relationship between our early organization (the Instructive District Nurses Association or IDNA) and The School of Public Health Nursing at Simmons, we found an absolute treasure….a 15 page book from November 1920 titled the “Twentieth Century Follies of the Public Health Nurse” filled with humorous and satirical poems, stories and cartoons written by the students and staff based on their experiences as visiting nurses.

The School of Public Health Nursing was founded in 1918 as a joint effort between the IDNA and Simmons College in order to provide college level training that was specific to the needs of public health, visiting or community nurses – one of the first programs in the country to do so. Up to this point, most nursing training took place in hospitals and the teaching was focused on issues faced by hospital patients and the nursing skills required for this population, as well as the unique needs of the particular hospital. The new School of Public Health Nursing was chronically short of funds in its early years and frequently appealed for support from both private and public sources. The students and staff created this book to help raise money for the school.

I will periodically share some of the gems from this collection – with GREAT gratitude to the original authors, who are unfortunately anonymous. I hope you enjoy these fun entries, many of which still strike a chord today!

An Everyday Occurrence

A call came into our office today

To visit a patient right away.

The flight was not known but you may know

‘Twas up to the roof where the nurse must go.

She finds the door and gently raps,

Gently, I say, for she’s near collapse.

With scarce any breath she asks the name

And would you believe it – it wasn’t the same.

She looks at her book to see if she’s right,

Where it is written in back and white.

She must call the doctor, and runs for a phone,

His message she takes with an inward groan.

“Did I say Blank Street? Oh, I meant Blank Alley,”

And out again we see her sally.

At last she reaches the highest flight

And wonders if the end is in sight.

She opens the door and walks into the room

She is greeted with tears as if some doom

Were there to stay, “Where is the patient?” we hear her call,

(Now wouldn’t this answer make you bawl?)

“She’s just gone to the hospital.”

History of the VNAB: The People, The Times and How We Became Who We Are

2011-04-18T15:45:00.000-04:00

VNA CEO readers know that we're celebrating our 125th continuous year as the very first Visiting Nurse Association in the United States. Thank you for your comments, questions and emails asking about our origins and storied history. I'm happy to announce that, starting today, our very own Rebecca Dempster, a talented writer and our education program coordinator, will begin the process of formally telling our story.

Here's the beginning...

My name is Rebecca Dempster and I am the Education Program Coordinator at the Visiting Nurse Association of Boston (VNAB). Over the next few months I will be a contributing writer chronicling the agency’s history and how it has been such an integral part of our community’s rich history. We are celebrating our 125th year in business, 1886 – 2011. Wow! That just goes to show what a great idea Miss Phebe G. Adam and Miss Abbie C. Howes had in 1885 and what an essential resource a visiting nurse is – then and now!

As we celebrate this anniversary we find ourselves gazing back over the decades and centuries. We dig out the boxes of old photos and see the serious and determined faces of our predecessors from the 19th century , the spiffy and energetic nurses of the mid-20th century and our coworkers at get-togethers from a the past 10 or 20 years. We revisit the bound volumes of annual reports sitting on an obscure shelf gathering dust, intending to spend a couple of minutes casually flipping through the pages, only to emerge an hour later having been drawn into the stories of the dedicated and passionate ladies who first envisioned visiting nurses in Boston and with vivid images of the valiant efforts of our first nurses.

This year, in addition to celebrating our 125th anniversary, we are also celebrating the re-establishment of our relationship with the School of Nursing at Simmons College – a relationship that was first formed in the early 1900s. We are working on exhibits displaying our rich history, so my colleagues and I headed out to the archives at Boston University and Simmons College to delve a little deeper into our past and to see what we could dig up in terms of original letters, articles and photos relating to important events in our history.

On a blustery day in March we were ushered into the Howard Gotlieb Archival Research Center at BU by Diane Gallaher, Nursing History and University Archivist. Diane issued each of us a pair of white cotton gloves, asked us to place all our bags, coats, sweaters, and scarves in a locked closet and to leave our IDs at the front desk. Then the 35 boxes of VNAB archival material were rolled into the hushed room. It was totally overwhelming and I couldn’t imagine how we were going to cover all this material. I randomly picked up Box 1 and started sorting through the collection of letters, notebooks and articles inside. While my colleagues efficiently absorbed the contents of several boxes, I sat there feeling pretty useless as I tried to decipher the spidery handwriting of Elizabeth Cordner, tried to understand what the Instructive District Nurses Association was, marveled at the extensive correspondence regarding fundraising and networking, and wondered who Mrs. Codman and her brother Ingersoll Bowdtich were.

Back at the office the next day I told anyone who would listen about how amazing these people were, and the amount of work that went into founding the VNAB and the energy and dedication that shone through all the activity revealed in that box of documents– and most of all how reading these documents brought to life what were otherwise just names on a page. I think I was starting to drive everyone crazy sending out long “Did you know….!” and “ Can you believe….!” e-mails, so the company has kindly offered me an outlet for my enthusiasm in the form of this blog and hopefully I will stop clogging in-boxes with my latest revelation!

As I read the original documents and think about our history, one of the things that drives me is a curiosity about the people – who they really were, what motivated them, what influences, personal and social, led them to do what they did. What were their strengths and weaknesses, how did they manage the work, did they like each other, was there friction, what were their family and social connections, did they do a good job? I also find myself curious about the social and political environment in which we operated and how that influenced the steps we took as an organization and perhaps how that differed from the track community health took in England. It is also interesting to see some of the same themes and concerns that we still talk about today: poverty, lack of education, infectious disease, chronic disease, tracking outcomes and finding money to keep the doors open. Does this mean that we have not succeeded in solving the public health problems we were facing 125 years ago and that we are still fighting the same battles? Or is it just the human condition, and the role of people in the “helping” professions is, and will forever be, to fight human tendencies that compromise our personal health and that of our communities and to support and facilitate change in behavior, provide opportunity, form healthy communities, and educate?

Lastly, just a couple of disclaimers before I finish up this week’s entry. I am not a historian and due to my limited time and expertise I am certain I will miss many events, that many of my thoughts will be naïve, and that I may even be downright wrong about some things. My guide is curiosity and my goals are to share some of the original material which would otherwise remain hidden away in boxes in archival collections, to put the path of our history into the context of what was happening in the world around us, and to try to bring to life the women…and even a few men, who played a part in establishing and the continuation of our venerable organization. Hopefully, in sharing what I find interesting and what I am curious about I will be able to create a kernel of interest in others. I also hope that readers will add their own comments, knowledge and reaction to the topics covered in the blog – and also perhaps suggest topics for investigation if you see a gap or are curious about something that an archival resource or a bit of historical research might shed some light on…or even to do some of investigating yourselves and share what you find! There are numerous on-line resources that provide Finding Aides for original material kept at repositories in Boston…the Massachusetts Historical Society, Boston Public Library, the Harvard Archives, Boston Atheneum – not to mention what we might find just scanning the VNAB bookshelves and looking in closets! Searching Google Books and the Boston Globe Archives can also be very informative.

Check back each week as I unearth and dive into the rich, sometimes ironic, but always interesting history of the VNAB.

Manhattan, tonight

2011-04-07T22:35:00.001-04:00

Face-to-face requirements set to kick in tomorrow

2011-03-31T16:42:00.000-04:00

This from the Visiting Nurse Associations of America. In short... bad news for home care agencies and the most vulnerable patients they serve.

VNAA Disappointed with CMS Decision and Pledges to Continue Improving Face-to-Face Requirements.

(Washington, DC) – March 31, 2011 – Jonathan Blum, Center for Medicare Management Director, notified the Visiting Nurse Associations of America (VNAA) and other national organizations via phone today that the Centers for Medicare and Medicaid Services (CMS) will stick with full enforcement of the face-to-face encounter provision effective April 1.

During the call to Kathleen Sheehan, Vice President of Public Policy for the VNAA, Blum said that CMS felt it was time to move forward with full implementation and that it would carefully monitor any problems that patients might face with access. While the face-to-face provision was put into effect on January 1, 2011, a grace period of 90 days had been granted by CMS before financial penalties for noncompliance would be levied.

The phone call was made to Sheehan in her role as the convener of a coalition of national organizations that have worked with CMS over the past couple of months to iron-out expected problems with implementation. Members of the coalition, which includes AARP, the American Hospital Association, the Catholic Healthcare Association, the American Medical Association, American Case Management Association, the Society of Hospital Medicine and the National Association for Home Health and Hospice had met with Jonathan Blum and CMS on several occasions to address implementation issues and asked that the grace period on financial penalties be extended for another 90 days to provide time to educate physicians about their new responsibilities and make system changes. The coalition's effort was unprecedented in terms of bringing together such a wide spectrum of beneficiary and provider groups behind regulations that impacts payment for home health and hospice services.

