COMMUNITY
ServICe plaN
2011 vISITINg NUrSe ServICe Of New YOrk
We count on the public–our donors–for support. Not all of our services are reimbursed by
governmental and private insurance plans. As a result, many programs are made possible only
through the generosity of our donors.
Thanks to contributions from these loyal supporters, together with a substantial contribution
from VNSNY, we are able to cover the gap between what it costs us to provide our life-saving,
life-altering, and life-enhancing philanthropically-funded programs and the reimbursements
that we receive. Your contributions enable us to fulfill our century-old commitment: to treat,
without expectation of payment, those who would otherwise go without care.
In 2010, the Visiting Nurse Service of New York provided $27.5 million in charitable care and
community services. Here are a few examples of what our donors helped make possible in 2010:
Expanding accEss to carE: $22.9 Million
• Free home care services for over 5,000 uninsured and underinsured patients, including children and newborns • Prescriptions, transport to doctors, and home life necessities at no cost 2 • Comfort care for cancer patients 4 • Support to hospice and palliative care programs 5 • Mental health outreach 6
opportunitiEs for disadvantagEd childrEn and familiEs: $2.6 Million
• Vital support for first-time, low-income mothers, fathers, and their babies 7, 8 • new initiatives in adolescent diabetes and pediatric palliative care 9, 10 • HiV/AiDS prevention and family support 11
dEvEloping futurE WorkforcE: $0.7 Million
• Jonas Distinguished lecturer Program in partnership with nursing schools
• internships, fellowships, and work/study programs for nursing students and hospice physicians 12
supporting aging in placE: $0.7 Million
• VnSnY Community Connections TimeBank 13 • Caregiver support 14 • Chinatown Community Center and nnoRC 15
rEsEarch: $0.6 Million
• Peer-reviewed, evidence-based research on understanding and preventing avoidable rehospitalizations
• investigative studies into the management of multiple chronic illnesses and other problems of aging 16
donatE to vnsnY 17
We’re part of the community.
We’re here for you.
W
E arE plEasEd to sharE With You thE visiting nursE sErvicE of nEW York’s 2011 communitY sErvicE plan.The Visiting Nurse Service of New York, in 2010, provided $27.5 million in chari-table care and community benefit, which included $12.7 million to deliver direct home health care services to more than 5,000 underinsured and uninsured New Yorkers.
VNSNY is committed to addressing the needs of the city’s underserved and vul-nerable populations. In 2010, community benefit dollars provided critical support to a host of health, educational, research, and community initiatives that bring some relief and hope to countless individuals. Profiles of these innovative programs are featured throughout this booklet. VNSNY stayed true to its mission to deliver care to New Yorkers in need–people who might otherwise have been denied care, from the very young to the very old, in every neighborhood of New York City as well as in Nassau and parts of Westchester Counties. We also continued to work hard to develop initiatives to improve the quality of our care and to produce excel-lent outcomes.
If you would like to receive VNSNY’s annual report to learn more about our community benefit initiatives, please contact us at 212-609-1525. To help support VNSNY’s community benefit and charitable care programs, please visit our website at www.vnsny.org/donate.
Thank you.
Kathryn Haslanger
Senior Vice President, Community Benefit & External Affairs
(Cover photo: Father and child from VNSNY Bronx Fatherhood Program) Kathryn Haslanger
Providing Home Health Care
Regardless of a Person’s Ability to Pay
NSNY is committed to providing care to the most vulnerable New Yorkers, in the most underserved communities. For 118 years, we have offered our ser-vices to those in need of home health care, regardless of their ability to pay. “Our mission is to serve the poor,” says Christopher Oates, Manager of Charitable Care. “VNSNY’s Charitable Care Program allows social workers and nurse case managers to fulfill this mission. They take the baton from the hospital or a clinical setting, and treat people in their communities. And, hopefully, our pre-ventative and treatment measures keep these patients out of emergency rooms.” In fulfilling our mission and our obli-gation as a not-for-profit organization, VNSNY provides free home care services
charitaBlE carE
to the undocumented, uninsured, and underinsured. In a well-structured pro-gram, VNSNY does outreach to hospitals and clinics in the metropolitan area— the five boroughs of New York City and Nassau and Westchester Counties— encouraging staff to refer likely ap-plicants who need free services based on their income level. “I don’t know any other organization, particularly in home care, that is being so proactive,” Christopher says. “As a former discharge planner and social worker, I would hear about charity care opportunities by word of mouth, mostly other social workers talking. What we do at VNSNY is tell anyone who might need us: ‘This is a re-source for your tool bag, and you’ll find it very helpful. And they listen.’”
