Gifford Administrator Joe Woodin wrote the following as an introduction to the 2012 Annual Report, segments of which we’ll be featuring on our blog:
It’s interesting to be working in an industry that continues to be under the microscope of the political process, with people wanting more control over the cost of health care. Frankly it can be a bit exhausting, but I can understand and agree with their concerns.
“What can we afford?” is becoming an uncomfortable theme both locally and nationally; although we can all relate to this in our daily lives when we go shopping for food or services. There are now so many involved in helping to “fix” the health care system that it becomes a daunting task just to stay focused on the basics: providing quality patient care with compassion and kindness.
This report highlights a few of our providers who have remained focused and undistracted by all of the changes in health care. As the years have ticked by, they have not lost their love of the profession, nor have they been dissuaded by all of the changes, paperwork, and new requirements. Their work has become a calling, and they have touched many of our lives when we have been in need of medical help.
The more we try to understand and solve the complicated aspects of health care, the more I am reminded that at the end of the day, there are still patients in beds or in clinic exam rooms awaiting care. They are usually anxious, at times scared or upset, and always hopeful that someone can give them answers and help them through the next step. Our role is to ensure that we have a provider willing to enter into patients’ lives, helping to answer questions and even hold their hand when the news is “not good”.
So regardless of where we end up with “health care reform”, hopefully Gifford will always be there with physicians and staff members who reflect the values of the professionals highlighted in this report. Many things will change moving forward, but unchanged will be our commitment to you and our communities.
Selfless community members give 16,524 hours to non-profit hospital
Susan O’Malley of Randolph
Gifford Medical Center recognized its 120 volunteers at an annual appreciation luncheon on Wednesday.
Volunteers gave 16,524 hours in 2012. That’s 2,066 eight-hour workdays or the equivalent of eight full-time employees, noted Ashley Lincoln, director of development and marketing. “That’s a pretty incredible number,” Lincoln said. “We really appreciate the smiles that you bring, your enthusiasm, and your willingness to come when you’re called.”
Arlene Conant of Randolph Center and Robin Rafuse Gurney of Randolph
Volunteers give of their time throughout the medical center, at its clinics, at the Adult Day, through chaplaincy, as part of the Board of Trustees and through the Gifford Auxiliary at the Thrift Shop. “We have a far reaching volunteer group and I thank all of you,” said Volunteer Services Coordinator Julie Fischer to the group of about 75 in attendance.
The volunteers were treated to live music by Thom Goodwin, quality and infection prevention manager at Gifford and a
Chris Furmeister of Randolph
musician. Gifford’s chefs prepared a meal based on the event’s Texas barbecue theme. Gifford staff volunteering as servers donned Western attire. And door prizes from generous local businesses, including Onion Flats, Randolph Village Pizza, Blue Moon Boutique, Belmains, Bud and Bella’s Bookshop, Dandelion Acres, Central Supplies, Chef’s Market, Holiday Beauty Salon and Tozier’s, were given out.
One volunteer in particular received a standing ovation after it was announced that the hospital has nominated him for a senior service award. Major Melvin McLaughlin, 95, has been volunteering at Gifford for more than 40 years.
Lincoln read the hospital’s nomination, which describes McLaughlin’s service and hospital staff members’ regard for the long-time volunteer. “We at Gifford love Major. He is a brilliant and beautiful light in the day. As one nurse put it, ‘A day without Major is a day without sunshine.’ He is the personification of what we are as an organization – warm, compassionate, supportive, humbled and blessed to be able to care for others. Introduce a new staff member, patient or nursing home resident to Major and we have just told them everything they need to know about us. We care. We’re family. We’re here for you.”
Nap and Agnes Pietryka of Randolph
The text of the full nomination is available online at www.salutetoseniorservice.com. Hospital administrators are hoping staff, volunteers and community members visit the site between April 15-30 to vote for McLaughlin, a Randolph resident since 1967.
McLaughlin, a member of the U.S. Marines for 25 years, saluted his fellow volunteers as they cheered him.
Volunteers also offered their thanks for the opportunity to give of their time at the medical center, an experience so many find extremely rewarding.
