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America's Home Care Agencies: Leading the Way in Promoting Public Health

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When Marie Desil, a home care nurse with my agency, Visiting Nurse Service of New York (VNSNY), recently took on the case of Doris*, an elderly woman with heart failure, she immediately set to work explaining to Doris and her family how to take her medications properly and manage her symptoms--advice that included limiting Doris' sodium and fluid intake and reporting any sudden weight gain. But Marie's nursing care didn't stop there. "After discussing with Doris and her family the importance of an annual flu shot, I got the okay from her doctor to administer the vaccine on my next visit," she says. "And I'll also be giving her a pneumonia vaccination." In addition, they discussed the importance of overall nutrition, good hygiene, and social interaction, including enrolling and securing transportation to a nearby senior center with help of a VNSNY social worker. "I explained that just sitting at home all day isn't good for her, because it can contribute to depression as well as physical and mental decline," notes Marie.

If depression, anxiety or other behavioral health conditions appear to be affecting a patient, Marie also has the option of calling in one of our behavioral health nurses for an assessment and referral to additional care as needed. Similarly, if a patient has poorly controlled diabetes, she can make a referral to one of our diabetes nurse specialists. "I think of myself as a public health nurse," adds Marie, "because I'm not just coming into the patient's home to monitor and manage a specific illness--I'm there to care for the whole patient."

This period during National Influenza Vaccination Week, which began on December 4, is a perfect time to reflect on how America's thousands of home care agencies, including my organization, Visiting Nurse Service of New York, are playing a central and growing role in advancing public health issues like vaccinations, safe home environments, healthy lifestyle choices and community support networks. There's been a strong push in recent years to integrate public health more closely into America's clinical medical system--a goal that is supported by such organizations as the Institute of Medicine and the American Academy of Family Physicians. While primary care physicians are often mentioned as key players in this effort, in practice, the health professionals who are often best positioned to advance public health in the community are home care nurses, social workers, rehabilitation therapists and other home health agency staff.

There are number of reasons for this, starting with the regular, one-on-one sessions that home care professionals spend with patients and their families. These in-home encounters provide the time and opportunity to raise potentially sensitive issues like vaccinations and hygiene in a context of trust and connection. And because home care professionals also have the benefit of seeing patients in their daily environment, they can address topics like nutrition and socialization in a practical, real-life way.

On top of that, today's home health care delivery models embody a robust care coordination component, which means that agency staff are continually following up to ensure that the recommendations of their visiting home care clinicians are being implemented. The same holds true for long-term health plans that are administered by home care agencies, including our own VNSNY CHOICE managed care plans.

There's yet another reason why home care agencies are now taking the lead in public health, and that has to do with the unique role our organizations play in the communities that we serve. Many home care agencies have been in business for decades or more (VNSNY, for example. is about to reach our 125th anniversary). This longtime presence results in deep ties with the residents and community organizations in the neighborhoods where we work--connections that even the most involved local medical centers and physician practices are hard pressed to match.

Examples of public health collaborations that are supported by these home care¬-community relationships include:

Vaccination clinics. Besides encouraging and administering vaccinations for individual adult patients, home care agencies also have a long history of hosting vaccination clinics that give community residents access to various vaccinations. VNSNY has frequently sponsored free flu and shingles vaccinations for New York City seniors, while other home care programs have offered these and other vaccinations for conditions ranging from pneumonia to meningitis to hepatitis A and B at sites around the country

Services to retirement communities. Home care agencies also have forged links with retirement communities across America. These include formal retirement residential centers, which typically cultivate ongoing relationships with local home care agencies that in turn provide various personal care services to their residents, as well as government sponsored retirement networks like naturally occurring retirement communities (NORCs)--apartment complexes and neighborhoods that are home to a large number of senior citizens, where home care agencies step in to provide a range of health care management and support services. VNSNY administers one such NORC ourselves, in Manhattan's Chinatown district, and has relationships with several others.

Parenting support. The national Nurse-Family Partnership (NFP) program, in which specially trained nurses provide ongoing one-on-one health and social support to young, first-time mothers from pregnancy through their child's second birthday, as been widely praised as one of the most effective family interventions ever designed. Rigorous studies have shown that this home visitation program--which is continuing to expand steadily throughout the U.S.--provides life-long benefits to both mother and child, with positive ripple effects across entire families and communities. As the NFP website notes, its public health nurses, also known as maternal and child home nurse visitors, "are the backbone of Nurse-Family Partnership's success." These nurses are drawn from home health care programs across the nation, including VNSNY, which implements New York City-area NFP programs in the Bronx and Nassau County. We also sponsor a support program for young low-income fathers that encourages them to be active participants in their children's lives.

In addition, U.S. home care agencies are playing important roles in linking community residents to mental health and substance abuse treatment, ongoing care for chronic medical conditions, wellness education, and patient and caregiver support groups, all aimed at helping individuals become self-sufficient at managing their health, while avoiding unnecessary hospitalizations.

Taken together, these many contributions add up to one inescapable truth: At a time when there is a growing emphasis on finding cost-effective ways to help the American public stay as healthy as possible, home care is emerging as an increasingly important part of the solution.

*Name has been changed to protect privacy