MILDRED STERLING

Vol. 3, No.3, August 1978 0360-7283/78/0303-0155 $0.50 © 1978, National Association of Social Workers, Inc.

HEALTH AND SOCIAL WORK,

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Fistiing Aides Training Program

T of Mercy Hospital in Miami, Florida, has added to its services an unusual HE SOCIAL WORK DEPARTMENT

plan for meeting the needs of recently discharged elderly patients. Under the plan, known as the Mercy Visiting Aides Training Program, mature members of the community are given a course of supervised field practice in supplying the personal and domestic needs of former patients. Mercy Hospital is a 560-bed private, nonprofit institution sponsored by the Order of the Sisters of Saint Joseph. Many of its patients are elderly, reflecting the popularity of southern Florida as a retirement area. Because of this characteristic of the hospital's patient population, its social work department is involved exten156

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This article describes a hospital-sponsored service program in which mature members of the community are given a course of supervised field training in the home care of recently discharged patients. The program benefits the trainee, the patient, and the general taxpayer.

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sively in discharge planning. Upon concluding a hospital stay, many elderly patients need nursing home placement or specific services such as home nursing, homemaking, or meal delivery. The training program adds a new dimension to discharge planning by offering major benefits not only to the sick but also to the elderly individuals who serve as trainees. For the sick, the program provides: (l) care and comfort in crisis situations, either at the time of discharge or during a period of domestic difficulty, and (2) a timely response to the urgency of patient needs. Aides are assigned daily by the hospital's social work department, and no other community program can respond so promptly. For the elderly trainees, the program provides: (1) feelings of continued worth and increased satisfaction as a result of having the opportunity to be of service to their peers, and (2) a source of additional income, which is so important to many senior citizens on meager, fixed incomes in a constantly inflating economy. The program is designed to offer immediate attention to the unmet needs of the discharged patient. It is a type of crisis intervention, and its services are brief, intense, and total. The visiting aide is trained to perform the following duties: • Help with the bathing and grooming of the patient. • Change and clean the patient's bed linen. • Launder and repair the patient's clothing. • Clean and tidy the patient's house. • Prepare and serve food appropriate to the patient's diet. • Shop for groceries and household supplies.

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TRAINING VISITING AIDES

HEALTH AND SOCIAL WORK

• Comfort family members and teach them to provide services for the patient. • Accompany the newly discharged patient on the trip to his home or be there when he arrives. • See that the house is in order for the patient's return. The aide is also trained to meet the patient's needs by developing the following abilities: • Learning to use and maintain the supply of sickroom equipment. • Becoming sensitive to the patient's likes and dislikes and trying to accommodate them. • Learning to recognize symptoms of mental or physical distress. • Developing sensitivity to the family situation by working with the family members and learning to accept their differences and weaknesses as well as their strengths. The assignment and supervision of cases, as well as the direct teaching of the trainees is done by the social worker supervisor-coordinator in the hospital's social work department. Each trainee reports to the coordinator daily to discuss cases, receive new assignments, and plan continued service. At this time, the trainee reports any of the patient's unmet needs to the social worker, who is responsible for providing a solution to such problems. The following case studies illustrate the various duties of the trainees.

DUTIES OF TRAINEES In the first example, the visiting aide provided comfort for a patient's wife and taught her how to care for her

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husband and to overcome her fears and lack of selfconfidence. Mrs. X was 69 years old and her husband was over 70. They had been married for 50 years. Mrs. X had never seen her husband sick until he suffered the stroke which brought him to the hospital. His ailment left him completely incapacitated, with a complete loss of mental faculties and impairment of speech, accompanied by incontinence and loss of ambulation. Although Mrs. X was devastated, she decided to take her husband home to care for him rather than place him in a nursing home. She was frightened and did not know how to give him proper personal care. She had no experience in the use of a hospital bed or bedpans and no knowledge of bathing and feeding procedures for invalids. The day before her husband's release from the hospital, she sought out his social worker and confided her fears. She was distraught over her lack of knowledge and competence. The visiting aide trainee assigned to this case went home with Mr. and Mrs. X in the ambulance. She got the patient to bed and fed and toileted him. She succeeded in making both the husband and wife comfortable for the night. The trainee returned on each of the next five days and instructed Mrs. X in the details of the husband's daily care. When such services were no longer required, the aide was withdrawn from the case. A second example demonstrates how a trainee helped fulfill a patient's wish to be allowed to die with dignity in his own home with his family. Mr. Y was in the final stages of cancer and could no longer walk and care for himself. The original plan was to send him to a nursing home. However, on the day he was to go to the nursing facility, he began to cry and begged his wife to take him home. He wanted to die where he had

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HEAL TH AND SOCIAL WORK

lived, among his possessions and close to his wife and teenage daughter. Unfortunately, Mr. Y's Social Security grant was insufficient to meet his family's needs, and his wife had been forced to take a job. Thus, neither she nor his daughter, who attended school, was available to care for Mr. Y on a full-time basis. In spite of this situation, his wife and daughter were determined to take Mr. Y home. Arrangements were made with a Medicare home health agency to supply the skilled nursing care he needed and to make a home health aide available for a maximum of four hours a day. Each day when the health aide left, a hospital aide trainee arrived and stayed for an additional four hours, allowing Mrs. Y to work and her daughter to attend school. Mr. Y died two weeks later, at home in his own bed, comforted by his wife and daughter. The social worker in charge received a letter from Mrs. Y thanking the visiting trainee for helping the husband realize his last wishes. A third example demonstrates how the training program provided immediate help in allowing a patient to be in her own home rather than in a nursing home during the first few critical days following her discharge from the hospital. Mrs. Z, 62 years of age, had been in and out of Mercy Hospital for several years suffering from syringomyelia (a condition in which abnormal liquid-filled cavities form in the spinal cord). She was too young to qualify for aid from Medicare home health services, but each time she left the hospital she needed help at home while she regained her strength and the ability to care for herself. Referral for the services of a professional homemaker usually takes a few weeks to process. Thus, although this referral was made upon the patient's discharge, the trainee visiting aide was

