In this conversation with Judy Peterson, president and CEO of the Visiting Nurse Association of Chittenden and Grand Isle Counties, we learn how more and more care is being delivered at home – from wound care, recovery from surgery and tele-monitoring for patients with chronic disease to even the most complicated treatments like ventilators and feeding tubes. She also describes how coordination of patient care across all providers will improve now that the VNA has joined the University of Vermont Health Network.
Listen to the interview at the link below or read the transcript that follows.
UVM Medical Center: If you’re like most people, you’d rather receive medical care at home than in a hospital or some other institution, and that’s for all the obvious personal reasons. But it also turns out to be a good idea in terms of the quality of care you get.
People tend to recover more quickly, and there are fewer trips back to the hospital, among other advantages, and for those and other reasons, it’s often less expensive. You put all that together and add in that there’s an increasing number of older people who want and need home care, and you can see why there’s more focus than probably ever before on the role that home care plays in the healthcare system.
So we thought it would be a great time to learn more about what’s happening in home care, and I think you’re going to be surprised by a lot of what you’re going to hear today.
With us as our guide is Judy Peterson, the president and CEO of the Visiting Nurse Association of Chittenden and Grand Isle Counties, which is Vermont’s oldest and largest nonprofit home health and hospice agency, serving 22 cities and towns across northwest Vermont. Judy is a nurse herself with a 40-year career dedicated to home health nursing and leadership. Before assuming this role, she was the CEO of Central Vermont Home Health and Hospice, and I should add she’s a native Vermonter, a farm girl, and a graduate of the UVM College of Nursing and Health Sciences. One last thing, in addition to talking about everything I just mentioned, we’re also going to ask her about the VNA recently joining the UVM Health Network: why that makes sense, how patients will benefit, and what the opportunities are for both organizations in that new relationship. Thanks very much for joining us.
Judy Peterson: Thank you, and good to be here.
UVM Medical Center: I’m here, actually, in your offices in Colchester and think it would be good to start with a big picture idea of the size and shape of this organization, and number of patients you care for – a general overview.
Judy Peterson: Sure. I always think that people are surprised when they learn how large the VNA is. We have over 600 employees. Those employees travel over a million miles a year throughout Chittenden and Grand Isle Counties, it’s 22 towns, but those two counties, providing services to people of all ages. Sometimes people think that the VNA is only long-term care or supportive services for older Vermonters, but we see people of all ages. We do prenatal care through birth, all through childhood, and adult diseases and conditions, to end of life, as you know, with our hospice services.
UVM Medical Center: Has that always been the case, or have you been sort of adding more as you’ve gone along?
Judy Peterson: Yes. I do think that when home health started, visiting nurses started as physician helpers by extending the reach of the physician out to the home. Once in the ’60s Medicare and Medicaid started paying for home health services, then we were really able to expand what we were able to do. Now in the days of healthcare reform where there’s so much innovation, home health is just expanding by leaps and bounds. It’s just amazing the kinds of things we do. We provide a complex level of care in the home now that, at one time, was only done in hospitals and even intensive care units.
UVM Medical Center: Give me an example or two of that.
Judy Peterson: Some of the most complex care we do is at our High-Tech Program. High-Tech is nursing care provided in the home for as many as up to 17 hours a day, every day, to really support families who are taking care of someone who is avoiding institutionalization by being at home. They may be somebody who’s on a ventilator or somebody who has a tracheostomy, feeding tubes, or multiple modalities, so you can see that the kind of care we do now in the home is something that has never happened in the past.
UVM Medical Center: I told people they’d be surprised. Dealing with a ventilator, I mean that is very complex and risky if it’s not done well, right?
Judy Peterson: That’s right, and hand in hand with the nursing care, of course, is family education. Those family members are just amazing. None of the care that the VNA does, or really any of the healthcare in this country, could happen without family caregivers and significant others, so part of our role, as the VNA, is to support those caregivers, educate those caregivers, teach them how to recognize the signs and symptoms of problems, and be able to give them respite by doing the care ourselves.
UVM Medical Center: Yeah, I was going to say, there’s that teaching role, but there is also that very, very important respite role because people just burn out. It’s a big burden.
Judy Peterson: That’s right, and people need respite care when they’re doing very complex care like caring for somebody at home with a ventilator, but also when you think about end-of-life care. We do hospice services for people in the home, and we have a cadre of about 500 volunteers who go into the home and will do things like sit with the person, read mail, or do errands, go to the drugstore to pick up the prescription, and do all kinds of supportive services to make it easier for families to spend time with their loved ones.
Another form of caregiver relief that the VNA does is we have three adult day centers. Adult day centers are very home-like, and they’re just so warm and inviting. People who are frail elderly, or have cognitive disabilities, or people with permanent disabilities who are younger can go and spend the day at one of our adult day centers where there’s very rich programming so that families can keep their loved one at home longer, even though the family members have to be at work all day. I said we have three adult day centers. One is here at our Prim Road office in Colchester. Another is in Essex. The third is in South Burlington, and that facility is only for people with memory loss.
UVM Medical Center: If you’re just tuning in, you’re listening to Judy Peterson. She’s the president and CEO of the Visiting Nurse Association of Chittenden and Grand Isle Counties, the newest member of the UVM health Network. We’re learning more and, probably, new things for a lot of listeners about what’s involved with home care and what the VNA does. We’re also going to talk about how health care reform is impacting all that, and the new relationship with the Network. But before I do, I wanted to give you an opportunity – and you may have covered some of this already – to explain the things that you wish people knew that you don’t think they know about the VNA.