v
for 118 years, we have
offered our services to
those in need of home
health care, regardless
of their ability to pay.
vNSNY Charitable
Care provides aid for
thousands of people
in need. Here is one
of their stories:
“W
e recently had a patient whohad been in a car accident,” says Joanna Valentine, RN, Lead Home Care Consul-tant at the Hospital for Special Surgery. “He had pretty serious injuries—multiple fractures and problems with his spine. When it was time for him to begin rehab, he told us that he couldn’t afford it. He said he was unemployed, living off credit cards, overwhelmed with debt, and his accident had just added to his financial burden. “With injuries like his, a relatively short period of rehab makes the difference between a full recovery and life-long physical limitations, resulting in years of costly health care treatments. With rehab, he would be able to get better, to eventually get back to work, get himself
out of debt. Without it, he would be stuck with very limited mobility for the rest of his life, which could, over time, become a financial burden both for him and on the health care system as a whole. “Luckily, he qualified for VNSNY’s Charitable Care, and we were able to get him back into his home and on the road to recovery. In addition to regular visits from a nurse and a physical therapist, he had a home health aide help him with day-to-day activities—living in a fourth floor walk-up, without the aide, things like going to the pharmacy and the grocery store would be nearly impossible. We were able to help him get through the most difficult time, both medically and logistically, and he’s getting better.”
uring 2010, VNSNY volunteers made an impact on almost 6,000 patients, including some of the most vulnerable in our service area: children and families in need and individuals suffering from mental illness. VNSNY volunteers do many important things for the organiza-tion, including raising funds and providing “extras,” such as toys for children from low-income families, layettes to young families just starting out, enriching activities like music and art therapy or tabletop gardening to seniors at adult day care centers, and in-kind services, including apartment furnishings, to new mothers moving out of shelters. VNSNY volunteers are made up of high school and college students, working and nonworking adults and retirees, and corporate employees. Volun-teers range in age from 14 to 92 years old, a quarter of them teenagers and a quarter 65 or older. About 60 percent are female.
Some VNSNY volunteers donate their time and services because they just want to give back to their communities. Jermaine Evans, a Bronx Fatherhood Program volunteer who mentors new fathers, says volunteering for VNSNY “can not only benefit you and improve your outlook on life, but it can make you a productive, active part of society.” Leslie Schatzer, for instance, volunteers fit-ting wigs for VNSNY cancer patients. “They still 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 vol-unteers donated to VNSNY was valued at $1.8 million. Really, though, the work of VNSNY volunteers, who go out of their way to keep patients safe and healthy in their communities, is priceless.
Helping Us Help Patients
in Their Communities
vnsnY voluntEEr program
last year, our volunteers
had an impact on almost
6,000 patients.
d
Photo: VNSNY volunteer Leslie Schatzer fits wigs for VNSNY cancer patients.
Providing Support and Comfort
to People with Terminal
ill
nesses
hospicE and palliativE carE sErvicEs
NSNY Hospice and Palliative Care is a program of hope and humanity, designed specifically to meet the needs of people with terminal illnesses, and their families. VNSNY delivers this specialized care in a number of settings–in the home, in a nursing home, at our Shirley Goodman and Himan Brown Residence, and at the VNSNY Haven Hospice Specialty Care Unit. Our staff includes physicians, nurs-es, social workers, spiritual care coun-selors, dieticians, bereavement councoun-selors, home health aides, a massage therapist, and volunteers.
Our goal is to promote comfort and quality of life by providing the best medical, nurs-ing, emotional, and spiritual care. VNSNY welcomes contributions in support of our important work. Philanthropy often makes a critical difference in our ability to serve patients at the end of life and their families. Donors help to sustain our programs as well as to undertake new initiatives that expand our reach to those most in need.
