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Home care nurses meet challenges after Sandy

Monday November 19, 2012
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From left, Anne Calvo, RN, assistant vice president; joins Netta Waters, RN, nursing supervisor, and Kathy Gallo, RN, field nurse, coordinator, Winthrop-University Hospital Home Health Agency, who worked at the local medical shelter to help special needs patients.
(Photo courtesy of Winthrop-University Hospital Hom)
Throughout the crisis caused by Superstorm Sandy and its aftermath, home care nurses made extraordinary efforts to ensure their clients were safe and secure in the New York/New Jersey Metro region. Despite their own personal losses, treacherous roads and extensive power outages, they traveled by foot, bicycle, car or public transportation to see their patients, some even going to nearby shelters to find them.

Many nurses opened their homes to serve as command centers and office sites or to provide personal shelter and meals for colleagues who were displaced or in distress.

"We did what we needed to do," said Karine Cadet-Julien, RN, home care nurse with VillageCare Rehabilitation and Nursing Center, Manhattan, who sees patients in the Carnasie, Bay Ridge and East New York areas of Brooklyn.

In the days after Sandy, Cadet-Julien did much more. She also traveled to Brooklyn’s Coney Island, Park Slope and Red Hook communities, which were hit hardest by the storm and in desperate need of help.

When her car broke down, Cadet-Julien walked to see patients who were insulin- and oxygen-dependent and needed wound care. She also brought patients food, blankets, flashlights, water and supplies.

Mary Figueroa, LPN, pediatric trach and vent nurse with Bayada Home Health Care, Toms River, N.J., knew if she didn’t reach a medically fragile patient, he would have to go to the hospital. Traveling for nearly two hours by car, she made it to his home despite downed trees and electrical wires and extensive street flooding.

Figueroa, who is studying to become an RN, also cares for children in the Toms River and Brick, N.J., area who require tube feedings, ventilator and tracheostomy care, suctioning and personal care.


On the heels of Superstorm Sandy, the New York and New Jersey regions were hit with an ice and snowstorm that resulted in even more power outages and treacherous roads.
(Photo courtesy of Kathleen Emr, RN)
Must go, must care

With a snake flashlight around her neck, which she called "hurricane bling," Avigail Weiss, RN, coordinator of care, Revival Home Health Care, Brooklyn, trudged over sand mounds and entangled debris and climbed hundreds of steps in high-rise buildings to make sure her patients were safe in the Far Rockaway, Rockaway Park and Belle Harbor areas of Queens. "Our elderly patients don’t want to leave; their communities are their families," said Weiss, who was displaced from her own home by Sandy. "It was the roughest week for me, but the most rewarding one. It reminded me of why I became a nurse."

Likening the conditions to a developing nation, Weiss credited local volunteers for their support; the National Guard, who helped carry patients down flights of stairs to safety; and building managers, who knocked on apartment doors to locate patients in need.

On Long Island, finding clients was the first major challenge immediately after the storm, and many RNs and interdisciplinary team members completed "drive-bys" to check on them. Besides inoperable traffic lights and limited access to homes, the gas shortage made working conditions doubly difficult, said Anne Calvo, RN, BSN, MPS, assistant vice president, Winthrop-University Hospital Home Health Agency, Mineola, N.Y., who worked closely with staff to get to open gas stations and with equipment companies to deliver oxygen tanks to those in need.

RNs in the four Barnabas Health home care agencies each faced their own set of unexpected obstacles, according to Patricia Toglia, RN, MS, vice president, Barnabas Health Home Care, which includes JerseyCare Home Health and Medical Center Health Care Services, West Orange, N.J.; and Community Kare and Community Medical Center Home Health, Toms River, N.J.


Power and phone outages at the VNA of Somerset Hills agency caused several departments to relocate to private homes to provide uninterrupted services to patients and the community. From left, referral center manager, Christie Ponessa, RN, and home care coordinator, Laurene Pollio, RN, continue to process new patient referrals.
(Photo courtesy of VNA of Somerset Hills)
In the south, some patients from the barrier island extending from Point Pleasant, N.J., to Long Beach Island, N.J., did not evacuate as directed. Extensive cell phone service interruption disrupted communication in that area, and massive flooding destroyed patient and staff homes and personal possessions.

