For the Love of Patients, Families, and the Community – Dr. Lou DiNicola

Dr. Lou DiNicolaBorn in New Jersey, Dr. Lou DiNicola moved to Randolph in June of 1976 to become a local pediatrician. Passing up job offers in much larger areas then and since, he chose to stay in Randolph because he’s been able to able to practice medicine as he always envisioned. He has been able to affect change on a state level; create unique, trend-setting models of health care; and demonstrate his love of the community through his work.

Married to his wife Joann for 43 years, the couple has two grown children, two grandchildren, and a third on the way. Dr. DiNicola is an outdoor enthusiast, enjoying hiking, snowshoeing, walking, and gardening. He’s also a photographer and works with his artist wife, framing her paintings. 

Dr. DiNicola has spent his entire career in Randolph while also working in Rochester from 1977-1992 with internal medicine physicians Drs. Mark Jewett and Milt Fowler. 

Below is his story as told in his own words, as featured in our 2012 Annual Report.

Thirty-six years ago I was fresh out of residency and looking for job opportunities when I saw an ad in a magazine for a pediatrician in rural Vermont. Vermont was where I wanted to work, so I sent in my curriculum vitae, the medical equivalent of a resume, but never heard a word back. I called but the response was less than enthusiastic. I was basically told “thanks, but no thanks.”

I had three job offers in Pittsburgh and was literally sitting down to take a job at Children’s Hospital of Pittsburgh where I’d just completed my internship and residency when my pager went off. It was Gifford President Phil Levesque’s secretary, wondering if I could come up in a couple of weeks for an interview. “I’ll come this weekend, or I’m not coming at all” was my response. The secretary covered the phone, relaying my message to Phil. “Hell, let him come” was his reply.

Needless to say, I came, and stayed.

More than three decades later I hope I have made a positive impact on the community and my patients, and know they have made a remarkable impact on me – teaching me how to communicate care, respect, and love.

It’s amazing how much you can love your patients. Also amazing is the window being a pediatrician gives you to see the love between a parent and a child. No more clearly is that demonstrated than in the unconditional love between a parent and a special needs child. More than once, parents of special needs children have amazed me and inspired me, as have the children themselves. I’ve seen parents of special needs children go on to adopt more children with special needs. Those are the moments that touch you most; those, and loss.

Dr. Lou DiNicola

Dr. DiNicola thumb wrestles with patient Troy Daniels.

There is no greater loss than the loss of a child. Throughout my career, there have been car accidents, disease, malignancies, and newborn deaths. I think of two patients I lost to cancer, both of whom I visited at their bedsides at home as they were dying. As I reflect on my career, I think of them not with tears but fondness because of the relationships I have had with their families.

At Gifford, we are small enough to have that closeness with our patients and courageous enough to get up the next day and reflect on what we did or didn’t do, what we could have done differently, and how we can improve care. This ability to affect change is one of the things that has kept me practicing – happily – in this community and state for so many years.

One of the biggest changes Gifford has been able to enact in health care is around childbirth. When I first came to Gifford, I kept hearing about this guy Thurmond Knight, a local physician who was delivering babies in people’s homes. I met Thurmond at a Medical Staff meeting. He was knitting. I asked him what it would take for him to deliver babies at the hospital. He answered “a Birthing Center”. We opened the Birthing Center (the first in the state of Vermont) 35 years ago in 1977.

I’ve also been fortunate to be part of and help form organizations that were decades ahead of their time, in many ways laying the foundation for today’s medical home and Vermont Blueprint for Health models as well as utilizing computers for communication at the advent of the computer revolution. Additionally, Vermont has provided me with the opportunity to work on important legislation, such as child abuse laws, outlawing corporal punishment in schools, mandatory kindergarten, and the recent immunization law. These opportunities along with the privilege of making a difference in kids’ and families’ lives keep me going.

One of the things I find incredibly rewarding is living and working in the same town. I don’t mind if I run into someone downtown and they ask me a question. And I feel it’s so important that we recognize and talk to kids. One way I have been able to successfully converse and care for kids for so long is through humor. I try to infuse that in my appointments with children and often am treated – sometimes at unexpected moments – to humor in return.

