There’s No Place Like Home

Nov. 10-16, 2005
VOL 124 NO. 39
There’s No Place Like Home
By Claudia Mathis/ SUN staff writer
SUN photo(s) Paul Finch
Visiting nurse Maria Giannio, listens to 3-month-old Grace Ann Chiarenza’s chest as the baby’s mother Amy Chiarenza observes More than five million Americans nationwide currently receive home health care for both acute and long-term needs. In less than 10 years, one out of every five Americans will be over the age of 65. As Americans live longer, this figure will continue to rise, and caring for the sick at home will continue to assume a significant place in the nation’s health care delivery system. The cost, covered by a variety of private and public sources including Medicare and Medicaid, saves the government billions of dollars every year. Home care remains the most cost-effective provider of health care.

The Visiting Nurse Association has been in operation since 1890. Its history dates to the late 1880’s when a group of local women were concerned about the “destitute sick” in the community. The members of the group visited the sick themselves and employed a trained nurse for the more serious cases. From this group, three unusually public-spirited members, Arria Huntington, Dr. Juliet Hanchett and Laura Mills Marlow, formed the organization now known as the Visiting Nurse Association. This early leadership represents the same three groups that function in the Visiting Nurse Association today: the layperson, Huntington; the physician, Dr. Hanchett; and the nurse, Marlow, who was a graduate of Bellevue Hospital and the first graduate nurse in the city of Syracuse.

The purpose of the Visiting Nurse Association was to care for the sick in the comfort of their own homes, to teach families how to help care for their ill loved ones, and to provide nursing supervision for the maternity patients, infants and young children.

The Visiting Nurse Association is making a difference in the daily lives of those who need it most. Sharon Cwikla, RN, a parishioner of St. Matthew’s Church in East Syracuse and a nurse case manager for the Visiting Nurse Association in Onondaga County, is making a difference in the life of patient Winnie Portmess. She has been under Cwikla’s care since July 2003. A victim of lung cancer, Portmess said she doesn’t know what she would do without Cwikla’s care. “She’s my lifeline,” said Portmess.

When Cwikla visits Portmess at her home, she asks her about her pain and her blood sugar readings (she is a diabetic). Cwikla also listens to her lungs and checks her vital signs. She asks Portmess how she is eating and managing her medications. Cwikla also stresses with Portmess the importance of keeping in touch with her doctor and nurse with any concerns that she might have. “Sharon keeps tabs on me and communicates with my doctors,” said Portmess. “Sharon is a person that I can talk to — you need to have a person to confide in. I don’t want to burden my family.”

Cwikla has been working for the Visiting Nurse Association for close to nine years. After working at Crouse Irving Memorial Hospital for one year after graduating from nursing school, Cwikla decided to sign on with the Visiting Nurse Association because of several factors. “The great thing about working with the Visiting Nurse Association is I get to treat the whole person,” said Cwikla. “When I worked in the hospital, I never got to treat the whole person. When I care for my patients now, I’m their friend and family — some patients have no family. I can connect my patients to resources that they don’t know are available to them.” Cwikla also enjoys the diversity of the patients that she cares for. She ministers to both long- and short-term care patients.

On an average day, Cwikla visits up to six or seven patients. “I watch them very closely, and I try to be consistent in my care so that the patients feel secure,” said Cwikla. “People are happiest at home.” Last June, Cwikla began using a new in-home telemonitoring technology system to assist her in caring for her patients. Patients are now getting a check-up every day in the comfort of their homes. With the new system, the patients’ vital signs are checked every day using a small, alarm clock-sized telecommunication device placed in their homes. The telemonitor verbally guides the patient through the collection of their vital signs — blood pressure, weight, heart rate, temperature and oxygen saturation. Within minutes, the readings are transmitted to the clinicians at the Visiting Nurse Association for review, and, if they notice even the slightest abnormality, action can be taken to address the problem.

By practicing early intervention when any health problem is detected, the Visiting Nurse Association is helping to prevent emergency room visits and hospitalizations, which account for a significant portion of the overall healthcare expenditures in the U.S. “It’s wonderful,” remarked Cwikla. “The system is ideal for the patients whose systems go up and down periodically. It alerts us to something that is going wrong. The ultimate goal is to prevent re-hospitalization.” “I love what I do,” she said. “I feel totally supported by the management — anything that I suggest, they take seriously.”

