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By: Patricia Hudak, RN and Chelsea Cassidy, LCSW 

Stephanie Meyer is a registered nurse and has been with AT Home Care since 2018.  Her nursing career began in 2003 as a Patient Care Technician in the hospital emergency room with Bon Secours Hospital.  Stephanie had a front row seat in this position to see how people were dying, and she knew it could be better.  Stephanie applied for several transfers within the hospital and was uncertain which unit she wanted to be on however she did know that she wanted the dying process to be different.  After speaking with her boss, she transitioned to a hospice RN Case Manager 14 years ago. Stephanie began educating the medical field and community on hospice and focusing on how people should have a dignified and peaceful death.  She has great compassion for quality of life and individuals experiencing a comfortable death. A hospice admission nurse is usually the first clinician that the patient or family will meet.  The patient or family will often have an initial conversation about hospice with a marketer or intake coordinator and once they are ready to be evaluated by a nurse for hospice criteria, the admission RN is sent to meet the patient.  There are three main factors to be considered when a patient is being admitted to hospice: (a) a doctor’s order for hospice evaluation and treatment needs to be obtained, (b) the patient needs to meet hospice criteria based on their terminal diagnosis, and (c) the patient/family needs to agree to the hospice philosophy and plan of care (Medicare). The admission nurse is the storyteller – they are collecting bits and pieces of a patient’s story and helping them see an option to transition from curative care to palliative care.  Stephanie takes each individual story and translates it into a beginning point of care for the entire hospice team. An admission nurse is collecting the medical, emotional, psychosocial, and spiritual aspects of a patients care.  Stephanie takes this personalized story and turns it into a picture that is not necessarily black or white but filled with parts of gray.
Stephanie beautifully stated, “The medical field, especially hospice, is not black or white.  It is often gray, and I have learned that gray is a very pretty color.”
Stephanie is very thorough in her evaluation and patient assessment.  During this time frame, she is providing education to the patient, family, and the facility staff if a patient resides in a facility.  Stephanie provides active listening which helps to build trust as this is often a big decision for a patient to make about their health. Part of Stephanie’s role includes completing hospice admission consent paperwork, educating on hospice, calling in medications and DME, and also obtaining approval from the Medical Director and the family if they are not present. Since COVID-19, many families are limited in being able to see their loved ones, especially in a facility. Stephanie often goes above and beyond to help connect the patient and family with one another. Non-admits can occur when the patient/family are not quite ready for comfort care.  Their mindset and goals are focused on curative treatments or aggressive options.  Families may be experiencing denial and see hospice as a last resort rather than the quality of life it can provide with pain management, physical, and psychosocial support. Alzheimer’s and dementia diagnosis is one of the top five admission diagnoses for hospice. Showing decline for hospice eligibility can be a challenge for the admission nurse.  Stephanie works closely with the Intake Department as they have the initial conversation with the patient/family and will obtain the necessary orders and medical information to determine a patient’s eligibility. Stephanie works a seven on / seven off shift Wednesday-Tuesday 9pm-7pm.  This allows her to complete multiple admissions throughout the day. Self-care can be a challenge for people, especially those that are working as a caregiver, such as a nurse.  Stephanie practices self-care by “wiping her feet at the door.”  She has promised herself to never sacrifice herself spiritually.  She remains mentally and emotionally prepared for each admission by being fully present in the moment.  When she ends her documentation and sends her report, she accepts her part is complete to the best of her ability. Stephanie is reliable, compassionate, genuine, and accountable.  She has served AT Home Care Hospice in numerous ways.  She courageously went out to take care of patients that were COVID positive without hesitation in the very beginning of the pandemic.  She voiced this is her calling, and when she became a nurse, it was in good times and even during unknown pandemic times.  She consistently shows up to work daily with a positive attitude and a heart to serve regardless of the circumstance.    AT Home Care & Hospice is celebrating nurses during the month of May! Meet Stephany and learn about her passion for nursing as she describes her path to hospice nursing. “It started when I was young; my father was the Chief Orthopedic Technician at Richmond Memorial Hospital (the old one on Westwood Ave). I would go to the hospital with him when he was called in and sit with the nurses at the nurse’s station or go with him to see a couple patients (he of course asked them first). I watched him put casts and halos on patients and adjust traction on some, so I always knew I wanted to do something to help people.
At first, my circumstances didn’t allow me to pursue a nursing career. Then, I began working my way towards my Associates Degree for my RN. At first, I worked in a hospital, and loved the people I worked with on nights. Eventually, the night shift interfered with other parts of my life, so I became a RN/CM at a home health company, shortly after I transferred to their Richmond location, and eventually made my way to ATHC. I finally made the decision that I needed a change and have loved the people I work at ATHC ever since. They have been so supportive and mentoring on how to do things that I had not done before; it has been amazing! Although I am sitting in a home office right now, I know that my job is essential in order to make sure each patient under my team is taken care of to the best of our ability. I miss seeing patients at times; seeing how they look at you when they are feeling sick or when you are there to brighten their day by being someone to talk to. Teaching patients how they can better take care of themselves and make themselves feel better is what it’s all about! It’s all worth it when one patient tells you that you’re a life saver, or just thanks you and smiles at you. Now, I love receiving those same phone calls and letters from patients about my team members!”
Carol Elrod, AT Home Care’s Director of Continuing Quality Improvement, returned from the VAHC leadership conference in Staunton, ready to take on Capitol Hill. The focus of the meetings were how to meet the increased government demands on home health agencies which threaten reimbursement for services.  In an effort to step up collections of money on perceived overpayments to providers, aggressive strides are being taken to accelerate the recouping of Medicare dollars that have already been paid to home health agencies.  CMS is adopting a massive recovery audit program by employing RACs (Recovery Audit Contractors) to flag claims where they perceive any discrepancy.  These independent medical collection agencies, RACs, are hired by CMS and paid a fee as an incentive to find overpayments.  Elrod believes that Congress needs to be educated about these programs which unfairly target honest home health care agencies.   She has already written her congressmen about the benefits of home health care verses long term stays in hospitals and nursing homes.  She encourages everyone to join her in writing their national representatives by using the Virginia Association for Homecare website www.vahc.org.  Select Legislative Action Center and follow the prompts to congressmen’s emails.  Everyone can get involved and make a difference!

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