The event concluded with a presentation from LaRae Francis of Gifford’s Blueprint Community Health Team, who explained the team’s work to connect Gifford patients with needed community services and to help them better navigate the health system. The program is aimed at helping the chronically ill better manage their diseases by reducing barriers to care. The team has had 600 referrals since it began in February of 2011.
Community members wanting to access the program to receive help and learn about available community services can call (802) 728-2499. For information on volunteering at Gifford, call Fischer at (802) 728-2324.
The following is an excerpt from our 2011 Annual Report. Our 2012 Annual Report will be out soon.
Blueprint Care Coordinator Keith Marino meets in Gifford primary care with patient Cheryl Abbey of Randolph.
The Vermont Blueprint for Health is a state-led initiative aimed at improving care coordination, especially for the chronically ill. The goals of the initiative are to improve health, enhance the patient experience and reduce, or at least control, health care costs.
This is accomplished through what the Blueprint is calling “advanced primary care” that seamlessly coordinates a broad range of health and human services for patients and their families.
In 2011, the Vermont Blueprint for Health came to life at Gifford. Each of the medical center’s primary care practices was recognized as a Patient-Centered Medical Home and a huge care coordination effort got under way to meet patients’ diverse needs.
The care coordination effort, which is supported in part by grant dollars, is twofold. First, Gifford formed its own small care coordination team made up of three core employees; Blueprint Care Coordinator Keith Marino, Gifford Diabetes Educator Jennifer Stratton and
Health Connections Caseworker Michele Packard. Second, a larger Community Health Team consisting of a diverse group of state and regional community housing, aging and disability agencies as well as eye care professionals, a pharmacy, insurers and more, was formed.
Blueprint core team members – Health Connections caseworker Michele Packard and diabetes educator Jennifer Stratton – meet weekly with Blueprint Care Coordinator Keith Marino at the Bethel Health Center to discuss individual patients and how to better serve them.
The Community Health Team meets quarterly while a care coordination team meets weekly. More importantly, referrals are bouncing back and forth between the agencies and teams ensuring patients are getting the services they need to maintain and improve their health. Keith coordinates this work, meeting directly with patients, spending time in each
of Gifford’s Patient-Centered Medical Homes, conferring with health care providers and helping patients access needed services.
Patients and community members are referred to Keith for a huge variety of reasons. They may need help managing chronic conditions, be struggling socio-economically, need mental health assistance, be disabled or elderly, have housing or transportation needs or just need help navigating the health system.
The Blueprint provides that help directly or refers them to an appropriate community agency. The help comes in the form of one-on-one meetings with Keith and outreach on his part to get the patient connected with needed resources.
“My role is to make sure patients are getting access to proper services, which enables them to self-manage their chronic condition,” Keith says.
Medicine Division Vice President Teresa Voci gives the example of a chronically ill patient who, because of financial pressures, has to choose between food and medication. Without medication, their health suffers. With the Blueprint services, their health care provider has a central resource to offer the patient for those issues that fall outside the health care setting but are barriers to care, like help with finding resources to buy food and medications.
Kim Flood of Barre is a real life example.
All three of Kim’s sons were diagnosed with asthma. The younger two, ages 4 and 1, were especially sick, including being hospitalized. Kim thought she knew the problem – mold in her Barre apartment.
Pediatric hospitalist Dr. Lou DiNicola referred Kim to the Blueprint. “Keith helped us find someone to do mold testing, help us with legal aid,” Kim says, “and he got city officials to come to the apartment. I had tried for months to get the housing inspector and building inspector to our house. I just got the runaround from everyone.”
With the mold verified and the help of legal aid, Kim settled with the landlord and in October moved into a home she bought in Barre Town on nine acres.
The kids haven’t been sick since.
Kim is one of 230 referrals Gifford’s Blueprint team has received since Keith was hired and the program got under way in February, notes Blueprint Project Coordinator LaRae Francis. Most of the referrals are from primary care providers, like Dr. Terry Cantlin of the Bethel Health Center.
“He’s been invaluable,” says Dr. Cantlin of Keith, who does the work primary care physicians simply do not have time to do in their busy practices.
Now if a patient is not taking their medication due to financial pressures, is missing needed appointments because of transportation issues or struggling with social issues – all scenarios Dr. Cantlin sees – he now has a one-stop resource for the patient.
