The Healing Power of Home

JoAnn Bruch, LMSW

Not all heroes wear capes, but in JoAnn Bruch’s case, they do drive an older-model Hyundai Elantra. Bruch, LMSW, a senior social worker for ChristianaCare HomeHealth, had stopped to visit a client in Sussex County who lived alone in a home surrounded by corn fields.

When she knocked at the door, there was no answer even though the lights were on, the phone rang busy and the TV blared. Bruch could have returned to her car and motored on to her next patient, chalking the missed visit up to a miscommunication, but she knew better.

Bruch walked around to the back of the house to look for another entrance. That’s where she found her client – lying in the backyard without shoes or a coat as the snow fell around her.

“I love the patients I see. I love being able to make a difference in their lives.”

— JoAnn Bruch, LMSW

The woman had gone outside to check her oil heat but had slipped and fallen to the ground, immobile.

Without Bruch’s visit, she might not have survived exposure in freezing temperatures.

Although Bruch is quick to give the credit to divine intervention, caregivers like her exemplify the love and excellence of ChristianaCare HomeHealth, which celebrates 100 years of providing home-based care to Delawareans.

Since opening in 1922 as the Visiting Nurses Association, ChristianaCare HomeHealth has brought expert skilled care to Delawareans’ homes as they recover from a hospitalization, live with chronic illnesses, or seek to maintain independence at home as they age.

“I love every single minute of every single day I am at work. I love the people I work with. I love the patients I see. I love being able to make a difference in their lives,” said Bruch, who has worked for ChristianaCare HomeHealth for five years. “My day is spent meeting with folks and figuring out how to keep themselves or their loved ones safe.”

Care where people most want to be

Employees like Sharon Williams, a HomeHealth homemaker, are partners in care, making a difference in the lives of patients and their loved ones.

Staffed with nearly 450 highly trained caregivers who understand the unique needs of caring for people in their homes, ChristianaCare HomeHealth is the highest-volume home health agency in Delaware with a national reputation for exceptional patient care.

“Our HomeHealth caregivers have been warmly welcomed into the homes of countless patients for the past 100 years,” said Janice Nevin, M.D., MPH, president and chief executive officer of ChristianaCare.

“ChristianaCare is honored to have served our neighbors as trusted, expert partners in their care, and we are proud to continue our legacy of caring for our neighbors in the comfort of their homes.”

In-home care is increasingly important as the U.S. population ages and as more Americans are living longer. A 2022 poll by the University of Michigan National Poll on Healthy Aging found that 88% of Americans feel it is important to remain in their homes as long as possible.

Ric Cuming, Ed.D., MSN, RN

“As HomeHealth marks this important milestone, caregivers continue to provide expert, team-based care that’s designed to help people flourish,” said Ric Cuming, Ed.D., RN, chief nurse executive of ChristianaCare and president of ChristianaCare HomeHealth.

“Our HomeHealth caregivers are deeply committed to meeting the needs of our community where they feel most comfortable receiving their care — at home. The tireless efforts and teamwork of our talented, compassionate caregivers make that possible.

“Because of them, we can make a true, positive impact on the health of our neighbors, one at a time.”

A change from the first days on French Street

The Visiting Nurse Association (VNA) first opened for business at 228 French St. in Wilmington, Delaware. In its first year, the staff of 12 public health nurses made 22,117 home visits across a service area that included 188,000 people.

By comparison, ChristianaCare HomeHealth caregivers made 219,091 home visits — in addition to virtual visits — in 2021 and logged more than 1 million miles of travel from Brandywine Hundred in New Castle County to Georgetown in Sussex County.

Today, Delaware has a population of nearly 1 million people. And the patients who seek out HomeHealth often have complicated health conditions that require caregivers to be able to work independently but also collaborate with others to provide optimal care for a patient.

“ChristianaCare is honored to have served our neighbors as trusted, expert partners in their care, and we are proud to continue our legacy of caring for our neighbors in the comfort of their homes.”

— Janice Nevin, M.D., MPH

Unlike the visiting nurse staff 100 years ago who walked to cover their relatively small service area, HomeHealth aide Joe Seward can drive up to 190 miles round trip during a typical week as he sees patients in Townsend, New Castle and Newark. For Seward, it’s meaningful to help someone feel better about their day, whether it’s assisting with personal grooming or with tasks around their home.

“I smile a lot and I’m someone who’s always in a good mood,” he said. “I figure I’m doing something to help people. Not everyone can do this.”