“We are deeply disappointed that more time was not provided as there was a strong consensus among diverse groups that it takes about 6 months for an educational and system change of this magnitude," said Andy Carter, VNAA President and CEO. "Our nonprofit members are most likely to take the risk of serving patients who may not have a primary care physician and may not be able to get the documentation done within the timeframe. Our goal now is to work with VNAA members and others to document and report the problems implementing this provision that will most certainly delay or limit access to care for some patients. ”

Carter also noted that while VNAA members and the Face-to-Face Coalition were not able to win a further grace period, they have worked hard to convince CMS to make the implementation less onerous and that they will continue to do so.

For more information, visit the VNAA's Face-to-Face Webpage http://vnaa.co/F2Fhelp.

Co-pays for home care

2011-03-30T16:13:00.001-04:00

The Massachusetts Home Care Alliance hosted an event for members of the Massachusetts elected delegation and their staffs. I had an opportunity to address them. Here are my remarks:

Thank you for the coming to our luncheon today and for this opportunity to speak to you about home health care.

I am Rey Spadoni, the President of the Visiting Nurse Association of Boston... an organization that is celebrating, this year, our 125th anniversary as the very first home health care provider in the United States. In the late 1800s, a group of bold and visionary women took note of the unmet needs of the most vulnerable members of the Boston area community... the individuals who were falling through the cracks of the then emerging network of infirmaries, clinics and hospitals. We are most pleased to be able to say that their vision is alive and well in our organization a century plus later as we continue to fill in those gaps for those among us who are, in fact, the most vulnerable.

I begin my comments by expressing our gratitude for all that you, your colleagues and our entire elected delegation from Massachusetts have already done for these members of our community and the agencies such as the VNA of Boston who care for them. Thank you for making us in this room the envy of our colleagues from 49 other states.

I also want to acknowledge that in my almost 30 years of working in the health care industry, I've never seen it like this before. It's a time of great change... and great stress.

There's no doubt that every one of us in this room believes in the importance of ensuring high quality home care services. Services that are good, dependable and consistent. There's also little doubt that all here believe that it's important to ensure access for every single person in our community.... whether they are people of means or people who struggle. But now, the third leg of the stool, the cost of health care, is front and center. Reigning in the escalating costs of health care has emerged as critical to not only preserving the health care system, but also in helping to address the larger economic problems and even long-term fiscal viability of our nation.

We certainly get that.

In the years I've worked in this industry, I have come into this building... sometimes talking about the issues of the acute care hospital industry, sometimes post-acute hospitals and on one occasion, the needs of federally qualified community health centers. On each occasion, I offered perspectives... perspectives you are all very familiar with... that each segment of the industry I represented at that time had unique needs and that we were part of the solution, not part of the problem. The points I made were legitimate.

But as I come here today to talk about organizations such as the VNA of Boston, I would like to point out two important differences between home care and the other parts of this industry.

First, we keep people out of those institutions. We keep people where they want to be most of all... in their own homes... living as independently as they are able... keeping families together... and providing dignity.

In the home care industry, we don't talk about the fixed costs associated with brick and mortar construction projects and we don't need to recoup R&D dollars associated with new and costly diagnostic technologies. We keep people out of those settings and in their own homes.

The second point relates to the fact that patients are being discharged more quickly and sicker than ever before from the hospital. Across the United States, 29% of all home care patients are readmitted to the hospital because their medical condition has deteriorated. At the VNA of Boston, that figure is 25%. It's 25% because we invest in training for our staff, focus on medication reconciliation, and deploy remote technologies into homes so that we know right away when a patient's condition requires immediate follow-up care. That 4% difference spread to larger populations... that is... paying for home care services instead of hospital readmissions, is a critical component of cutting overall costs in the health care industry. It is also a vital component of the emerging Accountable Care Organization movement.

If you or your colleagues have never been on a home care visit, I would like to invite you to accompany one of our skilled nurses or therapists on one. I guarantee that it will be eye opening and that you will enjoy it.

If you have not been on a home visit, I would like to tell you about one I recently made.

Pat, a 20-year home health veteran nurse, and I traveled together out to perform an admission of a 59 year old man named Richard. Richard lives alone in a large apartment complex in Quincy, Massachusetts. I learned upon arriving in his small three room home that Richard was honorably discharged from active service in Viet Nam when he sustained a nearly life-ending injury serving this country. The reason for our visit was due to a recent orthopedic related hospitalization, but the home care admission process requires a very thorough examination of a whole variety of health related topics... and thank goodness for that for Richard.

I couldn't help but notice as we entered his apartment that there was visible evidence of great patriotism everywhere, as well as signs of a hobby constructing intricate small scale models of 18th century ships. I subsequently learned that this was a long past hobby due to the advancing arthritis in Richard's hands. I also could not help but notice the multitude of prescription bottles on the coffee table in front of us. Because of Richard's arthritis, he can't contend with child-proof caps and so all bottles were open, with several tipped over, leaving a multicolored array of pills before us.

As I said, it's a good thing that the home health admission process calls for a thorough evaluation on a number of issues because it was during that process that Pat discovered a significant discrepancy between the medications listed on his hospital discharge summary and the one his primary care doctor had given him just a few months earlier. When questioned, Richard appeared to be confused over exactly which set of prescriptions he should be following. Rather than spending 45 minutes in his home, Pat and I were there for nearly two hours. During that time, Pat contacted the hospital staff first and then the nurse practitioner at the medical practice where his doctor works. She sorted through the complex set of drugs, focusing mostly on the ones he takes for diabetes, and ultimately came up with not only a game plan but also secured an appointment for him very next morning with his physician.

As she was on the phone dealing with this, I learned more about Richard. I learned about the reasons he is now homebound, I learned about the challenges he faces... including financial... and I saw firsthand just how much he trusts the VNA.

As we walked out of his apartment, Pat told me that it was likely that Richard would have experienced a significant medical problem, diabetes related, within days caused by the medication confusion. That problem would have most assuredly resulted in an ambulance ride to the emergency room and a 2 or 3 day hospitalization. That trauma, those additional expenses, were all avoided. Matter of factly, Pat told me "it happens all the time" as we drove away.

It happens all the time.

And so, I wanted to tell you about a proposal to levy $150 co-payments per 60 day episode of care upon patients such as Richard. MEDPAC has suggested the institution of these co-pays as a way to control Medicare spending.

When our nurses, who care for patients in the poorest neighborhoods of Boston, hear about this suggestion... they roll their eyes and tell us that most... most... of their patients will not pay them. They will prioritize paying for their prescriptions, their rent and food before they will pay for home care services. For most of our patients, age 80 and above, they are already spending 30% of their limited incomes on uncovered medical care.

At the VNA of Boston, we support initiatives that foster a greater degree of engagement and participation in health care decisions and costs... which co-pays are designed to do. But we have evidence that they are not the answer in home health care... having been tried before and eliminated in the 1970s when they were found to increase inpatient spending.

A recent "New England Journal of Medicine" article profiled 900,000 Medicare Advantage beneficiaries and the impact of new ambulatory visit co-pays. They found that for every $7,000 saved through the adoption of the co-pays, inpatient costs increased $24,000. Patients avoided the ambulatory visits, their health status had worsened... and their care cost our system more. Not only do co-pays not work for this population, they backfire.

We need your active help in preventing this mistake from happening once again.

Co-payments are short-sighted. They are ineffective. And unfortunately, they are cruel.

Please join in our fight to prevent them.

Thank you...

The Cherry Blossom Chill

2011-03-27T14:25:00.001-04:00

This weekend marks a most welcome start to the annual Cherry Blossom Festival in Washington, DC. This yearly rite ushers in expectations of warmer weather, sunnier skies and bursting beauty to offset the declining frost and grays of the season just ended. We sense great hope, we anticipate, and we are optimistic.

But as I peck this post onto the onscreen keyboard of my iPad (yes, I'm in Airplane Mode; I'll upload when we land), I wonder about the snow that is now falling in the city of blossoms. Our pilot just instructed us to expect a choppy ride as we descend into wintry conditions.

This weekend also marks our annual trek to Capitol city with our National Association for Home Care & Hospice colleagues to plead our case to elected legislators and the surrounding multitude of policy makers, regulators and analysts.

I recall last year at this time...

Rumors of forthcoming cuts to home health care reimbursement prevailed and so we readied strategies of pointing to evidence that home care is the solution... not the problem... in terms of escalating health care expenditures. On paper, we looked good. We were hopeful and we were optimistic. And we had good reason to be. Everyone who met us on The Hill told us they were on our side. They described themselves as The Good Guys and our hearts warmed a little to be surrounded by so many good guys. We clapped and cheered at luncheons and patted each other on the back in front of cheese trays and regal china.

But then the cuts did come...

And for organizations such as the VNA of Boston, agencies who don't skim off the topmost layer of best-paying customer cream, we reeled. We planned for difficult days and we hunkered down and readied for the storm. But would the storm linger... or pass by quickly?

That is the question as we prepare to descend into the wintry conditions of the "rebasing" and "copayment" talk now in DC. Talk that portends of more cuts.

And I fully anticipate I'll meet up with The Good Guys once again. They will tell us we are preaching to a choir and that our fight is with others. But our message this time is to enlist them in this fight, to request their entry into our fray.

