COMMUNITY ServICe plaN - Visiting Nurse Service of New York

CHARITABLE CAREProviding Home Health CareRegardless of a Person’s Ability to PayFor 118 years, we haveoffered our services tothose in need of homehealth care, regardlessof their ability to pay.2VNSNY is committed to providingcare to the most vulnerable New Yorkers,in the most underserved communities.For 118 years, we have offered our servicesto those in need of home healthcare, regardless of their ability to pay.“Our mission is to serve the poor,” saysChristopher Oates, Manager of CharitableCare. “VNSNY’s Charitable Care Programallows social workers and nurse casemanagers to fulfill this mission. Theytake the baton from the hospital or aclinical setting, and treat people in theircommunities. And, hopefully, our preventativeand treatment measures keepthese patients out of emergency rooms.”In fulfilling our mission and our obligationas a not-for-profit organization,VNSNY provides free home care servicesto the undocumented, uninsured, andunderinsured. In a well-structured program,VNSNY does outreach to hospitalsand clinics in the metropolitan area—the five boroughs of New York City andNassau and Westchester Counties—encouraging staff to refer likely applicantswho need free services basedon their income level. “I don’t knowany other organization, particularly inhome care, that is being so proactive,”Christopher says. “As a former dischargeplanner and social worker, I would hearabout charity care opportunities by wordof mouth, mostly other social workerstalking. What we do at VNSNY is tellanyone who might need us: ‘This is a resourcefor your tool bag, and you’ll findit very helpful. And they listen.’”

VNSNY Charitable Care In ActionVNSNY CharitableCare provides aid forthousands of peoplein need. Here is oneof their stories:“W e recently had a patient whohad been in a car accident,” says JoannaValentine, RN, Lead Home Care Consultantat the Hospital for Special Surgery.“He had pretty serious injuries—multiplefractures and problems with his spine.When it was time for him to begin rehab,he told us that he couldn’t afford it. He saidhe was unemployed, living off credit cards,overwhelmed with debt, and his accidenthad just added to his financial burden.“With injuries like his, a relatively shortperiod of rehab makes the differencebetween a full recovery and life-longphysical limitations, resulting in yearsof costly health care treatments. Withrehab, he would be able to get better, toeventually get back to work, get himselfout of debt. Without it, he would be stuckwith very limited mobility for the rest ofhis life, which could, over time, becomea financial burden both for him and onthe health care system as a whole.“Luckily, he qualified for VNSNY’sCharitable Care, and we were able to gethim back into his home and on the roadto recovery. In addition to regular visitsfrom a nurse and a physical therapist, hehad a home health aide help him withday-to-day activities—living in a fourthfloor walk-up, without the aide, thingslike going to the pharmacy and thegrocery store would be nearly impossible.We were able to help him get throughthe most difficult time, both medicallyand logistically, and he’s getting better.”3

VNSNY VOLUNTEER PROGRAMHelping Us Help Patientsin Their CommunitiesLast year, our volunteershad an impact on almost6,000 patients.Photo: VNSNY volunteer LeslieSchatzer fits wigs for VNSNYcancer patients.During 2010, VNSNY volunteersmade an impact on almost 6,000 patients,including some of the most vulnerablein our service area: children and familiesin need and individuals suffering frommental illness. VNSNY volunteers domany important things for the organization,including raising funds and providing“extras,” such as toys for children from lowincomefamilies, layettes to young familiesjust starting out, enriching activities likemusic and art therapy or tabletop gardeningto seniors at adult day care centers, andin-kind services, including apartmentfurnishings, to new mothers moving outof shelters. VNSNY volunteers are madeup of high school and college students,working and nonworking adults andretirees, and corporate employees. Volunteersrange in age from 14 to 92 years old,a quarter of them teenagers and a quarter65 or older. About 60 percent are female.Some VNSNY volunteers donate their timeand services because they just want to giveback to their communities. Jermaine Evans,a Bronx Fatherhood Program volunteerwho mentors new fathers, says volunteeringfor VNSNY “can not only benefit you andimprove your outlook on life, but it can makeyou a productive, active part of society.”Leslie Schatzer, for instance, volunteers fittingwigs for VNSNY cancer patients. “Theystill go out — shopping and doing things,”Leslie says, “and they still like looking good.”As to helping them look good, “I do love it.I really love it.”In 2010, the dollar value of the time volunteersdonated to VNSNY was valued at$1.8 million. Really, though, the work ofVNSNY volunteers, who go out of theirway to keep patients safe and healthy intheir communities, is priceless.4

