Cutting-Edge VNSNY Program Delivers Hospital-Level Services at Home

For the patient, an older woman diagnosed with COVID-19 in the Mount Sinai emergency department whose husband had just died of the illness, the path ahead was challenging. But there was a bright spot: she would be able to continue her treatment at home, where she most wanted to be, while still getting hospital-level care and attention through VNSNY’s unique Hospitalization at Home program.

Delivered in collaboration between Mount Sinai Health System (MSHS), Contessa Health and VNSNY, the program’s hospital-level services include IV infusions, blood draws, wound care, nebulizer treatment, inpatient-level physical therapy, and X-rays, as well as patient and caregiver education. “For those who can be safely managed at home, the program is effective and comprehensive,” says Denise Simmonds, a VNSNY Home Care nurse specially trained to provide Hospitalization at Home care to patients. “We find a way to get them the care they need, when they need it. And not ‘tomorrow’—it’s always, ‘We’ll get this done today.’”

“When patients are home, they can socialize with their families and eat the food they like,” adds Hospitalization at Home nurse David Heron. “Being home helps them feel and heal better.”

“When patients are home, they feel more comfortable, more secure and more confident about the care,” agrees Soraya Gomez, also a Hospitalization at Home nurse. “There’s more one-on-one communication, and that helps them understand their care more.”

Patients who come to a Mount Sinai emergency department with acute symptoms are typically admitted to the hospital’s inpatient unit. But those meeting certain criteria, including having appropriate support and safety at home, can be offered admission instead to Hospitalization at Home. Once admitted, they receive daily in-home visits from Mount Sinai doctors and nurse practitioners, as well as twice-daily visits from VNSNY nurses.

During the COVID-19 pandemic, the Mount Sinai clinician visits have often been taking place through telehealth, so VNSNY nurses are also helping patients learn to use the telehealth technology. Meanwhile, VNSNY nurses have continued making in-person visits to deliver their extensive hands-on care.

For her patient who was discharged home with COVID-19, Denise did blood work, helped her get out of bed and walk to build strength and take pressure off the lungs, and trained her on techniques to improve her breathing—all while also supporting the patient emotionally as she grieved the loss of her husband. Denise credits the program’s collaborative nature with helping her achieve all this. “It was so important to have the Mount Sinai team there to support me in understanding how I could help her clinically in her healing,” she says. “She did recover physically. Emotionally, though, it will still take some time.”

Patients are on the program for three to seven days. Typical diagnoses include congestive heart failure, COPD, asthma, cellulitis, and, now, COVID-19. After discharge, patients can continue on with traditional home care, just as they might after being discharged from a hospital stay.

Since the coronavirus pandemic flooded Mount Sinai’s emergency rooms in March and April, the Hospitalization at Home program’s volume has increased significantly, with an average daily census of 5 to 7 patients. Of the more than 50 patients admitted during the pandemic, almost 60% have been COVID-positive. To support the additional volume, VNSNY trained 30 additional Home Care nurses to participate in the program. They join the three full-time Hospitalization at Home nurses and 18 Home Care nurses already specially trained for the program.

“During the pandemic, VNSNY has been at the forefront with this successful model of care delivery,” says Lorna Canlas, Director of Strategy, Performance & Innovation. “We’ve been able to assist the Mount Sinai Health System, Contessa Health and the state in opening up more beds, by returning patients back home while still providing them the sophisticated care they need. The program is gaining a lot of recognition in the community, the state, and the nation.”

Lorna notes that she and Susan Northover, Senior Vice President Patient Care Services, are now sharing best practices with other home health agencies interested in starting their own Hospitalization at Home programs in partnership with Contessa Health.

In addition to the Hospitalization at Home clinicians, the program also owes its success to Marsha Serrano-Ramos, VP and Program Lead; Branch Directors Myrle Braithwaite and Shawn Connor; and Stephanie Olic-Krupka, Program Coordinator.

Their colleagues at the forward-looking health care organizations that VNSNY works in close collaboration with are also essential to the program’s success.  They include Contessa Health’s COO Aaron Stein, Director of Operations Marion Kruse, and Nurse Manager Alisa Gadon, along with Contessa’s committed Recovery Care Coordinators. Instrumental on the Mount Sinai team are Dr. Albert Siu, Professor and Chair Emeritus, Geriatrics and Palliative Medicine; Dr. Linda DeCherrie, Clinical Director of Mount Sinai at Home; and the dedicated MSHS Nurse Practitioners who deliver care excellence every day.

“When I was treating my patient with COVID-19 who had recently lost her husband, it reminded me how essential this program is,” says Denise. “Nobody asks for this virus, and it’s just devastating. Anything we could do to help her healing, we would do.”

To read more VNSNY Heroes of 2020 stories, click here.