Cardiac team and clinical nurse manager Diane Nanno, RN, is a parishioner of St. Michael’s Church in Syracuse and has worked with the Visiting Nurse Association for the last 23 years. She completed some home care nursing when she attended nursing school at Niagara University. After graduating from nursing school, Nanno worked as a nurse at New York University Medical Center for a year and a half, and after that, she worked for one year at Crouse Hospital. “I came to the Visiting Nurse Association because I wanted to do community health,” said Nanno.

“I really enjoy home care,” she said. “I like the contact I have with the patients — teaching them how to take care of themselves to make their quality of life better. We can help them prevent future health problems. I also enjoy working with the families — we don’t just treat the patient. Most of what we do is teaching and it is very rewarding.” As a clinical nurse manager, Nanno teaches the new nursing staff the methods of home care nursing. “If a patient is extremely ill or if a case is difficult, I will go with the staff to the patient’s home to help solve the problem,” said Nanno.

Another vital aspect of Nanno’s job is her role of cardiac team manager. In this role, she oversees the Heart Smart program, a specialty program for heart failure patients. The Visiting Nurse Association has integrated this plan in an attempt to prevent hospitalizations and to keep the patients living at home. Studies have shown that heart failure patients over 65 years of age repeatedly end up being hospitalized.

Patients who are enrolled in the Heart Smart program are educated on how to take their medication and how to exercise. A nutritionist visits the patient to evaluate the patient’s dietary needs. Also included in this plan is a physical therapy evaluation with any necessary physical therapy provided for the patient. If the patient needs to be referred to an occupational therapist, a referral is made at that time. Only three and a half months old, patient Grace Chiarenza is being cared for and monitored in her home by Maria Giannino, RN, who has been a parishioner of St. Ann’s in Syracuse for the last 24 years. She is a pediatric nurse and educator from the Visiting Nurse Association.

Diagnosed with Cystic Fibrosis, Grace was released from the hospital one week ago. When she was being released from the hospital, it was recommended that the family arrange for a home care agency to care for Grace. Because Grace’s grandmother had previously worked for the Visiting Nurse’s Association, the decision was made to contact that organization.

Grace needed in-home care because she was sent home from the hospital with her nasal gastric feeding tube still in place. The only way that the hospital would allow Grace to go home was if she received home care. Grace had been admitted to the hospital numerous times since she was born. “We are going to see if we can get her to gain weight and make sure she is well hydrated, and then go from there,” said Giannino. After spending numerous hours in the hospital with her daughter, Chiarenza is relieved that Grace is being cared for at home. “It’s nicer and quieter here at home,” said Chiarenza. “It can get very tedious spending a lot of time in the hospital.”

When Giannino visits Grace at her home, she checks Grace’s weight, lung sounds, and heart rate. Giannino also talks to her caregivers about how Grace is feeding and about how to make the feedings a little bit easier. Giannino has worked for the Visiting Nurse Association for the last 15 years. After working as a pediatric nurse at Crouse Hospital and as nurse for a pediatric allergist, she became interested in working for the Visiting Nurse Association because she was looking for a position that would offer her flexible hours yet would also allow her to stay in the pediatrics field, because at that time she was starting a family of her own. “Working in home care, I schedule my own clients and I am able to make visits as I need to,” explained Giannino.

Giannino enjoys many things about working with the Visiting Nurse Association. “I like dealing with the whole family concept,” remarked Giannino. “It’s much nicer than working in a hospital. I enjoy going into the home — I get to see the full picture of my client. Some of my patients that are chronic, I’ve had for 11 years. In that case, I become extremely involved with the patient and I become part of the family.” Giannino said she likes the independence she has working with the organization. “Working in home care, you have to feel comfortable about your assessments,” she explained. “ I like being able to know and to learn what I need to and being able to go out there and share it. We do everything for our clients as far as helping the families — getting them services like getting an aide to come in and help, or if they need a private duty nurse we will arrange for that. It’s case management — it’s bringing the whole picture altogether and helping the family get through it.”

Giannino said the most enjoyable thing for her is watching a two- or three-pound baby grow, especially if she cares for that patient for a long time. She once cared for a one-year-old patient until he was discharged from her care at age six. “When you see someone for that many years, you become very attached,” said Giannino. “I like watching the children and families grow and develop.”

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