Providing skilled nursing care so patients can recover in the comfort of their homes has been shown to improve outcomes and reduce the incidence of the patient having to go back into the hospital. Home health nurses are becoming even more important today as an integral part of a healthcare team. But it is not a new idea. The St. Vincent Visiting Nurse Association (VNA) is celebrating its 75th anniversary this year.“We were the first home health agency in the state,” said Denise Looker, LSW, MA, director of operations for the St. Vincent VNA. “We started in 1938. At the time, a need was identified in the community by the Junior League. The United Way joined with the Pulaski County Medical Society and the Junior League to form the VNA. It started out as a free-standing agency until 1996 when we were acquired by St. Vincent.”Looker said the benefits of home health are going to become more prominent as healthcare reform is instituted. Home care is the lowest cost provider. Visiting nurses can help patients make the transition from the hospital setting to the home setting. “The home health service is a bridge between not just the hospital, but the physician, medical clinics, skilled nursing facility and nursing homes,” she said. “Regardless of the setting a patient is in, home health serves as a bridge so patients don’t fall through the cracks. We make sure the patients have follow-up appointments with physicians so they don’t have to go into the hospital again. We see it as a circle, a continuum of care.”Looker, who has been with VNA for 30 years, said the service started out with just nurses and evolved to include social workers, speech therapists, physical therapists, occupational therapists and home health aides for personal care. “It really is a team approach to the patient’s care,” Looker said. “And care is different in the home than in the hospital. The patient is more comfortable and clinicians can really see the impact of the home environment on the patient. Everyone assumes patients have the perfect a layout in the house and food in the kitchen—that they have everything they need to get well. The reality is, that is not true in a lot of cases.”One of the biggest issues is making sure patients are taking their medications correctly. For fifty percent of the patients who end up back in the hospital within 30 days, it is because their medications were not properly managed. Nurses can go on into the home, find out which medications are outdated and those that have been replaced by other medications, and help make sure medications are organized correctly.“Sometimes we see patients with limited financial resources and medications can be very expensive, so we might have to intervene with their physician to get a different medication, one the patient can afford,” Looker said. “Some companies provide home pharmacy services, and we work with them to make sure they have what they need.”The VNA clinical staff carries laptops and can access each patient’s information no matter where they are. The nurses have access to telehealth equipment that can be put in a patient’s home when needed to remotely monitor vital signs. In addition to providing healthcare providers with the information they need to intervene when necessary, Looker said it also provides security for the patient. “It teaches them how to manage themselves better,” she said. “If they are not taking medicine or eating correctly, they will see changes in weight or blood pressure.” Jane D. Evans, PhD, RN, MHSA, an assistant professor of nursing at University of Arkansas Little Rock, worked for VNA from 1993 to 2003 as director of clinical services. She has also seen how much the VNA has helped her mother, Patricia Goss Retzloff.“I love VNA with all my heart,” Evans said. “The work they do is 100 percent focused on patient care. It is multidisciplinary. Not only are they able to go out into the community and give good nursing care, but through their patient assistance fund they are often able to meet basic needs for food and clothing for folks who are less fortunate. It is a very comprehensive, mission-oriented organization.”Evans said when her mother was ill in her late 60s and again in her late 70s, VNA came out and helped restore her to fully independent function, and connected her with services she could use even after she was discharged from VNA. “Home healthcare is generally short term and extremely structured,” she said. “The patient receiving it has to be physically homebound. The goal is to restore independence so patients at least can physically perform their own care and, at best, be able to go back into the community and participate fully. Mom had a great experience with VNA.”A few months ago her mother, who is 87 now, had a spell of low sodium. VNA kicked in, came on a Friday afternoon and got her all set up so she didn’t have to go to the hospital to get fluids. They got the blood levels back in balance, and also arranged to have a physical therapist come out to help restore her strength and balance after a couple of weeks with little activity. She was also taught good cane techniques to prevent falls. “Mom feels better now than she did six months ago, which is a bit of a miracle,” Evans said. “She is back to her adorable self. Recently she was dancing at my 30th wedding anniversary celebration.”
