Registered Nurse Beth Waldron, Director of Patient Services of the Hamilton County Public Health Service, spoke to an attentive group for ninety minutes at the Byron Building, Indian Lake, on Thursday, March 4th. The League of Women Voters of Hamilton County (NY) began its series on healthcare with the leader of hands-on healthcare providers that serve persons needing home-based medical care. Waldron, with the benefit of more than two decades of experience, first explained the structure of the agency and the regulatory bodies that oversee their work thru regular reports and unannounced on-site visits, the results of which are available on internet thru the NYS Department of Health website at www.health.state.ny.us
In total the County Public Health Service has an annual budget of approximately $1 million. The Patient Services section which she heads is a Certified Home Health Agency (CHHA) comprised of licensed providers including registered and practical nurses, physical therapist, occupational therapy, speech therapist, medical social worker and dietician. Their objective is the provision of intermittent care to patients through home visits with acute or chronic conditions to assist the patient in recovering or facilitating their maintenance in their own home. They accept referrals from hospitals, physicians, clinics, social agencies, community members, family, friends or self. Contributors to payment include Medicare, Medicaid and private health insurance. Following a financial screening process services are provided on a sliding fee scale in such a way that no person in need would be denied care. Patient Services works in collaboration with other community-based agencies such as Helping Hands Caregivers and the County’s Department of Social Services, Community Services and the Warren-Hamilton Office for the Ageing that provide supportive assistance not of a strictly medical nature. Church groups, friends, neighbors and family are often drawn into the shared care plan.
Beth elaborated on the specific programs directed at different sectors of the population: Women, Infants and Children (WIC), Newborn Visiting, Pre-School Special Education (3-5yrs.), Children with Special Healthcare Needs (less than 21 yrs.), Prenatal Visits, Early Intervention (birth-3yrs.), Childhood Immunizations, annual School Clinics and Adult Immunization and provided a handy directory. One participant noted that in spite of the significant proportion of the county’s population that was age-eligible it was difficult to get local immunization against herpes zoster (shingles) although the Center for Disease Control recommends it for persons 65 years of age and older.
Having grasped the breadth of the work the participants were drawn into questioning Nurse Waldron about the challenges the staff finds in the work. Traveling long distances across the county on a single day, sometimes having to enter into sparse home environments, caring for people who are in the process of dyeing (and some who have returned to Hamilton County specifically to do so) and dealing with their loss, especially if in quick succession with another recent death of a patient, and the weight of demand upon an ageing nursing population. She also emphasized the paperwork demand imposed by NYS which requires the first nurse evaluator to carry out a lengthy and detailed analysis of the patient, and for her to further review the details of that analysis. In her view this volume of paperwork was not proportional to the benefit derived by the patient or the service providers. She also made clear the importance of having all patient records up to date within hours lest the State make a spontaneous visit and criticize the timeliness of recordkeeping.
Most captivating was her description of providing services to individuals who felt uncomfortable receiving services within the healthcare facility on White Birch Lane, Indian Lake. She described providing (good or bad news) HIV counseling or just usual injections to persons in various parking lots and back roads around the county. Beth is the only qualified HIV counselor in the county. Achieving this qualification required her to attend an intensive three day course in Albany during which she learned much more than she had anticipated would be necessary! It included a round-robin exercise in which all 40 participants had to come up with street and slang terms for genitalia in order to get participants comfortable with the vocabulary of one of the prevalent means of transmission. In view of her intended retirement later this year plans are in progress to replace this mandatory service provision.
Participants included leaders from the county’s emergency service sector who were further able to explain the relationship between the nursing service and the overall county healthcare services apparatus including areas for improvement. Attendees left having received an earful on the local situation which could inform their thinking about national and state healthcare provision policymaking.
