As a resident of Addison County since 1975, I have a great deal of respect for the many medical practices and practitioners in Addison County. From the expertise and care of the private, single doctor offices that have evolved into a larger Porter Medical Center system, the standard of compassionate care and professionalism has been exceptionally high. That evolution and the years of innovation were not without struggle and pain. Practices, staff and patients have been challenged by insurances, management decisions, changes in diagnoses, technology and high costs.
 When Helen Porter Nursing Home morphed into Helen Porter Healthcare and Rehabilitation Center, the change was a response to healthcare needs of elders and the changing demographics of the county. A designated rehab facility addressed the challenges of recovery from strokes, joint replacements, pneumonia and much more. Under the direction of experts in memory care, the “neighborhoods” designated for those with cognitive challenges became “home” for those who could no longer remember where home was or recognize family.
Upgrades in patient care, implementation of advanced nursing skills, and computer charting have been ongoing. There were reconfigurations of many support services. A sense of community beyond the doors was strengthened through events like the Pumpkin Patch and the summer events. Residents have been proud of their facility, and connected to each other and to staff. The focus on the individual intensified as the diversity of complex diagnoses increased.
 The excellence of the facility has been recognized in annual evaluations by the state, and any issues, addressed. Caregiving for those who struggle to dress or feed themselves, to communicate, to maintain a sense of personal dignity is an intensive, complicated, and at times, heart-wrenching vocation, not just a job, for those who work at Helen Porter. As the chaplain at Helen Porter for 16 years, I know that family and friends play a major role in healing, a role that becomes more crucial and less possible as a person depends more on others to maintain contacts. For family and friends to not make a daily trip to Rutland or Burlington is sometimes the critical difference in access to the resident, and the key to recovery.
 Helen Porter Healthcare and Rehabilitation Center (HPHRC) is a remarkable place. Unfortunately, it seems that comments about the facility in articles often refer to the deficit connected to it, rather than the services it provides. While escalating healthcare costs are known, if not accepted as normal, until individuals need to use them, some facts are not known. Medicare covers 100 days in a facility, but does not cover long-term care or memory care. If Medicare does not cover the stay, neither will secondary insurance.
If there is not a “three-day qualifying admission” to a hospital, Medicare does not cover rehab. There is an established room charge at Helen Porter. Medicare covers less than 80 percent of the charge. Medicaid covers less than 60 percent. Continue those percentages to prescriptions, supplies and procedures. To qualify for Medicaid, an individual must “spend down” resources. Between 75-85 percent of residents rely on Medicaid. Do the math. Financial issues are systemic, at state and federal levels, and in the case of Helen Porter, not based on local management.
 HPHRC residents were business owners, farmers, engineers, teachers, mothers and fathers, world travelers, native Vermonters, and respected, active community volunteers. They have carried the history of their communities and passed it on to the coming generations. None of them stood up in kindergarten and said that they wanted to be in a long-term care facility when they grew up. No one wanted to be “on the dole”; all wanted to “leave” something for their children. Some counted on pensions that disappeared in the recession, and social security is not sufficient to cover the costs of either round-the-clock care in the home or placement in a facility.
When I began as chaplain at HPHRC, most of our residents were mobile, with or without canes or walkers. Others propelled their own wheelchairs. Now, those who are ambulatory are mostly in the memory care neighborhoods. The care needs of residents have become complex and time consuming. In my years at HPHRC, I was continually in awe of the patience, devotion and expertise of staff, committed to offering the best care possible from the time a resident entered the facility to the time they left. If end of life care was part of a resident’s progress, the staff supported family and friends as they watched and waited, doing the difficult care for and grieving the loss of someone they cared for, sometimes for years.
 Individuals come with a history. No one is perfect. As a not-for-profit organization, Helen Porter responds to imperfect situations. I believe that Helen Porter is crucial to community-located, patient-centered, cradle-to-grave care. The strength of our communities throughout the state has been our independence and our connection to our neighbors. I trust that Helen Porter’s worth as a community resource will be recognized and upheld in uncertain times for healthcare, and maintained as part of the Porter Hospital system, for all of us when we need that level of care. 
Rev. Lucy C.B. Pellegrini
Deacon, Episcopal Diocese of Vermont Retired Chaplain,
Helen Porter Healthcare and Rehabilitation Center