It also prevents patients unaware of available community resources from “falling through the cracks,” says Mary Ellen Otis, executive director of the Orange County Parent Child Center in Chelsea.
That center, which provides a vast array of family services from new baby visits to parenting education, is part of the Community Health Team and refers clients to Gifford as well as gets referrals from the hospital. Under the new coordinated effort, Mary Ellen says, referrals are now far more efficient.
Maryette Withington can attest to that.
The Barnard resident has a relative with Alzheimer’s disease. Dr. Cantlin referred Maryette to Keith for help learning more about the disease. He met with her at the Bethel Health Center and connected her with the Randolph Area Senior Center and the Vermont Chapter of the Alzheimer’s Association. Within 24 hours Maryette had information in her hands about the disease that she says has changed everything in her life.
“You’re totally responsible for that person. I just needed to know what to expect.”
She will have an ongoing relationship with the association and also continues to receive help from Keith, Dr. Cantlin and her Gifford health care team. It’s help she appreciates. “I have the best health care team in the world,” she says.
Need help yourself? Call the Blueprint Care Coordinator at (802) 728-2499.
The following is an excerpt from our 2011 Annual Report.
Information Systems Director Sean Patrick sits amid the old way of keeping patient records – paper files – and the new way to come – electronic medical records updated by providers via new laptops or even iPads.
As lawmakers embark on an ambitious schedule to create a health care exchange required under the federal Patient Protection and Affordable Care Act by 2014 and a Vermont single-payer system by 2017, Gifford is mindful of its role as a community care provider.
The laws seek to bend the health care cost curve, in part through information technology, advanced primary care and payment reform.
Through the implementation of Vermont Blueprint for Health initiatives, Gifford is embarking on reform initiatives including care coordination for the chronically ill and recognition of Gifford’s five primary care practices as Patient-Centered Medical Homes.
The medical center has chosen an electronic medical record (EMR) vendor and is progressing toward both the installation of an EMR system and meeting federal requirements for “meaningful use” of electronic health records (EHRs). EMRs are internal electronic medical records. EHRs can be viewed by appropriate outside entities, including specialists and providers from other hospitals.
Gifford’s modest budget requests and responsible spending also align with reform, notes Trustee Paul Kendall, who actively follows reform legislation.
But the non-profit community medical center is by choice not at the forefront of reform efforts.
Gifford Administrator Joe Woodin likens health care reform to a passing ship. Where others might be quick to jump on – appropriately, the region’s larger health care providers – Gifford is waiting to ensure the medical center commits to the best choice for
Gifford’s size, patients and rural area.
“Gifford is more inclined to stay on the dock and wait for the boat to come around on health care reform,” Joe says. “It takes a lot of fortitude to humbly wait for the boat to make a reiteration.”
“We continue to be watchful of what’s going on and gradually position ourselves to do
what is right and appropriate,” agrees Paul, noting some initiatives like information
technology upgrades can require huge investments of time and financial resources.
Gifford also strives to be a voice in discussions leading up to reform legislation. Leadership is suggesting cost-saving ideas the state could pursue now. They continue to set a standard
for financial stability and maintaining strong relationships with other hospitals, state and federal lawmakers, and health care organizations, like Bi-State Primary Care and the Vermont Association (VAHHS).
VAHHS represents the state’s nonprofit hospitals before lawmakers and the Green Mountain Care Board, which was created by the Legislature in 2011 to oversee the creation of a single payer Vermont system. Bea Grause, VAHHS president and chief executive officer, sees small hospitals’ role in health care reform as one of preserving local access to high-quality care.
“Hospitals are seeking to create reform opportunities by working with the Green Mountain Care Board and federal lawmakers that will balance the need to contain costs with the need to ensure sufficient revenue that will help hospitals meet their local missions,” she says. “Issues such as recruitment and retention of physicians and other health professionals, improving quality, ensuring access and long-term financial sustainability are just a few of the challenges small hospitals will face as Vermont and the entire industry prepare for a decade of continued change on all levels.”
Gifford’s work with Bi-State Primary Care in part addresses the recruitment piece.
Bi-State Primary Care is a nonprofit membership organization of Vermont and New Hampshire rural health care providers working to support primary care practices in medically under-served areas. Its members represent more than 175,000 Vermonters. This equates to one in four residents, or 46 percent of Medicaid enrollees and 52 percent of the state’s uninsured.
