Healing happens at home

The Sonoma Valley Hospital Home Care program marks 20 years of existence – and 200 years of service – this year. The current staff of 31 has collectively logged 200 years of work since the program started in 1989, said Barbara Lee, the program’s director. They average 800 visits a month among them. The team offers skilled nursing care to people in their homes.
Their oldest patient was pushing 100 and their youngest was weeks old. Of the total, 50 percent are over age 85 and 29 percent live alone. The staff includes RNs, physical therapists and occupational therapists. They help rehabilitate people with total joint replacements, perform wound care, educate people on how to manage medications, and even look around the home to put up bars or get rid of throw rugs that might be a danger to patients.
“Visiting nurses have been around forever, probably since Florence Nightingale!” said nurse Cathy Arata, who was working at Sonoma Valley Hospital when the home care program started.
At the time, Care Home Health was the only group that provided the service in the Valley, led by director Barbara Ottens. Ann Marie Mulligan, then working in hospice for the hospital, handled the administration for the program and Ottens handled a lot of the hands-on work to get it started.
“From not a scrap of paper, she had to start it all,” said Arata.
SVH Home Care now has no shortage of paper – Lee counts it among their challenges that the work is very paperwork-intensive. The program is accredited and Medicare-certified. When the local program was founded, it was a very lucrative niche of the healthcare market because Medicare paid per-visit. That changed with the Balanced Budget Act of 1997 and the implementation of diagnosis-related groups (DRGs) and the “prospective payment” system, which were developed to better control how patients consume resources. Now payments are based on the acuity of the case and the patient’s profile and status.
Arata said it takes a certain kind of person to work in home care – highly competent, confident, and highly autonomous.
“At the hospital, everybody is hooked up to machines to tell you what’s going on. We have to read the patient,” said Arata. “It’s the hands-on, old-fashioned nursing – but at a high level. The doctors rely on us. We’re their eyes and ears.”
People either love it and stay forever or they don’t last long. Joanna Brown, a physical therapist, is one of those who have stuck around – for 16 years in her case.
“I love it. It’s fabulous,” said Brown. She was at SVH for two years and wanted to go part-time so she could care for her small child.
“I got to be a full-time mom, but I also got to have a career I love,” Brown said. She was able to work six hours, three days a week, and as her daughter grew up, she increased her hours to four 8-hour days.
“What I really like was seeing people in their home, really being able to see the people instead of seeing them in hospital gowns. You could see who they were, the obstacles they had to deal with in their homes,” said Brown. “We could really individualize the program.”
She is always casting an eye around for low chairs that are hard to get out of, loose throw rugs that might slip and obstacles in the bathroom.
She works with three other therapists who have been there as long as she has.
“We really take care of each other and each other’s patients. It’s unique,” she said.
All home care agencies report data to the state. Based on that data, Sonoma’s program ranked in the top 25 percent of providers in the country for patient satisfaction and outcomes, according to the 2008 Homecare Elite analysis.
Kit Schmidt said her job as a nurse with Home Care requires a lot of nurturing and emotional support. That means different things for each patient. Sometimes she has a patient with a Type A personality who is “chomping at the bit,” and other times, she’s telling her patient to go further and push harder. She works with families at one of their most difficult moments and it’s not easy.
“Humor goes a long way,” she said, quoting a co-worker’s favorite tag line: “I put the fun back in dysfunction.”
“Every family has their share. It comes out in times of vulnerability,” said Schmidt.
She has worked in home care about 15 of her 25 years as a nurse.
She said a lot of what she does is education – helping people to understand how the body heals and responds, knowing what to expect.
“One of the most rewarding parts is watching the healing process – seeing someone reclaim their life,” she said. The celebration in honor of the anniversary will take place on Tuesday, Feb. 18 at 3 p.m. at Sonoma Valley Hospital.