Fredyla Urena, RN, from VNSNY’s Nurse-Family Partnership with a first-time mom and her son in Nassau County, NY.
As the largest not-for-profit home- and community-based health care organization, the Visiting Nurse Service of New York (VNSNY) is committed both to caring for those in need, and also advancing knowledge and policy around the delivery of health care in a residential and community setting. This mission, which dates back to our organization’s founding in 1893, includes providing home care services to those who couldn’t otherwise afford it, and also helping to pioneer a number of community-based programs that are now gaining traction throughout the U.S.
One such program is the Nurse-Family Partnership, in which specially trained nurses provide support and counseling to young, first-time, low income mothers (many of whom are teenagers), starting in pregnancy and continuing up to the child’s second birthday. Here in NYC, this national initiative includes a city-wide program overseen by the NYC Health Department in which VNSNY has participated for many years. Our program helps mothers to break out of the cycle of poverty and is increasingly being introduced across the nation. Another example involves VNSNY’s Mobile Crisis initiatives, in which behavioral health workers can be summoned quickly to help deescalate children and adults in emotional or psychological crisis. This program, funded by New York City, has helped reduce psychiatric hospitalizations and school expulsions, and is serving as a template for similar programs in other regions.
While VNSNY’s focus is on home- and community-based care, we also partner closely with hospitals and related organizations to improve the transition from hospital to home. Today, it’s widely recognized that effective health care is a continuum, in which caregivers in the community collaborate with hospitals and other acute care providers to help people manage their health conditions and age safely in their own residences.
One of our key collaborators in this area has been an organization even older than ours—the United Hospital Fund (UHF), a non-profit formed in 1879 that is dedicated to advancing health care policy and practice in New York State. The most recent example of our partnership is a report published just a few days ago, titled “I Can Take Care of Myself!”, which examines why some patients refuse home health care services after they’re discharged from the hospital—a decision that can increase their risk of being readmitted later. The report was based on a study conducted by Kathryn Bowles, PhD, the director of VNSNY’s Center for Home Care Policy & Research. This study found that over one-quarter of discharged patients in the research sample refused home care services, for reasons that included financial worries and loss of privacy. The study also found that patients in this “refuse” group were twice as likely to end up back in the hospital within the next two months.
The report highlighted the need for improved policies around discharge planning, and also offered a number of concrete recommendations—including taking steps to improve access to home care services, and developing guidelines for what to do when a patient turns down home care services. “As medical care increasingly moves from hospitals into the community, which for most people means care at home, the importance of home health care services in discharge planning is growing in importance,” noted report co-author Carol Levine, director of UHF’s Families and Health Care Project (which helped spearhead the study and related discussion). “But there is little guidance for hospital staff on what to do when eligible patients refuse home health care.”
Together, VNSNY and UHF are moving the discussion forward on this vitally important topic. Earlier this month, the United Hospital Fund also took another step to support home health care when, for the first time, it included the board members of home care agencies in its annual recognition of leading health care trustees in the New York metropolitan area. VNSNY was thrilled to have two of our trustees among the 31 honorees—Carl Pforzheimer III, who has served on the VNSNY Board for 43 years, and Anne Ehrenkranz, another longtime VNSNY Board Member who was recognized by the UHF for her parallel service on the Board of the Hospital for Special Surgery in New York City.
To Carl, whose long service has included a ten-year stretch as Chairman of the VNSNY Board, the inclusion of VNSNY and other home care agencies in the UHF’s leadership salute is a welcome sign that the health care field recognizes the important—and often unsung—role that VNSNY and our fellow agencies play in supporting the health and well-being of Americans everywhere. On learning of his selection, Carl wrote an open letter to the VNSNY staff, which I’d like to share with you here:
“As you may be aware, I was honored by the United Hospital Fund at their 27th Annual Tribute to Hospital and Healthcare Trustees on May 1. As I understand it, the Fund has not honored people from a home health agency before, only from hospitals. And as I also understand it, I was suggested by the staff of VNSNY as the person to accept the honor as a VNSNY trustee. That made it a double honor for me, since I know after many years on the VNSNY Board that the staff is the heart and soul of the agency.
“Some history on that board tenure might be of interest to you. Way back in 1974, I received a call from Steve Goodhue, then on the VNSNY Board (and soon to become President) asking if I was interested in joining the board. I had met Steve when he and I were on a committee together at another organization and, enjoying his company and reading the mission of VNSNY at that time, I said yes. I have never regretted that decision, not for a moment!
“…After 43 years [I] can honestly say I have enjoyed my service on the VNSNY board more than any other. The mission that originally attracted me was the one that Lillian Wald championed and is, even now, exemplified by the iconic photograph of women in VNSNY uniforms climbing rooftops to give care in their homes to young mothers and children living in poverty. The mission today is more complex, yet much the same as it was at the beginning, still with a heavy component of charitable care. Nurses, now joined by paraprofessionals, still give aid in the home, but the home is sometimes communal and the VNSNY patient population more likely to include an older and frail person…. But the care is still the best that can be offered, still given by the most skilled and compassionate of nurses and aides and still deeply welcomed by the patient as it always was. The agency is vastly bigger but, in the words of what I still consider to be the best advertising slogan ever created, ‘We bring the caring home.’
“The mission is why VNSNY was chosen to be the first home health care agency to be included in the United Hospital Fund event; and that is why I was so honored to be chosen by the staff to represent VNSNY. Thank you so much.”
As someone with a deep knowledge and experience of the Visiting Nurse Service of New York and home health care in general, Carl eloquently expresses a great truth about the home care field: That our calling is indeed a mission to spread health and well-being to every corner of our nation and the world, and that this mission is one we share with the many other health care workers that we collaborate with each and every day. And for that, we can all be thankful.