Last spring Livingston was hired by DA&D to determine strategies the state and health care providers can use to lessen the current staffing problem for the paraprofessional level staff. Livingston’s study included both an extensive literature review and interviews with several thousand paraprofessional staff working in Vermont’s nursing homes and home health agencies. The final report is due in March.

Concerning expanding the pool of possible workers, Livingston discovered that most personal care attendants (PCAs) and Licensed Nursing Assistants learned about their positions through word of mouth. Virtually no PCAs or LNAs report that they found their jobs through high school guidance counselors. Livingston suggests that effective partnerships between Vermont’s high schools and the health care industry are needed.

The report suggests that industry wide marketing to make para-professionals care more attractive is needed. Anecdotal information suggests that there is a lack of broad public awareness of the rewards of working as a PCA or LNA.

Improved wages and benefits are also a critical component for improved recruitment and retention, according to the report. While PCAs and LNAs were relatively satisfied with most aspects of their work, both groups expressed dissatisfaction with current wages.

Clearly defined career ladders which would involve opportunities to grow within positions as PCAs or LNAs were also sighted in the survey results as crucial to job satisfaction. LNAs working in nursing homes, and PCAs employed by home health agencies, expressed interest in training opportunities. LNAs working in nursing homes, and PCAs employed by home health agencies, expressed the most interest in training and development.

Diana Peirce RN CRNH, hospice and palliative care director at CVHHH, has been appointed to the Board of the National Hospice and Palliative Care Organization (NHPCO). She will represent the North Atlantic Region (Rhode Island to Maine). A longtime member of NHPCO as well as the Hospice and Palliative Care Nurses Association, Diana serves as president of the Hospice and Palliative Care Council of VT and represents the state on the Regional Advisory Group to the fiscal intermediary.

"I feel that the practice of hospice and palliative care in rural New England has a number of unique opportunities and challenges. I hope to be a voice for our typically small, community health agency based programs. I know that I have a great deal to learn, but I am confident that NHPCO has many able teachers. I appreciate the opportunity to serve.

A $50,000 grant from the Pharmaceutical Research and Manufacturers of America (PhRMA), the trade association of the nation’s drug manufacturers will help Rutland Area Visiting Nurses Association and Hospice (RAVNAH) launch a statewide program to assist low income residents in obtaining low cost or free medicines, according to RAVNAH director, Ron Cioffi.

"We are very grateful to RhRMA providing the seed money necessary to help us start a program that meets this pressing need in our community," said Cioffi.

Currently, major pharmaceutical companies sponsor programs to provide free medicines to low-income patients. The RAVNAH program will make it easier for patients to access these programs and assist them in applying for these free medicines. The program will also help patients enroll in State of Vermont programs that assist individuals in obtaining low cost drugs.

The project, which is slated to be up and running in the near future will work with doctors, hospitals and other health care providers to educate them about all available prescription drug assistance programs. "We will soon be publicizing an in-state 800 number which will direct patients to the most appropriate programs and help them in completing applications for assistance, "said Cioffi.

"Modern medicines save lives and make life better," said Gabrielle Williams of Pharmaceutical Research and Manufacturers of America (PhRMA). "They also save money by keeping people out of the hospital and emergency rooms. We want all Vermonters to have access to these life saving, life enhancing treatments and are proud to be part of the project that will make this happen," she said.

The Vermont Program for Quality Improvement (VPQHC) intends to include home health care in its news CQI project geared toward developing a set of measures to assess the quality of health care and patient safety in the communities participating in the Critical Access Hospital program (basically Vermont’s smaller hospitals) and to tie all the data to the Healthy Vermonters 2010 project. What VPQHC wants to do is to expand the traditional approach to assessing quality - examining one institution at a time - to include as many players in the community as possible such as hospital, home care, adult day, and so on, to determine whether the quality at one institution effects the services provided by another and if, by working together, the health status of the people in the community can be improved.

This ambitious project is at its very preliminary stage. The hope is that home care will not need to reinvent the wheel, rather currently collected data can do the job.