The organization is working on Gifford and small, rural primary care practices’ behalf to improve access by recruiting providers to underserved areas. They are also working on health information exchanges and quality improvement initiatives.
The ultimate challenge the state – and likely hospitals by default – will face for successful health care reform, however, will be answering the question: “What can we afford?”
“There are a lot of uncomfortable issues with health care reform that we don’t talk about. The most common issue is ‘what can we afford,’” Joe says, hoping lawmakers will address that question. If they don’t, it will fall on hospitals, which will be given limited funds to provide care. They will have to make tough choices on what care they can afford to
All ages invited to join local experts in talking about end-of-life care options,to improve quality of life now.
RANDOLPH – Visiting Nurse and Hospice of Vermont and New Hampshire, the Vermont Ethics Network and Gifford Medical Center’s Advanced Illness Care Team are joining to create a community discussion around end-of-life care planning.
Called “Start The Conversation,” the talk will be held on Nov. 29 from 5-6:30 p.m. in Gifford’s Conference Center at the main medical center in Randolph.
“Start The Conversation” is a public education initiative of Vermont’s Visiting Nurse and home health and hospice agencies in partnership with the Vermont Ethics Network. Collaborating with medical providers like Gifford, the talk is offered around the state. A Web site, starttheconversationvt.org, also focuses on the issue of end-of-life planning.
“In life we prepare for everything: college, marriage, children and retirement. Despite the conversations we have for these important milestones, rarely do we have conversations about how we want to be cared for at the end of our lives,” explains the site.
“Talking is the single most important thing that you can do to prepare for the death of someone you love. While difficult, the end of life can be amazingly rich. Talking about this time makes a rich ending more likely. Often such conversations are avoided out of an understandable desire to spare each other’s feelings. They need not be.”
An Advance Directive is one way to get the conversation started and experts leading this Nov. 29 talk in Randolph will talk about end-of-life options, medical decision making and how to put ones wishes in writing through an Advance Directive.
“Planning for end-of-life care before it becomes a worry is as important as all the other life plans you make. Having a plan in place makes it easier for you, your doctor and your loved ones if you are unable to tell them your health care choices because of an injury or serious illness,” explains Jared King, business development manager for Visiting Nurse and Hospice of Vermont and New Hampshire.
“Every moment is precious – especially at the end-of-life. Starting the conversation early can ensure that your choices are heard. It also means that when time becomes short, it can be spent doing what you most enjoy and not making last-minute decisions.”
As a psychologist and member of Gifford’s inpatient care management team, Cory Gould spends much of her day talking to patients about Advance Directives. “We spend a lot of the day holding discussions with family members about how to talk about death,” Gould says. “The beauty of bringing this discussion to the forefront is to improve the quality of all of our lives.”
If end-of-life wishes are known there is more opportunity to enjoy the present and erase the worry, Gould explains. Discussing how one wants to celebrate the end can also increase understanding about what matters most to that individual in life. “Thinking about death is a way of celebrating life,” Gould says.
For Gifford and its Advanced Illness Care Team, the talk will be the first in a series on death and dying. Titled “A ‘Good’ Death,” the series will look at what is a “good” death, family dynamics when death approaches, what happens when someone dies, grief and more. The series begins with “Start The Conversation.”
“Start The Conversation” is free and open to people of all ages. Registration is not required. The Gifford Conference Center is on the first floor of the medical center and marked by a green awning from the patient parking area. For handicap access, take the elevator from the main lobby to the first floor and follow signs to the Conference Center.
To learn more about this talk or the upcoming series, call Gould at (802) 728-2608 .
RANDOLPH – Gifford Medical Center is launching a Caregiver Support Group this November.
Open to anyone caring for a family member or loved one, the group meets on the second Tuesday of each month from 11 a.m. to noon in the Randolph hospital’s Conference Center.
The group is participant-driven with members deciding how the meetings will be designed, choosing a facilitator and picking discussion topics. Samantha Medved, a licensed social worker and behavioral health specialist at Gifford, will also work with the group, providing ongoing support.
“Caregivers invest so much of themselves – both physically and mentally – into caring for others. This group is an opportunity to have time away to deal with the normal range of emotions all caregivers experience, by gaining support from peers experiencing similar issues,” Medved said.