VNSNY Hospice and Palliative Care is the largest program of its kind in the New York metropolitan area. On any given day, we have more than 700 Hospice and Palliative Care patients in our care.
Our goal is to promote
comfort and quality
of life by providing
the best medical,
nursing, emotional,
and spiritual care.
Providing Mental Health Services
so no one Falls Through the Cracks
NSNY offers a wide range of city, state, and charitable care funded Community Mental Health Services programs that serve the severely and persistently mentally ill, provide geriatric mental health case management, and offer mental health counseling to children and families. Our FRIENDS program, for instance, provides comprehensive mental health and social support to high-risk emotionally disturbed children in the Mott Haven sec-tion of the Bronx. The goal is to stabilize challenging behaviors while ensuring greater academic and social achievement. The FRIENDS program, which is a collabo-ration between VNSNY, the New York State Office of Mental Health, and the Department of Education, has been so successful that, just recently, we expanded the program into five South Bronx elementary schools.
Among our dozen Community Mental Health programs, we have a Geriatric Mental Health Outreach pro-gram that provides short-term mental health services to seniors in the Bronx and Upper Manhattan who are 60 years old or older who require assessment, in-home counseling, psychiatric consulta-tion, or case management. We also have Mobile Crisis Teams that provide rapid assessment and short-term, in-home mental health services to individuals in the Bronx, Manhattan, and Queens who are expe-riencing—or are at risk of experiencing —a psychiatric or psychosocial crisis and are unable or unwilling to secure mental health services.
vNSNY’s Community
Mental Health programs
serve the severely and
persistently mentally ill,
provide geriatric mental
health case management,
and offer mental health
counseling to children
and families.
v
Breaking the Cycle
of Absentee Fatherhood
he goal of VNSNY’s Fathers First and Bronx Fatherhood programs is to break the cycle of absentee fatherhood and help young men who may have grown up in fatherless homes play an active role in their children’s lives. Targeting 16- to 24-year-old first-time fathers, the two programs provide a positive structure and support system through which young fathers can change their perception of the responsi-bilities and joys of fatherhood and learn new ways to approach them.
Both the Bronx Fatherhood program, which serves the Bronx, and the Fathers First Initiative, which serves the Rockaway
section of Queens, teach fathers basic feed-ing, bathfeed-ing, and diapering techniques, provide information about child develop-ment, and offer methods of caregiving for fathers who live either with the child’s mother or in a separate residence. The young men have sessions twice a week with 10- to 12-man support groups, sharing problems, experiences, and solutions. Additionally, the program connects fathers with community resources that help them continue their education and find employment. In the past year, VNSNY has worked with almost 170 fathers in the Bronx and Queens.
fathErs first and Bronx fathErhood programs
t
The goal is to break
the cycle of absentee
fatherhood and help
young men who may
have grown up in
fatherless homes play
an active role in their
children’s lives.
nursE-familY partnErship
NSNY’s Nurse-Family Partnership (NFP) supports the evidence-based find-ing that suggests it is never too early to intervene in the life of an inexperienced mother. The program works by identifying first-time, low-income mothers-to-be— half of whom are teenagers—and pairing each of them with a nurse who remains on board from the second trimester of pregnancy to the child’s second birthday. The goals of our Nurse-Family Partnership program are to:
1) Monitor the woman’s health during pregnancy to improve prenatal health and birth outcomes.
2) Promote the child’s growth by encouraging breastfeeding and assessing development at regular intervals. 3) Help parents become self-sufficient by completing high school or receiving
a GED diploma, and to continue on to a two- or four-year college in order to support themselves and their child. Mothers in our Nurse-Family Partner-ship tend to have better prenatal health, wait longer to have another baby, are more likely to get a job, and return to school. Our NFP outperforms most local NFPs in such areas as increased breastfeeding and immunization rates, and reduced rates of babies being born prematurely or with low birth weights, infant emergency room visits, and domestic violence.
The ultimate goal is to create an environ-ment in which the child is appreciated, valued, learning, and growing from the very first day of life.
