Many people may fear the hospital, but some find leaving it even more daunting. If they are carrying home a surgical wound, the effects of a stroke, or some other limiting condition that is new to them, it helps to know that someone will be there to help.
That’s where Sea View’s Home Health Care division comes in. In addition to its nursing home facility in Bolongo Bay, St. Thomas, Sea View provides home health care to the community. These so-called “visiting nurses” are actually a whole team of medical and support staff, including physical and speech therapists, home health aides, a dietician, a wound care specialist, and a medical social worker, as well as several registered nurses and licensed practical nurses.
Kim Jerome, a registered nurse who is the administrator for the division, said there are about 20 clinicians on staff, a couple of whom double as administrative workers, and another five people in strictly administrative positions. Sea View serves clients territory-wide.
In three years in the post, “I’ve not had a Water Island patient yet,” Jerome said. But there have been plenty on St. Croix, St. Thomas and St. John.
The number of patients under active care varies considerably, depending in part on how many surgeries are performed in a given time frame, Jerome said. She estimated the number at anywhere from 20 to 40 per month.
“Our two offices are slightly different” in terms of the types of conditions that are most common, she said. On St. Croix there is a lot of post surgical physical therapy and many wound patients, as well as patients with congestive heart failure. On St. Thomas, there seem to be a lot of stroke patients as well as a lot of orthopedic after care.
In both districts, there are many people who simply need to be re-conditioned after a somewhat lengthy hospital stay. Their muscles have atrophied due to an extended period of little use, and they need strengthening.
Some may also need specialized services, such as intravenous therapy or catheter care.
Many are elderly. In fact, Jerome said, “The majority of our patients are Medicare patients.”
That means that Medicare sets the perimeters of their care. To be eligible for home health care a person must be homebound, in need of intermittent skilled care that is medically reasonable and necessary, and under the care of a physician.
“Everything we do is with a physician’s order,” Jerome said. “We’re the physician’s eyes and ears in the home.”
The home-health-care worker’s observations are on a very practical level. Is the patient eating regularly? Is he taking his medicine as prescribed, or does he have trouble opening the cap or reading the dosage? Are there throw rugs in the house that could trip a person whose balance was compromised by a stroke? Would it help to have a raised toilet seat so the patient doesn’t have to lean over so far and risk falling? How about installing grab bars or a shower seat?
“All the care that we provide is completely individualized,” Jerome said, based on the client’s medical history, limitations, environment and attitude.
Ideally, the effort is a joint one. Jerome said the home-health worker encourages the client to work towards specific goals, all of which ultimately should lead to more independence. But no one is forced.
“Patients have a right to participate or to refuse care,” and their rights must be respected, she added.
The length of care is determined by the physician, with advice from the home health worker and within Medicare guidelines. Jerome said the Sea View patient who has been in the program the longest started in 2009, but that is not typical.
Medicare runs in 60-day periods, so if a patient requires care for a longer period of time, there must be a re-evaluation. There must be an expectation that the patient will meet certain goals in order to continue under Medicare, she said.
While the home-health-care provider is tending to patient needs, she is also teaching the patient and/or members of the household how to perform some of the services she is providing so they can take over.
“It takes a special kind of clinician to be a home-health clinician,” Jerome said. Working in a doctor’s office or a medical facility is one thing. You can count on there being adequate lighting, access to a sanitizing area, air conditioning, and a host of things that just make the job easier. None of that is guaranteed in a private home.
Just getting there can be a challenge too. The patient’s directions aren’t always clear to the health worker, about 60 percent of whom are not native to the Virgin Islands. In some cases, there is a language barrier to overcome.
But Sea View makes a commitment to be there for their clients, Jerome said. In fact, “we normally apply for hurricane passes each year” so that neither sleet, nor snow, nor tropical storm keeps the care giver from tending to her patients.
“The owner (Dr. Alfred Heath) and management (led by CEO Linda Pulley) have a shared vision for the community,” Jerome said.
The vision is to help patients to recover fully or as fully as possible, and to keep them from going back into acute care.