AIDS program integrates volunteers, providers
Care teams take burden off nurses
When you're working with AIDS patients, it's hard enough to keep up with the new medications and make sure your patients are on the right combination. You've got to deal not only with the AIDS but also with all the comorbid conditions. Do you have time to find out why one of your patients is missing his scheduled appointments? Are you sure she's taking her medications at the right times and in the right doses? Do you have someone to send to the homes to make sure they're eating the right foods? Does your system have the money to pay for home health aides to take care of all these things and more?
Probably not, but if you live in the New York capital region, there are people who do have the time to give individual attention to AIDS patients, and they do it for free. The Troy, NY-based Eddy Visiting Nurse Association's AIDS Care Team Program is based on the RAIN (Regional Interfaith Network) model that has engendered church-based volunteer AIDS care teams around the country. Volunteers provide such services as transportation to doctor visits, meal preparation, babysitting, and companionship. But the Eddy program does it with a twist: It incorporates the in-home volunteer support with the medical care given by the health care provider. That means nurses spend less time on non-medical needs and more time providing care.
Michael Losinger, a lay AIDS minister in the Episcopal church who manages the program, studied other RAIN model programs and decided the idea might work better if the volunteers were part of the health care team. "I decided I wanted to make a few changes in the model, and one of those was to take the model into a health care partnership," Losinger says. "I wanted to test the continuum of care with nurses, home health aides, social workers, and volunteers. I also wanted to measure what we're doing so the health care system would pay for it. There are so many burdens on the health care system, and we think we can help with productivity."
The idea sounded good to Northeast Health, the parent company of The Eddy Network, which provides home-based nursing and rehabilitation therapy, says Marybeth Rutkowski, RN, MSN, vice president and director of The Eddy Visiting Nurse Association (Capital Region). The Eddy VNA has three AIDS nurses who currently serve about 50 patients under a physician plan of care that includes teaching, monitoring, assessment and working with patients and families on medication protocols.
"The nurses really work with the care teams to play a part in that whole process," Rutkowski says. "In our whole medical model, the kinds of things the volunteers do have been totally overlooked. We don't realize these things are an important part of the care process. It helps the patients' whole outlook and attitude, and that has a positive impact on how they live with the disease."
Eddy has 29 care teams made up of a coach and seven members of varying ages and backgrounds. Each team goes through a three-month training program that includes team-building exercises and education sessions given by nurse practitioners and social workers on the physiological and psychological issues surrounding AIDS. Each team meets monthly with the nurse for their patient, and Losinger and the team coaches communicate with the nurses daily. The team might babysit while the AIDS patient attends an Alcoholics Anonymous meeting, plan a birthday party, sit with the patient in the hospital, or provide transportation for an out-of-town relative to visit the patient before he or she dies. They also help patients stick to their medication schedules and physician office visits.
"It's really a coordinated effort. The nurse may notice something the team can help with, and the team may notice something the nurse should look into," Losinger says. "When patients are doing fairly well, they don't get to see the nurse as much but the team provides that regular contact. They can be an information source and may notice something gradual like dementia setting in."
A study to measure the economic success of the program is under way, funded by a grant from a local foundation and implemented by graduate nursing students. Data including weekly documentation of care team activities, financial records, and clinical records are being analyzed. Losinger says the preliminary results show that The Eddy's cost per patient is less when the patient has a care team, but the final results have not yet been released.
"People are healthier when they have support," Losinger says. "These patients get a lot of attention from our teams, and that means the nurses don't have to spend as much time. The teams encourage their patients to take better care of themselves, and that results in more compliance with doctors' orders and with medications."
Even without the hard data, Rutkowski says it just makes sense that the patients receive better care at less cost with the volunteers there to help. "When the nurses are teaching the patients, it really helps to have team members there to help them absorb and remember the information," she says. "The physicians speak highly of the volunteers. They say some of the patients wouldn't be complying with their medications and office visits without the teams. The process helps extend their lives to a certain degree, and it saves on home health costs, as well."
[For more information on AIDS care teams, contact: Michael Losinger or Marybeth Rutkowski, The Eddy Visiting Nurse Association, 433 River St., Suite 3000, Troy, NY 12180. Telephone: (518) 270-1355.]
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