Then and Now

by Amor Bango, RN, BSN

Amor started her homecare career in 1972 at Rensselaer County Public Health Department in Troy, NY, as a public health nurse. Here are her thoughts about what homecare was like then and how it has changed. 

I never thought the day would come when I could look back and say I saw history unfold. Times were easier in the 1970s. Nurses and home health aides were more plentiful, families and neighbors were available to help. Nurses could be nurses back then. Nurses shared two wall phones in our office. Nurses have always been responsible for case management, but their responsibilities have increased tremendously. They deal with multiple doctors for one patient. So many procedures are done on an outpatient basis and patients go home to recover. Nurses are now responsible for clinical care, financial reimbursement, government forms. We can’t get through the day without cell phones. But, homecare is where I can practice the philosophy of nursing I was taught. It is one of the few forms of health care where a patient is treated holistically and nurses can be creative in overcoming the complexities of care delivery.

During her 35-year homecare career, Amor has been Director of Field Services for Home Aides of Central New York, Inc., in Syracuse, NY, and Assistant Director at Loretto, the largest provider of elder care services in upstate New York. She is now the Director of Clinical Operations for the Visiting Nurse Association of Central New York, a Basic Member of the Beacon Institute™, where she has worked for the last six years.
--------------

by Mary Helen Tieken, RN, BSN

Mary Helen first experienced home health care when she started an agency in 1984. She shares her recollections.

Unlike many nurses, I learned homecare as I set up an agency. There was no home-care in my community so I approached the local hospital. Together we built an agency. The hospital administrator invested in our operation, hiring a former HCFA official (who worked on setting up the Medicare home health system) to be our consultant. He knew homecare and taught me that the Conditions of Participation, coverage criteria, and state rules and practice acts are the foundation. Today not enough homecare leaders know and appreciate the regulations. Many who teach homecare have never practiced homecare. Life in the 1980s was simpler so scheduling homecare nurses for evenings, weekends, and holidays did not present so many challenges. Nurses were eager to go the extra mile. Finding nurses today for on-call coverage is challenging. Back then, many more nurses were leaving hospitals to become homecare nurses. Now, it is increasingly difficult for administrators and directors to maintain staffing ratios. Effective communication in south Texas has always been a challenge. In the early days of my career, pagers didn’t work in the rural areas so nurses had to call from gas stations and fast food restaurants. Even today, cell phones aren’t always reliable because there aren’t many cell towers around here. The most significant change I’ve witnessed is commercialization. Then, agencies were smaller, “mom and pop” types. Today, homecare is big business — traded on the stock market, board room strategies versus meat-and-potatoes case conferencing. Back then, we focused on our concerns; today we compare our outcomes against each other’s, even though numbers may not tell the whole story. In homecare, you get to look at the patient as a whole — not an assortment of pieces. Today’s world presents more problems and complexity but it still is the best form of health care.

* * *

After managing a large hospital unit of dialysis and cancer patients, Mary Helen entered the homecare arena. Today she is President of Nurses in Touch in Floresville, TX, a Premium Member of the Beacon Institute.