One such humorous moment came from a 5-year-old. I try to end all my appointments by asking if patients have any questions for me. This 5-year-old’s question: “Why do frogs jump so high?” Should I ever write a book, I think this will be the title.

~ Lou DiNicola, M.D.
Gifford pediatrician

Dr. Lou DiNicola

Above left – Dr. DiNicola in 1979. Above right – Dr. DiNicola with Kim Daniels of Berlin and her adopted son Troy. Troy along with his siblings, Maggie, Ben, and Alex, were patients of Dr. DiNicola’s for years. Dr. DiNicola credits Kim, who had a special needs child and then adopted two more, with showing him the true meaning of love and parenting. Troy credits Dr. DiNicola with seeing him as a person.

Year in Review – Part 2

Our 2012 Annual Report included a month-by-month “Year in Review” section. Here is the second quarter excerpt.

APRIL

Blueprint teamTo support patient needs, the Blueprint team grows to include a behavioral health specialist (social worker) and a second care coordinator.

Gynecologist Dr. Ellamarie Russo-DeMara of the Bethel and Twin River health centers leads a free women’s health talk at the Montshire Museum on menopause and genetic testing for breast and ovarian cancers.

Gov. Peter Shumlin visits the Menig Extended Care Facility to offer thanks to the state’s top nursing home, calling it a “tribute to the community”. “We’re proud of you. Thank you from the bottom of our hearts,” the governor said to residents, families, and staff members. The governor’s visit came in the wake of the U.S. News Report “2012 Honor Roll” listing.

Gov. Peter ShumlinJoining Gov. Shumlin are Vermont Disabilities, Aging and Independent Living Commissioner Dr. Susan Wehry, Vermont Health Care Association Executive Director Laura Pelosi, Division of Licensing and Protection Director Suzanne Leavitt, and Assistant Director Fran Keeler.

Gifford provides free assistance with advance directives in conjunction with National Healthcare Decisions Day.

Gifford’s more than 200 volunteers are honored with a luncheon served by hospital managers, prize awards, musical performances, and more.

Dr. Sandy Craig joins the hospitalist team, having previously practiced at The Health Center in Plainfield for many years.

March of DimesEmployees raise $455 for the March of Dimes by donning “Blue Jeans for Babies”. At the same time, the Vermont Chapter of the March of Dimes recognizes Gifford with a Leadership Legacy award for its commitment to prenatal, birth, and newborn care, and its support of the non-profit organization working to prevent birth defects, premature births, and infant mortality.

Long-time pediatrician Dr. Lou DiNicola receives a national award for his work around childhood immunizations.

Dr. DiNicola is recognized by the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases and the CDC Foundation as the first ever “CDC Childhood Immunization Champion” for the state of Vermont.

MAY

Ob/gyn Dr. Anne Galante joins the women’s health team full-time. She had worked as a Menig celebrationlocum tenens, or part-time contracted, provider at Gifford since 2009.

Menig residents celebrate a “Day of Play” with representatives of the Vermont Department of Disabilities, Aging and Independent Living. The day celebrated Older American’s Month and included a scavenger hunt.

JUNE

The Robin’s Nest Child Enrichment Center holds its annual preschool graduation, complete with caps and gowns.

Gifford and Valley Rescue Squad Inc. move forward with the formation of a new non-profit aimed at stabilizing ambulance costs and maintaining or improving quality through a new non-profit to be called Supporting Ambulances for Vermont Emergencies (SAVE).

A free men’s health talk by general surgeon Dr. Ovleto Ciccarelli and urologist Dr. Richard Graham address colorectal health, prostate cancer, and erectile dysfunction.

For an eighth consecutive year, the Menig Extended Care Facility receives a Nursing Home Quality Recognition from the Vermont Department of Disabilities, Aging, and Independent Living.

A free talk on Medicare insurance, why it’s important, why participating in Medicare Part B is beneficial, and what one’s choices are under Medicare Part D is offered.