Amy Buzzell, physical therapist, and Vanessa Khouri-Smith, speech therapist, are regular visitors to the Wood-Lewis household, working with Ben and teaching exercises and skills to Valerie and Michael. Amy and Vanessa are part of VNA’s Pediatric Rehabilitation Team.

VNA’s Pediatric Team is comprised of two speech therapists, two physical therapists and one occupational therapist that are specially trained in the area of pediatrics. Amy and Vanessa make about 25 – 30 visits each week. "This is not a job you leave at the end of the day. You really get to know these little kids who you see two or three times a week from the time they’re born until they’re three," said Amy.

Ben was referred to the VNA by the Family Infant and Toddler Project, which serves children in Chittenden County from birth through age. This federally funded program, administered by Parent to Parent, makes referrals to the VNA Pediatric Rehabilitation Team in conjunction with their pediatrician. VNA therapists then go visit the children and assess his or her needs. An individualized services plan is then created with the family’s input. "This is a very family-centered process," said Amy.

Valerie and Michael Wood-Lewis appreciate the in-home services. "We couldn’t possibly give him the services he needs if we had to leave the home," said Valerie. "The days are busy as it is." The Wood-Lewis’s have two therapy appointments each day in addition to three medical appointments each week. The Wood-Lewis’s are able to keep track of Ben’s services and progress through a record kept in their home at all times. "These guys write great notes to each other and to us so that everyone knows what’s going on," said Valerie. "Michael and I look back through the notes all of the time."

The Wood-Lewis’s also have nurses in their home overnight almost every night. Almost all of the VNA Care Connection nurses have been with the family since Ben first came home from Fletcher Allen Health Care’s Neonatal Intensive Care Unit. "We feel pretty blessed by the caliber of care that Ben receives. Our VNA team is excellent," said Valerie.

Amy laughs when she compares home therapy services to office-centered services. "My car is always full – I can’t fit another thing in!" Amy carries two large therapy balls, a therapy wedge and bolster, toys, batting Ts, jump ropes, hula hoops and Fisher Price buses in her car’s trunk and backseat at all times. "I visit children in their homes, at their daycares or on the playground."

"Ben is much more comfortable in his own home with his own toys," said mom Valerie. "Michael and I can observe and the other people in his life are able to experience his therapy."

While watching speech therapist Vanessa move Ben’s lips while he makes sounds, Valerie says, "These women go the extra mile. I watch every day and try to recreate what they do, but they seem to have extra and magical hands." The Wood-Lewis’s were able to create a training video by recording Amy and Vanessa working with Ben.

"The best part of this job," says Amy, "is when you see a child who hasn’t been able to walk and they’re taking their first steps. Or a children getting equipment so that they can get themselves around."

If you would like more information on VNA Pediatric Rehabilitation Team, please call (802) 658-1900.

Vermont Howard Dean has selected a Blue Ribbon Commission on Health Care to study Vermont’s health care system. The members of the Commission are: Senators Nancy Chard and Cheryl Rivers, Representatives Frank Mazur and Tom Koch, Human Services Secretary Jane Kitchel, and BISCHA Commissioner Betsy Costle. Con Hogan is the Commission’s director. The Commission has been charged to deter-mine both the state of Vermont’s health care system and to devise strategies to assure that health care in Vermont is affordable, high quality and an accessible. The work of the Commission is expected to begin after the close of the current legislative session.

Dr. Quill is a primary care internist, Professor of Medicine and Psychiatry at the University of Rochester School of Medicine and Dentistry, and the lead physician plaintiff in the New York legal case challenging the law prohibiting physician-assisted death that was heard in 1997 in the U.S. Supreme Court. His stories and slides of patients and families he has worked with paint a compassionate and compelling picture of care until death and he is the keynote speaker at the NHPCO conference in Orlando.

The conference will be co-sponsored by VT ExCEL, the coalition of VT Medical Society, VT Ethics Network, and the Hospice & Palliative Care Council of Vermont, who will host a dinner that evening for physicians and nurses with Dr. Quill. Clinical presentations, updates on palliative care services around the state, and task force committee work will continue on Friday.

Last Modified 4/1/2001