The most vulnerable among us need that. The ones who are homebound... and who rely upon us to be their voice... deserve that.

Otherwise, it will all... once again... be merely frost upon a cherry blossom spring.

- Posted via BlogPress/iPad

foregone

2011-03-13T13:55:00.001-04:00

unaided...

2011-03-06T08:10:00.001-05:00

A Day on the Hill...

2011-03-04T20:30:00.001-05:00

This time, it was on Beacon Hill, the location of the Massachusetts Capitol and home base for the Commonwealth's government officials.

I, and two of my VNA of Boston colleagues, attended a reception hosted by our local association, the Massachusetts Home Care Alliance. Our positions:

Allow trained and certified home health aides to administer certain medications in the home.
Change how specific home health services are reimbursed, including paying for telehealth.
Establish a more equitable rate of payment of home care agencies providing continuous skilled nursing care to children.
And most importantly, create reasonable reimbursement rates for services provided to Medicaid recipients.

Pictured: Maria Dunn, RN,, clinical manager, and Janice Sullivan, vice president of external affairs.

From our meetings with representatives, it's clear that the process to develop a comprehensive and unified health care cost containment bill will be long and contentious. Despite Governor Patrick's proposals, it's likely he will have a long road ahead of him to push through the reforms that his bill contains. Some members of the legislature perceive that the Governor seeks a quick victory on this topic to aid in this emerging national role in pushing the President's own health reform law across the country. And not everyone's willing to play it seems.

Then again, no one predicted that the Massachusetts legislature would give then Governor Romney a health care victory he could tout for his own presidential ambitions. The Democrat controlled legislature did just that for the Republican governor... so, a decisive win for Governor Patrick could certainly still be in the cards.

Door to door scams still exist

2011-03-04T18:53:00.001-05:00

I was just visited at my home by a pleasant young man asking if he could see a copy of my most recent gas and electric bill. He said he was here in partnership with my energy companies. In fact, he noted, his company, "Just Energy", was doing this service for the energy companies' customers by switching the "underlying supplier" of the energy to a cheaper and greener source.

When I told him I was uncomfortable with giving this information to a stranger, he asked me whether I was uncomfortable with saving money. Uncomfortable with saving the planet.

Uhm... red alert.

A google search pointed out quite a bit about "Just Energy".

To which I reply, just be careful

When I'm 64

2011-02-27T15:41:00.000-05:00

I had a chance to see "Rain: A Tribute to the Beatles on Broadway" yesterday afternoon. In a word - breathtaking. Seriously.

As I was positioned halfway across the universe... er... balcony, I couldn't actually see the faces of the performers... and that's a very good thing. From my perch, they looked just like John, Paul, George and Ringo. And more impressively, they sounded just like them as well. The costumes, the wigs, the huge screens broadcasting scenes from the 1960s beside and behind the quartet all added to the illusion. And I, along with the entire audience, was happy to subscribe to it for a few hours on a February afternoon in Boston. It was the 1960s. We were the screaming fans in Ed Sullivan's soundstage and Shea Stadium. And it was the Fab Four right there in front of us. Breathtaking.

But here's the most impressive part. There were a lot of kids in the audience. And the vast majority didn't look as though they would all rather be sitting at a Justin Bieber concert, marking time because mom and dad didn't get a babysitter. No, these kids were having fun. And many of them were singing right along: "Shake it up baby..." "Yesterday, all my troubles seemed so far away..." "Speaking words of wisdom, let it be..." The 10 or so year old kid in front of me nailed every last word of "I Am the Walrus", right down to the last goo goo g'joob. Impressive.

As a child of the '70s, I didn't listen to any music from the '20s or '30s. But that would have been the parallel situation.

It looks as though the Beatles are going to be safe and sound for another generation or two. Thank goodness!

Only on a weekend...

2011-02-27T15:23:00.000-05:00

This was sent to me by a co-worker. As impressive as the "hand dancing" is, I found myself more impressed by the deadpan facial expressions and the bizarre backdrop.

Discussing End of Life Care

2011-02-23T11:17:00.001-05:00

Here's some great... and helpful... information from VNA Hospice Care. It's geared toward providers, but anyone considering hospice care for a friend or family member can benefit from the information here:

Understand that every discussion surrounding end of life care will be different. Each patient and family will have differing personal, cultural and spiritual concepts and experiences with death and dying. These will be brought to the forefront as you begin your discussion. There is no "one way" to have this conversation.

Don't expect the patient's physician to have done all the "heavy lifting" for you. Recent surveys, done both here and abroad, of physicians likely to provide care for someone who is dying reveal that only about 1/3 of them ever have open, honest and frank discussions with their patients about the fact that they are dying. A full 2/3 of these physicians have expressed discomfort with such conversations as well as a real willingness and need to learn how to do them better.

Before beginning any conversation review your own experiences with death and dying first. Examining your own thoughts, emotions and beliefs about death and dying will give you a focal point to work from and better prepare you for the questions, concerns and fears the patient and family may want to discuss. By understanding and being comfortable with the choices you would make, it will better help you to accept those they may choose to make for themselves.

Pick a time and place when the discussion can be done in a calm and unhurried manner. If your visit is a particularly task oriented one and procedures are your primary focus it may be better to set aside the discussion until you can visit again and have more time to talk and especially, listen. Any time a patient or caregiver brings up the topic first is the time to have the discussion. If you are the one initiating the conversation, include it into your plan of care as a priority as you anticipate the patient's condition declining. It is best not to have the conversation when there is a medical crisis already in play or the family is in turmoil over other issues.

Know about the patient's disease process and its likely progression. As importantly, explore with the patient and family what their understanding of it is. Are their goals of the care you can continue to provide realistic and consistent with what their condition now warrants? Are they in denial or do they understand the severity of the disease and are just having great difficulty in expressing their fears about it? If key words like "hospice" are likely to be problematic as you "break the ice", suggest rather that they may be interested in learning about another "level of care" from a colleague and friend you work with.

Know a bit about what hospice care can offer in the way of services. You do not have to be an expert in hospice care. Simply getting them to allow you to have hospice come in to provide a consultation for informational purposes will be enough. If you can, try to schedule that consultation for a time when you can be present in the home. You know your patient and family better than we do. Your presence during our first visit may greatly relieve any family anxiety over the consultation and will serve to educate all of us to better collaborate in the future.

Remember that help with initiating these discussions is always available to you 24/7.

Just give us a call and we can talk about what the issues are.

Question of the Month:

What is the single most common expression made by patients who are most likely ready to discuss hospice and palliative care?

Answer:

"I don't want to go to the hospital any more."

Hospital stays are no vacation. If they were, you could schedule a trip to them via your travel agent and skip the ambulance ride. We all have said this and no one ever wants to be re-hospitalized but when someone with a chronic, increasingly more debilitating illness says this, the question then becomes, is anyone really listening?

"I'm ready to refer a client for hospice services"

Call ext. 2888 or 781-569-2888 and ask to speak with our Referral Center

"I'm not sure; I need more information and help first"

Call the "Bridge to Hospice Hot-Line" ext. 6888 or 617-886-6888

And request a callback conversation

Nursing... through the years

2011-02-23T11:11:00.001-05:00

As we're celebrating our 125th anniversary as America's first home health agency, we thought it would be fun to consider "the nursing look" through the years. These dolls are on loan from our friends at HealthAlliance Home Health and Hospice.

We're creating a mobile display celebrating 125 great years of caring for the residents of Boston and Eastern Massachusetts. More to come...

The Elusive...

2011-02-16T23:06:00.001-05:00

Beach walker...

2011-02-15T00:33:00.001-05:00

President's budget Good News for home care... but don't take that to the bank just yet!

2011-02-15T00:20:00.001-05:00

Most industry experts have been predicting further cuts to Medicare reimbursement for home health care services in 2012. And most industry executives have been preparing, even if on paper, for the probable effects of those cuts on service offerings, access to care for vulnerable members of the communities they serve and employees. No wonder all eyes have been on President Obama's budget, which was just released and contains, for the time being, good news. The proposal contains:

$3.7 trillion in new taxes for oil and gas companies (a back door green incentive?) and high income individuals
increased spending on education
push out the so called "physician fix" which stabilizes Medicare physician payments
cuts to a variety of Federal programs and departments
new integrity (anti-fraud) programs for Medicare and Medicaid
no home health or hospice Medicare cuts

I'm currently attending the Home Care 100 conference and at a panel discussion today, Billy Tauzin, lobbyist and 25 year veteran of the U.S. House of Representatives (Louisiana) was quick to point out that the road ahead is long and that no one should take comfort in this... yet. The forthcoming Senate and House processes will quite possibly include new proposals to reduce home care reimbursements.

Health Reform: For or Against? What's your politics?

2011-02-03T15:35:00.001-05:00

The Kaiser Family Foundation recently conducted a ten question "pop quiz", asking Americans questions regarding the Health Reform law that passed last year. The results were quite interesting. In short, we didn't pass.

