HOME HEALTH: VISITING CAREGIVERS PROVIDE VARIETY OF SERVICES LOCALLY

When it comes to local home health care, there's no lack of it to choose from.

There's Southeast Missouri Hospital's Home Health Services, the Visiting Nurse Association (VNA) of Southeast Missouri, and the Cape Girardeau County Public Health Center, among others. Combined, the three have made up to an estimated 17,800 home visits a year.

Home health care helps hospital patients get home sooner, said Home Health Services Administrator Barbara Rauh, and helps to make them safer at home and have continued health care and instruction.

"We do anything for them that can be done for them in the hospital. We do a lot of dressing changes. We take care of a lot of pain control for the terminally ill," she said. The terminally ill, said Rauh, are cared for through the service's Hospice program.

"The whole goal is to have a long-term assessment of the patient and to teach them how to stay well." Plus, she said, the goal is to confront a medical problem before it requires hospitalization.

Rauh said Home Health Services, at 781 South Kingshighway, made over 7,000 home visits last year and dealt with somewhere between 400 and 500 people, 39 of them being Hospice patients. The service has about eight registered nurses, three nursing assistants, a psychiatric nurse, and a physical therapist, she said. A speech therapist and an occupational therapist from Southeast also make visits for the service.

To get home health care from the service, a person doesn't need to be a Southeast patient. The service gets referrals from St. Louis hospitals and doctor's offices, said Rauh, and provides service to Veterans Administration patients. It also provides service to people with AIDS and those found to be positive with HIV, the virus that leads to AIDS.

In Medicare cases, Rauh said, Home Health Services is reimbursed $50 to $80 a visit. Rauh said someone wouldn't be able to be in the hospital for less than $300 a day.

The service doesn't turn down anyone who can't pay and has a fair amount of indigent care, she said.

Pat Huttegger, the patient care coordinator with VNA, located in Cape Girardeau at 1143 North Kingshighway, said there is continual growth in home health care.

"I think (there's) anywhere from 12 to 18, 19 percent growth every year. It mainly has to do with the DRG (Diagnostic Related Groups) regulations requiring patients to get out of the hospitals sooner. Patients are not put in the hospitals as quickly as years past when they didn't have to worry about DRG."

Diagnostic Related Groups, which the hospitals use for Medicare reimbursement, refers to a patient's particular affliction, which could be a heart problem, a stroke, or cancer, she said.

VNA is a nationwide association and a not-for-profit agency, said Huttegger. The per-visit cost for home health care is $60 to $90, depending on what service is being provided. She said VNA also provides charity service if someone is unable to pay.

The area association has seven regional offices and covers Cape Girardeau, Perry, Bollinger, Scott, Mississippi, New Madrid, Dunklin, Pemiscot, Stoddard, Madison, and Butler counties. The area association has contracts for home health care with St. Francis Medical Center, Missouri Delta Medical Center in Sikeston, and Twin Rivers in Kennett.

The Cape Girardeau office has six full- and part-time registered nurses and three nursing aides, or certified home health aides, for home health care. It covers Cape, Perry, Bollinger, and Madison counties, as well as the northern third of Scott County. The office makes an average of 500 to 600 skilled nursing and home health aide visits a month.

"We take care of patients on ventilators," Huttegger said. "We do a lot of patient teaching in relation to diabetes and cardiac problems."

VNA also provides service to patients who have problems with physical mobility and its nurses aides give baths and help with personal care, she said.

VNA was initiated in Kennett in 1972 under another name, said Huttegger. In 1985 it became VNA and opened an office in Cape Girardeau, she said.

The director of the county health center, Charlotte Craig, said until a few years back, the county health center was "the only ball game in town" for home health care and made over 800 home visits a month. The center offers skilled nursing and personal care.

"We've been doing home health longer than anybody. Public health nurses have been doing home visits for 115 years," she said.

But with the deregulation of home health care in 1985, she said, hospitals got into the business and private agencies sprang up. Now the center averages 200 to 300 referrals a month, said Craig.

The center, which is supported by county taxes and state funds, offers home health care for free, just as it does with any of its services. It has five nurses who make home visits, Craig said, in addition to their other work.

Craig said anyone a family member, patient, doctor, neighbor can call with a referral for home health care.

"We'll make an assessment visit to see if we really need a home visit or skilled nursing," he said. "If they need us, we'll contact their physician and get orders to be in the home.

"If another service other than what we can offer is needed, then we'll point them in the right direction and make the referral for them." A lot of times, Craig said, another agency is needed.

Rauh said Home Health Services is offering two new programs. The first offers a companion service for anyone in Cape Girardeau County over the age of 60. The program is funded through the county's tax for older adults, she said.

Under the program, she said, hospital patients are helped with any tasks they would not normally be able to do after leaving the hospital. Help is available up to a total of 80 hours, in any increments, said Rauh.

Rauh said the second program, funded by grant money through the state Division of Aging, provides time away to the primary care giver of someone who is suffering from Alzheimer's Disease. Up to eight hours of relief is available per week.

Craig said the county health center is providing personal care in the home also through the older adult tax.

"We're making a stab at accommodating that. The requirement is that they need to have some assistance. It's got to be someone who doesn't have anyone else to help them out."