HOSPICE AND PALLIATIVE CARE SERVICESProviding Support and Comfortto People with Terminal IllnessesOur goal is to promotecomfort and qualityof life by providingthe best medical,nursing, emotional,and spiritual care.VNSNY Hospice and Palliative Care is aprogram of hope and humanity, designedspecifically to meet the needs of peoplewith terminal illnesses, and their families.VNSNY delivers this specialized care ina number of settings–in the home, in anursing home, at our Shirley Goodmanand Himan Brown Residence, and at theVNSNY Haven Hospice Specialty CareUnit. Our staff includes physicians, nurses,social workers, spiritual care counselors,dieticians, bereavement counselors,home health aides, a massage therapist,and volunteers.Our goal is to promote comfort and qualityof life by providing the best medical, nursing,emotional, and spiritual care. VNSNYwelcomes contributions in support of ourimportant work. Philanthropy often makesa critical difference in our ability to servepatients at the end of life and their families.Donors help to sustain our programs as wellas to undertake new initiatives that expandour reach to those most in need.VNSNY Hospice and Palliative Care is thelargest program of its kind in the New Yorkmetropolitan area. On any given day, wehave more than 700 Hospice and PalliativeCare patients in our care.5

COMMUNITY MENTAL HEALTH SERVICESProviding Mental Health Servicesso No One Falls Through the CracksVNSNY’s CommunityMental Health programsserve the severely andpersistently mentally ill,provide geriatric mentalhealth case management,and offer mental healthcounseling to childrenand families.VNSNY offers a wide range of city, state,and charitable care funded CommunityMental Health Services programs thatserve the severely and persistently mentallyill, provide geriatric mental health casemanagement, and offer mental healthcounseling to children and families.Our FRIENDS program, for instance,provides comprehensive mental healthand social support to high-risk emotionallydisturbed children in the Mott Haven sectionof the Bronx. The goal is to stabilizechallenging behaviors while ensuringgreater academic and social achievement.The FRIENDS program, which is a collaborationbetween VNSNY, the New York StateOffice of Mental Health, and the Departmentof Education, has been so successful that,just recently, we expanded the programinto five South Bronx elementary schools.Among our dozen CommunityMental Health programs, we have aGeriatric Mental Health Outreach programthat provides short-term mentalhealth services to seniors in the Bronxand Upper Manhattan who are 60 yearsold or older who require assessment, inhomecounseling, psychiatric consultation,or case management. We also haveMobile Crisis Teams that provide rapidassessment and short-term, in-home mentalhealth services to individuals in the Bronx,Manhattan, and Queens who are experiencing— or are at risk of experiencing—a psychiatric or psychosocial crisis andare unable or unwilling to secure mentalhealth services.6

FATHERS FIRST AND BRONX FATHERHOOD PROGRAMSBreaking the Cycleof Absentee FatherhoodThe goal is to breakthe cycle of absenteefatherhood and helpyoung men who mayhave grown up infatherless homes playan active role in theirchildren’s lives.The goal of VNSNY’s Fathers First andBronx Fatherhood programs is to breakthe cycle of absentee fatherhood and helpyoung men who may have grown up infatherless homes play an active role in theirchildren’s lives. Targeting 16- to 24-yearoldfirst-time fathers, the two programsprovide a positive structure and supportsystem through which young fathers canchange their perception of the responsibilitiesand joys of fatherhood and learnnew ways to approach them.Both the Bronx Fatherhood program,which serves the Bronx, and the FathersFirst Initiative, which serves the Rockawaysection of Queens, teach fathers basic feeding,bathing, and diapering techniques,provide information about child development,and offer methods of caregivingfor fathers who live either with the child’smother or in a separate residence. Theyoung men have sessions twice a weekwith 10- to 12-man support groups, sharingproblems, experiences, and solutions.Additionally, the program connectsfathers with community resources thathelp them continue their education andfind employment. In the past year, VNSNYhas worked with almost 170 fathers in theBronx and Queens.7

