As our nation struggles to redefine balance in an unspeakably difficult year, I want to take a moment to reflect on the power of resilience and the important role it has played — and continues to play — in the home health care arena. Against the backdrop of the surging coronavirus pandemic and the more than 268,000 American lives lost to it (and counting), we continue to weather an economic crisis of historic proportions, and a society and health care system that remain roiled by racial injustice and inequity.
Even in this worst of times, though, we have seen the absolute best of humanity — in the women and men on the front lines of home health care, a uniquely resilient force who have cared brilliantly for those in need during this time of crisis. Home care and hospice workers, both out in the community and working remotely from makeshift desks and offices, have shown unwavering commitment and care for individuals and families nationwide. As they work long hours, fearful for their health and the health of their families, constantly alert to ever-evolving regulatory and safety protocols, these are some of the most remarkable people I have ever known.
Believing deeply that they were the right people for the job, trained for this moment, and having the support they needed, the frontline workers — nurses, physicians, rehabilitation therapists, social workers, and home health aides — at the Visiting Nurse Service of New York, where I work, stepped up valiantly this year to help vulnerable patients breathe easier, grow stronger, and avoid spreading the virus to family and community.
Their work has paid off. A recent study by the VNSNY Center for Home Care Policy & Research, the University of Pennsylvania School of Nursing, and Villanova University shows the very real benefit that home health care workers can have for COVID-19 patients recovering after hospitalization. Of patients with COVID-19 referred to home health care, 94% were discharged having shown statistically significant improvements, the study reveals. Yet, as reported in Home Health Care News, “only one in 10 patients hospitalized with COVID-19 are discharged home with home health services, according to the U.S. Centers for Medicare & Medicaid Services (CMS).”
We each have our own idea of what it takes to be resilient and bounce back in the face of adversity — in this case, the largest and most severe public health crisis in over a century. Over this last year, I have come to my own definition, and I remain inspired by and grateful for these elements of resilience I see in our workforce: courage, the fortitude to live with anxiety and still come to work every day; optimism, the inspiration to keep oneself — and others — positive and motivated when the going got unbelievably tough; commitment to mission, the fuel that helped them get through the day; and the ingenuity to create new tools and approaches that enabled them to adapt to unprecedented challenges.
During the first pandemic peak in NYC and continuing right through to the latest surges across the country, home health care workers demonstrate the essential truth behind President Franklin D. Roosevelt’s legendary observation: “Courage is not the absence of fear, but rather the assessment that something else is more important than fear.”
Frontline workers summoned courage because the need was so great. At VNSNY, our Community Mental Health Services team continued to respond urgently to the clients who count on them: individuals in emotional distress, people battling substance abuse, children and families whose daily struggles were amplified by the shutdown and financial crisis. “We’re out in the community meeting people where they are and where they live — making a difference every day,” said Deirdré DeLeo, Associate Director of CMHS Programs and Clinical Operations. “The staff are putting aside their own fears and doing what’s best for those who are in greatest need in our community. We take the responsibility of being a safety net for New Yorkers very seriously.”
Frontline workers across VNSNY were able to summon courage in part because they knew people like Rose McNeal, a VNSNY manager on the business side in the Long Island office, always had their back. “They’re doing an incredible job out there, and my job is to make their job a little easier, a little smoother,” said Rose, who always tries to stay one step ahead by ensuring that all equipment, especially PPE, is stocked as fully as possible and is accessible for clinicians to grab-and-go as needed.
I’ve been so impressed by frontline workers who in these dark times found a distinct way to make someone’s day better… who could indeed see — and often be — the light at the end of the tunnel.
For 101-year-old Evelyn, that optimism came every morning, when she received a radiant greeting from her home health aide, Shaunae Phaire: “Hello gorgeous, hello beautiful.” Shaunea’s attitude? “Once your feet hit the floor, you sit up and think, ‘Thank God, I got up this morning and I can move.’”
When coronavirus came to the nursing home where Evelyn lived, Shaunae donned an N95 mask and gown and made sure her client got out of bed each day, video chatted with family and even got her nails done. When Evelyn contracted COVID and passed away, her family was grateful that, thanks to Shaunae’s care and commitment, their loved one’s final days were filled with life. “They said, ‘Not everyone would come to the nursing home when there was COVID,’” Shaunae shared. “But if I didn’t come in, who would take care of her? I promised to stay as long as I possibly could. That’s just me.”
Committed to Mission
In times of crisis, home care workers are quick to mobilize to protect society’s most vulnerable. VNSNY nurse Ruth Caballero (see video above) could not wait to begin delivering care in the comfort of home to patients recovering from COVID-19. “I’m so happy that COVID-19 patients are coming home,” Ruth said, once VNSNY gave the go-ahead to begin such in-person visits. “I can’t imagine how isolating it has been, not to see their families, and with medical staff in the hospitals having limited time with patients. Our visit may be the longest time a healthcare worker has spent with them. We’re committed to doing whatever we can to help patients return to the community, and ultimately return to their optimal level of health and wellness.”
Home Care Nurse Nina Miro heard the suggestion from friends more than once during the pandemic’s surge: “The front lines are too dangerous, can’t you step back a little?” Instead, Nina stepped up. When she heard that an acquaintance was taking her mother home from a nursing home — and didn’t know what to do next — Nina sprang into action. She made phone call after phone call to get home care in place, from doctor’s orders to an in-home nursing visit and home health aide support. “As community health nurses, we run towards the fire,” Nina says, “we don’t run away.”
Innovating in Crisis
With hospitals overburdened and so many patients recovering from a volatile illness, our home care staff was ideally suited to step into the breech through an innovative program called Hospitalization at Home. In partnership with other forward-thinking health care organizations, VNSNY was able to expand our program, which delivers hospital-level care in patients’ homes. This helped hospitals manage emergency room admissions and free up beds, while also benefiting eligible patients by letting them recover in the comfort of home.
The same is true of telehealth, where future-forward technology meets timeless commitment to compassionate care.With in-person ambulatory care and home care restricted during the pandemic surge, VNSNY saw a rise in telehealth, particularly in the areas of respiratory and behavioral health care, for which almost one-third of the care was delivered virtually. Certain care, such as wound care, still necessitates primarily in-person visits, and we believe that a clearly defined and clinically determined approach to telehealth should translate to continued expansion beyond the exigencies of the pandemic. Indeed, we are calling on Congress to help keep vulnerable people closely connected to care from the comfort of their homes by allowing home health agencies to be reimbursed for telehealth services.
“What’s coming out of the COVID-19 pandemic is an understanding of the important role of telemedicine in health care,” says Rose Madden-Baer, VNSNY Senior Vice President of Population Health and Clinical Support Services. “Our clinicians can remotely monitor a patient’s weight, blood pressure, temperature, heart rate and blood oxygenation, and blood glucose levels, and even listen to their respiration and heartbeat. This is urgent care being done right in the home — without sending someone to an urgent care facility.”
As a year that has been defined by unthinkable suffering draws to a close, it is important to keep in mind the strength and resilience we’ve also seen again and again in those around us — and within ourselves. I am grateful to have witnessed that strength in so many powerful and life-changing ways. I think VNSNY Home Care Nurse Nina Miro sums it up best when she says: “There’s no quitting — this is my job.”