Residents in the Edisto Savannah Public Health District, Region 5, are among the 11 million Americans who receive home-delivered health care from providers specializing in everything from nursing and physical therapy to medical social work and speech therapy services.

The National Association for Home Care & Hospice has designated November as National Home Care Month in honor of the health care administrators, nurses, clinicians, therapists, aides, homemakers, chore workers and companions who provide quality care in the comfort of patients' homes.

<b>'Quality, cost-effective services'</b>

Held under the theme, "Compassionate Health Care Delivered to Your Doorstep," the celebration is extended to the approximately 35 staff members who comprise the S.C. Department of Health and Environmental Control Home Health Services, a division of the Orangeburg County Health Department.

The office is part of DHEC Region 5, serving Orangeburg, Bamberg, Calhoun, Barnwell, Allendale and Aiken counties.

"We're making a remarkable difference in the lives of those patients and families," said Brenda McLellan, RN, BSN, regional home health services nursing administrator with DHEC. "We see individuals from a couple of days old to the elderly. With DHEC Home Health being able to see patients in their homes, it's possible for them to be cared for and surrounded by their loved ones."

McLellan, who has worked in the home health care field for 28 years, said staffers have "many years" of experience in the field.

"Most of our staff have probably over 15 years of experience, the oldest of whom has 33 years and still works as a part-time registered nurse," she said.

McLellan said she has, however, seen changes in the health care system that have made providing quality care more challenging.

"Over the past 28 years, families and caregivers have become more involved in their care," she said. "Patients coming home from the hospital today are much sicker. DHEC today is teaching the patient, family and caregiver about a disease and action s.jpg to take if they experience a change in conditions."

The use of blood sugar machines and wound vacs, the change of porta catheter and wound dressings and the administrations of IVs are all among the lessons families, patients and caregivers are taught, she said.

However, an 11 percent cut in prospective payment system beginning in 2008 will impact care, McLellan said. Begun in 2000, the PPS is where Medicare pays a home health agency a predetermined payment for each 60-day period of care. The payment is adjusted for the health condition, the patient's care needs and geographic wage differences.

"There will be an 11 percent cut over the next four years, but DHEC will continue to focus on improving the patients' outcomes while ensuring quality and cost-effective services are provided to their patients," McLellan said.

"Home Health has served probably around 1,000 patients in the last fiscal year. That may not seem a lot, but when you see what patients' needs are, including their nursing, therapy, and aide or social worker, that becomes a lot of visits," she said.

Patricia Yunis Brown, RN, is the Orangeburg team leader for DHEC Home Health, Region 5. She said providing preventive care is the key in keeping individuals out of emergency rooms and nursing homes.

"There's always someone on call," Brown said. "Preventive measures that can be taken to prevent additional hospitalizations or future Home Health referrals are an important aspect of care. Part of this is also linking individuals to other community services."

"You have to have a nurturing, compassionate nature in you to work in home health," she said. "We've had some families that we've served for three and four generations. You take time with the patient not just for his physical health, but also the psychological aspect of care."

Anne Weathers, MSW, said she works to assist in long-range planning and to provide the community resource link that patients need.

"Families who are so overwhelmed by the degeneration they're facing with a loved one just can't focus and think through all of the variables and don't know which ones to consider. I can't help them with that," Weathers said.

She said the Lower Savannah Council of Governments is also now working with Orangeburg and Calhoun counties on the development of a transportation system by which Medicare patients can get to doctor appointments easier.

"They're also working on providing transportation for the three colleges in the area and helping disability board clients get to work," Weathers said. "I'm also getting ready to participate in an arthritis self-management training course so that I can conduct those courses out in the community, and that is very much preventive care."

Beth Weaver, RN, is a case manager who said helping a diabetic patient who had recently undergone an amputation keep his leg wound from further infection was preventive care that she enjoyed giving.

"His caregiver told me that she really appreciated everything that I had done in being so caring and compassionate to make sure that that leg healed. Those little things make you feel good. This is a real gr.jpgying job," Weaver said. "There are 99.9 percent of patients that are so appreciative of everything you do."

Physical therapist Lockwood "Lock" Tupper has worked in Home Health for the past 22 years.

"I think one thing that distinguishes this agency from others is that our staff is pretty much home grown and rooted in this area," he said. "Some of the other agencies are bringing in people from out of state, ... and oftentimes, there's not very good continuity."

He said the onslaught of diagnosis-related groups, or DRGs, has impacted the type of patients he is seeing.

"Under DRGs, insurance companies pay a set amount for a particular illness. As a result, hospitals are putting them out of the hospital much sooner now. So, we're getting patients coming to us with multiple chronic conditions," said Tupper, who said he relies on a holistic health approach in working with his largely elderly case load.

"We're getting very sick and debilitated patients who require therapy in order to get back to their normal activities of daily living, but we look at the whole patient," he said. "Sometimes a patient with a knee problem will have additional problems, so we have to take a holistic approach to treatment."

<b>'The care means everything to me'</b>

Holly Hill resident Nathaniel Washington is a paraplegic who was injured in a 1991 car accident. He is seen by home health officials, who assist him with wound cleaning and catheterization.

"The care means everything to me, because when I first came out of the hospital, ... I just didn't want to see anybody," Washington said. "When they started coming, that made all the difference in the world. The Home Health workers' attitudes are so pleasing, and we just get along. They're on call night and day."

North resident the Rev. Jack Poole said Tupper helped him bounce back from hip replacement surgery. Everything from movement exercises to the installation of a toilet seat adjuster were what the physical therapist helped him with.

"He knew exactly what to do, and then he began to explain what we were going to do. It was just wonderful," Poole said. "I had had three other surgeries that required rehab, and I to go down to Orangeburg to get that done."

"It was much easier for him to come into my home. His wisdom and knowledge of what to do made me more comfortable, and it made my recovery a lot easier and better," the 71-year-old Poole said.

Orangeburg resident Gilda Cobb-Hunter was another of Tupper's patients following joint replacement surgery on her hip.

"I contacted a private provider about the ... physical therapy and, quite frankly, was not satisfied. I decided to call DHEC, and it was just what the doctor ordered. The convenience of having someone come into your home and provide professional, quality service can not be underestimated," said Cobb-Hunter, noting that attitude is everything.

"I dealt with a great nurse as well. Attitude was really the big difference between the private provider and the DHEC staff. Attitude affects the level of care and your response to it," she said.

-- T&D Staff Writer Dionne Gleaton can be reached by e-mail at dgleaton@timesanddemocrat.com or by phone at 803-533-5534. Discuss this and other stories online at TheTandD.com.

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