The House Call Makes a Comeback : Health care: Patients can receive services ranging from visits by RNs to physical therapy and nutritional counseling as they recover outside the hospital. The approach is gaining momentum as a cost-effective alternative.
GLENDALE — Susan Treptow slipped the blood pressure cuff off the woman’s arm and smiled as she noted her findings.
“You done me out of a job,” said Treptow, a registered nurse, teasing 80-year-old heart patient Ruth Linsel.
That day, almost seven weeks after being hospitalized for congestive heart failure, Linsel was being discharged. Only she was not going home. She was already there.
Thanks to six weeks of visits from Treptow and another nurse, both from the Verdugo Hills Visiting Nurses Assn., Linsel was able to leave the hospital after five days and recuperate in her La Crescenta apartment. This would be Treptow’s last visit.
The Glendale-based nonprofit association is celebrating its 50th anniversary of home health care services as part of a national network of more than 400 agencies.
In 1943, the Glendale agency started with one registered nurse and an executive director.
Today, the association has 140 full- and part-time employees, including physical therapists, home health aides and social workers, and a staff of 50 volunteers. They make an average of 2,500 visits a month to patients in Pasadena, Burbank, Eagle Rock, Sunland-Tujunga, La Canada Flintridge, La Crescenta and Altadena.
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Patients are usually referred to the agency by their doctors.
Services include visits by RNs and home health aides, who help patients with baths and light housekeeping. In-home physical therapy, nutritional counseling and social workers are also available.
The association also has a home hospice program for terminally ill patients, allowing them to spend their last days at home rather than in a hospital.
“I know (home health care) is the wave of the future,” Treptow said. “It’s more cost-effective.”
Dr. John Gunnell, a Glendale oncologist, agrees. Citing an in-house audit of the nurses association, he said that, for home health care during the average last year of a person’s life, “the per-client health care cost, including everything, is $3,000.”
Quoting an article in the Wall Street Journal, he said that an average of $60,000 is spent on a person who is in a hospital or skilled nursing facility for the final year of life.
Patients also seem to do better in their own homes, especially those who have good support from their family and friends, experts say.
“I think people are healthier and happier at home,” said Michelle Jahns, a social worker for the association who sees the emotional side of what patients go through in their recoveries.
“They want to stay home so badly,” Treptow said of her patients.
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She spent most of her visit with Linsel offering encouragement and going over the information that Linsel would need to stay healthy, such as diet and learning how to take her own pulse.
“You have the lungs of an 18-year-old,” Treptow told her patient after checking her with a stethoscope.
“Give me the legs of an 18-year-old,” Linsel quipped.
Although she is happy to be feeling better, Linsel, who lives alone, was not happy that this was Treptow’s last visit.
“Well, darn it, I’m going to get sick again to have you come back,” she said.
“These are the ones that lift you up,” Treptow said as she left for her next patient.
The nurse acknowledged that her work can be emotionally draining, especially when a patient dies.
“I’d be lying if I said I didn’t get involved,” she said. “There have been patients where I just took the next day off. I don’t think you ever get immune.”
Treptow, 32, has been an RN for eight years. She worked as a pediatric nurse at Childrens Hospital Los Angeles before joining the association five years ago.
“I would say the big difference between this and the hospital is that you have more independence, but you also have more responsibility. You are the doctor’s eyes,” she said.
“In the hospital, you have more control” over such things as when a patient eats or get medication. Patients at home tend to fall back into their personal habits. “Our job is to work around these habits,” Treptow said.
“The nice part is you’ve really helped (the patients). And your day is your own,” she said of the flexibility she has in setting her schedule.
Treptow estimated that she drives about 35 miles a day making the rounds, not counting her commute to West Hills, where she lives with her husband.
The hardest part for Treptow and other home health providers is the tremendous need for their services that is not being met.
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“I think a lot of people are not being helped by home health care that could be and should be,” said Dr. Phyllis Moeller, a Glendale general practitioner since 1953.
The problem is mostly a matter of money. There are other home health care companies, but they are for-profit agencies that must watch their bottom lines and are dependent on what insurance companies will pay.
“It’s been a problem,” said Dr. Christine Evelyn, a Glendale arthritis specialist. “I’ve had an experience where the patient was home for two weeks, and (the insurance company) canceled everything,” including a visiting nurse and home physical therapy.
But while association relies mostly on Medicare reimbursements, thanks to United Way funds and two major fund-raisers a year, they are also able to take on cases that other agencies cannot.
“They do so much charity work, it’s just incredible,” Gunnell said.
“Many, many, many times we’ll take a patient that other health care agencies won’t touch,” said Jahns, part of whose job as a social worker is to find support services, such as Meals on Wheels and Dial-A-Ride, for people without insurance or family.
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Treptow’s next visit was to see Farah Fawaz, 17, and her infant son, Moustafa, at the Burbank home they share with Farah’s grandmother, brother, his wife and their four young children. The young mother is a native of Lebanon and has been in the United States for 20 months.
The baby was born two months early, weighed only four pounds and, like a lot of premature infants, had trouble nursing because the upper palate in his mouth had not yet closed.
Farah has been grateful for Treptow’s help.
“It’s good because I don’t have a lot of friends,” she said. “I feel very good because she checks him.”
Treptow, again stressing encouragement, watched as Farah fed the baby, rotating the bottle and holding the baby’s lips closed, which creates suction, and the baby began to suck.
Treptow got out her portable scale and weighed the infant, who she found was gaining weight nicely. In fact, by the time he was recently discharged from her care, the child weighed 9 pounds, 4 ounces, up from 7 pounds, 10 ounces when Treptow started visiting him.