There remains a great deal of polarization and confusion regarding the actual law and provisions contained within it. To say it has been politicized would be a significant understatement.

The pop quiz contained questions regarding specific components of the law and Americans were asked to respond whether each was included or not in the final bill. For example, participants were asked whether the law contains 'death panels' (government run committees charged with making critical end of life decisions for beneficiaries). Hint: it does not.

Only 25 percent of respondents got seven of ten correct. Less than 1 percent got all ten right. Overall, 65 percent scored five or more answers correct.

Democrats (who mostly support the law) scored all ten right in 32 percent of cases. In contrast, Republicans scored 18 percent.

Six in ten Americans believe the law creates a government run health plan - it does not. Over 65 percent believe that all businesses must provide health insurance - smaller businesses, with less than 50 employees, are exempt, however.

Regarding death panels, four in ten believe they are contained in the new law. Again, they're not.

So, the House has decided to repeal the law (though the Senate did not) and legal challenges have caught fire across the country, particularly among Republican AG states. The politicization of the law continues, leading to great misunderstanding. It's part of our U.S. system to debate and politicize and I believe, ultimately, we're better for it. The unfortunate circumstance, however, is that managing and planning within the health care delivery system can become particularly challenging. Organizations such as the VNA of Boston are accountable to the patients we serve... who are often the most vulnerable. And who may be unlikely to care about these politics.

See all results here.

Penny wise, pound foolish

2011-01-18T14:37:00.000-05:00

The home health industry is just now beginning to grapple with the devastating cuts to Medicare reimbursement and now talk of a $150 co-pay for home care services has resurfaced. In some ways, the concept of co-pays makes complete sense. Adding co-pays defrays the growing cost of health care to our Federal budget and helps empower individuals by making them more aware of the cost of their care. The other side of the coin, however, must be considered. Past experience suggests that cash strapped individuals will forego care altogether in order to avoid having to shell out the co-pay. Sick patients often become sicker and then require far costlier visits to hospital ERs or even require inpatient stays instead. Additionally, many of the patients that mission-driven organizations such as the VNA of Boston see simply do not have the resources to cover a co-pay. Because we're mission-driven, we are faced with the dilemma: provide the care and lose the $150 revenue or walk away. We don't walk away...

Our national association, the Visiting Nurse Associations of America, had this to say today:

(Washington, DC) – January 18, 2011 – The Visiting Nurse Associations of America (VNAA), which represents nonprofit home health and hospice patients, strongly opposes re-instatement of co-payments for the home health benefit as recommended at MedPAC’s January 13-14, meeting.

While the formal MedPAC recommendation does not mention a specific co-payment, the figure $150 per episode was discussed. Under the MedPAC plan, the co-payment would not be applicable for patients that are discharged from a hospital or other post-acute settings but would apply to all community-based admissions.

For those who are eligible for both Medicare and Medicaid, MedPAC presumes that Medicaid would pay for the co-payment for community-based admissions – but there was also a recognition that States are in financial crisis and Medicaid agencies might be unable or unwilling to make the co-payment for duals. In addition, many individuals who live just above the poverty level would be unable to make a co-payment.

"A co-payment would create a significant access barrier for Medicare beneficiaries who need medically necessary home healthcare per their doctor’s orders,” said Andy Carter, President and CEO of VNAA. "These patients are much more likely to end up back in the hospital or another institutional setting at much greater costs," said Carter.

Congress eliminated co-payments in 1972 to encourage use of less costly, non-institutional services. VNAA will fight against co-payments because they do not work and they increase overall Medicare costs.

VNAA will work with other national organizations including those that represent beneficiaries to oppose co-payment. In an economy where many seniors and families are struggling to make ends meet, a co-payment does not make sense.
###

VNAA Contact:

Emily Swanson
202-384-1422
eswanson@vnaa.org

About VNAA: VNAA is a national association that supports, promotes and advocates for community-based nonprofit home health and hospice providers that care for all individuals regardless of complexity of condition or ability to pay. They provide comprehensive services for Medicare, Medicaid, uninsured, and privately insured patients. VNAAhttp://www.vnaa.org/ today.

How to shovel snow

2011-01-17T07:59:00.000-05:00

One of our great occupational therapists forwarded this to our staff right after the last blizzard.

I should have watched it...

reminds me of...

2011-01-13T16:21:00.000-05:00

The power of collaboration

2011-01-12T08:23:00.000-05:00

A guest post from our Vice President of External Affairs, Janice Sullivan:

This blog has recounted the VNA of Boston’s continuing efforts to ensure our outcomes exceed both state and national benchmarks. Many of these outcome measurements (found on medicare.gov/HomeHealthCompare) are intended to improve care for chronic diseases and to keep people out of the emergency rooms and hospitals. One of the indicators we pay most attention to is the re-hospitalization rate for our patients and I’m proud to say we beat state and national benchmarks here.

Our referral partners at acute hospitals around the state also are diligently working on initiatives to prevent unnecessary hospital re-admissions. Not only is it better for the patient, but hospitals won’t be paid for these readmissions very shortly. It all ties back to providing value in the health care system. More efficient and high quality providers will be rewarded, the others…not so much.

Work on this initiative can range from improving the discharge process and paying attention to smooth transitions of care to implementing comprehensive clinical processes to insure better care for patients with certain chronic diseases. And, we’d contend, successful initiatives will have a strong home health care partner at the planning table to see real progress in reducing unnecessary readmissions. Our hospital partners are acknowledging this as well.

At a recent joint meeting regarding these initiatives at one of our acute care teaching hospitals, Dr. Eric Coleman, a national expert on care transitions, facilitated a discussion of a patient and the patient’s history of readmissions. The selected patient had received services from the VNA of Boston. The hospital discussed their perspective of the patient’s care and the VNAB team discussed it from their point of view.

There was a rich and thoughtful conversation with many on the hospital side of the table and Dr. Coleman expressing their admiration for the work being done by the VNAB to have kept the patient out of the hospital for as long as we did. They were also struck by the fact that we grounded our treatment plan not only on what was best clinically but what was best from the patient’s point of view. The meeting ended with more in-depth understanding and learning by both the hospital team and by the VNAB team…with commitments to follow up individually and as a group.

Bottom line, this type of collaboration will lead to value for the health care system, better processes to ensure smooth transitions and most importantly, better care for the patient. My congratulations to the VNAB team of clinicians. They have persevered to improve the health and well being of a patient who is facing a myriad of complex health challenges in a complex and fragmented health care system.

"A perfect ending to her life..."

2011-01-12T08:09:00.000-05:00

Here's a nice letter sent by the family member of a recent patient at VNA Hospice Care. With his permission, I'm including an image of his letter here.

It speaks to the difference that high quality, compassionate hospice care can make to the family members of a patient. It also speaks volumes about our hospice staff and caregivers.

Punishing the Solution

2011-01-11T13:06:00.000-05:00

A collection of thoughts regarding the recent cuts to home health services:

I met a brand new mother whose son had just been discharged a day or two earlier from a high tech hospital neonatal ICU. The infant, born prematurely, suffers from serious heart defects and respiratory problems and has survived three complicated operations already. His eager, loving mother gingerly and anxiously held her baby, unsure and worried. Then the nurse confidently and reassuringly took hold of the child and weighed him on the portable scale she brought into the home. She placed a small stethoscope that she had warmed with the palms of her hands over the child’s tiny thumping chest and carefully examined him with skill and poise. After a few minutes, she turned her attention to the mom. The visiting nurse instructed her on how to care for the child and then, before we left together, showed the mother how best to hold him, teaching her that holding him often was best.

And then there was the elderly man who lives alone in a third floor apartment building. He felt bewildered and overwhelmed when the hospital staffer read his complicated discharge instructions and asked him to sign the triplicate hospital forms. When we entered his home the next morning, the physical therapist I accompanied, before he did anything even remotely resembling physical therapy, reviewed the discharge papers and carefully and clearly explained them to the man. And when we left forty-five minutes later, I marveled at the transformation I had just witnessed - a transformation where despair and confusion gave way to anticipation and hope.

Not-for-profit home health agencies, such as the Visiting Nurse Association of Boston, do not construct sprawling medical complexes and we do not purchase multi-million dollar technological marvels. The wares of our trade are exceptional clinical skills and limitless compassion…. all brought to the one place most of us want to be – not a high cost institutional setting but our own homes.

The recently passed health reform law rightly focuses on improving access to care and curbing the high costs associated with providing that care. Unfortunately, the home health industry has experienced substantial reimbursement cuts in the process. The logic holds that there are home health corporations and agencies that have been able to generate vigorous financial margins, thus suggesting that the Federal Government has historically overpaid for services. But organizations such as the VNA of Boston have never been motivated by the quest for financial margins. We began 125 years ago on the waterfront in Boston, seeking only to provide care for those who require our assistance and today we are the largest provider of home health care services in the region for those in need regardless of ability to pay. The VNA of Boston does not turn anyone away and our 125-year track record of doing so will never help us to generate vigorous financial margins.