The group is offered as part of Gifford’s efforts through the Vermont Blueprint for Health. No registration is required. Medved and the Blueprint team can be reached at 728-7100, ext. 6, with any questions.
The Gifford Conference Center is in the main medical center at 44 S. Main St. (Route 12) in Randolph. From patient parking, the Conference Center entrance is marked with a green awning. For handicapped accessibility, take the elevator from the main lobby to the first floor and follow signs to the Conference Center.
The following is an excerpt from our 2011 Annual Report.
What is a Medical Home?
A medical home is an approach to providing comprehensive primary care that builds partnerships between patients, their physicians and, when appropriate, their families.
The American Academy of Pediatrics was at the forefront of the medical home movement, detailing decades ago that every child needed a place where care was accessible, ongoing, patient and family-centered, of high quality, coordinated, and compassionate.
Today, those philosophies have been expanded to adults as they’ve been adopted by family practice and other health care associations.
In fact, the National Committee for Quality Assurance, a non-profit dedicated to improving health care quality, is now recognizing qualifying medical practices as Patient-Centered Medical Homes.
Bethel Health Center family physician Dr. Terry Cantlin talks with patient Eileen Strickland-Holtham of South Royalton during a routine exam. The Bethel Health Center is one of five Gifford practices recognized as a Patient-Centered Medical Home.
Patient-Centered Medical Homes
Achieving the Patient-Centered Medical Home recognition is part of the Vermont Blueprint for Health’s goals for all primary care providers in the state.
The hope is to improve primary care so patients are getting regular needed care and other supports to maintain their health before facing more costly emergency or inpatient care.
“The medical home adopts a ‘whole person’ approach to primary care, encompassing medical, behavioral and self-management support,” says Gifford Blueprint Project Coordinator LaRae Francis. “It’s the entire health care team wrapping its arms around the patient to provide the support and resources he or she needs to manage his or her health
“It aims to keep people healthier, enhance their quality of life and benefit them financially, both through reduced health care costs and secondary costs such as missed work.”
In 2011, each of Gifford’s primary care practices – the Gifford Health Center at Berlin’s pediatrics practice, the Bethel Health Center, the Chelsea Health Center, Gifford primary care in Randolph and the Rochester Health Center – was recognized as a Patient-Centered Medical Home following inspections by the National Committee for Quality Assurance.
The health centers, which serve a total 21,540 patients, each formed quality improvement teams to address expectations for a Patient-Centered Medical Home, primarily through honing and streamlining systems. Among those expectations, or standards, were access to care, communication, such as through timely callbacks to patients and tracking referrals and tests, such as lab results to ensure they are communicated back to the patient.
The process, says Vice President of Medicine Teresa Voci, allowed the health centers to identify and correct problems. It’s all work done behind the scenes, but also all work that makes care more timely for patients.
Labs, X-rays and referrals to specialists are all now better tracked to ensure the patient and the primary care provider know the results of those exams, notes Chelsea Health Center site manager and nurse Travis Worthen. Providers are also more often meeting with patients to go over results.
And the patient is increasingly a bigger part of the health care team.
“Historically, medicine has always told patients what to do and now medicine is really turning toward engaging the patient in a partnership for health outcomes,” Teresa explains.
Blueprint Project Coordinator LaRae Francis has headed up efforts to implement the Vermont Blueprint for Health at Gifford and in the larger Randolph Health Service Area.
The work doesn’t stop with Gifford.
With the medical center’s primary care locations now all recognized, LaRae, as Blueprint coordinator for the Randolph Health Service Area (a Blueprint-defined area spanning from Randolph to White River Junction), is now looking outside of Gifford. She’s reaching out to White River Family Practice in Wilder and the South Royalton Health Center.
She hopes to help these private health centers also earn the recognition, further improving patient care in our region.
Class focuses on Chronic Disease Self-Management and peer support
A new Chronic Disease Self-Management Healthier Living Workshop series begins Oct. 15 and continues Mondays through Nov. 19 from 10 a.m. to 12:30 p.m. at Gifford Medical Center.
Healthier Living Workshops are six-week classes for people with chronic conditions and their caregivers. They are offered for free – along with chronic pain workshops – throughout the year by Gifford as part of the Vermont Blueprint for Health.
