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02/05/2020 07:45 AMOne of the few remaining municipal home care programs in the state, Westbrook’s Visiting Nurses (WVNA) recently received an award of excellence and was designated as among the top 25 percent of home health agencies in the country. The recognition came from ABILITY Network, a self-described “leading healthcare technology company” that WVNA employs for billing services.
According to the award letter, 57 agencies were recognized by the company “out of this year’s class of 2,207.”
The selection is based on five criteria, explained WVNA Administrator/Supervisor Caroline Mullaney.
The first is quality of care and outcomes, she said. When a patient is first admitted or seen at home by a nurse, he or she is evaluated in terms of independence of movement and self-care. At the end of treatment, the patient is evaluated again; this determines the treatment outcome.
“Another [measure for the award] is best practice implementation,” Mullaney said. “Those are the steps that you take to lead to your outcomes.
“How [is the clinician] going to help the patient become more independent?” she said by way of example. By the time of discharge, it’s hoped that the patient either has the help of a family member or has the tools he or she needs.”
Quality improvement and consistency is a third measure, said Mullaney.
“We’re required to do a quality assurance performance improvement study each year,” she said.
Last year, WVNA chose to focus on pain and shortness of breath, setting up a program to improve its treatment and determining how to monitor those improvements.
Mullaney has implemented a number of improvements since she started at the agency in 2017. She moved WVNA, which was still using paper records, to an online records system, which now is required by Medicare.
The move to electronic records “helps us be more efficient and more timely with our documentation,” she said. “And it also improves communication from one clinician to another because they can see the note when they’re looking online.”
At the end of 2018, the agency instituted a training program for clinicians to enable them to keep up with changes in the questions homecare health providers ask patients. Known as an outcome and assessment information set, the set of questions, required in many cases by Medicare and Medicaid, comprise a “full assessment” of a homecare patient, Mullaney explained.
“Once we started this...training, we realized that included in there is training for home health aides, too,” she said. “So then, in August of 2019, we started our own home health aide program so we can hire the aides directly instead of through a contractor. We now have three aides” that work directly for WVNA.
Patient experience, which is collected by the Centers for Medicare & Medicaid Services (CMS), is another consideration for the HomeCare Elite program, said Mullaney.
CMS sends “the information back to us and we can look at our outcomes and see how we’re doing,” she said. “They measure us from one star to five stars and our patient satisfaction has been a five star.”
The last measure is the financial health of the agency, which Mullaney thinks is likely an assessment of “our billing practices, the consistency of our claims, and revenue versus what we pay our employees.”
Small Town Care
WVNA was founded in 1927 and is available 24 hours a day, seven days a week. Services are available both in the office and at home and include nursing; physical, occupational, and speech therapy; medical social services; and home health aides.
“Home care is very competitive,” Mullaney explained. “There’s many home care agencies that overlap each other’s territories and hospitals, and skilled nursing facilities [SNFs] a lot of times they have” particular agencies they tend to refer patients to.
“We want...residents to know that if they want to receive our services, they have to request us,” she continued.
If they don’t make the request, patients are likely to be referred to a different home care agency. WVNA requires a referral from a hospital, SNF, or doctor to provide home-based care.
The agency’s offices are right in Town Hall, as is the Westbrook Senior Center. Physical therapist Noreen Saunders teaches exercise classes and other outreach at the Senior Center and sometimes the WVNA sponsors speakers on health topics of interest to seniors.
Primary funding is provided by the Town of Westbrook.
“We certainly bill for our patients with insurance,” said Mullaney. “We take the vast majority of insurances out there: Medicare, Medicaid, Medicare Advantage,” as well as private plans. “It’s always our goal to cover our expenses. We don’t always get there.
“It’s harder and harder for the small home care agencies to survive because there’s lots of regulations from Medicare that we need to follow,” she explained. “I have someone that helps me with [quality assurance], but she doesn’t do...all the reports that Medicare requires.”
The agency is important to Westbrook residents and primarily seniors, according to Mullaney.
“We have the Senior Center and we keep up a rapport with the seniors and they know that we’re here for them,” she said. “And I think they really like the idea that they have their own nurses.
“A few days ago, a senior was leaving [Town Hall] and it was really windy that day,” Mullaney continued. “The wind blew her over and she hit her head on the cement walkway. Zach [Faiella,
Director of] Public Health, saw her and brought her in to us.”
Mullaney treated her: She had a gash and a bump on her forehead.
“We called 911 and sent her to the hospital,” she said. “But sometimes [seniors] come up from the Senior Center...and ask if they can have their blood pressure checked or sometimes they just want to talk to a nurse. So I think they like having us around and I think that’s why we’re still in existence.”
Home care services are not limited to seniors, however. They’re available to anyone, young or old, who needs them, whether temporarily or on an ongoing basis. Services are provided not only to Westbrook residents but to residents of Clinton, Killingworth, Essex, Deep River, and Old Saybrook.
Office hours are 8:30 a.m. to 4 p.m. daily at 866 Boston Post Road, Westbrook, but there is always a nurse on call. For more information, call 860-399-3088.