The Commission on Cancer of the American College of Surgeons grants accreditation with commendation to the cancer program at Gifford. Gifford’s cancer program, which includes outpatient chemotherapy, has been accredited since 1965.

Family nurse practitioner Emily LeVan joins the Bethel Health Center.

Gifford is awarded a Hospital of Choice Award from The American Alliance of Healthcare Providers for “courteous, compassionate, and caring services for patients, family, and the community.” The ranking places Gifford among “America’s most customer-friendly hospitals”.

Year in Review – Part 1

Our 2012 Annual Report included a month-by-month “Year in Review” section. Here is the first quarter excerpt.

JANUARY

pediatrics' open houseUrologist Dr. Richard Graham and menopause practitioner Dr. Ellamarie Russo-DeMara of the Twin River Health Center offer a free talk at the Montshire Museum on urinary incontinence.

Gifford is once again awarded a grant from the Avon Breast Health Outreach Program. For the 11th year, Gifford is the only entity in Vermont to receive the $35,000 grant for breast cancer awareness education and outreach.

Pediatrics and adolescent medicine moves from the main medical center building to Dr. Chris Soares’ former space at the corner of South Main and Maple streets. Joining the practice on the first floor of the renovated, spacious Victorian home is pediatric physical, occupational, and speech therapies.

A free three-week series on heart health includes talks from cardiologist Dr. Bruce Andrus and registered dietitian Stacy Pelletier as well as a heart-healthy cooking demonstration from Gifford’s chefs.

FEBRUARY

As part of Gifford’s expanded efforts under the Vermont Blueprint for Health, a chronic illness support group – Chronic HealthShare Consortium – is launched and begins meeting monthly.

Dr. Ovleto Ciccarelli strives to bring colon health to the forefront with a free health talk, “Everyone’s Got One: A Discussion on the Colon and How to Keep It Healthy”.

Pacemaker surgeries return to Gifford after a quarter century hiatus.

The Menig Extended Care Facility is named among nation’s top 39 nursing homes by U.S. News and World Report, which released a list of “2012 Honor Roll” nursing homes. Menig was the only nursing home chosen in Vermont and neighboring New Hampshire.

MARCH

The 106th Annual Corporators Meeting is held at the medical center and features Steve Kimbell, commissioner of what was then the Vermont Department of Banking, Insurance, Securities and Health Care Administration. Leo Connolly, Fred Newhall, and Peter Nowlan are elected to the Board of Trustees.

A Vermont House of Representatives resolution recognizes “the outstanding health care services provided by Gifford Medical Center”. The resolution is in honor of Gifford’s more than 100 years of service to the Randolph area and for its many recent awards.

The Diabetes Education Expo focuses on teeth and feet and how diabetes can keep both healthy. It is the 7th annual exposition organized by the Diabetes Clinic especially for the growing diabetes population.

An open house is held for pediatrics’ new space at 40 South Main Street. Children attending enjoy face painting, balloons, snacks, tours of their new doctor’s office, bike helmet fittings, and painting tiles that have become part of the clinic’s permanent decor.

A Message from the Administrator

Joe WoodinGifford 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.

Gifford Volunteers Honored

Selfless community members give 16,524 hours to non-profit hospital

Susan O'Malley of Randolph

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

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

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.

Major salutes

Major salutes

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

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 Vermont Blueprint for Health: Redefining Primary Care

The following is an excerpt from our 2011 Annual Report. Our 2012 Annual Report will be out soon.

Vermont Blueprint

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.

Vermont Blueprint

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.

A Conservative Approach to Health Care Reform

The following is an excerpt from our 2011 Annual Report.

health care reform

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.

conservative approach to health care reformGifford 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
provide.

‘Start The Conversation’

All ages invited to join local experts in talking about end-of-life care options, to improve quality of life now.

Start the ConversationRANDOLPH – 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 .

 

Gifford Launching Caregiver Support Group

Caring for the CaregiverRANDOLPH – 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.

Not Just a Medical Center; A Medical Home

The following is an excerpt from our 2011 Annual Report. 

What is a Medical Home?

medical homeA 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.

medical center

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
conditions.

“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

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.