January 3, 2016

Efficient, Effective Home Care For Veterans

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U.S. Army veteran Bob Swirsky’s face lights up when home health care nurse Jeanette Hutchinson enters his room to check his blood pressure and attend to his body to prevent bedsores.

“It’s going to be 120 over 60,” Swirsky says, as Hutchinson inflates the cuff on the meter on his left arm. “Close,” she said, “124 over 60.”

Nurse Jeanette Hutchinson checks veteran Bob Swisky's vital signs.

Derek Torrellas Photo.

Nurse Jeanette Hutchinson checks veteran Bob Swisky’s vital signs.

In Connecticut, there are 209,882 veterans, according to the most-recent U.S. census data, and 29.4 percent are over the age of 75. This group forms the core of veterans with chronic medical issues who are targeted by a VA program to treat them in their own homes.

Most of the patients in the VA’s Home Based Primary Care (HBPC) program are like Swirsky, who is bed-bound and not able to easily get to the West Haven VA Hospital. He enrolled in the HBPC program in August. Swirsky’s daughter, Mindy Hart, said, “It is tremendously tiring for him to get into a car, or even just to move around.”

Home Based Primary Care, “is a team approach in which we have multiple disciplines that come out to the house and visit our veterans who typically have a difficult time getting into the hospital to see their provider on a regular basis,” said Hutchinson.

The team is comprised of the program director, physicians, psychiatrists, nurses, social workers, registered dieticians, physical therapists, clinical pharmacists, and program support staff.

Prospective patients are veterans who are already registered in the VA health care system. Veterans are referred to HBPC by the hospital, or their doctors, or sometimes veterans request the service themselves, said Aileen O’Connell, HBPC program director. A registered nurse assesses referrals.

Bob Swirsky talks about the VA care program.

Swirsky, 96, lives just a few miles from the West Haven VA and falls within the territory HBPC covers. Across the state, the general guideline is 30 miles or 30 minutes from the VA facilities in West Haven or Newington, or from one of the community-based outpatient clinics, located in New London, Winsted and Waterbury.

August Palmer of Stratford was recommended to the program after receiving an implanted defibrillator. “I’m 93,” he said, “I can hardly walk.” Staying at home to obtain care has put less of a burden on Palmer’s children. “My son David takes me – or my daughter Mary – and so they don’t work and everything,” he said. “That’s not fair.”

Pawcatuck resident and Army veteran Donald MacLean, 67, has been an HBPC patient for about four years, after he suffered a fall while being treated for tumors, and he was transferred to a nursing home.

He still needed care when he was released to his house, MacLean’s wife, Leslie, explained over the phone. The problem was, she couldn’t provide it.

“When they first started coming, I had nothing,” she said. “Cindy [Anderson, MacLean’s HBPC nurse] walked in the door and immediately she ordered a hospital bed, she ordered stuff for the showers. She got everything I needed that I had no idea how to get, or that I even could get.”

The nurse visits her husband once a month to check on him and review all his medication, ordering more if needed. Maclean said she was under a great deal of stress around the time her husband began receiving care at home. When Anderson noticed, she asked permission to bring one of the team’s social workers to meet her.

“I think that the other side of home-based care is the social worker,” MacLean said. She’s grateful for the social worker’s personal assistance, she said, especially when needing help completing any paperwork relating to the VA or insurance.

It costs the VA about $16,000 to take care of a veteran at home, not including other non-HBPC expenses incurred by the VA and Medicare for these patients. The program has resulted in a 36 percent reduction in the number of days veterans spend in a hospital once they begin receiving home care. This decrease leads to an about 12 percent reduction in combined VA and Medicare annual cost per patient, according to the VA.

In fiscal 2015, a daily average of 444 patients were enrolled in Home Based Primary Care in the state; the number has remained steady the past several years. Nationally, the average daily total is 35,982 patients, an increase from 27,102 in fiscal year 2011, according to the VA.

Nurse Jeanette Hutchinson checks veteran Bob Swirsky.

Derek Torrellas Photo.

Nurse Jeanette Hutchinson checks veteran Bob Swirsky.

In November, Stars and Stripes reported on an increasing number of veterans on waiting lists for home care. Five facilities – Los Angeles, White City, Ore.; Puget Sound, Wash.; Richmond, Va.; and Beckley, W.Va. — accounted for more than half of the 2,566 waiting veterans.

In Connecticut, there is no waiting list, according to the care team. Referrals are immediately addressed and sent to the nurse that covers the patient’s geographic area.

For Swirsky, the benefits are numerous.

“You let us have our dignity,” he said to Hutchinson. “It’s being in your own bed, being in your own environment, and people who you know come in and visit you. That’s important.”

Derek Torrellas a C-HIT intern and recent graduate of Southern Connecticut State University.

 

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