"Besides meeting patients’ medical needs, our nurses provided food, water and clothing to patients who did not have power in their homes and volunteered at local medical shelters, which housed thousands of displaced people," said Debbie A. Argenio, RN, assistant director, patient care, CMC Home Health.

In the Essex County area, which was hit by extensive power outages, Barnabas Home Health staff climbed a dark stairwell to bring an elderly man to safety; rescued a bedridden patient trapped in bed in the upright position for 36 hours; and stayed overnight with a debilitated patient who needed help with basic activities of daily living, said Melissa Garfield, RN, BSN, clinical nursing supervisor, JerseyCare Home Health.

Above and beyond

Through it all, home care nurses recognized their patients’ courage and perseverance and their colleagues’ efforts and dedication.

After some New York residents from Long Beach and Island Park were evacuated to Nassau Community College in Garden City, Netta Waters, RN, BS, nursing supervisor, and Kathy Gallo, RN, BSN, field nurse, coordinator, Winthrop-University Hospital Home Health Agency, performed patient review instrument screenings at the shelter for those with special medical needs.

"I am so touched by patients’ resilience and strength and by the way they’d say, 'We’ll bounce back. We’ll get through this,’" Gallo said.

Sally Liptak, RN, MSN, area director of operations, Amedisys Home Health Services of Hackensack and Secaucus, Hospice Program of Hackensack, and the Hospice House, credits staff for working diligently to keep patients at home, rather than sending them to the hospital. Despite poor phone service, staff managed to reach physicians for medical management of one patient’s urinary tract infection and another patient’s persistent vomiting. When a patient’s backup generator failed, staff contacted local fire department personnel, who delivered another generator for his nebulizer treatments.

A levee break and subsequent flooding in Little Ferry and Moonachie, N.J., presented additional challenges to Hackensack nurses who serve more than 1,100 patients in New Jersey’s Bergen and Hudson counties. Home hospice patients in the community who had no power or heat were transferred to the inpatient hospice units for warmth, food and medications they needed, Liptak said.

Nurses at the Visiting Nurse Association of Somerset Hills, in Basking Ridge, N.J., visited patients they could not reach by phone right after the storm. Because Christie Ponessa, RN, BSN, referral service center manager, continued to receive referrals after patients were discharged from the hospital, RNs stopped by new patients’ homes unannounced. During the gas shortage, support staff waited in gas lines and gave field nurses the agency cars filled with fuel, Ponessa said.

Weather conditions deteriorated suddenly for Michelle King, RN, a home care nurse at Catholic Home Care, a member of Catholic Health Services of Long Island, during a Copiague home visit Oct. 29, the day the storm hit. Within 90 minutes, the road leading up to her patient’s home was impassable, and King was forced to wade through more than 3 feet of water to higher ground, where neighbors rescued her in their car and brought her to safety. "My car is destroyed, but I wouldn’t do it any differently," said King, who primarily sees oncology patients in the Amityville, Copiague and Lindenhurst areas of Long Island.

Prepare, prioritize

Days in advance, with access to updated lists of priority patients in their areas, RNs and ancillary personnel visited and called patients to make sure they had enough oxygen, battery backup, at least a week’s supply of medications, emergency phone numbers, family contact information, nonperishable food and water, and essentials such as flashlights and battery-operated radios.

Serving an average of 1,150 patients, staff at the Visiting Nurse Services in New York’s Westchester and Putnam counties contacted all priority patients the weekend before the storm, and reassigned RNs to patients who lived closer to them. In the days after the storm, there were thousands still without power, which was especially difficult for elderly patients who live alone or have only an elderly partner as their caretaker, said Suzanne Moses, RN, BSN, MHA, director of patient services.

Allison Reece-Dressekie, RN, staff and field nurse, VillageCare, and colleagues prepared ready-made meals for insulin-dependent patients. They helped patients acquire emergency mobile phones to contact the agency or family. Reece-Dressekie now is working with patients to reschedule missed medical appointments.

"Everyone should know what a wonderful job home care nurses did to take care of their patients and each other," Liptak said. "We hoped that we could weather the storm. Even though it was difficult, that’s exactly what we did."

Janice Petrella Lynch, RN, MSN, is a regional nurse executive.


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