The transformational nature of HomeHealth was one of the draws for Lori Davis-Palmer, who started 22 years ago as a nurse case manager before taking roles as a nurse educator, home care liaison and nursing supervisor.

She appreciated how the care of HomeHealth staff really made an impact on the health of their patients, whether it was helping them to better manage their medications or maintain their low-sodium diet.

Because of their unique role, HomeHealth caregivers see in real time how a patient is faring and whether additional medications, strategies or interventions are needed.

“It’s more complex than it’s ever been, and so is the acuity of the illness for some patients who are living at home,” said Davis-Palmer, now a director of clinical care for HomeHealth.

“We’re providing a level of care to a hospital medical-surgical unit right in the home. We’re really seen as a true partner in that care now more than ever.”

Providing the right care in the right place

Stephanie Potts

It’s common for HomeHealth caregivers to identify a problem and find a way to make a difference. When occupational therapist Stephanie Potts, OT, recognized symptoms of a stroke in a patient during a home visit, she not only waited for paramedics to arrive, but she also contacted the emergency department and made sure a stroke alert was called, saving precious time when the patient arrived at the hospital.

Cynthia Cordrey, a music therapist in HomeHealth, took her sessions on the road to serve her clients when COVID-19 forced the temporary closure of the Evergreen Center, ChristianaCare’s adult day program for people with dementia and other conditions. The Evergreen Center has since reopened and Cordrey is back to making music with clients in person.

Lynn Jones, FACHE
Lynn Jones, FACHE

HomeHealth’s strong connections with inpatient and outpatient care have helped caregivers in the home be prepared for a patient’s transition from acute care, said Lynn Jones, FACHE, who served as past president of HomeHealth.

“Nurses in HomeHealth have to be clinically strong to provide what their patients need,” said Jones, president-elect of the Delaware Academy of Medicine/Delaware Public Health Association. “We were able to develop these connections because of what our caregivers already do.”

Working with specialty areas, such as cancer, orthopaedics and kidney transplant, has allowed HomeHealth to develop home-based protocols that have helped improve outcomes and patient experience for those receiving care at home.

The result of that alignment of care is better health on multiple levels, said Rita Landgraf, board chair of ChristianaCare HomeHealth.

“When people are discharged from the acute care system and go back into their homes with the appropriate support, it advances their overall health and well-being,” said Landgraf, former cabinet secretary for the Delaware Department of Health and Social Services.

“The added value that HomeHealth has provided is just tremendous, not only in years of service to our state, but the impact on individuals’ lives.”

Caring for the whole family

Elena Gomez, RN

Elena Gomez, RN, has been a HomeHealth nurse for eight years. She values the opportunity to concentrate on one patient at a time and appreciates the team approach that HomeHealth caregivers use to meet patient needs.

“We have incredible caregivers,” said Gomez, who works in the Middletown area. “What I really like is that when patients fill out the surveys, they mention the whole team helped them to get better.”

The collaboration among HomeHealth caregivers made all the difference for Angelo Marinelli of Smyrna, who broke his right femur earlier this year during a fall at home.

After undergoing surgery and a stay at a rehab center, Marinelli headed home, where he received care from several HomeHealth caregivers, including physical therapists, occupational therapists, nurses and aides. They helped him get back on his feet – literally – by working with him to walk using a walker and practice getting in the shower safely.

ChristianaCare HomeHealth Services include: Skilled nursing care, home health aide assistance, Alzheimer’s and dementia care, infusion therapy, medication management, occupational therapy, pain management, physical therapy, rehabilitation services, social work support, speech therapy and wound care.

Call 888-862-0001 for a referral.

It was Angelo Marinelli’s care team that also recognized his wife needed help, too.

“They realized I was drowning,” said Barbara Marinelli, who was overwhelmed with full-time caregiving for her husband of 64 years. The team arranged for a HomeHealth aide to assist with some of his daily care activities.

“I don’t know what I would have done without ChristianaCare HomeHealth. Because of them, my husband has progressed to where he is now,” she said, noting that Angelo hopes to soon transition to a cane.

“You appreciate the professional, but you also recognize the personal impact they have on your family.”

Alexa, what is the future of home health?

“As technology continues to impact patient care, it will open up more opportunities for HomeHealth patients to have preventive care that can improve their overall health and reduce their risk for future hospitalizations,” said Ann Painter, MSN, RN, senior vice president, ChristianaCare HomeHealth & Community Services.