We are preparing for over $2 million of cuts to our reimbursement, challenging our ability to continue to meet our mission and to remain viable. More importantly, the reimbursement cutbacks pressure the one segment of the health care industry that can unquestionably demonstrate that we are the most efficient and best health care investment for taxpayers. A typical four-day hospital stay can cost over $20,000 while a typical three-week visit from a home care provider will cost far, far less. In Massachusetts, 28% of all home care patients will ultimately be readmitted to the hospital during their home care treatment. By investing in state-of-the-art information systems, creating intensive training programs for our staff, and developing clinical centers of excellence in diabetes and cardiopulmonary disease and others, VNA of Boston patients are readmitted at a rate of 25%. That three percent difference applied to large populations can result in billions of savings annually.

Recent Federal payment decisions have left us besieged and distressed. If organizations such as ours do not survive, patients will be forced into more costly settings. The infants, mothers and seniors we care for today will not fare better without skilled and compassionate home care.

Access to care and reducing medical costs are worthy goals. Visiting nurse associations have been devoted to these goals for decades and, in our case, for over a century. We have not been the problem… we have been the solution.

Clever, nested...

2011-01-11T09:26:00.000-05:00

Photo by Dave Polette. For insight into how this was done, see here.

Shall we head out for Home again tomorrow?

2011-01-09T08:36:00.002-05:00

Adele is Back!

2011-01-05T21:09:00.000-05:00

Here's the first single.

New album due February 22nd.

Yes, I'm a fan.

echo

2011-01-04T22:32:00.000-05:00

We understand the problem, sir...

2011-01-04T14:37:00.004-05:00

I was sent a clip from The Boston Herald this morning, quoting Dr. Domenic Paolini on the topic of forthcoming Massachusetts health care reform. I don't know Dr. Paolini, but upon reading that he is a physician (heart surgeon, no less) and attorney, my interest was piqued. Here is someone uniquely qualified to comment on the matter, I thought... offering perhaps not only a great perspective, but also some possible solutions as well.

Unfortunately, the piece offers the often repeated arguments against reform, but no real suggestions otherwise. I've commented below on the specific elements of his case.

“When doctors lose money, patients lose lives, and limbs,” warned Paolini, a critic of the new health care payment plan state leaders will soon roll out.

That seems a bit dramatic. He certainly has my attention, though.

“When doctors aren’t adequately compensated, they need to see more patients, and because there’s only so many hours in a day, they spend less time with patients, and less time preparing for patients, and that’s when accidents happen.”

I agree with the underlying concepts here. Inefficiencies in our system, of which there are many, and shortages of key clinical personnel, which are well documented, do cause doctors to spend less time with patients. The ever expanding paperwork requirements, which the home health industry is certainly also experiencing, also force clinicians to divert their attention and time away from the valuable skills they've acquired and toward less productive administrative tasks. But... those tasks have been mandated by the need to standardize treatment protocols and to drive toward higher quality outcomes as well as the fact that some opportunistic providers and their agents have fraudulently billed for reimbursement. Both have resulted in more demanding documentation requirements. And more paperwork.

And for the record, doctors do need to be "adequately compensated". The rigors of training and the personal sacrifices necessary to motivate college students through pre-medical programs and onto medical schools, residencies and advanced speciality training programs are real. We want our top students to heed the calling to become physicians and to withstand the many challenges facing them as they pursue that goal. Skimping on physician compensation is most decidedly not a viable solution to the perennial health care cost crisis.

By month’s end, Gov. Deval Patrick and the state’s most powerful legislators are expected to make national news, with a bill that aims to curb health care costs by changing how we pay for care.

If the bill becomes law, insurers will stop paying doctors for each test and office visit, and implement “global payments” and “accountable care organizations.”

All this means that in the future, insurers and the government will put doctors’ groups and hospitals on an annual per-patient health care budget, by giving them a lump sum of money to spend on care. Eventually, supporters say, doctors will stop treating a specific illness, and start treating the whole patient. And, they say, as our collective health improves, we’ll wind up paying less for health insurance.

It sounds great, but Paolini isn’t buying it. He’s skeptical because the architects of this plan claimed in 2006 that once everyone had health insurance, our premiums would nosedive, and that patently hasn’t happened.

Reaping the benefits of providing reasonable health coverage, including primary care services, will take far longer than four or five years to realize. The investments in a person's health status when he or she is twenty years old may not prove out until a heart attack and complex cardiac surgery is averted thirty years later.

Additionally, we were paying for the uninsured population to receive care through the "Free Care Pool" and other even more obtuse funding systems. And these costs were spiraling upward, causing premiums to rise.

Of this latest initiative, Paolini said, “We’ve already tried this, but back then it was called managed care, and that began when businessman decided to move money out of the health care system, and into their own pockets,” he added.

To make that happen, he said, the government and the insurers began slashing doctors’ pay.

“All the other money was going into the bureaucracy, the $2 million-a-year hospital administrators and the insurance companies,” he said, adding that they are the ones who have the governor’s and legislators’ ears. Take the money away from doctors, and watch the case loads and errors rise, Paolini said.

Even casual observers would conclude that in the recent health reform debate, physicians had "the governor's and legislator's ears", so I don't believe that lack of advocacy effectiveness is the real issue here. Additionally, the "into their own pockets" argument is shallow at best. Yes, some insurers and executives have benefited, but administrative costs are still a small fraction of total health system dollar outlays. Additionally, the increasing complexity in the system driven by anti-fraud programs and the quest to develop better information systems and quality programs are expensive. Payers, as well as providers, have had to bear those costs too.

Dr. Paolini does not talk about some of the other, perhaps bigger, problems. These include:

The home health industry is currently experiencing very dramatic Medicare reimbursement cuts. Yet... as has been argued in this blog, the cost associated with the provision of high quality home care services pales in comparison to the cost of institutional inpatient and emergency care. For example, VNA of Boston clinicians are able to keep a higher proportion of patients out of the hospital than Massachusetts and U.S. averages suggest (25% readmission rate for VNA of Boston vs. 28% and 29% respectively). Yet we are being cut at a disproportionately higher rate than other sectors.
Our aging population poses an ever increasing strain on our limited health care resources. We're living longer and needing more operations, more diagnostic procedures, more medications and then, institutional care for longer periods of time. I'm not arguing that we deny these services to these populations... only that we stop denying how much this all is costing us.
Palliative care is still viewed as "giving in" as we cling to life and hope for miraculous and intensive life saving cures. There is nothing inherently wrong with this, but by the same token, we ought to recognize and encourage approaches that offer compassion and comfort when all professionals concur that the miracle cure isn't coming.

The health care cost and access conundrum isn't going away soon, despite the passage of Massachusetts and now National reform laws. The problem is well understood, but simplified explanations involving fat cat insurance executives and threats of medical mistakes and death do little to promote dialogue and problem solving.

clarity

2011-01-03T21:57:00.000-05:00

that kind of day

2011-01-02T09:33:00.001-05:00

Beautiful voice tackles beautiful song

2011-01-02T09:24:00.002-05:00

fresh start

2011-01-01T19:25:00.002-05:00

the coming of another

2010-12-31T18:51:00.002-05:00

Out of tragedy...

2010-12-30T11:01:00.003-05:00

This past summer, I wrote about a tragedy that took place when a local family vacationed on Martha's Vineyard... and our Hospice's efforts to help with the healing and grieving process. See here.

We recently received a nice letter from the Executive Director of Hospice of Martha's Vineyard which spoke of the efforts of our own David Quemere.

Here's a copy of that letter... with a big thank you to David and our exceptionally compassionate caregivers at VNA Hospice Care.

Hint: If you click on the letter, you'll be able to read it in a separate (and bigger) window - depending on which browser you're using.

Planning End Game

2010-12-30T10:01:00.000-05:00

I believe it's how we're hardwired, how we approach life. Some of us love to live in the moment and some of us love to plan. Some of us experience a thrill in not knowing what's around the next bend, others of us feel anxiety when the road ahead is unclear, uncertain.

Some of us focus on only the very next chess move. And some of us plan two or three moves ahead.

Don Schumacher, head of the National Hospice and Palliative Care Organization (NHPCO), has some common sense advice about planning two or three moves ahead...

December 28, 2011

NHPCO President and CEO Don Schumacher has an opinion article posted on CNN.com that we want to share with members. The article can be found on the CNN website and is copied below.

Why end-of-life planning is smart, necessary.

By J. Donald Schumacher, Special to CNN

(CNN) -- Thinking about death can be frightening, no matter your age or medical condition. As we get older, the reality of our own mortality tends to come into clearer focus; this doesn't make talking about death or life-sustaining treatments any less frightening though.

It was fear -- stoked by certain politicians -- that led to the inaccurate and misguided "death panel" rumors that surrounded health care reform proposals last year.

Beginning January 1, Medicare will reimburse physicians who advise patients, in voluntary discussions, about their preferences for end-of-life care treatment during their annual Medicare "wellness visit." This is advance care planning, and it is a good thing for seniors, their families and health care professionals.