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needed for the first few weeks after discharge. Mrs. Z, who was educated, alert, and inquisitive, was determined to overcome her handicap, and the services of the trainee made it unnecessary for her to use a nursing home. HISTORY OF THE PROGRAM

The Mercy Visiting Aides Program was established in cooperation with two previously existing projects: the American Red Cross Companion Aide to the Elderly Program and Project Renew. The Red Cross program consisted of a training course in the basic principles of home care for the elderly. Project Renew was a government-funded program that sought to develop ways in which the elderly might combat their loneliness and feelings of worthlessness as well as supplement their meager Social Security grants. Project Renew found that the healthy elderly make excellent companions for those who are sick and housebound, and in March 1974, it offered the services of two Companion Aides to the Elderly to Mercy Hospital's social work department. These Red Cross-trained aides were subsidized through Project Renew at the rate of $2.10 per hour, working 24 hours a week during the 16-week period of the hospital's field-training program. The hospital supplied the trainees with office space, courtesy meals, and $5.00 per week for local bus transportation. To be selected for visiting aides training, persons must be at least 55 years old and must be graduates of the Red Cross Companion Aide to the Elderly course. Project Renew and Mercy Hospital complete their training by providing a form of structured internship or

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supervised field practice that offers trainees an opportunity to learn while serving patients. A certificate is awarded to each candidate who successfully completes 16 weeks of field training. The graduates are distinctively qualified to provide home care for the sick. They are neither homemakers nor nurses, but their hospital training has equipped them to give patients both personal care and domestic services. In the first 3 years of its operation, the Mercy program graduated 24 visiting aide trainees. These aides provided 8,008 hours of service to 1,006 patients. Of these patients, 907 were served until other adequate care became available, 68 until they recovered, and 31 until they expired. Of the patients served, 97 percent were elderly, 2 percent were young adults, and 1 percent were mothers of newborn babies. Four of the graduates are now employed in agencies serving the elderly. The others provide home care for patients and usually work on temporary or shortterm assignments. These aides form a registry of trained people well known to the hospital's social work department, and they have been called upon by the department to care for patients who can afford to pay. However, no charge is made to the patient for the services of a visiting aide who is in training. The success of the Mercy Hospital Visiting Aides Training Program, the number of patients it has served, the kind of services administered, and the many expressions of appreciation received from the patients and families served demonstrate the need for such a program. Many patients may have the length of their stay in the hosiptal reduced if their home environment is prepared to receive them and if they and their families

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have help during the first few days following discharge. Proper care during this post-discharge period may help patients avoid rehospitalization or confinement in a nursing home. Moreover, as the following examples demonstrate, taxpayers' money can be saved through the use of trained visiting aides. In the previously described case of Mr. X, the cost to the taxpayer for program services was $49.50 (for 15 hours of trainee service at the then-prevailing minimum wage of $2.30 per hour paid by Project Renew), plus $5.00 for carfare and $10.00 for administrative costs, paid by Mercy HospitaL If Mr. X had gone to a nursing home, he would probably have had to live his life out there. His family's resources would have been depleted quickly, and the county would have been required to pay the nursing home $650.00 a month to care for Mr. X. If he had lived only one month in the nursing home, the public funds spent on his care would have been $600.50 more than the total amount that the visiting aides program cost. For Mr. Y, the cost-of program services was' $102. The cost of a Medicare home health nurse was $280, making a total of $382 paid out of public funds. If Mr. Y had been sent to a nursing home for the two weeks he lived, the cost would have been $470, paid out of Medicare funds. There was a saving of $88. Mrs. Z received help from the program five times in three years, following periods of hospitalization. Without the help of a visiting aide after each discharge, she too would have had to resort to a nursing home, since she was incapable of caring for herself during those critical days. After Mrs. Z's last discharge from the hospital, she required ten 4-hour visits from an aide who shopped for her, prepared her meals, and helped

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TRAINING VISITING AIDES

HEAL TH AND SOCIAL WORK

her bathe. The services of a physical therapist were also required at this time, but these costs were paid by the patient's insurance company. If Mrs. Z had spent this 10-week period in a nursing home, the cost to the county would have been $975, as opposed to the actual cost of $112. The Mercy Hospital Visiting Aides Training Program is indeed an exceptional tool that society Gan use to the advantage of many, including the patient in distress, the elderly citizen, and taxpayers in general. The success of the program justifies the wider application of the concepts it embodies.

About the Author Mildred Sterling, MSW, is Director of Social Work, Mercy Hospital, Miami, Florida.

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Visiting aides training program.

MILDRED STERLING Vol. 3, No.3, August 1978 0360-7283/78/0303-0155 $0.50 © 1978, National Association of Social Workers, Inc. HEALTH AND SOCIAL WORK,...
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