Creating a Nurturing Environment
for low-income, First-Time Mothers and Their Babies
v
The Nurse-family
partnership creates an
environment in which
the child is appreciated,
valued, learning, and
growing from the very
first day of life.
v
NSNY’s Pediatric Palliative Care Program meets the needs of families with children who have life-threatening or life-limiting conditions.The program starts services at the time of diagnosis and allows families to pursue curative treatments, while providing skilled care, such as pain and symptom management and psychosocial support. The diagnoses might be cancer or a birth defect–condi-tions that may cause a child’s health to decline fairly rapidly or remain stable over a relatively long term.“Diagnosis is often the time that families need the most support,” says Marilyn Lugo, Clinical Nurse Specialist. “Imagine taking your child to the doctor, thinking it’s the flu, and finding out instead that it’s
The program starts
services at the time
of diagnosis and allows
families to pursue
curative treatments
while it provides
skilled care, such as
pain and symptom
management and
psychosocial support.
Providing All the Care
a Child
with a life-Threatening illness needs
pEdiatric palliativE carE program
cancer. That’s when you need help. Our team gives the child and family the emo-tional and medical support it needs from the beginning.”
Once a child is identified as needing palliative care, a VNSNY nurse approaches the family and offers the services of an interdisciplinary team made up of an ex-perienced physician, a Pediatric Palliative Care social worker, and a bereavement counselor who doubles as a registered expressive arts therapist. Children receive home visits for nursing care, pain man-agement, psychosocial assistance, and guidance on following their medication treatment plan, all of which avoids unnec-essary hospitalizations.
adolEscEnt diaBEtEs
NSNY’s Diabetes Care Management Program for Adolescents is an innovative program that helps adolescents with Type 1 diabetes in the Bronx and Upper Man-hattan better manage their health, lower blood sugar levels, and reduce hospital visits. With the support of a VNSNY reg-istered dietitian and social worker special-izing in diabetes, the program guides teens toward making critical behavioral changes. Each participant is given a BlackBerry to talk with caregivers and enter health information, which can be monitored and analyzed. “Teens may not understand their disease and the complexities of managing it,”
says Joann Ahrens, Manager, Special Programs, Children and Family Services. “They might be dealing with other social or medical issues, or they may not have support at home. Teens don’t want to be different. If everyone goes out after a movie for pizza, they want to go, too. They don’t want to have to stop to take more insulin beforehand.”
The program reaches adolescents in Upper Manhattan and the Bronx, historically underserved areas of the city where life as a teenager is challenging enough, without the added burden of managing a lifelong and potentially life-threatening illness.
Empowering Teens
to
Manage Their Diabetes
The program helps
teens with diabetes
make critical behavioral
changes to manage
their diabetes.
t
he Visiting Nurse Service of New York has been providing home health care services to people with HIV/AIDS since the start of the epidemic in the 1980s. Today, we are the largest provider of HIV/ AIDS services in New York City. Each year, more than 1,200 men, women, and children receive a comprehensive range of health and supportive services from us. The mission of VNSNY’s HIV/AIDS Services Department is to provide care and support to people living with HIV/ AIDS, educate health care professionals in the latest treatment regimens, and pro-vide technical assistance in managing the complex medical and psychosocial issues affecting our patients.Our Family Support Team, for instance, provides a network of services to sup-port families affected by and coping with HIV. The program, which is funded by the Ryan White HIV/AIDS Modernization
Providing Care and Support
to People with HiV/AiDS Since the 1980s
vNSNY is the largest
provider of HIv/aIDS
services in New York City.
Act of 2006, takes a comprehensive ap-proach and provides a variety of disciplines to address each family member’s medical and psychosocial needs. Our staff, which includes advanced practice nurses, social workers, psychiatrists, nutritionists, and homemakers, provides services to many types of HIV-affected families, including:
• Families with children or adolescents who are acting out;
• Family members who do not adhere to medical regimens;
• Families in which the parent or guardian is ill and needs assistance with child care;
• Families with mental health problems;
• Families with current or past substance abuse problems.
The program serves families in the Bronx, Brooklyn, Manhattan and Queens.
mong our nation’s most daunt-ing health care challenges is a growdaunt-ing shortage of professional nurses, including the need for 100,000 new nurses in home health care.Further complicating the issue, nursing schools across the country tend to emphasize hospital-delivered care over in-home care. As a result, while there is a general shortage of professional nurses, there is an even greater lack of home health care nurses.