It's not new. In 2008, President George W. Bush signed legislation that allowed end-of-life planning to be part of a patient's "welcome to Medicare" exam. Health care reform turned the welcome visit into an annual wellness visit. And now regulations clarify that these important discussions will be covered should the Medicare beneficiary wish to take advantage of this opportunity.

Advance care planning allows a person to make his or her wishes and care preferences known before being faced with a medical crisis. Advance care planning is simply smart life-planning.

Another way to think about advance care planning is that it's like planning a trip to an unfamiliar destination. If you're like many people, once you have your destination in mind, you begin mapping the route you will take to get there. Some people consult AAA or Google Maps to help them chart their course. Other people talk to friends and family members about their experiences on their trips.

While people approach mapping their route in differing ways, few would expect to arrive at their destination safely and comfortably without having a well-thought out map in hand before hitting the road. Yet only 30% of Americans have a living will, a map detailing where they want their health care to go should they become unable to voice their wishes.

An individual's personal wishes, beliefs and values are among the most important factors when making care decisions brought about by a serious or life-limiting illness. Such wishes and preferences can be known only if they are discussed openly.

Research has shown that patient-physician discussions result in a higher quality of life for patients and their family caregivers facing the end of a life.

By having Medicare cover these voluntary consultations, beneficiaries will be able to get information that will help them make their own decisions about their care and what they would or would not want at life's end. And it's only appropriate that patients should be able to have these discussions with the very physicians who have been caring for them and that these doctors be compensated for this valuable service.

An advance care planning consultation is not about limiting or rationing care. It's not about hastening death. It's not about having choices made for the patient. It's not about saving money.

Advance care planning is about examining options, planning and communicating the choices that the individual wants -- either to limit treatments, accept all treatments or something in between. The course charted is decided by individual patients, not their doctors, and certainly not the government.

Advance care planning includes completing a living will and appointing a health care proxy.
A living will charts the course for your health care, letting your family and health care providers know what procedures and treatments you would want provided to you and under what conditions.
A health care proxy or health care power of attorney form allows you to choose someone you trust to take charge of your health care decisions in case you are unable to make those decisions yourself.
Advance directives, as these documents are also known, can be changed as an individual's situation or wishes change.
Based on my 35 years of experience running hospice programs and caring for people at life's end, I know firsthand that frank, open discussions with one's health care providers can relieve anxiety about a situation that we all will one day face.

It makes sense that Medicare help facilitate this important planning.

The opinions expressed in this commentary are solely those of J. Donald Schumacher.

ADVOCACY WORKS!

2010-12-28T16:32:00.001-05:00

If you've been following this blog, you know that the Centers for Medicare and Medicaid Services (CMS) have imposed significant new physician face-to-face documentation requirements along with the dramatic funding cuts... all set to hit on January 1st.

Well, there's some good news to report:

Thanks to the advocacy of our Federal delegation and support from our partner physicians including Board members Drs. Bob Witzburg and Juergen Bludau, last week, CMS announced that they will provide a three month transition period for enforcement of the face-to-face encounter requirements.

I want to emphasize that CMS is requiring, and VNAB will meet, the January 1, 2011 implementation date of the face-to-face encounter rule. The difference is that now we have three months to iron out the kinks in the system and to work with our physician partners to ensure that patients do not lose access to home health care services while we proceed with implementation of the rule.

Our VNAB team has done a fantastic job getting our systems and processes ready for implementation of this rule so I am confident we will move forward internally with minimal disruption on January 1.

Innovation, the key...

2010-12-28T11:48:00.000-05:00

Though the year had a few bumpy spots (for example, "antenna-gate"), I'm wondering if any company in the history of commerce has had a better year than Apple did in 2010. Here's a "fanboy summary" (I didn't coin that) that's floating around the internet.

Makes you think about the role of innovation and exceeding customer expectations again and again and again...

The Post Office has nothing on us...

2010-12-28T11:24:00.000-05:00

From an email to all employees:

"That's what team work is all about..."

So says our own Dan Pagliuca when I thanked him for driving a clinician to a home in the North End during yesterday’s snowy weather.

Because last winter was so uncharacteristically mild, I never had a chance to see firsthand one of the facets of VNAB & Affiliates’ reputation - that inclement weather doesn’t deter the staff and managers from rising to the occasion and providing care to those who most need it. Well, that changed yesterday… and I was able to witness why our organization has deservedly earned that reputation.

This email is a big thank you to everyone who successfully contended with the challenges of the recent blizzard. Over the past 24 hours, I’ve heard numerous stories of commitment and persistence for which I’m grateful. Some of those stories relate to night and weekend staff and managers working hard to make sure that “must see” patients were seen, team members withstanding rough commutes to get to the office, clinicians navigating parking bans and employees volunteering to transport our staff members to patients’ homes.

Again, thank you to all who contributed.

Rey

sMall

2010-12-21T16:53:00.002-05:00

Would you hike this trail?

2010-12-19T19:42:00.000-05:00

"This walkway now serves as an aproach to Makinodromo, the famous climbing sector of El Chorro in Spain's Andalucia. And it is the hairiest path. The area of El Chorro situated in the south of Spain is renowned amongst travelers and mountain hikers for its stunning scenery and climbs, yet this is not the main attraction on offer, El Chorro is host to one of the most dangerous walkways in the world, built by workers to transport materials between the Chorro and Gaitanejo Falls." Source here.

Had it all happened in 2010

2010-12-19T19:07:00.001-05:00

Regardless of your religious bent, you have to admit that this is clever.

chill bound

2010-12-18T08:42:00.000-05:00

Party Metronorth style

2010-12-17T21:00:00.000-05:00

25+ years! Congratulations Jean and Peg...

An unbalanced delay tactic?

2010-12-16T14:06:00.001-05:00

Health reform unconstitutional? So says a Federal judge in Virginia. The center of this brewing storm relates to the ability of the U.S. Government to mandate that individuals purchase health insurance coverage.

And today, attorneys from 20 states have petitioned to have the new law overturned on the grounds that it will expand the government's powers in dangerous and far reaching ways.

I'm contrasting these actions with the comments of both Democratic and Republican Congressional staffers during our visit to Washington DC a few months ago (pre-midterm elections). The prevailing sentiment was that no matter the outcome of the elections, there would never be enough political vim and vigor to overturn the reform law.

But the issue they did not address was whether or not there might be enough legal basis to attempt to accomplish the same task. The legal challenge has been brewing for a while, but the recent decision in Virginia and the persistence of the 20 anti-reform states lends credence to the argument that legal action (or inaction) could tie up implementation of the major provisions of the law so as to render it largely irrelevant. I've asked a few attorney friends to comment on whether there is enough legal standing to truly impact reform law implementation. The emerging consensus view seems to be that the legal challenges may not have a great likelihood of holding water... yet, they may force substantial delays and postponements of key milestones such that a future Congress (which could actually have the votes to reverse major reform provisions) could take up the issue.

This is reminiscent of the onetime Massachusetts health reform deal crafted during the Dukakis Administration but then carved thin by the effects of time and ensuing economic crises which pushed it so far toward the back burner that it fell off the stove.

The home health industry does not have the luxury of waiting to see how these legal and political theatrics resolve. Massive Medicare reimbursement cuts are upon us now. Draconian face-to-face and documentation requirements are due to hit next month which will likely have the unintended effect of reducing access to services for the most needy among the populations we serve. I fear that the high impact provisions on home care will hit now while many of the downstream provisions will ultimately be delayed or even dropped.

If we're going to have these delay tactics, it would be best if their impact could be fairly distributed...

Farewell, friend of hospice movement...

2010-12-16T13:37:00.000-05:00

This from Carol of our VNA Hospice Care:

Elizabeth Edwards, long an advocate of hospice care, died on December 7. Her lengthy illness and death received extensive media coverage, and much of it referenced her passionate support for hospice. For that support, Edwards was named NHPCO’s 2009 Person of the Year.

Edwards spoke at the 2008 NHPCO Clinical Team Conference several years after her diagnosis with breast cancer. On that occasion, Edwards said, “Throughout my life, both personally and professionally, I have had the opportunity to see how people have been affected by illness and loss and the role the healthcare system may have played as they dealt with change in their lives. I also know that people can find a great deal of hope, even in the most challenging of life’s situations. Hospice and palliative care professionals support and care for people at a time when hope can be hard to find. The professionals of NHPCO know more than I will ever know about providing that care; I know more than I wish I knew about receiving it, and I am happy to share my perspective with them.”

Edwards, who at 61 still had two young children at home, continued her treatments until her physicians suggested it was time to stop. MarketWatch blogger Kristen Gerencher wrote of her, “Recent research suggests that starting palliative care early — at the time of diagnosis — can actually prolong life and not just increase its quality. That doesn’t mean you have to give up on aggressive treatments, and it sounds like Elizabeth Edwards went that route as long as she could and as long as that made sense to her. Maybe her life and death will usher in a new era of frank talk about what end-of-life care can be when people have grown-up conversations about the trade-offs of various approaches.”