Judy Peterson: I think that families probably don’t know the breadth of our services and the depth also, that we’re able to provide services to people of all age groups and all economic levels. Part of our mission says that we help people live their fullest lives wherever the call home, so that means that we will care for people in the most beautiful homes in Shelburne, to the trailer park in northern Vermont, to the little ranch house in Charlotte, or the tent on the railroad track. It is wherever somebody calls home. That’s where the VNA will go, so that’s kind of the breadth.
The depth is also the level of care that we provide, from very basic support services like volunteers who will run to the drugstore, like I mentioned, to personal care attendants who will spend hours a day with a frail elderly person who is really at a point in their life where they would be able to be admitted to a nursing home if they were willing and able to do that, but our personal care attendants provide that same kind of care to them in their own home so that they can avoid institutionalization. There’s that very basic support and what we consider long-term care services through the really skilled care that our nurses and our rehab therapists do every day.
The other thing I think that is kind of a best-kept secret at the VNA is what a fantastic career this is for providers. When a nurse works at the VNA, she is able to have such a rich experience, and you really have the opportunity to develop a relationship with your patient. You’re seeing somebody over a longer period of time. You get to see what we now call the social determinants of health. What is their home like? What are the safety teaching that you need to do for somebody? What’s in their refrigerator? When you’re doing education with them about their congestive heart failure, you’re able to actually talk to them about what they’re eating, and you can see what the opportunities for mobility are for them and for exercise.
I mean it’s just really a much broader holistic approach for nurses, and that is just so rewarding. I say that as an old home health nurse. When I first graduated from the University of Vermont I joined the Peace Corps, and when I was in the Peace Corps, this was in Central America, that’s where I fell in love with community health. That’s where I realized that healthcare really takes place in the home at the kitchen table, if you will. Hospitalization, that acute care, is just a tiny portion of anybody’s total healthcare experience. The rest of it takes place with their primary care physician and in their own home, and so that’s what makes home health so exciting and so rewarding, because we’re able to be the physician’s eyes and ears in the home and do all that relationship building, and real teaching, and assessment, and as I said, very state-of-the-art, complex care that we do.
UVM Medical Center: On top of all that, as I mentioned at the beginning, it seems like more eyes are turning in your direction, all the folks who are involved in healthcare policy and worried about efficiency and all that. This transitions into VNA joining the UVM Health Network, and that’s about trying to find ways to cooperate as much as possible so that, not only are people getting the right care in the right place, but it’s being done efficiently. Talk about why this made sense, this relationship.
Judy Peterson: If you look at the missions of the UVM Medical Center, the Health Network, the VNA, our missions are just so well-aligned. We really all talk about helping people live their fullest lives, thrive in their community, and help people access services that they need. The piece that was missing was the kind of integration that we’re now able to achieve through the affiliation where we’re really sitting at the same table, so it’s not just a referral relationship. We’re actually sitting down together and solving problems and supporting the work that one another does.
From the patient’s point of view, it’s just a win-win situation because with that closer integration between the hospital, the primary care physician, and home health, the patient’s care is better coordinated. We’re all communicating with one another about that same patient. As you can imagine, sometimes at the emergency room they’ll see a person who continually comes back, and they treat the acute situation and send them home. Well, now we have a program where the VNA works with the ED, so when they have somebody who’s coming back, they refer them to home health.
We’re able to go into the home, see what’s really happening, communicate with the primary care physician. So now you have the hospital, the physician, and the VNA all working together, and guess what? We’re able to figure out what’s happening. As you can see, it just brings everything together. It’s really about working as a team across the continuum of care. That’s the way we’re really going to have better health outcomes.
UVM Medical Center: When you’re at the same table, you can start talking about ideas and putting them into place. What’s one thing that’s coming down the road that you think is going to be exciting and have an impact?
Judy Peterson: One of the exciting things is telemedicine. The home health agency already does what we call tele-monitoring where we have a 90 devices that look like iPads that we’re able to take into people’s homes, and every day that iPad will notify the patient that it’s time to take their vital signs. It actually speaks to them and says, “Good morning. It’s time to take your vital signs,” and that information is electronically transferred to the VNA where we have one nurse at a central station here who’s able to see all of that information. That nurse, if she sees readings that are falling outside of normal for that person, she’ll call them, talk to them, maybe she’ll send a nurse out, or she’ll talk to the physician. They’ll make changes so that they’re really able to prevent a higher level of care like having to go to a hospital or an emergency room.
Now with the affiliation, the Network is helping us purchase new monitors that are video enabled, so we will now be able to not just call the doctor, but a nurse in the home will use the monitor to be able to show the physician what the person’s, say, wound looks like if they’re doing a dressing change, or to have that physician be able to ask questions and interact with the person. So it’ll be a real-time physician consult in the home. Just imagine how helpful that is for a person who is very sick and home-bound. To have them go to the emergency room would mean having to get an ambulance transport. We won’t have to do that now. We can bring the doctor to them.
UVM Medical Center: As you’re saying, you start thinking about all of the daisy chain effect and positive consequences down the line. It really is exciting. I’m afraid to say we’re out of time. I want to thank my guest very much. Judy Peterson is the president and CEO of the Visiting Nurse Association of Chittenden and Grand Isle Counties, Vermont’s oldest and largest nonprofit home health and hospice agency. It’s been a great pleasure to talk to you.
Judy Peterson: Thank you. I really enjoyed it.
UVM Medical Center: For more information on the VNA of Chittenden and Grand Isle Counties, you can go to vnacares.org. There, you can learn how to donate to and support these folks who are providing so much important care in our community. And you can also find out what the career options might be and explore how you can be part of this very exciting area of healthcare.