For the past decade, VNSNY has been working with leading colleges and univer-sities in the New York City area to address
the chronic nursing shortage. The VNSNY Jonas Distinguished Lecturer program prepares master’s- and PhD-level VNSNY nurses to serve as guest lecturers and adjunct faculty at nurs-ing schools. “Our nursnurs-ing education programs are strategically designed to foster a new generation of home health care nurses and therapists,” says Joan Chaya, Director of College Rela-tions and Staff Retention at VNSNY. We offer opportunities for nursing stu-dents and newly licensed professionals, including training for VNSNY hospice physicians, to pursue their interest in home health care and hone their in-home care skills. We offer a variety of programs, including a paid nine-month transition-to-practice internship program for new graduates; work-study opportunities for nursing and rehabili-tation therapy students; a Scholars in Home Health Care program, which offers nursing, physical therapy and occupational therapy students eight-week summer internship opportunities that are fully funded; and a clinical rotation program, which provides enhanced clinical experiences in home health care nursing to over 600 nursing students annually. “Our internship pro-grams provide unparalleled exposure to the specialties of home health care nursing, physical therapy and occupa-tional therapy,” says Joan.
By providing internships, fellowships, work-study programs, and clinical training in the field and classroom, VNSNY is working hard to improve the quality of home health care.
Addressing the
Chronic nursing Shortage
we offer opportunities
for nursing students
and newly licensed
professionals to pursue
their interest in home
health care and hone
their in-home care skills.
a
thE vnsnY communitY connEctions timEBank
NSNY’s Community Connections TimeBank is a unique community pro-gram that provides a way for neighbors to get to know each other and invest in one another’s care and well-being. It is about spending an hour doing something for somebody in your neighborhood, and, in return, that hour becomes bankable cur-rency that can be used to receive any other service provided by other “time bankers”. The TimeBank facilitates exchanges between people from different age groups, ethnicities and socioeconomic backgrounds in a shared marketplace of skills. It rec-ognizes that everyone has something to offer—even those who may typically be regarded as needing service.
The TimeBank forms partnerships with community and area agencies, businesses, and cultural organizations. This gives TimeBank members access to much-needed social services and business discounts.
In 2010, VNSNY’s TimeBank had a record-breaking 600-plus member enroll-ment, bringing the total to more than 1,700 individual members, over 100 organizational partners and 250-plus participating businesses.
A 2009 survey of older TimeBank mem-bers reported that TimeBank memmem-bership has a positive impact on their physical and mental health, access to services and support, social interactions, personal development, ability to age in place, and overall quality of life.
“The mission of our TimeBank,” says Mashi Blech, Director of VNSNY’s Community Connections TimeBank, “is to build a support network. TimeBank makes people more comfortable aging in their homes.”
Building Communities
Where
Everyone is an Asset
TimeBank creates a
pool of people of all
ages and backgrounds
who are willing to give
a hand to their
neigh-bors and communities.
E
thE familY carEgivEr support program
ach day, VNSNY’s nurses and frontline staff provide expert and compassionate care to tens of thousands of chronically ill and disabled patients. But who provides care after the home visit ends? In most cases, a family caregiver provides care to the patient, perhaps on a daily basis and over a period of months or years. After a year-long investigation of care-giver needs, in 2010, VNSNY launched the Family Caregiver Support Program in Staten Island. While all VNSNY nurs-es, rehabilitation therapists, social workers, and home health aides are trained to ensure caregivers can safely maintain a patient at home, the program aims to go one step further: to identify those
Focusing On
the Family Caregiver
The family Caregiver
Support program helps
caregivers combat
stress and improves
their caregiving skills.
caregivers who could benefit from addition-al training or those who may be jeopardiz-ing their own physical or emotional health while providing care to a family member. VNSNY’s Family Caregiver Support Program assigns an advocate to each caregiver—a VNSNY social worker who provides assessment, counseling, and resource referral to help the caregiver combat stress and improve his or her caregiving skills. And, because the physi-cal and emotional stress can remain even after a friend or family member no longer requires care, caregivers may remain in the program for up to a year after a pa-tient has been discharged.
here are approximately 2,000 residents of the Neighborhood Naturally Occurring Retirement Community (NNORC) in Chinatown, many of whom are immi-grants who came to the United States years ago and speak only their native Cantonese. For this reason, they would be invisible to the social services networks that other New Yorkers find readily accessible with-out special with-outreach efforts.