Politics Daily’s Eleanor Clift, herself an ardent champion of hospice since her husband’s illness and death, said, “Their time in hospice, brief as it was, allowed the Edwards family – Elizabeth and John, and their grown daughter Cate – to re-visit old wounds along with the new ones that ended their marriage. Seeing a loved one on his or her death bed tends to focus the mind, and for Elizabeth, who was courageous and clear-eyed all along about the progress of her disease, hospice gave her and her estranged husband a chance to heal those wounds, forgive each other, and sort out what they want for their children, Emma Claire and Jack, who are very young.” (Politics Daily)

Holiday fun at our Southwest Office party... more fun coming today!

2010-12-16T13:29:00.000-05:00

25+ Years of Service! Congratulations Sue, Katy and Annette.

notion

2010-12-14T22:10:00.000-05:00

strangers

2010-12-13T19:41:00.003-05:00

A story about talent, a Mac and the power of Youtube...

2010-12-11T08:30:00.000-05:00

According to my brother, Rob, film professor at Case Western University:

this guy shot the location footage for this film in a week

then spent three years on his mac

within a week after posting this on youtube, he was in hollywood fielding offers. he directed the film 'monsters,' out now

Myths Surrounding Hospice

2010-12-09T13:15:00.001-05:00

From VNA Hospice Care:

Due to the mystery of death and our inherent fears of the unknown, the word “hospice” has taken on negative and to some, perhaps, frightening connotations.

Myth: “Hospice hastens death”

Hospice does not hasten death nor does not it condone, participate or philosophically agree with the practices of euthanasia or physician-assisted suicide.

Hospice is the antithesis of such practices. Hospice care is about living your best quality of life until you die naturally.

Several recent studies have been done that show people who access hospice care earlier in their disease processes live longer and better lives than those who did not.

Myth: “Hospice withholds treatment”

The type of the care that someone receives while still hoping for cure changes as cure becomes less likely. People mistake this change in care as a lessening or a “withholding” of what is often called “aggressive” treatment. Hospice is just as “aggressive” about the care that is provided as any other form of health care.

Patients on hospice routinely still receive chemotherapy, radiation, dialysis, blood transfusions, intravenous or enteric nutrition, physical/occupation/speech therapies and diagnostic work-ups, for as long as this care is medically appropriate and indicated.

Myth: “Hospice is only for the hopeless”

The nature of hope changes throughout our lives. When we are young we hope for success, happiness and many other things for ourselves and for those we love.

When we become sick, we hope for cure and when cure is no longer possible, we hope our remaining days are ones of comfort, dignity and ones in which we are surrounded by those we love.

Hospice care is about hope.

Question of the Month:

My patients always worry that if they go onto hospice services and have to sign a “DNR” they will no longer be able to access the hospital and will loose their doctor.

What should I tell them?

Answer:

Patients do not need to agree to be “DNR”. This is a choice they make and does not affect their ability to access hospice care or the hospice benefit in full. They can continue using the same hospital for any of their care needs, as necessary, and they will keep the same doctor they have come to know and love. Nothing changes.

Want to learn more? Click here.

The 17th ANNUAL HOLIDAY EXPRESS TRAIN RIDES AGAIN!

2010-12-08T13:25:00.000-05:00

Press Release:

Boston, MA - On Sunday, December 5^th the VNA of Boston’s 17^th Annual Holiday Express Train Ride chugged along the Haverhill/Reading Commuter Rail line filled with nearly 2,100 passengers dressed in their best holiday pajamas. The non-stop, hour and fifteen minute train ride departed from the Malden Center Commuter Rail Station and made stops picking up passengers at the Melrose Cedar Park Station and the Reading Depot Station.

Over 65 student volunteers from Malden, Melrose and Reading High Schools spent the day as Santa’s elves, enchanting the children with their magic and enthusiasm. The children enjoyed a visit from their favorite cartoon characters that came to life especially for the ride. Elmo, Winnie the Pooh, Tiger, Frosty the Snowman, the Cat in the Hat and Rudolph the Red Nosed Reindeer helped celebrate the much anticipated visit by Santa Claus. After a reading of “The Polar Express” by Santa’s elves, cookies and milk were served along with a gift bag and a coloring book! The children sang along with the holiday music, drew in their coloring books and in keeping with tradition, each child received a silver bell from Santa’s sleigh.

The VNA of Boston’s ability to care for our communities most vulnerable members is highly dependent upon the success of annual fundraising events like the Holiday Express Train Ride. Last year, through the generosity of our supporters, our Free Care Fund allowed us to care for 500 patients without insurance or resources to pay for their care. Additionally, our Maternal Child Health Program provided direct care and specialized support services to almost 2,400 children and their families, making it one of the largest programs of its kind in Massachusetts.

holiday

2010-12-08T08:43:00.000-05:00

Cobweblog?

2010-12-02T08:39:00.001-05:00

Yes, it's been a long time...

No, this blog isn't dead...

Thanks for your emails. Lot's happening here in the real world... but know that more posts are coming soon.

Thanks,

Rey

- Posted using BlogPress from my iPad

Glad I had my camera...

2010-11-21T20:03:00.000-05:00

reflections of

2010-11-20T11:11:00.000-05:00

Best post-Beatles Beatles song?

2010-11-20T09:58:00.000-05:00

And by none other than "the quiet one"...

The Classical Music of our Generation?

2010-11-18T23:26:00.002-05:00

Nearly 50 years later and still so, so good.

Here, Sir Paul is joined by a collection of high achieving buds.

Death panels?

2010-11-18T17:27:00.002-05:00

You may recall that during the recent prolonged health reform debate, opponents of the then proposals cited the inclusion of "death panels" as Federally mandated authorities who could deny Grandpa necessary care and instead, send him off to die in a, perish the thought, hospice. Unfortunately, a debate that focused on governmental empowerment cast an unfavorable light on hospice care. That was most definitely unfortunate.

Yesterday's Boston Globe included a piece regarding the significant (and concerning) finding that where you live makes a material difference to where you'll die. And despite the fact that 80% of us would prefer to die with dignity, with the ones we love, and at home... in some locations that's less likely. According to the article:

Researchers at the Dartmouth Atlas Project in Lebanon, N.H., analyzed the records of 235,821 Medicare patients ages 65 and older who died between 2003 and 2007. Overall, the researchers found that one-third of patients spent their last days in hospitals and intensive-care units. But there was a big range. At one end was Manhattan, where 46.7 percent died in the hospital. In contrast, 7 percent of cancer patients died in the hospital in Mason City, Iowa.

While chemotherapy and other aggressive procedures can prolong life and enable some cancer patients to return home and to work, studies have shown that these treatments have little or no value for frail elderly patients and those with advanced cancer. But 6 percent of patients received chemotherapy in their last two weeks of life, and the rate was much higher — more than 10 percent — in some places, the researchers found.

Similarly, more than 18 percent of cancer patients were placed on a feeding tube or received cardiopulmonary resuscitation in their last two weeks of life in Manhattan, compared with less than 4 percent in Minneapolis.

Use of hospice care also varied a lot. In at least 50 academic medical centers, less than half of patients with a poor prognosis receive hospice services, the researchers found. And in some hospitals, patients were referred to hospice care so close to the day they died that it was unlikely to have provided much comfort.

Some of these findings are understandable. Hospitals and the physicians who work there are driven to heal and to save lives. In the distant past, most of us expected that we'd someday die in a hospital. Today, we'd rather not. In the not so distant past, referrals to hospice were greeted by patients and their families as admissions of failure and generated disbelief and denial. Fortunately, that is changing as a growing proportion of the public has positive hospice experiences with loved ones.

To learn more about hospice care, click here or call 781-569-2888.

Beatles on iTunes today!

2010-11-16T21:33:00.000-05:00

This is my bank account talking:

Compassion counts...

2010-11-16T08:29:00.000-05:00

... because it's not only nice, it's also necessary.

We've all been patients. We've all experienced, hopefully, the warmth of an empathetic caregiver. The confidence that comes from knowing that the clinician before us is actually listening to what we're saying. And the reassurance that comes from seeing that the information is being properly recorded somewhere so that others won't need you to repeat your entire story, word for word... five times. Put that all together, and it's the value of compassion. Unfortunately, most of us have experienced the exact opposite too.

See today's boston.com piece regarding The Schwartz Center survey of patients and physicians on this topic. Here's the link.

According to the article:

Dr. Beth Lown — a Mount Auburn Hospital internist and medical director of the survey’s sponsor, the Schwartz Center for Compassionate Healthcare — said she was encouraged that most doctors thought such factors could make a difference in whether a patient lives or dies.

“I think this is a knockout,’’ she said in an interview. Some “doctors feel that medical skills and scientific knowledge are the only things that turn into good outcomes. . . . I think all patients have always wanted emotional support, but it hasn’t always been in the doctors’ lexicon.’’

