NEW HAVEN — It was 48 years ago that a group of concerned Addison County residents saw a void in local health care system. There was a lack of professional community care services for patients wanting to heal away from the hospital — where stays were often lengthy for post-surgery monitoring.
“It was about a more complete view of community health,” longtime health care professional Marcia Wheeler recalled of the impetus for diversifying patient care in the late 1960s. “It was viewed as, ‘Hey, wouldn’t it be great if, after somebody was in the hospital, they had some help at home.”
Thus was born Addison County Home Health & Hospice (ACHH&H), without a lot of fanfare, in 1968, on the second floor of a Middlebury auto parts store. The nascent service had one CEO and one nurse to provide home-based care to clients throughout the county.
Wheeler would join the agency in 1978, and currently serves as its director of hospice services. At the time, Wheeler became ACHH&H’s fifth nurse, under the direction of a CEO and a clinical director. Wheeler signed on in concert with a second physical therapist. The agency also had two home health aides on staff.
“Pretty much, everyone went everywhere,” Wheeler said of the staff’s travel requirements.
“A lot of miles.”
Both literally and figuratively.
Now based in its own building off Route 7 in New Haven, ACHH&H is one of the county’s largest employers, with 155 full- and part-time workers, providing a wide range of health care services to county residents from birth to death (see related sidebar). Agency officials are doing far more these days than taking vital signs and changing bandages. They are also teaching stroke victims how to swallow again, administering intravenous fluids, instructing new moms about breastfeeding, conducting flu clinics, helping hip-replacement patients learn how to walk again, providing pediatric cancer care, and teaching families how participate in a loved one’s recovery.
And if an ACHH&H nurse, physical therapist or home health aide doesn’t have the background to provide a particular service, they’ll track down someone who can. ACHH&H has working relationships with many other social service agencies in the county who can fill the patient’s diverse needs of the moment, whether it be mental health counseling, supplies from a food shelf, or assurances that their beloved pet will be available to provide companionship during a challenging recovery period at home.
CHANGES IN HEALTHCARE
The agency’s growing mission is in part being driven by a massive shift in the way health care is being delivered nationwide. Officials explained that the system now places a premium on shorter hospital and nursing home stays and giving patients the services they need to heal — or deal with the daily challenges of a chronic illnesses — more affordably at home.
That strategy is right in the ACHH&H’s wheelhouse, and it will be imperative for the agency to be at the top of its game if it is to continue to capture the Spartan reimbursement it receives for patients covered by the federal Medicare and Medicaid programs. A majority of ACHH&H’s clients receive Medicaid and/or Medicaid insurance, which covers only around 60 percent of the true costs of the services provided, according to agency officials.
“Next year and the year after that, all of us — hospitals and home care agencies — will be measured on our re-admission rates back to the hospital,” said Sherry Greifzu, executive director of ACHH&H. “We’ll get penalized with reimbursement from Medicare and Medicaid (if re-admission rates are high). It’s no longer going to be that we’re going to be reimbursed just because the patients have insurance through Medicare and Medicaid. It’s going to be that they want to see the quality of what we’re giving … If we don’t have the quality and we’re not as good, or better than the national average, we will get penalized and have less money in our pocket to be able to take care of patients.”
And ACHH&H officials said they will not cut corners to conform to a balance sheet; the patient’s best interests have to come first.
“The decisions that we make are not driven by finances,” said ACHH&H Human Resources Director Kathleen Pratt. “They are decisions based on what the patient needs.”
Pratt recalled moving to the area five years ago, wondering “what this little building” was that she would occasionally drive past on Route 7. She became increasingly familiar with Home Health & Hospice when her own mom tapped into the agency’s nursing and hospice services. And she became intimately familiar with ACHH&H after she started working there.
“I would like to make sure the community knows what they have in this building,” Pratt said with pride. “I’m not sure everyone gets the impact that we have on the county. As an HR director, I can say we have a $6.5 million payroll that we are putting back into this community every year. That’s huge.”
The ACHH&H takes on all patients, regardless of their incomes.