NNORC members have aged in the old neighborhood in their four-, five-, even six-story walk-up apartments. While many are healthy and active, others are frail, find the stairs difficult to manage, and go outdoors less frequently.
The Visiting Nurse Service of New York and its partner agencies work to ensure that residents of the 24-block area that is the Chinatown NNORC do not remain isolated. We provide nursing care that is non-insurance reimbursable and helps to empower and support residents with chronic
illnesses to better manage their health care needs. We also offer health screen-ings, educational workshops for seniors as well as counseling on housing issues and mental health concerns.
For cultural reasons, the Asian com- munity is among the least likely to fill out Health Care proxies or to have colonosco-pies. The Chinatown NNORC promotes both of these things, and, specifically, encourages better colon health by con-necting members of the community who have undergone a colonoscopy with those who may be fearful of the procedure.
“We want to make Chinatown a great place to grow old,” says Hing-Lin (Helen) Sit, Manager of the Chinatown NNORC. “These seniors want to take care of their health, but they need assistance. Our Chinatown Community Center and Chinatown NNORC both play impor-tant roles in their lives.”
Making Chinatown
a
Great Place to Grow old
chinatoWn nnorc and thE chinatoWn communitY cEntEr
vNSNY and its partner
agencies work to ensure
that residents of the
24-block area that is
the Chinatown NNOrC
do not become invisible
or remain isolated.
or reasons that are unclear, African- Americans develop more complications and have a significantly higher death rate from high blood pressure than other subsets of the population. Additionally, they do not respond the same way to traditional medications.
With grant funds awarded by the National Heart, Lung, and Blood Institute, the Visiting Nurse Service of New York, through its Center for Home Care Policy and Research, carried out what is believed to be the first randomized clinical trial of hypertension management of
African-Americans within the home health care environment.
The trial examined whether a program in which nurses gave additional focus to patient support and medication adherence would produce benefits greater than what are typically seen with standard programs.
The 845 patients who participated in the trial were low-income individuals who, while receiving care from VNSNY for a variety of reasons, were found to have uncontrolled high blood pressure.
At a three month follow-up, the patients with the most severe hypertension who had received additional in-home support had statistically superior blood pressure control compared to those with the most severe hypertension who were in the usual care group. Moreover, the increased cost to provide this extra support was offset by a decrease in hospital readmission costs. The results show that home health care is capable of bringing about meaningful improvement in the management of a high-risk popula-tion with uncontrolled hypertension. This path-breaking analytic work will be a major contribution to health care decision makers as they seek effective solutions to address pressing community health care needs.
Studying High Risk Populations
to improve the Quality of Their Care
This path-breaking
analytic work will be
a major contribution
to health care decision
makers as they seek
effective solutions
to address pressing
community health
care needs.
f
As the largest not-for-profit home health care agency in the nation, we stand on the front lines 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 medical
needs and services to help parents care for their children at home; • Preventing caregiver burnout by providing caregiver support
to reduce stress while caring for a loved one;
• Supporting Aging in Place that allows older New Yorkers to remain independent in their own homes, with greater dignity and quality of life;
• Providing compassionate hospice and palliative care for people facing the end of life and bereavement services for their family members, including children;
• Helping VNSNY research innovative solutions to Health Care challenges that face us all.
Donor support also allows VNSNY to be a nationwide leader in program innovation, home care research, and public health policy.
Thank you for your support!
Donate to VNSNY
To find out how to become a VNSNY volunteer: Please call 212-609-1570
For more information about participating in our VNSNY Community Connections
TimeBank Program: Please call 212-609-7811 To make a donation to VNSNY: Please call us at 212-609-1525 or find us
107 East 70th Street, New York, NY 10021 | www.vnsny.org Phone: 212-609-1525