The survey found that doctors and patients agree on the importance of most but not all components of compassionate care, which include showing respect, listening attentively, giving information in a way that is understandable, involving the patient in medical decisions, and treating the patient as a person and not a disease.

As we continue (and for largely good reasons) to further specialize our health care industry, we also continue to depersonalize it as well. With more and more pockets of capabilities emerging, the gaps between those islands can grow and widen. Systems of care which emphasize filling those gaps and ensuring the highest levels of compassion will emerge and win in this rapidly changing industry. Expect studies such as the one cited here to continue to punctuate this point.

Some are just born with the gift...

2010-11-13T18:39:00.001-05:00

presence

2010-11-11T21:05:00.002-05:00

Holiday Express Train Rides Again!

2010-11-11T07:44:00.000-05:00

One more announcement for today. This one fun:

It may still be a bit warm outside, but the VNA of Boston is looking forward to snow covered lawns, red noses and Holiday cheer! On Sunday, December 5th we will once again board the Holiday Train to the North Pole for the 17th Annual Holiday Express Train Ride and would like to invite you to join us for this magical journey!

Each year, more than 2,000 children, parents and grandparents from Malden, Melrose and Reading chug along on a magical train ride to the North Pole. This cherished annual community event features the much-anticipated reading of The Polar Express by elves from the North Pole, gifts and treats, and Santa himself.

If you would like to be involved with the Holiday Express Train Ride, please consider placing an ad in the Coloring Book which is distributed to each child and kept as a keepsake by parents. You could use this opportunity to advertise your business or feature a coupon or sales event. The goal of the event is to raise vital funds for our Maternal Child Health and Charitable Care Programs, which provide home and community-based care to the most vulnerable and needy children and their families in the areas of maternal child health, infant and pediatric care, early intervention for developmental delays and social work support for at risk families. Please call the Development Department at (617) 886-6460 with any questions or to learn more about how you can get involved in this wonderful annual tradition.

A new educational partnership

2010-11-11T07:40:00.002-05:00

The VNA of Boston is partnering with Simmons College with the “Partnership for Advancing Home Care Education and Practice.” The two organizations hope to both educate and train home health professionals for the future and advance home health care practice and education – all ultimately intended to improve care for patients.

“Through this partnership we can access resources and experts at Simmons who can help us translate research into clinical practice to improve outcomes,” said Adele Pike, Director of Education at the VNA of Boston. “Our staff may also have the opportunity to collaborate in research and quality improvement projects with the school.”

Currently, staff from the VNA of Boston is working on a web-based home health care library for Simmons’ faculty and students. Simmons students can participate in the VNA of Boston’s CareLinks programs, which provide clinical placements for the students and enhances the agency’s presence in assisted living facilities and elderly housing programs throughout Boston. Pike concluded, “It’s a win for us, for Simmons, and ultimately our patients and our community.”

Innovating...

2010-11-11T07:39:00.001-05:00

As recently reported in our Homecoming newsletter:

The VNA of Boston is committed to providing the residents of Greater Boston with efficient, quality, patient centered care. To better serve our community and some of the high risk health problems it faces, Clinical Centers of Excellence (CCEs) were established with focuses in Cardiopulmonary Disease, Diabetes, Maternal Child Health and Wound Care.

Our clinicians care for over 12,000 patients each year. Over 2,900 of those patients have cardiopulmonary issues, 2,600 struggled with diabetes, 2,582 are new mothers and more than 3,000 needed assistance with wound care.

The creation of CCEs will assist us in improving clinical outcomes by ensuring that the care we provide is based on evidence and is continually improving. In each of the next four issues of Homecoming we will go into more detail on each of the CCEs.

A sign of our times

2010-11-07T15:03:00.000-05:00

I'd bet good money the Windows Phone isn't much to write home about, but this commercial? Simply brilliant. And a true commentary on life in 2010.

sometimes, the sky

2010-11-07T09:19:00.000-05:00

Thinking of getting a car like this...

2010-11-06T13:13:00.000-04:00

another look see

2010-11-05T22:09:00.000-04:00

iPad and Modern Medicine

2010-11-05T09:01:00.000-04:00

I've been touting the many endearing characteristics of the Apple iPad since it's launch earlier this year. A few recent reports have noted that the iPad comprises over 95% of all tablet sales (can you even name another tablet on the market?) and industry analysts, Gartner, is recommending that businesses quickly deploy iPads (see article here). According to Gartner:

The iPad is further portrayed as having "the potential to be hugely disruptive" to both the markets and business models of various enterprises. Aside from book and magazine publishers, Gartner posits everything from architectural firms and schools through to airlines and hospitals as being affected. "While there are no certainties, the iPad looks set to become a market-disrupting device, like the iPod before it," says Prentice. "Even if you think it is just a passing fad, the cost of early action is low, while the price of delay may well be extremely high."

It seems natural that iPads would find their way into the health care industry and HealthImaging.com has recently pointed out, with some caution, that the trend has started.

Launched in April, the iPad continues to make waves across the world. Technophiles, teenagers and grandmas alike love the iPad, which has been touted as the tool to mobilize business users. Apple has sold about 8 million, with many physicians among those who have been bitten by the iPad bug.

In a February survey by Epocrates, 20 percent of U.S. physicians planned to buy an iPad. A larger group, however, remained somewhat cautious; 38 percent of physicians expressed interest in the iPad, but wanted more information to solidify their purchase decision.

... and...

This fall, Stanford University in Palo Alto, Calif., equipped 98 incoming medical students with iPads. The main goal is to improve the student learning experience by giving them flexible access to content whether it is a virtual cadaver in the dissection lab, annotated lecture slides and videos in the classroom or journal articles for evidence-based practice in clinic.

The medical school has not yet determined the practical impacts of the project, but pioneers point to its potential.

See the entire piece here.

The bad news keeps coming...

2010-11-04T14:28:00.000-04:00

The final rule from CMS has been published and it's not good. If you're following this blog, you no doubt understand that the home care industry has experienced deep cuts to Medicare reimbursement. Despite valiant advocacy efforts, the most recent ruling contains more bad news.

This is a press release from the Visiting Nurse Associations of America:

Washington, DC – November 4, 2010 – In the final regulations on the Home Health Prospective Payment System Update for CY 2011, the Centers for Medicare and Medicaid Services (CMS) mandated cuts that exceed those legislated in the Affordable Care Act (ACA). Medicare home health provider rates will be cut across-the-board approximately 4.89 percent or $960 million in 2011 alone.

“Nonprofit home health providers simply cannot sustain this level of cuts and maintain the healthcare services that vulnerable patients rely upon,” stated Andy Carter, VNAA President and CEO. “VNAA worked hard to negotiate with Congress healthcare reform provisions designed to protect vulnerable patients from devastating cuts to Medicare home health reimbursement over the next ten years. We are disappointed that CMS has regulated additional Medicare cuts beyond the Affordable Care Act.”

VNAA is encouraged that CMS provided some flexibility on the requirements that home health and hospice patients must visit their physician or authorized practitioner in order to be certified for home health and recertified for hospice. For home health, CMS allows the visit to have taken place up to 90 days prior to the start of care instead of 30 days, as originally proposed, if the reason for the visit is related to why the patient needs home healthcare. If not, CMS will allow the visit to occur up to 30 days after the start of care instead of just 2 weeks, as issued in an earlier proposed rule. For hospice, CMS will also extend the timeframe for an in-person visit with a physician/authorized practitioner from 2 weeks to 30 days to recertify for hospice.

Many of the changes in the final regulations are designed to require providers to jump through hoops in an effort to address growing concerns about fraud and abuse in the Medicare home health benefit. Nonprofit home health agencies fully support federal action to thwart fraud and abuse but are concerned with the burdens placed on patients to meet the physician/practitioner visit requirements. It is very difficult to transport homebound patients to see their physician.

VNAA has developed concrete recommendations to reduce fraud and abuse in ways that do not incur significant burdens to reputable providers or patients. VNAA has also recommended CMS implement a temporary moratorium on new Medicare home health providers. (VNAA’s recommendations can be found at www.VNAA.org.)

“VNAA urges the federal government to exercise its power to establish a temporary moratorium on new Medicare agencies to put the brakes on fraud and abuse rather than mandate across-the-board cuts through legislation and regulation. Nonprofit home health agencies are already struggling and these additional cuts make it even harder for them to serve as a safety net in their communities,” stated Carter.

###
Contact:
Emily Swanson
Visiting Nurse Associations of America
202-384-1422
eswanson@vnaa.org

About VNAA: VNAA is a national association that supports, promotes and advocates for community-based nonprofit home health and hospice providers that care for all individuals regardless of complexity of condition or ability to pay. They provide comprehensive services for Medicare, Medicaid, uninsured, and privately insured patients. VNAA members share a mission to provide cost-effective and compassionate care to some of the nation's most vulnerable individuals, particularly the elderly and individuals with disabilities. Visit http://www.VNAA.org today.

Past and present

2010-10-30T19:59:00.002-04:00

the setting

2010-10-29T17:29:00.001-04:00

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