CREATIVE CARE PROGRAMS ALTERNATIVE TO HOSPITAL STAYS

Ada Werner, 64, has diabetes, congestive heart failure, poor vision and walks with a cane. Her husband, who also has poor vision, can no longer care for her. She has spent a lot of time in the hospital. Now Werner remains at home thanks to the availability of creative care programs.

The amount of time a patient spends in an institutionalized care setting is decreasing. Medical technology, expanding outpatient care services and new insurance practices have brought patient care home.

Helen Sander, a nurse and a professional community liaison for VNA (Visiting Nurse Association) of Southeast Missouri, said patients pay a fraction of what hospital care costs.

"A non-profit nursing service, such as ours, cost less than $100 a visit including medical supplies," she said. "On average, the cost to a home care patient is $55 to $60 a visit."

Because of shortened hospital stays many patients choose agencies such as the VNA to continue their care at home. All care is coordinated with the patient's hospital before discharge.

"We are contacted by a hospital nurse or a discharge planner, or by a doctor's request," said Sander. "They let us know what has been done in the hospital, so we can coordinate their care from medications to dressing changes."

Janet Niedbalski, Werner's nurse, said the preventative care her patient receives is what keeps her patient from further costly hospital visits.

"We see problems before they progress," she said. "We try to prevent her from going back into the hospital."

Neidbalski said Werner's outlook on life has improved since being allowed to remain at home.

"She can be on her own schedule and not the hospital's," she said. "Her attitude is improving; this keeps her healthier."

Area hospitals are initiating creative care programs that provide education and medical attention for patients who, in the past, would have remained in the hospital much longer.

Keeping people healthy is the goal of St. Francis Hospital's Wellness programs. Bill Logan, a nurse and Wellness Coordinator for the hospital, said staying healthy produces plenty of economic benefits while avoiding illness.

The U.S. Surgeon General's report of July 11, 1996, states that healthcare costs are rising at an alarming rate. By 1993 costs had risen by $1 trillion, and it was determined that 70 percent of all illnesses are due to lifestyle related causes and could be prevented.

Logan said wellness programs are becoming essential to the economic livelihood of many. Some businesses are offering wellness programs to their employees and many people are seeking out healthy lifestyle programs.

Preventive programs, such as a biometrics weight loss program, can help keep cholesterol and blood pressure down. Logan said doctors may recommend this type of program for illness prevention.

"Weight loss and exercise has many health benefits," he said. "It enables use to continue our activities of daily living."

The program lasts for six weeks, three days a week, and centers on customized exercises and food plans. A second step program, Lifestyles, incorporates aerobics and continued food plan.

"We try to change their health habits, rebuild lost muscle mass, and teach them to portion their meals," said Logan.

Other programs offered through the wellness program include the American Lung Association Freedom From Smoking program and PACE, an exercise program to help prevent further problems associated with arthritis.

Southeast Missouri Hospital started its mother-baby home visits in 1995 as a response to earlier and earlier patient dismissals.

All newly discharged mom and babies born at the hospital are visited.

The visits are included in Southeast's obstetrics care package.

Cape Girardeau mother, Angie Bell, 17, a Medicaid patient, left the hospital after two days following a C-Section.

"I would have stayed longer; I could hardly walk," she said, "but I wanted to go home."

Beverly Dirnberger, Bell's mother-baby home visit nurse, examined newborn Joshua.

During the examination she checked his umbilical cord, drew blood for PKU and physician ordered lab work and checked his weight.

"We always compare the birth weight and the discharge weight to the weight the baby is at the home visit," she said. "It is very important to know if he is gaining weight."

Dirnberger said because of earlier patient discharges, the newborn PKU test, a required test that identifies a serious metabolic disorder in the newborn, must be done as an outpatient.

"The mother-baby home visit saves the mother another costly visit back to the doctor for the test," she said. The PKU test must be done within four days after birth.

In addition to the baby's examination, Dirnberger checked Bell's health.

"If we find a problem with the mother's progress we call the doctor and tell him," she said. "We check for increased blood pressure and signs of infection."

While doing the visits Dirnberger said patients are educated on newborn care, on incision care, their emotions, breast feeding, and other issues.