Health Insurance Blog

Making a connection with the elderly and the homebound is what motivates Brenda Johnson, the manager of Visiting Nurses at Nantucket Cottage Hospital.

November is “National Home Care Month” and for Johnson, who has worked in the hospital’s emergency room, dialysis, obstetrics and orthopedic departments, her greatest passion is in homecare.

“My grandmother’s best friend was Goldie Howes and Goldie was the director of nursing,” said Johnson, who grew up on the island and moved away during her senior year of high school. “I became a nurse, because Goldie was a nurse.”

After she finished nursing school, Johnson returned in 1975 and started working at the hospital.

“I feel like I make a connection with the patients more in homecare,” said Johnson, whose husband Paul is a caretaker and property manager. Johnson met him when he was a technician in the hospital’s radiology department.

“When a patient is in the hospital, they tend to lose their identity. They are in a strange bed with a hospital gown on,” she said. “In the home, you get to see how they live,” she added. “You meet their caretakers, you meet the family. It’s a better environment for people to recover in.”

A couple of years ago, the hospital changed the name of the Home Health Department to Visiting Nurses.

Last year, the Visiting Nurses made 8,000 visits to 500 clients, up from 7,000 visits over the past year.

“People are understanding more of what we do. I believe that there is a bigger referral base,” said Johnson. “Most of our referrals come from physicians, but sometimes we get self-referrals. About 60 percent of the people who call us might think they need help with simple things, like a bath, but they actually need more services. The reverse is also true. People call thinking they need multiple services, but once an evaluation has sorted things out, they find a simpler solution.”

The Visiting Nurses Department is Medicare/Medicaid certified as well as accredited with the Joint Commission on Accreditation of Healthcare Organizations.

“You need to be homebound to be eligible for Medicare,” said Johnson, who oversees a staff of about 10 full- and part-time visiting nurses, some borrowed from other departments at the hospital. “We serve community members of all ages who require at-home, skilled care from registered nurses; physical, occupational, speech and language therapists; medical social workers or home health aides.”

“If there is an elderly person at home and all of a sudden he or she has a change in functionality, for example, a hard time getting out of the chair, or things have slowed, or the memory has declined a bit, that person might have an infection,” said Johnson. “An older person shows different signs of infection. They don’t get fevers and chills.”

One of the challenges of running a home-care agency on the island is following the rules and regulations which are developed for larger agencies serving thousands of clients.

“We have fewer staff members doing many functions to make it happen,” said Johnson. “I have an excellent group of people who work with us. They are highly qualified and competent and compassionate people.”

“When you are in the home-care business, you are a guest in someone’s house. You get to see the whole mix. You can work with the patient, it becomes a real team effort,” she added.

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The gap between rich and poor remains huge, but a survey of global health finds that significantly fewer people in poorer countries say they have had to go without food or health care because they lacked the money to pay for it.

The phenomenon was evident in almost two dozen of 35 countries in which trends were available in both low-income and middle-income countries, the Kaiser/Pew Global Health Survey, released Thursday, found. It credited improved national economic conditions since a similar survey in 2002.

In 23 of the countries, fewer respondents reported they had not missed health care because of money. Respondents in 20 of the countries reported similar results regarding food as well.

Jordan reported the largest percentage reductions in both categories, with 23 percent fewer missing health and 30 fewer missing food. Ghana and Russia also had large reductions in both categories.

“Declines in reported deprivations notwithstanding,” the report said, speaking of the entire sample, “the gaps between rich and poor nations in reports of hunger and lack of health care remain enormous. In nearly half of the nations surveyed, at least 40 percent of the public reports that they did without health care for lack of money.”

Respondents in all countries of sub-Saharan Africa, for instance, consider HIV/AIDS as a “very big problem” that their governments should be dealing with. In the other regions, crime, corruption, terrorism or pollution ranked as the biggest problem.