The workshops are led by trained facilitators and are designed to help improve strength, flexibility and endurance. They also provide tips for managing medications, eating healthier and improving communications with family and friends.
The goal is to help people better manage their health conditions and deal with the frustration, fatigue, and pain that can accompany a chronic disease.
Participants also benefit from meeting other people with chronic conditions, learning how they cope and enjoying the camaraderie of knowing that they are not alone in how they’re feeling, notes Gifford workshop coordinator Susan Delattre.
According to the Vermont Department of Health, past participants report increased energy, reduced stress, more self-confidence and fewer doctors’ visits as a result.
Gifford Healthier Living Workshop participants have called the series “very relaxed and you really felt free to express yourself” and said they most enjoyed “meeting people who understand what I am going through.”
To register or for more information, call Zach Bean at Gifford’s Blueprint office at the Kingwood Health Center at (802) 728-7100, ext. 6.
The workshop will take place in the Randolph hospital’s Conference Center at 44 S. Main St. From patient parking, the Conference Center is marked with a green awning. For handicapped accessibility, take the elevator from the main lobby to the first floor and follow signs to the Conference Center.
RANDOLPH – There are an estimated 64,000 home caregivers in Vermont – those who care for a loved one or friend at home rather than relying on a home health agency or nursing home.
Gifford Medical Center’s Blueprint Care Coordination Team is collaborating with the Central Vermont Council on Aging to offer advice and peer support to home caregivers who often selflessly work long, stressful hours.
Over the coming months, Gifford will offer a one-night course called “5 Minutes for Yourself.” The class will be led by Samantha Medved, Gifford’s Blueprint behavioral health clinician and a licensed social worker.
“The class is really designed to identify why caregivers need to take five minutes for themselves, and we’ll also talk about how to find that time during the day.”
The class will be offered on Aug. 20 from noon to 1:30 p.m. at Gifford in Randolph and from 5:30-7 p.m. on the following days and locations: on Aug. 23 at the Chelsea Health Center, on Aug. 28 at the Bethel Health Center, on Sept. 4 at the Gifford Health Center at Berlin, and on Sept. 13 at Gifford.
Participants need only take one of the classes, which will cover identifying stress in the caregiver role, how taking time for oneself can improve the caregiver’s ability to provide care, breathing techniques, how to find that “me time” and what activities to do during that time.
The class will be followed up by a six-week course from Jeanne Kern of the Central Vermont Council on Aging called “Powerful Tools for Caregivers” and running Wednesdays, Sept. 5-Oct. 10 from 3-5 p.m. at the Council on Aging at 59 N. Main St., Suite 200, in Barre.
The six-week workshop is also anticipated to be offered in Randolph in the fall with Kern and Brooks Chapin, a nurse and Gifford’s director of senior services.
The educational workshop is designed to help family caregivers take care of themselves while caring for a relative or friend. Participants will learn ways to reduce stress; communicate effectively; reduce guilt, anger and depression; set goals; and problem solve.
And finally, Gifford is planning ongoing, community-based support groups for caregivers beginning in September. The participant-run groups will be offered based on participants’ interest and availability.
The goal of all of the programs is to support caregivers and the vital, challenging role they play.
“Caregivers typically are caring for people they really love and are allowing those people to continue to live in their homes, with their families and in their communities.
Simultaneously, it’s a very hard and under-recognized role,” Medved said. “What we know is healthier caregivers provide healthier care, so we want to make sure we assist caregivers in being as healthy and happy as possible.”
To register for any of the upcoming “5 Minutes for Yourself” classes or to express interest in joining a support group, call Gifford’s Blueprint office at 728-7100, ext. 6. The class is free and light refreshments will be served.
To sign up for “Powerful Tools for Caregivers,” call Kern at the Council on Aging at (802) 476-2671. A $20 donation is suggested to help cover the cost of the course book that participants receive.
Participants need not be full-time caregivers. Anyone who helps support a loved one, such as through decision-making, providing transportation, or serving as a primary family support person is welcome.
Gifford also holds a monthly support group for those with chronic illnesses called the Chronic HealthShare Consortium. These free meetings continue on the second Wednesday of each month from 3-4 p.m.