Home health care provides lifeline for dozens of local families
By John Gever
For the Dominion Post
"Keep going, Bernie, the cat'll move."
Bernard Minor hesitates in his living room doorway, a fluffy white cat sprawled lazily at his feet. Diane Kenney, a physical therapist, is urging him to walk into the room.
Minor eyes the cat for a long moment, then takes a small step. The cat scurries off, and, with increasing confidence, Minor moves into the living room.
It's a small victory, but for Minor, 71, who is coping with the effects of several strokes, it's significant and rewarding.
At any given time, dozens of families around Monongalia County have a member who is too sick to leave home, but who may not need round-the-clock care.
Thanks to the Monongalia County Health Department and several private agencies, these families can get home visits from nurses, therapists, nutritionists and social workers. The care is closely supervised by physicians.
The list of services that people can receive at home is impressive. For example, stroke patients can get physical and speech therapy. Nurses will come to change dressings on wounds and surgical incisions or to draw blood. Diabetics can get help with blood-sugar monitoring and diet.
Most of the Health Department's home care is paid by Medicare or Medicaid, said Shelley Welch, program manager for enhanced health services. Some private insurance plans also cover home health care, as do the workers' compensation and black lung programs.
Home care's goal is to help patients, and also their families, have as much of a normal life as possible.
Diane Kenney spent 45 minutes with Minor on a recent morning, helping him walk around his Lakeview townhouse, exercising his arms, and bending his legs.
How would Minor feel if he had to undergo the same therapy at a clinic?
Now he doesn't hesitate. "It would be terrible," he declares.
His wife, Judy Kelley Minor, says it takes a full hour just to get him ready to leave the house. Add the half-hour trip each way to Morgantown, plus an hour for the actual therapy, and "you can see I'm talking about half a day."
Home care has allowed Minor and his family to have something approaching a normal life. Although simple acts of daily living take much longer than they once did, Judy Minor says, "He can shave himself like he used to. He still takes care of his personal needs.... What (home care) has meant to us is, he can be functional."
Frequently the care is more effective when given at home versus a clinic. "This is real life," Kenney says, waving at the Minors' not-too-spacious living quarters. With two cats underfoot and furniture crowding every room, it's an obstacle course for someone with difficulty walking.
But it's home.
Kenney recalls an earlier patient who had a complete knee replacement. "They taught her how to walk on linoleum in the hospital setting," she says. But the woman's house had shag carpeting. After getting home, she immediately needed an emergency visit, according to Kenney, "because she was afraid to get out of her chair and walk, because of the shag carpet. That's real life."
"Most people want to stay in their home, and will do a lot" to make that possible, Shelley Welch says.
But many patients don't need lifelong home care. Indeed, says Shelley Welch, "Our goal is not to have them need us."
One patient set to "graduate" from home care is James Adams, 80, of Laurel Point.
Adams, who lives alone, is recovering from heart bypass surgery he underwent on October 18. He's on an anti-coagulant drug that requires a weekly blood test to ensure the proper dosage. He can walk almost normally, but was unable to drive a car for a month after the surgery.
"I've got family" to help him with errands, he says, "but they've got to take off work" to get him anywhere during the day.
By Thanksgiving Day, he expects to be driving his car again. He would then no longer be home-bound and in need of home care.
In fact, with Medicare paying for the treatment, he would no longer be eligible for it.
Mon County Health Department rules say that home health services are available only to patients confined to their homes due to illness or injury.
Also, a doctor must certify that a patient needs the types of care provided by skilled home care workers. The patient can't be so sick that he or she needs round-the-clock care. And most important, the patient needs to have family members around on a daily basis.
Sometimes these limitations lead to painful choices for Welch, who has to decide whether she can provide home care to patients requesting it.
Patients and their families are often desperate to avoid nursing homes. "I'm sure I'd be the same way," Welch says. But some patients simply require more care than her workers can accomplish in an hour-long visit.
"I've refused a referral because a person was, I felt, so unsafe in their home." She particularly recalls the case of a man whose face was cut up from falling. "He fell all the time in his home, and he lived alone." She had to say no to home care for him.
"We do as much as we can, but there are times when it is unsafe" to use home care in place of nursing homes.
Federal budget cuts have also put constraints on the cases Welch can accept.
Welch, who has managed the county's program for about 10 years, once had a staff of 45 and served 400-450 patients at a time in a four-county region (Preston, Marion and Wetzel counties in addition to Monongalia). But in the past five years, she says, Medicare has cut its payments for home care by 18% and tightened the eligibility requirements.
Now, Welch has just 15 home caregivers on staff plus another 10 who work on contract. From May through October this year, the program has served a total of 137 patients, with 41 receiving services currently.
Congress is now looking at a sweeping revision of Medicare. Most of the attention has focused on the proposal to add a prescription drug benefit, but Welch says there is also talk of restoring some of home care's lost funding. She is asking people to contact their senators and representatives to support the funding boost.
But in the meantime, she emphasizes, "We still do a good job."
Home care providers generally wouldn't trade it for anything.
In a hospital setting, workers often focus on their own specialties: nurses change dressings, speech therapists help patients communicate, and so on. But working in people's homes helps providers treat the whole patient, seeing how they interact with their families in a natural environment.
You have to be a bit of a social worker" in doing home care, Kenney says, persuading people to change such things as furniture arrangements that might be hazardous.
Welch was a hospital nurse before entering home care. (Indeed, she says, all her workers must have at least one year of hospital experience.) Like most others who go into home health care, she was initially attracted to the more normal work hours. But, she discovered, "it's a different type of nursing," one she liked better.
"It can be a challenge," she says. Home care workers have to go out seven days a week, 52 weeks a year, in every weather, to the remotest corners of the region.
As Diane Kenney put it, "This is real life." Welch says she can remember only one or two workers who didn't think the rewards of "real life" were worth it.
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