NURSE-FAMILY PARTNERSHIPCreating a Nurturing Environmentfor Low-Income, First-Time Mothers and Their BabiesThe Nurse-FamilyPartnership creates anenvironment in whichthe child is appreciated,valued, learning, andgrowing from the veryfirst day of life.8VNSNY’s Nurse-Family Partnership(NFP) supports the evidence-based findingthat suggests it is never too early tointervene in the life of an inexperiencedmother. The program works by identifyingfirst-time, low-income mothers-to-be—half of whom are teenagers—and pairingeach of them with a nurse who remainson board from the second trimester ofpregnancy to the child’s second birthday.The goals of our Nurse-Family Partnershipprogram are to:1) Monitor the woman’s health duringpregnancy to improve prenatal health andbirth outcomes.2) Promote the child’s growth byencouraging breastfeeding and assessingdevelopment at regular intervals.3) Help parents become self-sufficient bycompleting high school or receivinga GED diploma, and to continue onto a two- or four-year college in orderto support themselves and their child.Mothers in our Nurse-Family Partnershiptend to have better prenatal health,wait longer to have another baby, aremore likely to get a job, and return toschool. Our NFP outperforms mostlocal NFPs in such areas as increasedbreastfeeding and immunization rates,and reduced rates of babies being bornprematurely or with low birth weights,infant emergency room visits, anddomestic violence.The ultimate goal is to create an environmentin which the child is appreciated,valued, learning, and growing from thevery first day of life.

PEDIATRIC PALLIATIVE CARE PROGRAMProviding All the Carea Child with a Life-Threatening Illness NeedsThe program startsservices at the timeof diagnosis and allowsfamilies to pursuecurative treatmentswhile it providesskilled care, such aspain and symptommanagement andpsychosocial support.V NSNY’s Pediatric Palliative CareProgram meets the needs of familieswith children who have life-threateningor life-limiting conditions. The programstarts services at the time of diagnosisand allows families to pursue curativetreatments, while providing skilled care,such as pain and symptom managementand psychosocial support. The diagnosesmight be cancer or a birth defect–conditionsthat may cause a child’s health todecline fairly rapidly or remain stableover a relatively long term.“Diagnosis is often the time that familiesneed the most support,” says MarilynLugo, Clinical Nurse Specialist. “Imaginetaking your child to the doctor, thinkingit’s the flu, and finding out instead that it’scancer. That’s when you need help. Ourteam gives the child and family the emotionaland medical support it needs fromthe beginning.”Once a child is identified as needingpalliative care, a VNSNY nurse approachesthe family and offers the services of aninterdisciplinary team made up of an experiencedphysician, a Pediatric PalliativeCare social worker, and a bereavementcounselor who doubles as a registeredexpressive arts therapist. Children receivehome visits for nursing care, pain management,psychosocial assistance, andguidance on following their medicationtreatment plan, all of which avoids unnecessaryhospitalizations.9

ADOLESCENT DIABETESEmpowering Teensto Manage Their DiabetesThe program helpsteens with diabetesmake critical behavioralchanges to managetheir diabetes.VNSNY’s Diabetes Care ManagementProgram for Adolescents is an innovativeprogram that helps adolescents with Type1 diabetes in the Bronx and Upper Manhattanbetter manage their health, lowerblood sugar levels, and reduce hospitalvisits. With the support of a VNSNY registereddietitian and social worker specializingin diabetes, the program guides teenstoward making critical behavioral changes.Each participant is given a BlackBerry to talkwith caregivers and enter health information,which can be monitored and analyzed.“Teens may not understand their diseaseand the complexities of managing it,”says Joann Ahrens, Manager, SpecialPrograms, Children and Family Services.“They might be dealing with other socialor medical issues, or they may not havesupport at home. Teens don’t want to bedifferent. If everyone goes out after amovie for pizza, they want to go, too. Theydon’t want to have to stop to take moreinsulin beforehand.”The program reaches adolescents in UpperManhattan and the Bronx, historicallyunderserved areas of the city where life asa teenager is challenging enough, withoutthe added burden of managing a lifelongand potentially life-threatening illness.10

