Selectmen Agree: Westbrook Nurses a Valuable Asset
A crunch for space led the Board of Selectmen (BOS) to consider switching to an outside contractor to provide nursing rather than add more expense to the current, town-employed nursing model. The query was answered last week with a resounding “No” by the selectmen, who agreed that the current town employee model is working well and there was no need to consider a change.
That BOS decision followed a 30-minute presentation by Lee Luft, head of the Westbrook Visiting Nurses Board’s Strategic Planning Committee. His talk praised the good work of the Westbrook Visiting Nurse Agency (VNA) and highlighted the elements of its track record of success.
Luft explained several differences between a town VNA like the Westbrook Nurses and an independent VNA in the way home visit services are provided.
As a town agency, the Westbrook Nurses can do home visits for Westbrook residents regardless of whether or not the client can pay.
“No commercial VNA will do that for you,” said Luft.
Of the 5,622 total home visits by Westbrook VNA nurses and physical therapists last year, 2,252 were offered by the town agency at no charge since the client did not have the ability to pay.
On the flip side, that means that the Westbrook VNA did get paid for the remaining 3,370 home visits. Medicare is the Westbrook VNA’s single largest revenue source, paying for 1,513 of the agency’s 5,622 annual home visits last fiscal year. Of the other visits, 984 were state-funded, 96 visits were funded by Anthem Blue Cross, 182 by private sources/with partial pay, and 595 by commercial insurers.
Skilled nursing support was the largest category of services rendered by Westbrook’s Visiting Nurses and public health agency home care providers, accounting for 2,780 of last year’s home-visits; physical therapy services were second with 1,497 home visits. Home health aide support was the next largest at 1,145 service visits. Of the remainder, 167 home visits were for occupational therapy services, 24 for speech language pathology, and nine for medical social work.
The Westbrook Nurses staff includes three physical therapists, two occupational therapists, one medical social worker, and one speech language pathologist, and can bring in an additional home health aide and physical therapy services.
Over the past five years, Luft said that payments from Medicare for each home visit have declined, the average age of the Westbrook agency’s clients served has risen, and the complexity of the cases handled has increased. At the same time, the Westbrook VNA still had a large group of clients who did not have the ability to pay for the home visit services. Together these factors have strained the agency’s finances, requiring that for the first time, Westbrook’s VNA needed town funds to help offset the agency’s costs.
Luft said that these strains, however, have not resulted in any loss of quality. He explained that the Westbrook Visiting Nurses and Public Health Agency was named in 2008 as one of the “Elite” 500 National Homecare agencies based on agency outcomes in 2007 and again, in 2015, one of only 20 VNAs in Connecticut to earn this honor. In 2016, the Westbrook VNA was one of only six VNAs chosen by Middlesex Hospital to be one of its preferred home care providers.
The Westbrook VNA was selected to be in the hospital’s preferred network based on its “cost per patient episode, service accessibility, consistent staffing, care coordination, service culture, and quality of care,” explained Luft.
When Luft finished, the selectmen opened the floor for public comments. All spoke in support of keeping the Westbrook Nurses as a town agency.
Senior Center Director Courtney Burks paraphrased a letter of support she had received for the Westbrook VNA from two town seniors who used the agency’s services.
“We [in Westbrook] have a VNA, a Senior Center, and now Sonia [Marino, the town health director]. To vilify people for being successful is [unfortunate]. We work so hard for the elderly of this town. Our services are needed,” said Burks.
Dr. Jeff Bernstein, the town’s former director of health and an emergency room physician at Middlesex Hospital, agreed, saying “I hope you consider continuing the Westbrook VNA. There are a lot of intangibles from having a local VNA and I know the residents appreciate it.”
“This is an excellent presentation. It’s amazing how much you do for what you do it for,” said Selectman Mary Labbadia.
Selectman John Hall III followed up, saying, “I’m baffled by why we’re here. Everything we have regionalized is triple the cost” of doing it ourselves, said Hall.
In response to First Selectman Noel Bishop’s question as to whether Hall and Labbadia were comfortable keeping the Westbrook VNA as is, they said they were.
Making Room
The discussion turned to the Westbrook Nurses’ agency needs, as defined several months ago by the Strategic Planning Committee that Luft heads. Those needs were three-fold: more space for the agency, the addition of one or two more staff members, and funds to convert the current paper records system to an automated computer-based records system.
Various space expansion options were put on the table and discussed including swapping the resident trooper’s space for the current Westbrook Nurses’ space. Any further steps, however, would require an architect to assess the spaces and provide pricing for the space options.
After discussing these issues, Bishop asked the Nursing Board and agency to prepare an immediate request to come before the Board of Selectmen at its December meeting for funds to hire a part-time administrative staffer who would work for under 20 hours a week for the reminder of the year.
Hall then asked the Nursing Board to “put in a budget request for another full-time person during the budget process and for funds [for conversion] to electronic medical records.”
The Town of Westbrook is one of only four towns in Connecticut that still retains the model of the visiting nurses function as a town agency. Most towns choose to contract with an independent visiting nurses agency to provide home visit services for town residents.
The VNA’s needs will next come before the Board of Selectmen at its Monday, Dec. 12 meeting.