Ann Painter, MSN, RN

Innovations that evolved during the COVID-19 pandemic offer a glimpse at the future of home health care. HomeHealth had already been an early adopter of telehealth, so when providers pivoted to virtual health at the height of the pandemic, HomeHealth already knew what to do.

Virtual health services, including HomeHealth’s participation in a remote nurse visit study, have made it possible for caregivers to intervene between in-person visits and keep patients out of the hospital, Davis-Palmer said.

“With some of our monitoring, we have changed our model so that not all in-home care will be in person,” Painter said.

“The added value that HomeHealth has provided is just tremendous, not only in years of service to our state, but the impact on individuals’ lives.”

— Rita Landgraf

“If we can make use of technology to accomplish some of these tasks, it will  increase the capacity to provide more services to more individuals.

“Hopefully, the end result of that is better access to care for all people.”

When Ronica Chalmers, administrative manager for HomeHealth Clinical Care, started with HomeHealth 31 years ago, everyone on the staff relied on paper and pen to stay updated on patient care.

Caregivers wrote everything down, and the paperwork was filed in a medical record room. By contrast, today’s HomeHealth team has used an electronic health record since 2004. Cell phones and iPads seamlessly communicate and securely transmit information.

“The technology has definitely changed and pulled it together for us,” said Chalmers, who works in the Georgetown office and oversees more than 100 HomeHealth aides. “Everyone is connected and just a phone call away.”

Denise Woods, PT, COS-C, of ChristianaCare HomeHealth won the health system’s 2018 Innovation Challenge with “The Future of Home Healthcare with Alexa.”

The increased collaboration among HomeHealth caregivers also drives innovation. In 2018, Denise Woods, PT, COS-C, rehabilitation clinical manager for Home Health, developed a HIPAA-eligible voice-based assistant designed to help home health patients stay engaged and follow their plan of care.

Painter said she expects more voice-related services to take a broader place in health care, offering an opportunity for HomeHealth patients to not only get reminders about upcoming care, but assistance with scheduling, such as for a colonoscopy or mammogram.

“We use technology to personalize the experience of the individuals we care for, making it possible for them to get care when they want and in the place they want,” said Randy Gaboriault, MS, MBA, chief digital and information officer. “This kind of caregiver-led technology creates a new model of care to truly impact health.”

‘Look at the difference you made’

Even with the latest technology assisting with patient care, the greatest strength of HomeHealth is its caregivers. This hasn’t changed in 100 years. Their care and dedication can be found in people like Phyllis Johnson, a HomeHealth aide for 29 years who sometimes visits people twice a day to make sure they have what they need.

Phyllis Johnson

Similarly, when the remnants of Hurricane Ian threatened parts of southern Delaware recently, the HomeHealth staff began planning days before the rain started to make sure patients in Sussex County were prepared in the event of an emergency.

Painter said when she gets positive reviews from patients, she makes a point to share them with caregivers so they know the impact they have.

“I always try to go back to our staff and say, ‘Look at the difference that you made in this patient’s life,’” Painter said. “We usually see patients for 30 to 60 days, so we get to see that improvement or them being able to manage their illness better.

HomeHealth teams celebrated the 100th anniversary with special breakfast events, like this one at the Camden, Delaware office.

“In HomeHealth, there’s a lot of teaching,” Painter said. “Being in the patient’s home, you can learn what might have led to a deterioration in their health status and you have an opportunity to help change that trajectory so that it doesn’t recur.”

It has been two years since Virginia Fagles’ son required HomeHealth care after a fall left him injured and needing assistance with walking. The HomeHealth team not only helped her son get adjusted to using a walker, but they were also especially sensitive to his need for additional time and reassurance as someone living with a disability.

“What difference it makes when people treat you with respect.”

— Virginia Fagles

The caregivers broke the ice with comments about his superhero t-shirt, but one of the HomeHealth aides – who has since retired – won Fagles’ son over by helping to connect a platform to reach his favorite recliner while using his walker. To this day, he still uses the chair – and they still think about ChristianaCare HomeHealth.

“After someone comes out of the hospital, especially an adult who is learning disabled, what a difference it makes when people treat you with respect,” Fagles said. “I just praise ChristianaCare HomeHealth.”

ChristianaCare HomeHealth provides after-hospital care, rehabilitation, pain management, infusion therapy, home health aide support, medical social work and medication management for patients of all ages. To make a referral, call 888-862-0001.