THE VNSNY NURSING EDUCATION PROGRAMAddressing theChronic Nursing Shortagethe chronic nursing shortage. TheVNSNY Jonas Distinguished Lecturerprogram prepares master’s- and PhDlevelVNSNY nurses to serve as guestlecturers and adjunct faculty at nursingschools. “Our nursing educationprograms are strategically designedto foster a new generation of homehealth care nurses and therapists,” saysJoan Chaya, Director of College Relationsand Staff Retention at VNSNY.We offer opportunitiesfor nursing studentsand newly licensedprofessionals to pursuetheir interest in homehealth care and honetheir in-home care skills.Among our nation’s most dauntinghealth care challenges is a growingshortage of professional nurses, includingthe need for 100,000 new nurses in homehealth care. Further complicating theissue, nursing schools across the countrytend to emphasize hospital-deliveredcare over in-home care. As a result, whilethere is a general shortage of professionalnurses, there is an even greater lack ofhome health care nurses.For the past decade, VNSNY has beenworking with leading colleges and universitiesin the New York City area to addressWe offer opportunities for nursing studentsand newly licensed professionals,including training for VNSNY hospicephysicians, to pursue their interestin home health care and hone theirin-home care skills. We offer a varietyof programs, including a paid ninemonthtransition-to-practice internshipprogram for new graduates; work-studyopportunities for nursing and rehabilitationtherapy students; a Scholars inHome Health Care program, whichoffers nursing, physical therapy andoccupational therapy students eightweeksummer internship opportunitiesthat are fully funded; and a clinicalrotation program, which providesenhanced clinical experiences in homehealth care nursing to over 600 nursingstudents annually. “Our internship programsprovide unparalleled exposureto the specialties of home health carenursing, physical therapy and occupationaltherapy,” says Joan.By providing internships, fellowships,work-study programs, and clinicaltraining in the field and classroom,VNSNY is working hard to improvethe quality of home health care.12

THE VNSNY COMMUNITY CONNECTIONS TIMEBANKBuilding CommunitiesWhere Everyone is an AssetTimeBank creates apool of people of allages and backgroundswho are willing to givea hand to their neighborsand communities.VNSNY’s Community ConnectionsTimeBank is a unique community programthat provides a way for neighbors toget to know each other and invest in oneanother’s care and well-being. It is aboutspending an hour doing something forsomebody in your neighborhood, and,in return, that hour becomes bankable currencythat can be used to receive any otherservice provided by other “time bankers”.The TimeBank facilitates exchangesbetween people from different age groups,ethnicities and socioeconomic backgroundsin a shared marketplace of skills. It recognizesthat everyone has something tooffer — even those who may typically beregarded as needing service.The TimeBank forms partnerships withcommunity and area agencies, businesses,and cultural organizations. This givesTimeBank members access to much-neededsocial services and business discounts.In 2010, VNSNY’s TimeBank had arecord-breaking 600-plus member enrollment,bringing the total to more than1,700 individual members, over 100organizational partners and 250-plusparticipating businesses.A 2009 survey of older TimeBank membersreported that TimeBank membershiphas a positive impact on their physicaland mental health, access to services andsupport, social interactions, personaldevelopment, ability to age in place, andoverall quality of life.“The mission of our TimeBank,” saysMashi Blech, Director of VNSNY’sCommunity Connections TimeBank,“is to build a support network. TimeBankmakes people more comfortable aging intheir homes.”13

THE FAMILY CAREGIVER SUPPORT PROGRAMFocusing Onthe Family CaregiverThe Family CaregiverSupport Program helpscaregivers combatstress and improvestheir caregiving skills.14Each day, VNSNY’s nurses and frontlinestaff provide expert and compassionatecare to tens of thousands of chronicallyill and disabled patients. But who providescare after the home visit ends? In mostcases, a family caregiver provides care tothe patient, perhaps on a daily basis andover a period of months or years.After a year-long investigation of caregiverneeds, in 2010, VNSNY launchedthe Family Caregiver Support Programin Staten Island. While all VNSNY nurses,rehabilitation therapists, social workers,and home health aides are trained toensure caregivers can safely maintain apatient at home, the program aims to goone step further: to identify thosecaregivers who could benefit from additionaltraining or those who may be jeopardizingtheir own physical or emotional healthwhile providing care to a family member.VNSNY’s Family Caregiver SupportProgram assigns an advocate to eachcaregiver—a VNSNY social worker whoprovides assessment, counseling, andresource referral to help the caregivercombat stress and improve his or hercaregiving skills. And, because the physicaland emotional stress can remain evenafter a friend or family member no longerrequires care, caregivers may remain inthe program for up to a year after a patienthas been discharged.