“Despite this variation, concern about health as a personal and family issue is high in most countries and across all regions,” the study said. “When asked to name, in their own words, the most important problems facing their families today, health issue rank second only to financial concerns in 33 countries (and are the number one concern in Germany and Sweden).”

On aid, the report found that people in countries that receive major amounts of aid tend more than others to say that rich nations are doing enough to help poorer ones. In Indonesia, for instance, more than half the respondents felt that way; the report speculated that was colored by the international response to the tsunami that hit Indonesia in 2004.

The poll involved telephone and face-to-face interviews with 45,239 people in 46 countries plus the Palestinian territories, conducted in April and May. All samples were national except for Bolivia, Brazil, China, India, Ivory Coast, Pakistan, South Africa, and Venezuela, where they were mostly or completely conducted in cities.

The numbers of people interviewed in each country varied from 500 each in Spain, Bulgaria, Ukraine and Kuwait to 3,142 in China. The margin of sampling error in each country ranged from plus or minus 2 percentage points to 4 percentage points.

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A genetic mutation known to increase the odds of breast cancer in some Jewish women has been found in significant numbers of Hispanic and African-American breast cancer patients as well, underscoring the need for genetic testing across ethnic lines to determine who is at risk.

A large multiracial study released Wednesday estimated that 3.5 percent of Hispanic women with breast cancer have a mutation in the BRCA1 gene. That compares with 8.3 percent of female Ashkenazi Jews (those of Eastern European ancestry), 2.2 percent of other non-Hispanic whites and 0.5 percent of Asian-Americans.

The researchers, from the Northern California Cancer Center and Stanford University, said they hope their data prompts genetic counselors to develop materials for discussing breast cancer risk in a culturally sensitive way and in languages other than English.

“Traditionally, studies have focused on white women,” said Esther John, a research scientist at the cancer center and lead author of the study. “There is a great need to study racial minorities in the United States.”

“A lot of young women die of breast cancer because they’re not even aware that lump in their breast could be cancer,” said Olopade, who wrote an editorial accompanying the paper in this week’s Journal of the American Medical Association. “If you know you’re at high risk, you’ll get that evaluated.”

Women who carry a BRCA mutation can have their ovaries removed, which greatly reduces the risk of both ovarian and breast cancer. They also can have mastectomies as a preventive step. Even if they choose not to take such drastic measures to prevent cancer, Olopade said, they can be more vigilant about detecting it earlier.

The policy is also short-sighted, Olopade argues. “The cost of treating cancer is much higher than the cost of preventing it,” she said. “So dollars should be spent on identifying high-risk individuals and preventing them from getting cancer.”

Everyone carries the BRCA1 gene, which makes a protein that helps cells repair DNA, but people who inherit a mutation in the gene are less able to fix DNA damage and tend to accumulate mutations that lead to cancer. Women with a BRCA1 mutation have about a 65 percent chance of getting breast cancer in their lifetime (compared with 12 percent for the general population), and their risk of ovarian cancer is about 39 percent.

Doctors are generally aware that Ashkenazi Jewish women are more likely to carry a genetic mutation predisposing them to breast cancer, so they frequently refer these women for genetic counseling. There is little or no awareness, however, that women and men of other racial backgrounds might also benefit from counseling and testing.

Men who carry a genetic mutation are more likely to develop cancer and can pass the mutation to their children.

The new study looked at 3,181 women diagnosed with breast cancer in the San Francisco Bay area between 1996 and 2003.

The Hispanic women tended to carry the same mutation as the Ashkenazi Jews. Other ethnic groups carried a wide range of mutations.

The researchers hypothesized that Hispanic women may have that mutation because of their Spanish ancestry. Spain was home to Sephardic Jews, who could have shared the mutation with Jews of Eastern European origin. As a result of persecution before and after the Spanish Inquisition, many Sephardic Jews officially converted to Catholicism but secretly continued to practice Judaism. Some of these “conversos” migrated to the New World.

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