“We not only take care of the very poor in the community; we also take care of the very rich,” she said. “People are sick, they need our services, and it doesn’t matter how much money they have. If it means doing the right thing and we have to lose money, we do it.
“We never say ‘no,’” Greifzu added.
Anne Nichols is clinical nursing team leader for ACHH&H. She noted the agency’s workers are intent on assessing a patient’s entire scope of needs — in consultation with the client’s physician — when first entering a home.
“The nurse goes out and does her initial first assessment, and then might realize that there’s more than just nursing that’s needed,” Nichols said. “Then we talk to the patients to make sure they’re willing to allow all these different services to come in, and we confer with the physician.”
For example, the ACHH&H worker might notice the patient is having a hard time getting inside his or her home. So the worker might relay the need for a handicap-access ramp, or set up a bed on the main floor of the client’s home to help them avoid climbing stairs.
Sometimes, patients need some gentle persuasion before accepting advice to make their lives easier.
“People minimize their story; they’re terribly afraid they might get put into a nursing home and taken out of their home, so they want to tell the doctor ‘Everything is wonderful,’” Wheeler said.
But in many cases the client’s health picture is far from wonderful, and it’s up to the ACHH&H workers to take notes and create a plan of action.
“We are stretching the capacity to keep these people at home as long as possible, with as many resources as we can provide,” Greifzu said.
“Some people need us for two months; others need us for two years.”
With finances so tight, Home Health & Hospice officials are constantly having to urge state and federal lawmakers to make sure funding for home-based care doesn’t dry up.
“We have to be in every legislator’s ear to translate what needs to be done at the bedside, so they understand what they are lobbying for,” Greifzu said. “We have a huge responsibility not to waste money and time, and have the best available people to provide the care. We can’t just ask for money and then waste it.”
SAVING MONEY
In most cases, home-based care is saving the health care industry money — and a lot of it, according to ACHH&H officials.
Jason LeBeau is director of therapy services for ACHH&H. He noted the stark contrast in costs between a private rehab facility and what Home Health & Hospice can deliver.
“Therapy services that would cost roughly $3,000 per day at a rehab facility, if they can be done at home, it saves Medicare a boatload of money,” LeBeau said. “We’re talking about $30,000 over 10 days, versus us seeing the patient for 60 days for around $3,000. And we have all the services that a rehab (facility) would have.”
Greifzu said this is a particularly challenging time of year for hospice patients, their families, and the caregivers.
“During the holidays, people hold out until the very last minute,” Greifzu said. “They want one more Christmas, one more new year’s. They want to see one more baby born. (The hospice caregivers) really try to provide that for the patients.”
In some cases, hospice workers make multiple trips each day to make sure a patient is as comfortable and alert as possible to enjoy at least one more family moment.
“They really do some heroic things,” Greifzu said of hospice staff.
In addition to providing key health care services, Nichols said ACHH&H provides an important social link for patients who must spend a lot of time indoors.
“It takes away some of that isolation,” Nichols said, specifically citing examples of parents staying home with their sick children.
Home Health & Hospice caregivers are trained not to pass judgment on the housekeeping abilities of the folks they serve. One nurse recounted speaking with a home-bound client whose pig strolled into the kitchen while they were talking. Another caregiver was advised not to look into a client’s window, knowing the patient had a firearm and wasn’t enamored of trespassers.
Nichols has cared for a lot of patients during her years with ACHH&H. Her interactions with clients have made for some wonderful memories. The most challenging patients have invariably been the ones who have made the most profound impact on Nichols. And given the self-sufficient, independent nature of most Vermonters, there’s been no shortage of clients who aren’t too keen on being told what to do.
“My favorite patients were always the ones who did not want us, and refused to do the things that should have done,” Nichols said with a chuckle. “Those were always the ones that you really made the most positive relationship with. They would go from, ‘I am not leaving my house’ … to really accepting (advice) and partnering for quality care to the end of their lives.”
More information about ACHH&H can be found at achhh.org.
Reporter John Flowers is at [email protected].