CHINATOWN NNORC AND THE CHINATOWN COMMUNITY CENTERMaking Chinatowna Great Place to Grow OldVNSNY and its partneragencies work to ensurethat residents of the24-block area that isthe Chinatown NNORCdo not become invisibleor remain isolated.There are approximately 2,000 residentsof the Neighborhood Naturally OccurringRetirement Community (NNORC) inChinatown, many of whom are immigrantswho came to the United States yearsago and speak only their native Cantonese.For this reason, they would be invisibleto the social services networks that otherNew Yorkers find readily accessible withoutspecial outreach efforts.NNORC members have aged in the oldneighborhood in their four-, five-, evensix-story walk-up apartments. Whilemany are healthy and active, others are frail,find the stairs difficult to manage, and gooutdoors less frequently.The Visiting Nurse Service of New Yorkand its partner agencies work to ensurethat residents of the 24-block area that isthe Chinatown NNORC do not remainisolated. We provide nursing care that isnon-insurance reimbursable and helps toempower and support residents with chronicillnesses to better manage their healthcare needs. We also offer health screenings,educational workshops for seniorsas well as counseling on housing issuesand mental health concerns.For cultural reasons, the Asian communityis among the least likely to fill outHealth Care proxies or to have colonoscopies.The Chinatown NNORC promotesboth of these things, and, specifically,encourages better colon health by connectingmembers of the communitywho have undergone a colonoscopywith those who may be fearful ofthe procedure.“We want to make Chinatown a greatplace to grow old,” says Hing-Lin(Helen) Sit, Manager of the ChinatownNNORC. “These seniors want to take careof their health, but they need assistance.Our Chinatown Community Center andChinatown NNORC both play importantroles in their lives.”15

CENTER FOR HOME CARE POLICY AND RESEARCHStudying High Risk Populationsto Improve the Quality of Their CareThis path-breakinganalytic work will bea major contributionto health care decisionmakers as they seekeffective solutionsto address pressingcommunity healthcare needs.16For reasons that are unclear, African-Americans develop more complicationsand have a significantly higher death ratefrom high blood pressure than othersubsets of the population. Additionally,they do not respond the same way totraditional medications.With grant funds awarded by the NationalHeart, Lung, and Blood Institute, theVisiting Nurse Service of New York,through its Center for Home Care Policyand Research, carried out what is believedto be the first randomized clinical trial ofhypertension management ofAfrican-Americans within the homehealth care environment.The trial examined whether a programin which nurses gave additional focus topatient support and medication adherencewould produce benefits greater than whatare typically seen with standard programs.The 845 patients who participated in the trialwere low-income individuals who, whilereceiving care from VNSNY for a variety ofreasons, were found to have uncontrolledhigh blood pressure.At a three month follow-up, the patientswith the most severe hypertension who hadreceived additional in-home support hadstatistically superior blood pressure controlcompared to those with the most severehypertension who were in the usual care group.Moreover, the increased cost to providethis extra support was offset by a decreasein hospital readmission costs. The resultsshow that home health care is capable ofbringing about meaningful improvementin the management of a high-risk populationwith uncontrolled hypertension. Thispath-breaking analytic work will be a majorcontribution to health care decision makersas they seek effective solutions to addresspressing community health care needs.

Donate to VNSNYAs the largest not-for-profit home health care agency in the nation, we stand on the frontlines of public health care. For many of our patients, the Visiting Nurse Service of New York(VNSNY) is the only source of quality home care services, providing direct home care by physicians,nurses, rehabilitation therapists, psychologists, and more.Gifts large and small will promote the health and well-being of our patients and their families.Your generous donation to VNSNY helps in many ways, such as:• Providing urgent and long-term health care for New Yorkers who are uninsured or underinsured;• Funding home health care for babies who have complicated medicalneeds and services to help parents care for their children at home;• Preventing caregiver burnout by providing caregiver supportto reduce stress while caring for a loved one;• Supporting Aging in Place that allows older New Yorkers to remain independent in theirown homes, with greater dignity and quality of life;• Providing compassionate hospice and palliative care for peoplefacing the end of life and bereavement services for their familymembers, including children;• Helping VNSNY research innovative solutions to Health Carechallenges that face us all.Donor support also allows VNSNY to be a nationwide leader in program innovation, homecare research, and public health policy.Thank you for your support!To make a donation to VNSNY:Please call us at 212-609-1525 or find usonline at www.vnsny.org/donateTo find out how to become a VNSNY volunteer:Please call 212-609-1570For more information about participatingin our VNSNY Community ConnectionsTimeBank Program:Please call 212-609-781117

Visit us on the web at: www.vnsny.org107 East 70th Street, New York, NY 10021 | www.vnsny.orgPhone: 212-609-152520VNSNY-248